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Sample records for health system utilizing

  1. Valve Health Monitoring System Utilizing Smart Instrumentation

    NASA Technical Reports Server (NTRS)

    Jensen, Scott L.; Drouant, George J.

    2006-01-01

    The valve monitoring system is a stand alone unit with network capabilities for integration into a higher level health management system. The system is designed for aiding in failure predictions of high-geared ball valves and linearly actuated valves. It performs data tracking and archiving for identifying degraded performance. The data collection types are cryogenic cycles, total cycles, inlet temperature, body temperature torsional strain, linear bonnet strain, preload position, total travel and total directional changes. Events are recorded and time stamped in accordance with the IRIG B True Time. The monitoring system is designed for use in a Class 1 Division II explosive environment. The basic configuration consists of several instrumentation sensor units and a base station. The sensor units are self contained microprocessor controlled and remotely mountable in three by three by two inches. Each unit is potted in a fire retardant substance without any cavities and limited to low operating power for maintaining safe operation in a hydrogen environment. The units are temperature monitored to safeguard against operation outside temperature limitations. Each contains 902-928 MHz band digital transmitters which meet Federal Communication Commission's requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates data from the sensor units and generates data event logs on a compact flash memory module for database uploading. The entries are also broadcast over an Ethernet network. Nitrogen purged National Electrical Manufactures Association (NEMA) Class 4 enclosures are used to house the base-station

  2. Valve health monitoring system utilizing smart instrumentation

    NASA Astrophysics Data System (ADS)

    Jensen, Scott L.; Drouant, George J.

    2006-05-01

    The valve monitoring system is a stand alone unit with network capabilities for integration into a higher level health management system. The system is designed for aiding in failure predictions of high-geared ball valves and linearly actuated valves. It performs data tracking and archiving for identifying degraded performance. The data collection types are: cryogenic cycles, total cycles, inlet temperature, outlet temperature, body temperature, torsional strain, linear bonnet strain, preload position, total travel, and total directional changes. Events are recorded and time stamped in accordance with the IRIG B True Time. The monitoring system is designed for use in a Class 1 Division II explosive environment. The basic configuration consists of several instrumentation sensor units and a base station. The sensor units are self contained microprocessor controlled and remotely mountable in three by three by two inches. Each unit is potted in a fire retardant substance without any cavities and limited to low operating power for maintaining safe operation in a hydrogen environment. The units are temperature monitored to safeguard against operation outside temperature limitations. Each contains 902-928 MHz band digital transmitters which meet Federal Communication Commissions requirements and are limited to a 35 foot transmission radius for preserving data security. The base-station controller correlates related data from the sensor units and generates data event logs on a compact flash memory module for database uploading. The entries are also broadcast over an Ethernet network. Nitrogen purged National Electrical Manufactures Association (NEMA) Class 4 Enclosures are used to house the base-station.

  3. Relationship Between Systems' Mental Health Paradigm and Personpower Utilization.

    ERIC Educational Resources Information Center

    Hurley, Daniel J., Jr.; Tyler, Forrest B.

    Recent proliferation at training and educational programs for paraprofessional and non professionals has occurred without systematic evaluation of systems' utilization of newly trained people. It was the purpose of this study to assess both job functioning and attitudes of paraprofessionals in relation to professionals and the interaction of…

  4. Veterans Affairs Health System Enrollment and Health Care Utilization After the Affordable Care Act: Initial Insights.

    PubMed

    Silva, Abigail; Tarlov, Elizabeth; French, Dustin D; Huo, Zhiping; Martinez, Rachael N; Stroupe, Kevin T

    2016-05-01

    The Affordable Care Act (ACA) was signed into law in 2010 and its individual mandate and expanded health care coverage options were implemented in 2014. These provisions may affect Veterans Affairs (VA) enrollment and health care utilization. Using data from two VA regional networks, we examined recent patterns in the number of new VA enrollees and their primary care use. Trends were assessed by enrollment priority group (based on the veteran's severity of service-connected disabilities, exposures, and income level) and a state's Medicaid expansion status. Compared to the same time period in the previous year, the number of new enrollees from low-income priority groups was higher during the open enrollment period and the increase was sharper in Medicaid non-expansion states (25-42%) than in expansion states (20-32%). In addition, low-income patients with a copay requirement who enrolled in the VA during the ACA open enrollment had a lower average number of primary care visits than counterparts who had enrolled in prior time periods (1.73 versus 1.87, p < 0.0001). Although this study is an initial step, more research is required to better understand veterans' decision making and behavior in regard to health care coverage through the ACA and related impacts on VA and non-VA health care utilization and care coordination. PMID:27136655

  5. Integrating Systems Health Management with Adaptive Controls for a Utility-Scale Wind Turbine

    NASA Technical Reports Server (NTRS)

    Frost, Susan A.; Goebel, Kai; Trinh, Khanh V.; Balas, Mark J.; Frost, Alan M.

    2011-01-01

    Increasing turbine up-time and reducing maintenance costs are key technology drivers for wind turbine operators. Components within wind turbines are subject to considerable stresses due to unpredictable environmental conditions resulting from rapidly changing local dynamics. Systems health management has the aim to assess the state-of-health of components within a wind turbine, to estimate remaining life, and to aid in autonomous decision-making to minimize damage. Advanced adaptive controls can provide the mechanism to enable optimized operations that also provide the enabling technology for Systems Health Management goals. The work reported herein explores the integration of condition monitoring of wind turbine blades with contingency management and adaptive controls. Results are demonstrated using a high fidelity simulator of a utility-scale wind turbine.

  6. A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance

    PubMed Central

    Chambers, Catharine; Chiu, Shirley; Katic, Marko; Kiss, Alex; Redelmeier, Donald A.; Levinson, Wendy

    2013-01-01

    Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. Methods. We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs). Results. Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical–surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical–surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations. Conclusions. In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services. PMID:24148051

  7. Adoption and utilization of electronic health record systems by long-term care facilities in Texas.

    PubMed

    Wang, Tiankai; Biedermann, Sue

    2012-01-01

    Long-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs. A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities. PMID:22737099

  8. Factors Affecting Health Care Utilization in Tehran

    PubMed Central

    Motlagh, Soraya Nouraei; Sabermahani, Asma; Hadian, Mohammad; Lari, Mohsen Asadi; Mahdavi, Mohamad Reza Vaez; Gorji, Hassan Abolghasem

    2015-01-01

    Introduction: Successful health system planning and management is dependent on well informed decisions, so having complete knowledge about medical services’ utilization is essential for resource allocation and health plans. The main goal of this study is identification of factors effecting inpatient and outpatient services utilization in public and private sectors. Methods: This study encompasses all regions of Tehran in 2011 and uses Urban HEART questionnaires. This population-based survey included 34700 households with 118000 individuals in Tehran. For determining the most important factors affected on health services consumption, logit model was applied. Results: Regarding to the finding, the most important factors affected on utilization were age, income level and deciles, job status, household dimension and insurance coverage. The main point was the negative relationship between health care utilization and education but it had a positive relationship with private health care utilization. Moreover suffering from chronic disease was the most important variable in health care utilization. Conclusions: According to the mentioned results and the fact that access has effect on health services utilization, policy makers should try to eliminate financial access barriers of households and individuals. This may be done with identification of households with more than 65 or smaller than 5 years old, people in low income deciles or with chronic illness. According to age effect on health services usage and aging population of Iran, results of this study show more importance of attention to aged population needs in future years. PMID:26153189

  9. Equity in health care utilization in Chile.

    PubMed

    Núñez, Alicia; Chi, Chunhuei

    2013-01-01

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile.The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992-2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index.Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894

  10. Equity in health care utilization in Chile

    PubMed Central

    2013-01-01

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 and the 2006 Satisfaction and Out-of-Pocket Payment Survey to assess equity in health care utilization using two different approaches. First, we used a two-part model to estimate factors associated with the utilization of health care. Second, we decomposed income-related inequalities in medical care use into contributions of need and non-need factors and estimated a horizontal inequity index. Findings of this empirical study include evidence of inequities in the Chilean health care system that are beneficial to the better-off. We also identified some key factors, including education and health care payment, which affect the utilization of health care services. Results of this study could help researchers and policy makers identify targets for improving equity in health care utilization and strengthening availability of health care services accordingly. PMID:23937894

  11. Rotor health monitoring and damage detection utilizing a disk spin simulation system

    NASA Astrophysics Data System (ADS)

    Gyekenyesi, Andrew L.; Baaklini, George Y.

    2001-08-01

    This paper describes a unique, disk spin simulation system currently being utilized at NASA Glenn Research Center. The system allows for precision controlled spin tests that can facilitate the application of various sensing technologies for in-situ detection of rotor damage. In addition, the disk spin simulation system has the capability for elevated temperatures up to 540°C (1000°F). The current rotor used to simulate a bladed disk consists of a 46 cm(18 in.) diameter, titanium disk with 30 machined gear teeth. The gear design imitates the blades of a compressor or turbine disk. Operating speeds for the system can reach 1000 revolutions per minute. This allows the system to achieve circumferential velocities paralleling those seen in actual aircraft engines. For this study, a new, innovative capacitive sensing system was used to monitor blade tip clearance (i.e., gear tooth clearance). In turn, the sensor information was employed to calculate the change in the center of mass of the rotor system. T he capacitive sensor and corresponding software were analyzed by attaching a localized weight at numerous positions on the disk. Upon calculating the change in the center of mass, the sensitivities of the sensor and software were established. In the end, it is hoped that by studying the motion and position of blades as well as the change in the center of mass of a rotor system, it may be feasible to identify alterations due to damage (e.g., cracks) eitehr in the blades or the disk itself.

  12. Cost-Utility and Cost-Effectiveness Studies of Telemedicine, Electronic, and Mobile Health Systems in the Literature: A Systematic Review

    PubMed Central

    López-Coronado, Miguel; Vaca, Cesar; Aguado, Jesús Saez; de Castro, Carlos

    2015-01-01

    Abstract Objective: A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Materials and Methods: Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as “cost-utility” OR “cost utility” AND “telemedicine,” “cost-effectiveness” OR “cost effectiveness” AND “mobile health,” etc. In the articles searched, there were no limitations in the publication date. Results: The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. Conclusions: There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures. PMID:25474190

  13. Health Service Utilization and Poor Health Reporting in Asthma Patients

    PubMed Central

    Behr, Joshua G.; Diaz, Rafael; Akpinar-Elci, Muge

    2016-01-01

    The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65) and hospitalization (OR 2.21, 95% CI 1.39–3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are

  14. Impact of a web-based personally controlled health management system on influenza vaccination and health services utilization rates: a randomized controlled trial

    PubMed Central

    Sintchenko, Vitali; Crimmins, Jacinta; Magrabi, Farah; Gallego, Blanca; Coiera, Enrico

    2012-01-01

    Objective To assess the impact of a web-based personally controlled health management system (PCHMS) on the uptake of seasonal influenza vaccine and primary care service utilization among university students and staff. Materials and methods A PCHMS called Healthy.me was developed and evaluated in a 2010 CONSORT-compliant two-group (6-month waitlist vs PCHMS) parallel randomized controlled trial (RCT) (allocation ratio 1:1). The PCHMS integrated an untethered personal health record with consumer care pathways, social forums, and messaging links with a health service provider. Results 742 university students and staff met inclusion criteria and were randomized to a 6-month waitlist (n=372) or the PCHMS (n=370). Amongst the 470 participants eligible for primary analysis, PCHMS users were 6.7% (95% CI: 1.46 to 12.30) more likely than the waitlist to receive an influenza vaccine (waitlist: 4.9% (12/246, 95% CI 2.8 to 8.3) vs PCHMS: 11.6% (26/224, 95% CI 8.0 to 16.5); χ2=7.1, p=0.008). PCHMS participants were also 11.6% (95% CI 3.6 to 19.5) more likely to visit the health service provider (waitlist: 17.9% (44/246, 95% CI 13.6 to 23.2) vs PCHMS: 29.5% (66/224, 95% CI: 23.9 to 35.7); χ2=8.8, p=0.003). A dose–response effect was detected, where greater use of the PCHMS was associated with higher rates of vaccination (p=0.001) and health service provider visits (p=0.003). Discussion PCHMS can significantly increase consumer participation in preventive health activities, such as influenza vaccination. Conclusions Integrating a PCHMS into routine health service delivery systems appears to be an effective mechanism for enhancing consumer engagement in preventive health measures. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000386033. http://www.anzctr.org.au/trial_view.aspx?id=335463. PMID:22582203

  15. Predictors of Adolescent Health Care Utilization

    ERIC Educational Resources Information Center

    Vingilis, Evelyn; Wade, Terrance; Seeley, Jane

    2007-01-01

    This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…

  16. Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

    PubMed

    Perkowski, Patryk; Rodberg, Leonard

    2016-01-01

    Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries. PMID:26545706

  17. Intelligent utility meter system

    SciTech Connect

    Frew, L.H.; Fuller, M.L.

    1989-02-07

    An intelligent utility meter system installation is described for measuring A.C. electric energy having repetitive A.C. cycles, comprising: (1) an ''outside'' principal meter unit including: (a) means for sampling current and voltage and for calculating power consumption at least 300 times per second; the sampling occurring asynchronously and not in any fixed time relationship with respect to the A.C. electricity cycles; (b) the outside unit further including means for determining the total kilowatt hours used, and the present billing status; and (c) alphanumeric display means for displaying power being used, total kilowatt hours and present billing status; (2) a remote ''inside'' unit including: (a) alphanumeric means for displaying the information displayed by the ''outside'' unit; (b) means for selectively retaining a desired continuously updated display; and (c) means for reading a credit card and automatically changing the billing status information within the intelligent utility meter as credit card information is read; and (3) the system including means for determining both the magnitude and direction of the electric power passing through the meter system.

  18. Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level

    PubMed Central

    Luboga, Samuel Abimerech; Stover, Bert; Lim, Travis W; Makumbi, Frederick; Kiwanuka, Noah; Lubega, Flavia; Ndizihiwe, Assay; Mukooyo, Eddie; Hurley, Erin K; Borse, Nagesh; Wood, Angela; Bernhardt, James; Lohman, Nathaniel; Sheppard, Lianne; Barnhart, Scott; Hagopian, Amy

    2016-01-01

    Objectives PEPFAR’s initial rapid scale-up approach was largely a vertical effort focused fairly exclusively on AIDS. The purpose of our research was to identify spill-over health system effects, if any, of investments intended to stem the HIV epidemic over a 6-year period with evidence from Uganda. The test of whether there were health system expansions (aside from direct HIV programming) was evidence of increases in utilization of non-HIV services—such as outpatient visits, in-facility births or immunizations—that could be associated with varying levels of PEPFAR investments at the district level. Methods Uganda’s Health Management Information System article-based records were available from mid-2005 onwards. We visited all 112 District Health offices to collect routine monthly reports (which contain data aggregated from monthly facility reports) and annual reports (which contain data aggregated from annual facility reports). Counts of individuals on anti-retroviral therapy (ART) at year-end served as our primary predictor variable. We grouped district-months into tertiles of high, medium or low PEPFAR investment based on their total reported number of patients on ART at the end of the year. We generated incidence-rate ratios, interpreted as the relative rate of the outcome measure in relation to the lowest investment PEPFAR tertile, holding constant control variables in the model. Results We found PEPFAR investment overall was associated with small declines in service volumes in several key areas of non-HIV care (outpatient care for young children, TB tests and in-facility deliveries), after adjusting for sanitation, elementary education and HIV prevalence. For example, districts with medium and high ART investment had 11% fewer outpatient visits for children aged 4 and younger compared with low investment districts, incidence rate ratio (IRR) of 0.89 for high investment compared with low (95% CI, 0.85–0.94) and IRR of 0.93 for medium compared

  19. Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level.

    PubMed

    Luboga, Samuel Abimerech; Stover, Bert; Lim, Travis W; Makumbi, Frederick; Kiwanuka, Noah; Lubega, Flavia; Ndizihiwe, Assay; Mukooyo, Eddie; Hurley, Erin K; Borse, Nagesh; Wood, Angela; Bernhardt, James; Lohman, Nathaniel; Sheppard, Lianne; Barnhart, Scott; Hagopian, Amy

    2016-09-01

    OBJECTIVES : PEPFAR's initial rapid scale-up approach was largely a vertical effort focused fairly exclusively on AIDS. The purpose of our research was to identify spill-over health system effects, if any, of investments intended to stem the HIV epidemic over a 6-year period with evidence from Uganda. The test of whether there were health system expansions (aside from direct HIV programming) was evidence of increases in utilization of non-HIV services-such as outpatient visits, in-facility births or immunizations-that could be associated with varying levels of PEPFAR investments at the district level. METHODS : Uganda's Health Management Information System article-based records were available from mid-2005 onwards. We visited all 112 District Health offices to collect routine monthly reports (which contain data aggregated from monthly facility reports) and annual reports (which contain data aggregated from annual facility reports). Counts of individuals on anti-retroviral therapy (ART) at year-end served as our primary predictor variable. We grouped district-months into tertiles of high, medium or low PEPFAR investment based on their total reported number of patients on ART at the end of the year. We generated incidence-rate ratios, interpreted as the relative rate of the outcome measure in relation to the lowest investment PEPFAR tertile, holding constant control variables in the model. RESULTS : We found PEPFAR investment overall was associated with small declines in service volumes in several key areas of non-HIV care (outpatient care for young children, TB tests and in-facility deliveries), after adjusting for sanitation, elementary education and HIV prevalence. For example, districts with medium and high ART investment had 11% fewer outpatient visits for children aged 4 and younger compared with low investment districts, incidence rate ratio (IRR) of 0.89 for high investment compared with low (95% CI, 0.85-0.94) and IRR of 0.93 for medium compared with

  20. Health Worker mHealth Utilization: A Systematic Review.

    PubMed

    White, Alice; Thomas, Deborah S K; Ezeanochie, Nnamdi; Bull, Sheana

    2016-05-01

    This systematic review describes mHealth interventions directed at healthcare workers in low-resource settings from the PubMed database from March 2009 to May 2015. Thirty-one articles were selected for final review. Four categories emerged from the reviewed articles: data collection during patient visits, communication between health workers and patients, communication between health workers, and public health surveillance. Most studies used a combination of quantitative and qualitative methods to assess acceptability of use, barriers to use, changes in healthcare delivery, and improved health outcomes. Few papers included theory explicitly to guide development and evaluation of their mHealth programs. Overall, evidence indicated that mobile technology tools, such as smartphones and tablets, substantially benefit healthcare workers, their patients, and healthcare delivery. Limitations to mHealth tools included insufficient program use and sustainability, unreliable Internet and electricity, and security issues. Despite these limitations, this systematic review demonstrates the utility of using mHealth in low-resource settings and the potential for widespread health system improvements using technology. PMID:26955009

  1. Utilization of the Native American Talking Circle to teach incident command system to tribal community health representatives.

    PubMed

    Granillo, Brenda; Renger, Ralph; Wakelee, Jessica; Burgess, Jefferey L

    2010-12-01

    The public health workforce is diverse and encompasses a wide range of professions. For tribal communities, the Community Health Representative (CHR) is a public health paraprofessional whose role as a community health educator and health advocate has expanded to become an integral part of the health delivery system of most tribes. CHRs possess a unique set of skills and cultural awareness that make them an essential first responder on tribal land. As a result of their distinctive qualities they have the capability of effectively mobilizing communities during times of crisis and can have a significant impact on the communities' response to a local incident. Although public health emergency preparedness training is a priority of federal, state, local and tribal public health agencies, much of the training currently available is not tailored to meet the unique traits of CHRs. Much of the emergency preparedness training is standardized, such as the Federal Emergency Management Agency (FEMA) Training Programs, and does not take into account the inherent cultural traditions of some of the intended target audience. This paper reports on the use of the Native American Talking Circle format as a culturally appropriate method to teach the Incident Command System (ICS). The results of the evaluation suggest the talking format circle is well received and can significantly improve the understanding of ICS roles. The limitations of the assessment instrument and the cultural adaptations at producing changes in the understanding of ICS history and concepts are discussed. Possible solutions to these limitations are provided. PMID:20300808

  2. A study of mental health administrators and systems utilizing a four-part rural/urban taxonomy.

    PubMed

    Perlman, B; Hartman, E A; Bosak, J

    1984-01-01

    A study of administrators working in public-sector community-level mental health systems was undertaken. Three hundred and fourteen managers representing 109 systems in both urban and rural settings were interviewed, with 91 percent providing completed questionnaires. Multiple discriminant analyses indicated significant differences in perception of ruralness; personal, job, and system characteristics; and nonwork dimensions. Administrators differed in what they did on the job, not in responses (e.g., turnover, stress) to their work. The rural manager seems more a generalist, but other stereotypes of the nature of rural mental health management and managers were contraindicated. Implications of the data and further research are discussed. PMID:6499402

  3. Scandinavian systems monitoring the oral health in children and adolescents; an evaluation of their quality and utility in the light of modern perspectives of caries management

    PubMed Central

    2014-01-01

    Background Recording reliable oral health data is a challenge. The aims were a) to outline different Scandinavian systems of oral health monitoring, b) to evaluate the quality and utility of the collected data in the light of modern concepts of disease management and to suggest improvements. Material and methods The information for in this study was related to (a) children and adolescents, (b) oral health data and (c) routines for monitoring such data. This meant information available in the official web sites of the “KOSTRA-data” (Municipality-State-Report) in Norway, the Swedish National Board of Health and Welfare (“Socialstyrelsen”) and Oral Health Register (the SCOR system, National Board of Health) in Denmark. Results A potential for increasing the reliability and validity of the data existed. Routines for monitoring other oral diseases than caries were limited. Compared with the other Scandinavian countries, the data collection system in Denmark appeared more functional and had adopted more modern concepts of disease management than other systems. In the light of modern concepts of caries management, data collected elsewhere had limited utility. Conclusions The Scandinavian systems of health reporting had much in common, but some essential differences existed. If the quality of epidemiological data were enhanced, it would be possible to use the data for planning oral health care. Routines and procedures should be improved and updated in accordance with the modern ideas about caries prevention and therapy. For appropriate oral health planning in an organised dental service, reporting of enamel caries is essential. PMID:24885243

  4. Preventive Health Services Utilization Among Korean Americans.

    PubMed

    Kim, Kyeongmo; Casado, Banghwa Lee

    2016-01-01

    This study examined the use of preventive health services among Korean American adults. Data were drawn from a cross-sectional survey of 212 Korean Americans in the Chicago, Illinois, metropolitan area. Guided by the Andersen's behavioral model, the authors examined whether predisposing (age, gender, marital status, household size, education), enabling (income, health insurance, English proficiency, citizenship, social network), and need (health status) factors are predictive of Korean Americans' preventive health services utilization. A binomial logistic regression showed that younger age, male, noncitizen, low income, no insurance, a larger family network, and better perceived health were associated with decreased odds of using preventive health services. PMID:27171558

  5. Kazakhkstan health system review.

    PubMed

    Katsaga, Alexandr; Kulzhanov, Maksut; Karanikolos, Marina; Rechel, Bernd

    2012-01-01

    Since becoming independent, Kazakhstan has undertaken major efforts in reforming its post-Soviet health system. Two comprehensive reform programmes were developed in the 2000s: the National Programme for Health Care Reform and Development 2005-2010 and the State Health Care Development Programme for 2011-2015 Salamatty Kazakhstan. Changes in health service provision included a reduction of the hospital sector and an increased emphasis on primary health care. However, inpatient facilities continue to consume the bulk of health financing. Partly resulting from changing perspectives on decentralization, levels of pooling kept changing. After a spell of devolving health financing to the rayon level in 2000-2003, beginning in 2004 a new health financing system was set up that included pooling of funds at the oblast level, establishing the oblast health department as the single-payer of health services. Since 2010, resources for hospital services under the State Guaranteed Benefits Package have been pooled at the national level within the framework of implementing the Concept on the Unified National Health Care System. Kazakhstan has also embarked on promoting evidence-based medicine and developing and introducing new clinical practice guidelines, as well as facility-level quality improvements. However, key aspects of health system performance are still in dire need of improvement. One of the key challenges is regional inequities in health financing, health care utilization and health outcomes, although some improvements have been achieved in recent years. Despite recent investments and reforms, however, population health has not yet improved substantially. PMID:22894852

  6. Health Behavior, Health Education, Health Service Utilization and Compliance with Health Regimes: An Annotated Bibliography.

    ERIC Educational Resources Information Center

    Toledo, J. R.; Hughes, Howard

    This bibliography includes references from major articles, Index Medicus (1972- 1977), and Psychological Abstracts (1967-1977). The material is arranged under four major headings--health behavior, health education, health services utilization, and compliance with health regimes. It will be of interest to persons working in medical settings and…

  7. Iceland: health system review.

    PubMed

    Sigurgeirsdóttir, Sigurbjörg; Waagfjörð, Jónína; Maresso, Anna

    2014-01-01

    This analysis of the Icelandic health system reviews the developments in its organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy at birth is high and Icelandic men and women enjoy longer life in good health than the average European. However, Icelanders are putting on weight, more than half of adult Icelanders were overweight or obese in 2004, and total consumption of alcohol has increased considerably since 1970. The health care system is a small, state centred, publicly funded system with universal coverage, and an integrated purchaser provider relationship in which the state as payer is also the owner of most organizations providing health care services. The country's centre of clinical excellence is the University Hospital, Landspitali, in the capital Reykjavik, which alone accounts for 70 percent of the total national budget for general hospital services. However, since 1990, the health system has become increasingly characterized by a mixed economy of care and service provision, in which the number and scope of private non profit and private for profit providers has increased. While Iceland's health outcomes are some of the best among OECD countries, the health care system faces challenges involving the financial sustainability of the current system in the context of an ageing population, new public health challenges, such as obesity, and the continued impact of the country's financial collapse in 2008. The most important challenge is to change the pattern of health care utilization to steer it away from the most expensive end of the health services spectrum towards more cost efficient and effective alternatives. To a large degree, this will involve renewed attempts to prioritize primary care as the first port of call for patients, and possibly to introduce a gatekeeping function for GPs in order to moderate the use of specialist services. PMID:25720021

  8. Toward utilization of data for program management and evaluation: quality assessment of five years of health management information system data in Rwanda

    PubMed Central

    Nisingizwe, Marie Paul; Iyer, Hari S.; Gashayija, Modeste; Hirschhorn, Lisa R.; Amoroso, Cheryl; Wilson, Randy; Rubyutsa, Eric; Gaju, Eric; Basinga, Paulin; Muhire, Andrew; Binagwaho, Agnès; Hedt-Gauthier, Bethany

    2014-01-01

    Background Health data can be useful for effective service delivery, decision making, and evaluating existing programs in order to maintain high quality of healthcare. Studies have shown variability in data quality from national health management information systems (HMISs) in sub-Saharan Africa which threatens utility of these data as a tool to improve health systems. The purpose of this study is to assess the quality of Rwanda's HMIS data over a 5-year period. Methods The World Health Organization (WHO) data quality report card framework was used to assess the quality of HMIS data captured from 2008 to 2012 and is a census of all 495 publicly funded health facilities in Rwanda. Factors assessed included completeness and internal consistency of 10 indicators selected based on WHO recommendations and priority areas for the Rwanda national health sector. Completeness was measured as percentage of non-missing reports. Consistency was measured as the absence of extreme outliers, internal consistency between related indicators, and consistency of indicators over time. These assessments were done at the district and national level. Results Nationally, the average monthly district reporting completeness rate was 98% across 10 key indicators from 2008 to 2012. Completeness of indicator data increased over time: 2008, 88%; 2009, 91%; 2010, 89%; 2011, 90%; and 2012, 95% (p<0.0001). Comparing 2011 and 2012 health events to the mean of the three preceding years, service output increased from 3% (2011) to 9% (2012). Eighty-three percent of districts reported ratios between related indicators (ANC/DTP1, DTP1/DTP3) consistent with HMIS national ratios. Conclusion and policy implications Our findings suggest that HMIS data quality in Rwanda has been improving over time. We recommend maintaining these assessments to identify remaining gaps in data quality and that results are shared publicly to support increased use of HMIS data. PMID:25413722

  9. Austria: health system review.

    PubMed

    Hofmarcher, Maria M; Quentin, Wilm

    2013-01-01

    This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibilities and frequently results in inadequate coordination. For this reason, efforts have been made for several years to achieve more joint planning, governance and financing of the health-care system at the federal and regional level. As in any health system, a number of challenges remain. The costs of the health-care system are well above the EU15 average, both in absolute terms and as a percentage of GDP. There are important structural imbalances in healthcare provision, with an oversized hospital sector and insufficient resources available for ambulatory care and preventive medicine. This is coupled with stark regional differences in utilization, both in curative services (hospital beds and specialist physicians) and preventative services such as preventive health check-ups, outpatient rehabilitation, psychosocial and psychotherapeutic care and nursing. There are clear social inequalities in the use of medical services, such as preventive health check-ups, immunization or dentistry

  10. Health care utilization by immigrants in Italy.

    PubMed

    De Luca, Giuliana; Ponzo, Michela; Andrés, Antonio Rodríguez

    2013-03-01

    Healthcare utilization studies show how well documented disparities between migrants and non-migrants. Reducing such disparities is a major goal in European countries. However, healthcare utilization among Italian immigrants is under-studied. The objective of this study is to explore differences in healthcare use between immigrant and native Italians. Cross-sectional study using the latest available (2004/2005) Italian Health Conditions Survey. We estimated separate hurdle binomial negative regression models for GP, specialist, and telephone consultations and a logit model for emergency room (ER) use. We used logistic regression and zero-truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Adjusting for risk factors, immigrants are significantly less likely to use healthcare services with 2.4 and 2.7 % lower utilization probability for specialist and telephone consultations, respectively. First- and second-generation immigrants' probability for specialist and telephone contact is significantly lower than natives'. Immigrants, ceteris paribus, have a much higher probability of using ERs than natives (0.7 %). First-generation immigrants show a higher probability of visiting ERs (1 %). GP visits show no significant difference. In conclusion Italian immigrants are much less likely to use specialist healthcare and medical telephone consultations than natives but more likely to use ERs. Hence, we report an over-use of ERs and under-utilization of preventive care among immigrants. We recommend improved health policies for immigrants: promotion of better information dissemination among them, simplification of organizational procedures, better communications between providers and immigrants, and an increased supply of health services for the most disadvantaged populations. PMID:23239018

  11. 29 CFR 1910.302 - Electric utilization systems.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 5 2014-07-01 2014-07-01 false Electric utilization systems. 1910.302 Section 1910.302 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Electrical Design Safety Standards for Electrical Systems § 1910.302 Electric utilization...

  12. The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post-Discharge Healthcare Utilization in a Low-Income Population.

    PubMed

    Hewner, Sharon; Casucci, Sabrina; Castner, Jessica

    2016-08-01

    Economically disadvantaged individuals with chronic disease have high rates of in-patient (IP) readmission and emergency department (ED) utilization following initial hospitalization. The purpose of this study was to explore the relationships between chronic disease complexity, health system integration (admission to accountable care organization [ACO] hospital), availability of care management interventions (membership in managed care organization [MCO]), and 90-day post-discharge healthcare utilization. We used de-identified Medicaid claims data from two counties in western New York. The study population was 114,295 individuals who met inclusion criteria, of whom 7,179 had index hospital admissions in the first 9 months of 2013. Individuals were assigned to three disease complexity segments based on presence of 12 prevalent conditions. The 30-day inpatient (IP) readmission rates ranged from 6% in the non-chronic segment to 12% in the chronic disease complexity segment and 21% in the organ system failure complexity segment. Rehospitalization rates (both inpatient and emergency department [ED]) were lower for patients in MCOs and ACOs than for those in fee-for-service care. Complexity of chronic disease, initial hospitalization in a facility that was part of an ACO, MCO membership, female gender, and longer length of stay were associated with a significantly longer time to readmission in the first 90 days, that is, fewer readmissions. Our results add to evidence that high-value post-discharge utilization (fewer IP or ED rehospitalizations and early outpatient follow-up) require population-based transitional care strategies that improve continuity between settings and take into account the illness complexity of the Medicaid population. © 2016 Wiley Periodicals, Inc. PMID:27284973

  13. Healthcare Utilization Monitoring System in Korea

    PubMed Central

    Shin, Hyun Chul; Lee, Youn Tae; Jo, Emmanuel C.

    2015-01-01

    Objectives It is important to monitor the healthcare utilization of patients at the national level to make evidence-based policy decisions and manage the nation's healthcare sector. The Health Insurance Review & Assessment Service (HIRA) has run a Healthcare Utilization Monitoring System (HUMS) since 2008. The objective of this paper is to introduce HIRA's HUMS. Methods This study described the HUMS's system structure, capacity, functionalities, and output formats run by HIRA in the Republic of Korea. Regarding output formats, this study extracted diabetes related health insurance claims through the HUMS from August 1, 2014 to May 31, 2015. Results The HUMS has kept records of health insurance claim data for 4 years. It has a 14-terabyte hardware capacity and employs several easy-to-use programs for maintenance of the system, such as MSTR, SAS, etc. Regarding functionalities, users should input diseases codes, target periods, facility types, and types of attributes, such as the number of healthcare utilizations or healthcare costs. It also has a functionality to predict healthcare utilization and costs. When this study extracted diabetes related data, it was found that the trend of healthcare costs for the treatment of diabetes and the number of patients with diabetes were increasing. Conclusions HIRA's HUMS works well to monitor healthcare utilization of patients at the national level. The HUMS has a high-capacity hardware infrastructure and several operational programs that allows easy access to summaries as well as details to identify contributing factors for abnormality, but it has a limitation in that there is often a time lag between the provision of healthcare to patients and the filing of health claims. PMID:26279955

  14. Association between Electronic Health Records and Health Care Utilization

    PubMed Central

    Edwards, A.; Kern, L.M.

    2015-01-01

    Summary Background The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited. Objective To determine any association between EHRs and health care utilization. Methods We conducted a cohort study (2008–2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics. Results Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions. Conclusions Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs. PMID:25848412

  15. Utilization review. Health economics and cost-effective resource management.

    PubMed

    Rosenstein, A H

    1991-01-01

    In an effort to reduce their health care burden, health care payors have turned to utilization controls and restructured health care payment systems to control health care costs. While health care payors are interested in economic restraints, health care providers are being placed at increasing levels of financial risk, and they struggle to maintain high quality services. Quality of care must remain our number one priority, but it is essential to achieve this goal in a cost-efficient manner. Cost-efficiencies are gained through the development of a comprehensive physician education program that encourages information exchange, physician input, and the implementation of positive alternatives that lead to efficiencies in resource management. PMID:1824449

  16. Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

    ERIC Educational Resources Information Center

    Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

    2008-01-01

    Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

  17. Using an electronic medical record system to describe injury epidemiology and health care utilization at an inner-city hospital in Indiana.

    PubMed

    Odero, Wilson W; Tierney, William M; Einterz, Robert M; Mungai, Simon

    2004-12-01

    Injuries are a major public health problem worldwide. In the USA, injuries cause 146, 400 deaths annually, with 31 million non-fatal injury visits to emergency departments (EDs). EDs thus represent an important source of injury data. The primary objective of the current study was to describe the epidemiology of injury-related ED visits and assess injury-related utilization of health care resources in an inner-city hospital in Indiana, using data stored in a computerized medical record system. It involved a retrospective review of the records for injury visits to EDs and injury admissions over a 3-year period. The variables extracted and analysed included patients' demographics, external cause of injury, diagnosis, length of stay, ED and hospital charges. A total of 60,470 injury-related ED visits were made, the majority of patients were male (61.6%), uninsured (63.1%), treated in ED and discharged (98.4%). The leading causes of injury were falls (18.8%), motor vehicle crashes (18.4%), assaults (17.6%), being struck (11.2%) and overexertion (10.6). Firearms caused most injury deaths (32.4%; n = 314); motor vehicle crashes were the leading cause of hospitalization (26.6%; n = 642) and also the most expensive to treat as inpatients (mean charge $19,190). The mean charge per patient treated and discharged was $150 compared to $11,116 for patients admitted. These findings demonstrate the value of computerized medical records in capturing and storing E-coded injury data. The system generates data that can be used for epidemiological surveillance and injury prevention at the local level, and for assessment of impact of specific injuries on health care resources. PMID:15903162

  18. Marital Distress and Mental Health Care Service Utilization

    ERIC Educational Resources Information Center

    Schonbrun, Yael Chatav; Whisman, Mark A.

    2010-01-01

    Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for…

  19. The Effect of Maternal Health Beliefs on Utilization of Childhood Preventive Health Services and Child Health.

    ERIC Educational Resources Information Center

    Tinsley, Barbara J.

    Relationships among mothers' beliefs and values concerning their children's health, utilization of childhood preventive health services, and children's health status were examined. Mothers' health beliefs were measured with Parental Health Belief scales developed to explore three factors: (1) mothers' degree of perceived control or internality…

  20. "Back to Basics" Approach for Improving Maternal Health Care Services Utilization in Lao PDR.

    PubMed

    Ngan, Do Kim; Kang, Minah; Lee, Chaeun; Vanphanom, Sychareun

    2016-04-01

    Earlier studies claim inadequate knowledge and understanding of maternal health care service among women and families account for low demand and utilization of these services. This study explores maternal service utilization in Lao PDR by interviewing women, families, health service providers, and community members in Xiengkhuang province. In general, women's attitude and acceptance of maternal health care were positive, with many expressing appreciation and need for maternal health services. Nevertheless, utilization of maternal health services remained poor largely due to dissatisfaction with services: inaccessibility, irregular services, fund shortage, poor facilities, and problems dealing with male health service providers. It appears that utilization of maternal health care services in Lao PDR is as much a health system concern as it is a user preference issue. This article advocates a "back to basics" approach for reviewing maternal health care infrastructure systems in developing countries to improve community health services and utilization. PMID:26969638

  1. The predictive validity of prospect theory versus expected utility in health utility measurement.

    PubMed

    Abellan-Perpiñan, Jose Maria; Bleichrodt, Han; Pinto-Prades, Jose Luis

    2009-12-01

    Most health care evaluations today still assume expected utility even though the descriptive deficiencies of expected utility are well known. Prospect theory is the dominant descriptive alternative for expected utility. This paper tests whether prospect theory leads to better health evaluations than expected utility. The approach is purely descriptive: we explore how simple measurements together with prospect theory and expected utility predict choices and rankings between more complex stimuli. For decisions involving risk prospect theory is significantly more consistent with rankings and choices than expected utility. This conclusion no longer holds when we use prospect theory utilities and expected utilities to predict intertemporal decisions. The latter finding cautions against the common assumption in health economics that health state utilities are transferable across decision contexts. Our results suggest that the standard gamble and algorithms based on, should not be used to value health. PMID:19833400

  2. Modern Medical Engineering and Health Information Systems

    ERIC Educational Resources Information Center

    Davis, John F.

    1975-01-01

    Describes the impact of medical engineering and system design on hospital design and construction, health care in the home and hospital, equipment design, information systems, and health resources utilization. (GS)

  3. 42 CFR 457.490 - Delivery and utilization control systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of health care services covered by such products to the enrollees, including any variations; and (b) Describe utilization control systems designed to ensure that enrollees receiving health care services under the State plan receive only appropriate and medically necessary health care consistent with...

  4. 42 CFR 457.490 - Delivery and utilization control systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... of health care services covered by such products to the enrollees, including any variations; and (b) Describe utilization control systems designed to ensure that enrollees receiving health care services under the State plan receive only appropriate and medically necessary health care consistent with...

  5. 42 CFR 457.490 - Delivery and utilization control systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... of health care services covered by such products to the enrollees, including any variations; and (b) Describe utilization control systems designed to ensure that enrollees receiving health care services under the State plan receive only appropriate and medically necessary health care consistent with...

  6. Celss nutrition system utilizing snails

    NASA Astrophysics Data System (ADS)

    Midorikawa, Y.; Fujii, T.; Ohira, A.; Nitta, K.

    At the 40th IAF Congress in Malaga, a nutrition system for a lunar base CELSS was presented. A lunar base with a total of eight crew members was envisaged. In this paper, four species of plants—rice, soybean, lettuce and strawberry—were introduced to the system. These plants were sufficient to satisfy fundamental nutritional needs of the crew members. The supply of nutrition from plants and the human nutritional requirements could almost be balanced. Our study revealed that the necessary plant cultivation area per crew member would be nearly 40 m 3 in the lunar base. The sources of nutrition considered in the study were energy, sugar, fat, amino acids, inorganic salt and vitamins; however, calcium, vitamin B 2, vitamin A and sodium were found to be lacking. Therefore, a subsystem to supply these elements is of considerable value. In this paper, we report on a study for breeding snails and utilizing meat as food. Nutrients supplied from snails are shown to compensate for the abovementioned lacking elements. We evaluate the snail breeder and the associated food supply system as a subsystem of closed ecological life support system.

  7. Utility integration issues of residential photovoltaic systems

    NASA Astrophysics Data System (ADS)

    Yamayee, Z. A.; Peschon, J.

    1981-05-01

    The economic aspects of residential solar photovoltaic (SPV) systems are discussed from the electric utility perspective. The following schemes of SPV integration are considered: (1) SPV with complete utility buy-back and backup; (2) SPV with utility system storage; and (3) SPV with residential storage. Estimates are made of the price that the utility might pay for SPV owner's surplus energy compared to what it would charge for deficits by evaluating economic savings of SVP to the utility.

  8. Report on health and environmental effects of increased coal utilization*

    PubMed Central

    1980-01-01

    major areas of uncertainty and concern requiring further investigation if the nation is to minimize undesirable consequences of increased coal utilization now, and in the future. Two critical health issues of concern are air pollution health effects and coal mine worker health and safety. Two critical environmental issues are global effects of carbon dioxide in the atmosphere and acid fallout. Two additional important issues of concern are trace elements in the environment and reclamation of arid land. Finally, because of the inadequate data and methodology used in the study of these matters, the Committee strongly recommended the establishment of an improved national environmental data collection, modeling and monitoring system. PMID:6775943

  9. Health Service Utilization among Older Adults in British Columbia: Making Sense of Geography

    ERIC Educational Resources Information Center

    Allan, Diane; Cloutier-Fisher, Denise

    2006-01-01

    The utilization of health services by older adults has received increased attention over the past decade, but little is known about how service utilization varies between rural and urban areas. In an era of restructuring and downsizing within the Canadian health care system, there are concerns that rural older adults may be increasingly…

  10. Household health care facility utilization in the Philippines.

    PubMed

    Russo, G; Herrin, A N; Pons, M C

    This paper presents probit estimates of household utilization of health care facilities in the Philippines. Using household data from the 1987 National Health Survey and supply data from the Department of Health, separate probit equations are estimated for each of the four major types of facilities in the Philippines: Public hospitals, private hospitals, major rural health units and barangay (village) health stations. The probability that a household will utilize services from these facilities is estimated as a function of socioeconomic, demographic and supply variables. The results indicate substantial differences in utilization patterns by income class. Households in the highest income quartile are approximately twice as likely (0.451 versus 0.236) to utilize private hospital services vis-à-vis households in the lowest income quartile, ceteris paribus. The results also indicate substantial substitution between public and private services. An increase in the availability of private hospital beds significantly reduces the probability that a household will utilize government facilities. PMID:10050192

  11. Assimilation and health service utilization of Korean immigrant women.

    PubMed

    Son, Juyeon

    2013-11-01

    In this case study, I present descriptive findings with regard to immigrant incorporation and health service utilization. Using focus groups and survey of Korean immigrant women in Wisconsin, I examine whether the ways in which they adapt to the U.S. society is relevant to their health services utilization and the alternatives they seek when available health services are less than satisfactory. The findings suggest that adherence to Korean identity appears to be associated with health service utilization. This is evident in the immigrants' evaluation of the U.S. health services as compared to those of Korea, and the consideration given by these immigrants to seeking health services in Korea instead of the United States. Such concerns on the part of these immigrants have important implications for health researchers, as they highlight the significance of immigrants' transnational experiences and their sense of personal agency in the use of health care. PMID:24108090

  12. Horizontal Inequity in Elderly Health Care Utilization: Evidence from India.

    PubMed

    Joe, William; Rudra, Shalini; Subramanian, S V

    2015-11-01

    Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly. PMID:26617450

  13. Horizontal Inequity in Elderly Health Care Utilization: Evidence from India

    PubMed Central

    Rudra, Shalini; Subramanian, S V

    2015-01-01

    Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly. PMID:26617450

  14. Improving the Utilization of Health Manpower.

    ERIC Educational Resources Information Center

    Goldstein, Harold M.; And Others

    The general objectives of the study were to determine whether one can motivate users of health personnel, such as hospitals, to modify their hiring-in-requirements to the actual needs of the job, to restructure health occupational skills, and to develop inservice training programs which permit upward job mobility. Five hospitals, representing a…

  15. Henry Ford Health Systems

    Cancer.gov

    Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.

  16. Czech Republic: health system review.

    PubMed

    Alexa, Jan; Recka, Lukas; Votapkova, Jana; van Ginneken, Ewout; Spranger, Anne; Wittenbecher, Friedrich

    2015-01-01

    This analysis of the Czech health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The Czech health-care system is based on compulsory statutory health insurance providing virtually universal coverage and a broad range of benefits, and doing so at 7.7 % of GDP in 2012 - well below the EU average - of which a comparatively high 85 % was publicly funded. Some important health indicators are better than the EU averages (such as mortality due to respiratory disease) or even among the best in the world (in terms of infant mortality, for example). On the other hand, mortality rates for diseases of the circulatory system and malignant neoplasms are well above the EU average, as are a range of health-care utilization rates, such as outpatient contacts and average length of stay in acute care hospitals. In short, there is substantial potential in the Czech Republic for efficiency gains and to improve health outcomes. Furthermore, the need for reform in order to financially sustain the system became evident again after the global financial crisis, but there is as yet no consensus about how to achieve this. PMID:26106825

  17. Mental Health Utilization Among Diverse Parenting Young Couples.

    PubMed

    Albritton, Tashuna; Angley, Meghan; Gibson, Crystal; Sipsma, Heather; Kershaw, Trace

    2015-09-01

    Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social-personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor-Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse's influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples. PMID:26163272

  18. Dementia in Ontario: Prevalence and Health Services Utilization

    ERIC Educational Resources Information Center

    Tranmer, J. E.; Croxford, R.; Coyte, P. C.

    2003-01-01

    To understand the impact of ongoing reform of mental health and dementia care in Ontario, an examination of prevalence and health services utilization rates is needed. However, there exists a gap in current prevalence and health services research specific to dementia care in Ontario. The objective of this study was to address these concerns using…

  19. Ukraine: Health system review.

    PubMed

    Lekhan, Valery; Rudiy, Volodymyr; Richardson, Erica

    2010-01-01

    The HiT profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Ukrainian health system has preserved the fundamental features of the Soviet Semashko system against a background of other changes, which are developed on market economic principles. The transition from centralized financing to its extreme decentralization is the main difference in the health system in comparison with the classic Soviet model. Health facilities are now functionally subordinate to the Ministry of Health, but managerially and financially answerable to the regional and local self-government, which has constrained the implementation of health policy and fragmented health financing. Health care expenditure in Ukraine is low by regional standards and has not increased significantly as a proportion of gross domestic product (GDP) since the mid 1990s; expenditure cannot match the constitutional guarantees of access to unlimited care. Although prepaid schemes such as sickness funds are growing in importance, out-of-pocket payments account for 37.4% of total health expenditure. The core challenges for Ukrainian health care therefore remain the ineffective protection of the population from the risk of catastrophic health care costs and the structural inefficiency of the health system, which is caused by the inefficient system of health care financing. Health system weaknesses are highlighted by increasing rates of avoidable mortality. Recent political impasse has complicated health system reforms and policy-makers face significant challenges in overcoming popular distrust and

  20. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization

    ERIC Educational Resources Information Center

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara

    2010-01-01

    Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

  1. Slovenia: Health System Review.

    PubMed

    Albreht, Tit; Pribakovic Brinovec, Radivoje; Josar, Dusan; Poldrugovac, Mircha; Kostnapfel, Tatja; Zaletel, Metka; Panteli, Dimitra; Maresso, Anna

    2016-06-01

    This analysis of the Slovene health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the population has improved over the last few decades. While life expectancy for both men and women is similar to EU averages, morbidity and mortality data show persistent disparities between regions, and mortality from external causes is particularly high. Satisfaction with health care delivery is high, but recently waiting times for some outpatient specialist services have increased. Greater focus on preventive measures is also needed as well as better care coordination, particularly for those with chronic conditions. Despite having relatively high levels of co-payments for many services covered by the universal compulsory health insurance system, these expenses are counterbalanced by voluntary health insurance, which covers 95% of the population liable for co-payments. However, Slovenia is somewhat unique among social health insurance countries in that it relies almost exclusively on payroll contributions to fund its compulsory health insurance system. This makes health sector revenues very susceptible to economic and labour market fluctuations. A future challenge will be to diversify the resource base for health system funding and thus bolster sustainability in the longer term, while preserving service delivery and quality of care. Given changing demographics and morbidity patterns, further challenges include restructuring the funding and provision of long-term care and enhancing health system efficiency through reform of purchasing and provider-payment systems. PMID:27467813

  2. Latvia: Health system review.

    PubMed

    Mitenbergs, Uldis; Taube, Maris; Misins, Janis; Mikitis, Eriks; Martinsons, Atis; Rurane, Aiga; Quentin, Wilm

    2012-01-01

    This analysis of the Latvian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health-system performance. Latvia has been constantly reforming its health system for over two decades. After independence in 1991, Latvia initially moved to create a social health insurance type system. However, problems with decentralized planning and fragmented and inefficient financing led to this being gradually reversed, and ultimately the establishment in 2011 of a National Health Service type system. These constant changes have taken place against a backdrop of relatively poor health and limited funding, with a heavy burden for individuals; Latvia has one of the highest rates of out-of-pocket expenditure on health in the European Union (EU). The lack of financial resources resulting from the financial crisis has posed an enormous challenge to the government, which struggled to ensure the availability of necessary health care services for the population and to prevent deterioration of health status. Yet this also provided momentum for reforms: previous efforts to centralise the system and to shift from hospital to outpatient care were drastically accelerated, while at the same time a social safety net strategy was implemented (with financial support from the World Bank) to protect the poor from the negative consequences of user charges. However, as in any health system, a number of challenges remain. They include: reducing smoking and cardiovascular deaths; increasing coverage of prescription pharmaceuticals; reducing the excessive reliance on out-of-pocket payments for financing the health system; reducing inequities in access and health status; improving efficiency of hospitals through implementation of DRG-based financing; and monitoring and improving quality. In the face of these challenges at a time of financial crisis, one further challenge emerges: ensuring adequate funding for the health

  3. Germany: Health system review.

    PubMed

    Busse, Reinhard; Blümel, Miriam

    2014-01-01

    This analysis of the German health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In the German health care system, decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance. A total of 70 million people or 85% of the population are covered by statutory health insurance in one of 132 sickness funds in early 2014. Another 11% are covered by substitutive private health insurance. Characteristics of the system are free choice of providers and unrestricted access to all care levels. A key feature of the health care delivery system in Germany is the clear institutional separation between public health services, ambulatory care and hospital (inpatient) care. This has increasingly been perceived as a barrier to change and so provisions for integrated care are being introduced with the aim of improving cooperation between ambulatory physicians and hospitals. Germany invests a substantial amount of its resources on health care: 11.4% of gross domestic product in 2012, which is one of the highest levels in the European Union. In international terms, the German health care system has a generous benefit basket, one of the highest levels of capacity as well as relatively low cost-sharing. However, the German health care system still needs improvement in some areas, such as the quality of care. In addition, the division into statutory and private health insurance remains one of the largest challenges for the German health care system, as it leads to inequalities. PMID:25115137

  4. The impact of health insurance on health services utilization and health outcomes in Vietnam.

    PubMed

    Guindon, G Emmanuel

    2014-10-01

    In recent years, a number of low- and middle-income country governments have introduced health insurance schemes. Yet not a great deal is known about the impact of such policy shifts. Vietnam's recent health insurance experience including a health insurance scheme for the poor in 2003 and a compulsory scheme that provides health insurance to all children under six years of age combined with Vietnam's commitment to universal coverage calls for research that examines the impact of health insurance. Taking advantage of Vietnam's unique policy environment, data from the 2002, 2004 and 2006 waves of the Vietnam Household Living Standard Survey and single-difference and difference-in-differences approaches are used to assess whether access to health insurance--for the poor, for children and for students--impacts on health services utilization and health outcomes in Vietnam. For the poor and for students, results suggest health insurance increased the use of inpatient services but not of outpatient services or health outcomes. For young children, results suggest health insurance increased the use of outpatient services (including the use of preventive health services such as vaccination and check-up) but not of inpatient services. PMID:24661805

  5. ADHD and Health Services Utilization in the National Health Interview Survey

    ERIC Educational Resources Information Center

    Cuffe, Steven P.; Moore, Charity G.; McKeown, Robert

    2009-01-01

    Objective: Describe the general health, comorbidities and health service use among U.S. children with ADHD. Method: The 2001 National Health Interview Survey (NHIS) contained the Strengths and Difficulties Questionnaire (SDQ; used to determine probable ADHD), data on medical problems, overall health, and health care utilization. Results: Asthma…

  6. Lithuania: health system review.

    PubMed

    Murauskiene, Liubove; Janoniene, Raimonda; Veniute, Marija; van Ginneken, Ewout; Karanikolos, Marina

    2013-01-01

    This analysis of the Lithuanian health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance since 2000.The Lithuanian health system is a mixed system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme, supplemented by substantial state contributions on behalf of the economically inactive population amounting to about half of its budget. Public financing of the health sector has gradually increased since 2004 to 5.2 per cent of GDP in 2010.Although the Lithuanian health system was tested by the recent economic crisis, Lithuanias counter-cyclical state health insurance contribution policies (ensuring coverage for the economically inactive population) helped the health system to weather the crisis, and Lithuania successfully used the crisis as a lever to reduce the prices of medicines.Yet the future impact of cuts in public health spending is a cause for concern. In addition, out-of-pocket payments remain high (in particular for pharmaceuticals) and could threaten health access for vulnerable groups.A number of challenges remain. The primary care system needs strengthening so that more patients are treated instead of being referred to a specialist, which will also require a change in attitude by patients. Transparency and accountability need to be increased in resource allocation, including financing of capital investment and in the payer provider relationship. Finally, population health,albeit improving, remains a concern, and major progress can be achieved by reducing the burden of amenable and preventable mortality. PMID:23902994

  7. Ukraine: health system review.

    PubMed

    Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica

    2015-03-01

    This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system. PMID:26106880

  8. Utilization of health services in Western Canada: basic Canadian data from the World Health Organization/International Collaborative Study of Medical Care Utilization.

    PubMed Central

    Matthews, V. L.; Feather, J.

    1976-01-01

    In a household health survey more than 15 000 individuals in four areas of Canada were interviewed as part of the World Health Organization/International Collaborative Study of Medical Care Utilization. Data were collected to describe the health services system in each area and to measure the population's utilization of health professionals, hospitals, medicines and selected preventive services, perceived acute and chronic morbidity, attitudes and beliefs about health and health care, and sociodemographic characteristics. The proportion of persons with perceived morbidity was twice that of persons reporting visits with a physician in the same 2-week period. Prescribed and nonprescribed medications had been used by more than 50% of respondents in each area in the 2 days before the interview, nonprescribed medicines accounting for more than half of this use. Respondents were found to be more sceptical of medical doctors than of medical science. PMID:1253067

  9. Community perceptions and utilization of a consumer health center*

    PubMed Central

    Ports, Katie A.; Ayers, Antoinette; Crocker, Wayne; Hart, Alton; Mosavel, Maghboeba; Rafie, Carlin

    2015-01-01

    The purpose of this study was to understand factors that may affect the usage of a consumer health center located in a public library. More specifically, the authors wanted to know what health resources are of interest to the community, what patrons' perceptions of their experience at the center are, and finally, how staff can increase utilization of the center. In general, perceptions of the center were positive. The findings support that participants appreciate efforts to provide health information in the public library setting and that utilization could be improved through marketing and outreach. PMID:25552943

  10. Community perceptions and utilization of a consumer health center.

    PubMed

    Ports, Katie A; Ayers, Antoinette; Crocker, Wayne; Hart, Alton; Mosavel, Maghboeba; Rafie, Carlin

    2015-01-01

    The purpose of this study was to understand factors that may affect the usage of a consumer health center located in a public library. More specifically, the authors wanted to know what health resources are of interest to the community, what patrons' perceptions of their experience at the center are, and finally, how staff can increase utilization of the center. In general, perceptions of the center were positive. The findings support that participants appreciate efforts to provide health information in the public library setting and that utilization could be improved through marketing and outreach. PMID:25552943

  11. Predictors of Healthcare Service Utilization for Mental Health Reasons

    PubMed Central

    Fleury, Marie-Josée; Ngamini Ngui, André; Bamvita, Jean-Marie; Grenier, Guy; Caron, Jean

    2014-01-01

    This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care. PMID:25321874

  12. Short-run effects of job loss on health conditions, health insurance, and health care utilization.

    PubMed

    Schaller, Jessamyn; Stevens, Ann Huff

    2015-09-01

    Job loss in the United States is associated with reductions in income and long-term increases in mortality rates. This paper examines the short-run changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 10,000 individual job losses and longitudinal data on a wide variety of health-related outcomes, we show that job loss results in worse self-reported health, activity limitations, and worse mental health, but is not associated with statistically significant increases in a variety of specific chronic conditions. Among the full sample of workers, we see reductions in insurance coverage, but little evidence of reductions in health care utilization after job loss. Among the subset of displaced workers with chronic conditions and those for whom the lost job was their primary source of insurance we do see reductions in doctor's visits and prescription drug usage. PMID:26250651

  13. Belgium: Health system review.

    PubMed

    Gerkens, Sophie; Merkur, Sherry

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Belgian population continues to enjoy good health and long life expectancy. This is partly due to good access to health services of high quality. Financing is based mostly on proportional social security contributions and progressive direct taxation. The compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. This Belgian HiT profile (2010) presents the evolution of the health system since 2007, including detailed information on new policies. While no drastic reforms were undertaken during this period, policy-makers have pursued the goals of improving access to good quality of care while making the system sustainable. Reforms to increase the accessibility of the health system include measures to reduce the out-of-pocket payments of more vulnerable populations (low-income families and individuals as well as the chronically ill). Quality of care related reforms have included incentives to better integrate different levels of care and the establishment of information systems, among others. Additionally, several measures on pharmaceutical products have aimed to reduce costs for both the National Institute for Health and Disability Insurance (NIHDI) and patients, while maintaining the quality of care. PMID:21224177

  14. France: Health System Review.

    PubMed

    Chevreul, Karine; Berg Brigham, Karen; Durand-Zaleski, Isabelle; Hernandez-Quevedo, Cristina

    2015-01-01

    This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending. PMID:26766545

  15. Relationships between sitting time and health indicators, costs, and utilization in older adults

    PubMed Central

    Rosenberg, Dori; Cook, Andrea; Gell, Nancy; Lozano, Paula; Grothaus, Lou; Arterburn, David

    2015-01-01

    Objective To examine whether self-reported sitting time is related to various health indicators, health costs, and utilization in adults over age 65. Methods A retrospective cross-sectional cohort study was conducted using the electronic health record (EHR) from an integrated health system in Washington State. Members who completed an online health risk assessment (HRA) between 2009 and 2011 (N = 3538) were eligible. The HRA assessed sitting time, physical activity, and health status. Diagnosis codes for diabetes and cardiovascular disease (CVD), height and weight for body mass index (BMI) calculations, health care utilization and health costs were extracted from the EHR. Linear regression models with robust standard errors tested differences in sitting time by health status, BMI category, diabetes and CVD, health costs, and utilization adjusting for demographic variables, BMI, physical activity, and health conditions. Results People classified as overweight and obese, that had diabetes or CVD, and with poorer self-rated health had significantly higher sitting time (p < .05). Total annual adjusted health care costs were $126 higher for each additional hour of sitting (p < .05; not significant in final models including health conditions). Conclusion Sitting time may be an important independent health indicator among older adults. PMID:26844078

  16. Gender disparities in HIV health care utilization among the severely disadvantaged: can we determine the reasons?

    PubMed

    Sohler, Nancy L; Li, Xuan; Cunningham, Chinazo O

    2009-09-01

    Data repeatedly demonstrate that HIV-infected people who regularly utilize primary health care services are more likely to have access to lifesaving treatments (including antiretroviral medications); have better indicators of health status; survive longer; and use acute care services far less. Women tend to have poorer HIV outcomes than men, which is likely due to gender disparities in optimal utilization of HIV primary care services. To understand the relationship between gender and the HIV health care system, we collected interview and medical record data between August 12, 2004 and June 7, 2005 from 414 severely marginalized, HIV-infected people in New York City and examined whether gender-related disparities in HIV health care utilization existed, and, if so, whether these patterns were explained by patient sociodemographic/behavioral characteristics and/or attitudes toward the health care system and providers. Women were significantly less likely to have optimal HIV health care services utilization, including lower use of HIV primary care services (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.35, 0.90) and greater use of the emergency department (OR = 2.13, 95% CI = 1.31, 3.46). Although we identified several factors associated with suboptimal HIV health care services utilization patterns in addition to female gender (low education, insurance status, mistrust of the health care system, and poor trust in health care providers), we were unable to identify factors that explained the observed gender disparities. We conclude that gender disparities in HIV health care utilization are due to a complex array of factors, which require more qualitative and quantitative research attention. Development of intervention strategies that specifically target severely disadvantaged women's HIV health care utilization is in great need. PMID:19663745

  17. Psychosocial working conditions and the utilization of health care services

    PubMed Central

    2011-01-01

    Background While there is considerable theoretical and empirical evidence on how job stress affects physical and mental health, few studies have examined the association between job related stress and health care utilization. Using data from the Canadian National Population Health Survey from 2000 to 2008, this paper examines the association between stressful working conditions, as measured by the job strain model, and the utilization of health care services. Methods A zero inflated negative binomial regression is used to examine the excess health care utilization due to job strain. Separate regressions are estimated for both males and females since studies have shown gender differences in health care utilization. Results Estimates for the whole population show that high or medium job strain has a positive and statistically significant association with the number of visits to both a general practitioner (GP) and a specialist (SP). On average, the number of GP visits is up to 26% more (IRR = 1.26, 95% CI = 1.19-1.31) for individuals with high strain jobs compared to those in the low job strain category. Similarly, SP visits are up to 27% more (IRR = 1.27, 95% CI = 1.14-142) for the high strain category. Results are quantitatively similar for males and females, save for medium strain. In general, findings are robust to the inclusion of workplace social support, health status, provincial and occupational-fixed effects. Conclusion Job strain may be positively associated with the utilization of health care services. This suggests that improving psychosocial working conditions and educating workers on stress-coping mechanisms could be beneficial for the physical and mental health of workers. PMID:21834974

  18. Israel: Health System Review.

    PubMed

    Rosen, Bruce; Waitzberg, Ruth; Merkur, Sherry

    2015-12-01

    Israel is a small country, with just over 8 million citizens and a modern market-based economy with a comparable level of gross domestic product per capita to the average in the European Union. It has had universal health coverage since the introduction of a progressively financed statutory health insurance system in 1995. All citizens can choose from among four competing, non-profit-making health plans, which are charged with providing a broad package of benefits stipulated by the government. Overall, the Israeli health care system is quite efficient. Health status levels are comparable to those of other developed countries, even though Israel spends a relatively low proportion of its gross domestic product on health care (less than 8%) and nearly 40% of that is privately financed. Factors contributing to system efficiency include regulated competition among the health plans, tight regulatory controls on the supply of hospital beds, accessible and professional primary care and a well-developed system of electronic health records. Israeli health care has also demonstrated a remarkable capacity to innovate, improve, establish goals, be tenacious and prioritize. Israel is in the midst of numerous health reform efforts. The health insurance benefits package has been extended to include mental health care and dental care for children. A multipronged effort is underway to reduce health inequalities. National projects have been launched to measure and improve the quality of hospital care and reduce surgical waiting times, along with greater public dissemination of comparative performance data. Major steps are also being taken to address projected shortages of physicians and nurses. One of the major challenges currently facing Israeli health care is the growing reliance on private financing, with potentially deleterious effects for equity and efficiency. Efforts are currently underway to expand public financing, improve the efficiency of the public system and constrain

  19. Fairness of utilizing health care facilities and out-of-pocket payment burden: evidence from Cambodia.

    PubMed

    Dalal, Koustuv; Aremu, Olatunde

    2013-05-01

    Catastrophic spending on health care through out-of-pocket payment is a huge problem in most low- and middle-income countries all over the world. The collapse of health systems and poverty have resulted in the proliferation of the private health sector in Cambodia, but very few studies have examined the fairness in ease of utilization of these services based on mode of payment. This study examined the utilization of health services for sickness or injury and identified its relationship with people's ability to pay for treatment seeking at various instances. Based on cross-sectional data from the Cambodian 2007 Demographic and Health Survey, the economic index estimated through principal component analysis and Lorenz curve was used to quantify the degree of fairness and equality in utilization and payment burden among the respondents. A distinct level of fairness was found in health care utilization and out-of-pocket payments. Specifically, use of private health care facilities and over-the-counter remedies dominate, and out-of-pocket payments cut across all socioeconomic strata. As many countries in low- and middle-income regions, and most importantly those in transition such as Cambodia, are repositioning their health systems, efforts should be made towards maintaining equitable access through adoption of finance mechanisms that make utilization of health care services fair and equitable. PMID:22958391

  20. Integrated Renewable Hydrogen Utility System

    SciTech Connect

    Proton Energy Systems

    2003-04-01

    Products based on Proton Exchange Membrane (PEM) technology offer a unique solution to today's energy conversion storage needs. PEM products have undergone continual development since the late 1950's for many diverse applications. Rooted in rigorous aerospace applications, this technology is now ''breaking away'' to provide commercial solutions to common power, energy, and industrial gas feedstock problems. Important developments in PEM electrolyzers and various energy conversion devices (e.g. engines and fuel cells) can now be combined to form the basis for a revolutionary energy storage system that provides a much needed link to renewable resources, and offers a credible alternative for off-grid power applications. This technology operates by converting electrical energy into chemical energy in the form of hydrogen as part of a water electrolysis process when excess power is available. When the primary source of power is unavailable, chemical energy is converted into electrical energy through an external combustion heat engine or other energy conversion device. The Phase II portion of this program began in May of 2000. The goal of Phase II of the project was to cost reduce the hydrogen generator as a critical link to having a fully sustainable hydrogen energy system. The overall goal is to enable the link to sustainability by converting excess renewable power into hydrogen and having that hydrogen available for conversion back to power, on demand. Furthermore, the cost of the capability must be less the $1,000 per kW (electrical power into the generator) and allow for a variety of renewable technology inputs. This cost target is based on a production volume of 10,000 units per year. To that end, Proton undertook an aggressive approach to cost reduction activities surrounding the 6kW, 40 standard cubic foot per hour (scfh) HOGEN hydrogen generator. The electrical side of the system targeted a number of areas that included approaches to reduce the cost of the power

  1. Poland health system review.

    PubMed

    Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard

    2011-01-01

    Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures

  2. Italy: health system review.

    PubMed

    Ferre, Francesca; de Belvis, Antonio Giulio; Valerio, Luca; Longhi, Silvia; Lazzari, Agnese; Fattore, Giovanni; Ricciardi, Walter; Maresso, Anna

    2014-01-01

    Italy is the sixth largest country in Europe and has the second highest average life expectancy, reaching 79.4 years for men and 84.5 years for women in 2011. There are marked regional differences for both men and women in most health indicators, reflecting the economic and social imbalance between the north and south of the country. The main diseases affecting the population are circulatory diseases, malignant tumours and respiratory diseases. Italy's health care system is a regionally based national health service that provides universal coverage largely free of charge at the point of delivery. The main source of financing is national and regional taxes, supplemented by copayments for pharmaceuticals and outpatient care. In 2012, total health expenditure accounted for 9.2 percent of GDP (slightly below the EU average of 9.6 percent). Public sources made up 78.2 percent of total health care spending. While the central government provides a stewardship role, setting the fundamental principles and goals of the health system and determining the core benefit package of health services available to all citizens, the regions are responsible for organizing and delivering primary, secondary and tertiary health care services as well as preventive and health promotion services. Faced with the current economic constraints of having to contain or even reduce health expenditure, the largest challenge facing the health system is to achieve budgetary goals without reducing the provision of health services to patients. This is related to the other key challenge of ensuring equity across regions, where gaps in service provision and health system performance persist. Other issues include ensuring the quality of professionals managing facilities, promoting group practice and other integrated care organizational models in primary care, and ensuring that the concentration of organizational control by regions of health-care providers does not stifle innovation. PMID:25471543

  3. Circumpolar Inuit health systems

    PubMed Central

    Ellsworth, Leanna; O'Keeffe, Annmaree

    2013-01-01

    Background The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic – Canada, Greenland, USA (Alaska) and Russia (Chukotka). In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. Objective To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska) and Russia (Chukotka) and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Study design Literature review. Results It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems’ effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of comparison in terms of

  4. Bulgaria health system review.

    PubMed

    Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout

    2012-01-01

    In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health

  5. Knee System Utilizing Personalized Solutions Instrumentation

    MedlinePlus

    ATTUNE® Knee System utilizing the TRUMATCH® Personalized Solutions Instrumentation Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2016 BroadcastMed, Inc. All rights reserved.

  6. Switzerland: Health System Review.

    PubMed

    De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm

    2015-01-01

    This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to

  7. Estonia: health system review.

    PubMed

    Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout

    2013-01-01

    This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system. PMID:24334730

  8. Regional Health Information Systems

    PubMed Central

    Fuller, Sherrilynne

    1997-01-01

    Abstract In general, there is agreement that robust integrated information systems are the foundation for building successful regional health care delivery systems. Integrated Advanced Information Management System (IAIMS) institutions that, over the years, have developed strategies for creating cohesive institutional information systems and services are finding that IAIMS strategies work well in the even more complex regional environment. The key elements of IAIMS planning are described and lessons learned are discussed in the context of regional health information systems developed. The challenges of aligning the various information agencies and agendas in support of a regional health information system are complex ; however, the potential rewards for health care in quality, efficacy, and cost savings are enormous. PMID:9067887

  9. Testing rank-dependent utility theory for health outcomes.

    PubMed

    Oliver, Adam

    2003-10-01

    Systematic violations of expected utility theory (EU) have been reported in the context of both money and health outcomes. Rank-dependent utility theory (RDU) is currently the most popular and influential alternative theory of choice under circumstances of risk. This paper reports a test of the descriptive performance of RDU compared to EU in the context of health. When one of the options is certain, violations of EU that can be explained by RDU are found. When both options are risky, no evidence that RDU is a descriptive improvement over EU is found, though this finding may be due to the low power of the tests. PMID:14508870

  10. Evidence-based decision-making 6: Utilization of administrative databases for health services research.

    PubMed

    Chowdhury, Tanvir Turin; Hemmelgarn, Brenda

    2015-01-01

    Health-care systems require reliable information on which to base health-care planning and make decisions, as well as to evaluate their policy impact. Administrative data provide important information about health services use, expenditures, clinical outcomes, and may be used to assess quality of care. With increased digitalization and accessibility of administrative databases, these data are more readily available for health service research purposes, aiding evidence-based decision-making. This chapter discusses the utility of administrative data for population-based studies of health and health care. PMID:25694328

  11. Romania: Health System Review.

    PubMed

    Vladescu, Cristian; Scintee, Silvia Gabriela; Olsavszky, Victor; Hernandez-Quevedo, Cristina; Sagan, Anna

    2016-08-01

    This analysis of the Romanian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Romanian health care system is a social health insurance system that has remained highly centralized despite recent efforts to decentralize some regulatory functions. It provides a comprehensive benefits package to the 85% of the population that is covered, with the remaining population having access to a minimum package of benefits. While every insured person has access to the same health care benefits regardless of their socioeconomic situation, there are inequities in access to health care across many dimensions, such as rural versus urban, and health outcomes also differ across these dimensions. The Romanian population has seen increasing life expectancy and declining mortality rates but both remain among the worst in the European Union. Some unfavourable trends have been observed, including increasing numbers of new HIV/AIDS diagnoses and falling immunization rates. Public sources account for over 80% of total health financing. However, that leaves considerable out-of-pocket payments covering almost a fifth of total expenditure. The share of informal payments also seems to be substantial, but precise figures are unknown. In 2014, Romania had the lowest health expenditure as a share of gross domestic product (GDP) among the EU Member States. In line with the government's objective of strengthening the role of primary care, the total number of hospital beds has been decreasing. However, health care provision remains characterized by underprovision of primary and community care and inappropriate use of inpatient and specialized outpatient care, including care in hospital emergency departments. The numbers of physicians and nurses are relatively low in Romania compared to EU averages. This has mainly been attributed to the high rates of workers emigrating abroad over the

  12. Denmark health system review.

    PubMed

    Olejaz, Maria; Juul Nielsen, Annegrete; Rudkjøbing, Andreas; Okkels Birk, Hans; Krasnik, Allan; Hernández-Quevedo, Cristina

    2012-01-01

    Denmark has a tradition of a decentralized health system. However, during recent years, reforms and policy initiatives have gradually centralized the health system in different ways. The structural reform of 2007 merged the old counties into fewer bigger regions, and the old municipalities likewise. The hospital structure is undergoing similar reforms, with fewer, bigger and more specialized hospitals. Furthermore, a more centralized approach to planning and regulation has been taking place over recent years. This is evident in the new national planning of medical specialties as well as the establishment of a nationwide accreditation system, the Danish Healthcare Quality Programme, which sets national standards for health system providers in Denmark. Efforts have also been made to ensure coherent patient pathways - at the moment for cancer and heart disease - that are similar nationwide. These efforts also aim at improving intersectoral cooperation. Financially, recent years have seen the introduction of a higher degree of activity-based financing in the public health sector, combined with the traditional global budgeting.A number of challenges remain in the Danish health care system. The consequences of the recent reforms and centralization initiatives are yet to be fully evaluated. Before this happens, a full overview of what future reforms should target is not possible. Denmark continues to lag behind the other Nordic countries in regards to some health indicators, such as life expectancy. A number of risk factors may be the cause of this: alcohol intake and obesity continue to be problems, whereas smoking habits are improving. The level of socioeconomic inequalities in health also continues to be a challenge. The organization of the Danish health care system will have to take a number of challenges into account in the future. These include changes in disease patterns, with an ageing population with chronic and long-term diseases; ensuring sufficient staffing

  13. Hungary health system review.

    PubMed

    Gaal, Peter; Szigeti, Szabolcs; Csere, Marton; Gaskins, Matthew; Panteli, Dimitra

    2011-01-01

    Hungary has achieved a successful transition from an overly centralized, integrated Semashko-style health care system to a purchaser provider split model with output-based payment methods. Although there have been substantial increases in life expectancy in recent years among both men and women, many health outcomes remain poor, placing Hungary among the countries with the worst health status and highest rate of avoidable mortality in the EU (life expectancy at birth trailed the EU27 average by 5.1 years in 2009). Lifestyle factors especially the traditionally unhealthy Hungarian diet, alcohol consumption and smoking play a very important role in shaping the overall health of the population.In the single-payer system, the recurrent expenditure on health services is funded primarily through compulsory, non-risk-related contributions made by eligible individuals or from the state budget. The central government has almost exclusive power to formulate strategic direction and to issue and enforce regulations regarding health care. In 2009 Hungary spent 7.4% of its gross domestic product (GDP) on health, with public expenditure accounting for 69.7% of total health spending, and with health expenditure per capita ranking slightly above the average for the new EU Member States, but considerably below the average for the EU27 in 2008. Health spending has been unstable over the years, with several waves of increases followed by longer periods of cost-containment and budget cuts. The share of total health expenditure attributable to private sources has been increasing, most of it accounted for by out-of-pocket (OOP) expenses. A substantial share of the latter can be attributed to informal payments, which are a deeply rooted characteristic of the Hungarian health system and a source of inefficiency and inequity. Voluntary health insurance, on the other hand, amounted to only 7.4% of private and 2.7% of total health expenditure in 2009. Revenue sources for health have been

  14. Predicting Health Care Utilization After Behavioral Health Referral Using Natural Language Processing and Machine Learning

    PubMed Central

    Roysden, Nathaniel; Wright, Adam

    2015-01-01

    Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient’s first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection factor analysis. PMID:26958306

  15. Health Literacy Impact on National Healthcare Utilization and Expenditure

    PubMed Central

    Rasu, Rafia S.; Bawa, Walter Agbor; Suminski, Richard; Snella, Kathleen; Warady, Bradley

    2015-01-01

    Background: Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Methods: Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. Results: The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national

  16. Netherlands: Health System Review.

    PubMed

    Kroneman, Madelon; Boerma, Wienke; van den Berg, Michael; Groenewegen, Peter; de Jong, Judith; van Ginneken, Ewout

    2016-03-01

    This analysis of the Dutch health system reviews recent developments in organization and governance, health financing, healthcare provision, health reforms and health system performance. Without doubt, two major reforms implemented since the mid-2000s are among the main issues today. The newly implemented long-term care reform will have to realize a transition from publicly provided care to more self-reliance on the part of the citizens and a larger role for municipalities in its organization. A particular point of attention is how the new governance arrangements and responsibilities in long-term care will work together. The 2006 reform replaced the division between public and private insurance by one universal social health insurance and introduced managed competition as a driving mechanism in the healthcare system. Although the reform was initiated almost a decade ago, its stepwise implementation continues to bring changes in the healthcare system in general and in the role of actors in particular. In terms of performance, essential healthcare services are within easy reach and waiting times have been decreasing. The basic health insurance package and compensations for lower incomes protect citizens against catastrophic spending. Out-of-pocket payments are low from an international perspective. Moreover, the Dutch rate the quality of the health system and their health as good. International comparisons show that the Netherlands has low antibiotic use, a low number of avoidable hospitalizations and a relatively low avoidable mortality. National studies show that healthcare has made major contributions to the health of the Dutch population as reflected in increasing life expectancy. Furthermore, some indicators such as the prescription of generics and length of stay reveal improvements in efficiency over the past years. Nevertheless, the Netherlands still has one of the highest per capita health expenditures in Europe, although growth has slowed considerably after

  17. Turkey. Health system review.

    PubMed

    Tatar, Mehtap; Mollahaliloğlu, Salih; Sahin, Bayram; Aydin, Sabahattin; Maresso, Anna; Hernández-Quevedo, Cristina

    2011-01-01

    Turkey has accomplished remarkable improvements in terms of health status in the last three decades, particularly after the implementation of the Health Transformation Program (HTP (Saglikta Donus, um Programi)). Average life expectancy reached 71.8 for men and 76.8 for women in 2010. The infant mortality rate (IMR) decreased to 10.1 per 1000 live births in 2010, down from 117.5 in 1980. Despite these achievements, there are still discrepancies in terms of infant mortality between rural and urban areas and different parts of the country, although these have been diminishing over the years. The higher infant mortality rates in rural areas can be attributed to low socioeconomic conditions, low female education levels and the prevalence of infectious diseases. The main causes of death are diseases of the circulatory system followed by malignant neoplasms. Turkeys health care system has been undergoing a far-reaching reform process (HTP) since 2003 and radical changes have occurred both in the provision and the financing of health care services. Health services are now financed through a social security scheme covering the majority of the population, the General Health Insurance Scheme (GHIS (Genel Saglik Sigortasi)), and services are provided both by public and private sector facilities. The Social Security Institution (SSI (Sosyal Guvenlik Kurumu)), financed through payments by employers and employees and government contributions in cases of budget deficit, has become a monopsonic (single buyer) power on the purchasing side of health care services. On the provision side, the Ministry of Health (Saglik Bakenligi) is the main actor and provides primary, secondary and tertiary care through its facilities across the country. Universities are also major providers of tertiary care. The private sector has increased its range over recent years, particularly after arrangements paved the way for private sector provision of services to the SSI. The most important reforms since

  18. The Utilization of Dental Health Services by Chicanos and Anglos.

    ERIC Educational Resources Information Center

    Garcia, John A.; Juarez, Rumaldo Z.

    The dental utilization patterns of Chicanos and Anglos were compared using several socio-demographic variables to explain any differences or similarities existing between the two groups. Data for this study were part of an extensive household survey conducted in Pima County, Arizona, to obtain information on various health indicators concerning…

  19. Adjusting capitation rates using objective health measures and prior utilization

    PubMed Central

    Newhouse, Joseph P.; Manning, Willard G.; Keeler, Emmett B.; Sloss, Elizabeth M.

    1989-01-01

    Several analysts have proposed adding adjusters based on health status and prior utilization to the adjusted average per capita cost formula. The authors estimate how well such adjusters predict annual medical expenditures among non-elderly adults. Both measures substantially improve on the variables currently used. If only health measures are added, 20-30 percent of the predictable variance is explained; if only prior use is added, more than 40 percent is explained; if both are added, about 60 percent is explained. The results support including some measure of use in the formula until better health measures are developed. PMID:10313096

  20. Health State Utilities for Patients with Brain Metastases

    PubMed Central

    Dosoretz, Arie P; Hayman, James A; Yu, James B

    2016-01-01

    Purpose: Estimating the cost-effectiveness of whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS), including Gamma Knife radiosurgery (GKRS), requires the quantitative measurement of patients’ health states after treatment. We sought to quantify individuals’ preferences for the relevant health states after WBRT or GKRS for brain metastases on a 0 to 1 scale, where 1 is perfect health and 0 is death. Methods: We prospectively measured utilities in patients with brain metastases evaluated at Yale for consideration of WBRT and/or GKRS, as well as oncology nurses who had cared for patients with brain metastases before and after WBRT or GKRS, using the Standard Gamble (SG) technique. Demographic information was also collected. Nonparametric tests were used to compare potential differences in utility values and for subgroups based on demographic characteristics. Results: There were 24 patients and 31 nurses who completed the study between December 2013 and May 2015. Median utilities ranged from 0.85 for the status-post (S/P) GKRS state to 0.25 (for neurologic dying). The median utility of being S/P WBRT was 0.70 compared to 0.85 S/P GKRS (p < 0.001). The cognitive decline from WBRT was associated with a notably low utility score of 0.30. There were no statistically significant differences between patients’ and nurses’ median utility scores. Conclusions: These SG utilities provide unique insights into brain metastases-related health states from the patient and provider perspective. As perceived by individuals with direct knowledge of the health states in question, WBRT has a significantly lower utility compared to GKRS. Cognitive decline following WBRT is associated with significant perceived reduction in quality of life. Differences in the relative importance of overall survival and quality of life with treatment existed between patients with different stages of disease. These utilities can be used to calculate quality-adjusted life

  1. Quality of Life, Health Status, and Health Service Utilization Related to a New Measure of Health Literacy FLIGHT/VIDAS

    PubMed Central

    Ownby, Raymond L; Acevedo, Amarilis; Jacobs, Robin J.; Caballero, Joshua; Waldrop-Valverde, Drenna

    2014-01-01

    Objective Researchers have identified significant limitations in some currently-used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. Methods The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. Results The new health literacy measure is significantly related to existing measures of health literacy as well as to participants’ health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. Conclusion The new measure of health literacy is valid and shows relations to measures of conceptually-related constructs such as quality of life and health behaviors. Practice Implications: FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy. PMID:24856447

  2. Strengthening health systems by health sector reforms

    PubMed Central

    Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech

    2014-01-01

    Background The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. Methods A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Findings Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging ‘street level’ policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. Conclusions The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems. PMID:24560261

  3. Cue System Utilization among Beginning Readers.

    ERIC Educational Resources Information Center

    Englander, Meryl; Harste, Jerome

    A study was conducted to determine which of three major cue systems (linguistic, cognitive, or extralinguistic) 146 subjects at the kindergarten, first grade and second grade levels used to reconstruct meaning when confronted with a reading task. Cue system utilization was related to four factors: modality (listening versus reading), reading…

  4. Maximizing Resource Utilization in Video Streaming Systems

    ERIC Educational Resources Information Center

    Alsmirat, Mohammad Abdullah

    2013-01-01

    Video streaming has recently grown dramatically in popularity over the Internet, Cable TV, and wire-less networks. Because of the resource demanding nature of video streaming applications, maximizing resource utilization in any video streaming system is a key factor to increase the scalability and decrease the cost of the system. Resources to…

  5. Health State Utility Values in Patients Undergoing Endoscopic Sinus Surgery

    PubMed Central

    Soler, Zachary M.; Wittenberg, Eve; Schlosser, Rodney J.; Mace, Jess C.; Smith, Timothy L.

    2011-01-01

    OBJECTIVES/HYPOTHESIS The primary study goal was to measure health state utility values in patients with chronic rhinosinusitis (CRS) before and after undergoing endoscopic sinus surgery (ESS). A secondary goal was to assess the meaning of these values by comparing them with other chronic disease processes and currently available medical or surgical treatments. STUDY DESIGN Prospective, observational cohort study METHODS Adults with CRS were enrolled after electing ESS and observed over a 5-year period. Baseline demographic and medical comorbidities were recorded for each patient, as well as computed tomography (CT), endoscopy, olfaction, and disease-specific quality of life scores. Utility values were derived using the Short-Form 6D (SF-6D) at baseline and again after surgery. RESULTS The mean SF-6D utility value for the baseline health state of all patients with CRS (n=232) was 0.65 (95% CI: 0.63–0.66). Baseline utility values correlated with disease-specific QOL as measured by the Rhinosinusitis Disability Index (RSDI) (r=−0.660; P<0.001), but not baseline CT, endoscopy, or olfactory scores. Follow-up utility values (≥6 months) after ESS improved by 0.087 (95% CI: 0.06–0.12; P<0.001) in patients with no history of sinus surgery and 0.062 (95% CI: 0.04–0.09; P<0.001) in those undergoing a revision procedure. CONCLUSIONS Patients with CRS who failed medical therapy and elected to undergo ESS report health state utility values which are significantly lower than the United States population norm. Utility values showed improvement after ESS which was statistically and clinically significant. These results provide the initial data necessary for formal cost-effectiveness analyses incorporating ESS. PMID:22034223

  6. Mental health care utilization and costs in a corporate setting.

    PubMed

    Tsai, S P; Bernacki, E J; Reedy, S M

    1987-10-01

    This article presents the mental health care utilization and costs among 14,162 employees and their families, covered under a major medical policy of a large multinational corporation for the 1984 policy year. Mental health care costs comprise a substantial portion of the total health care dollars expended (8.1%) for a relatively small fraction of the total number of claims (2.8%). The average hospital stay for mental disorders (20 days for employees; 15 days for spouses; 43 days for dependents) was significantly longer than for other illnesses (6.1 days for employees; 6.2 days for spouses; 4.4 days for dependents). Although the average daily hospital cost for mental disorders was less than that for non-mental conditions, total expenditures per admission were approximately three times higher due to the long lengths of stay. Case management, peer utilization review, and day treatment are recommended to reduce these costs. PMID:3681492

  7. Belarus: health system review.

    PubMed

    Richardson, Erica; Malakhova, Irina; Novik, Irina; Famenka, Andrei

    2013-01-01

    This analysis of the Belarusian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2008. Despite considerable change since independence, Belarus retains a commitment to the principle of universal access to health care, provided free at the point of use through predominantly state-owned facilities, organized hierarchically on a territorial basis. Incremental change, rather than radical reform, has also been the hallmark of health-care policy, although capitation funding has been introduced in some areas and there have been consistent efforts to strengthen the role of primary care. Issues of high costs in the hospital sector and of weaknesses in public health demonstrate the necessity of moving forward with the reform programme. The focus for future reform is on strengthening preventive services and improving the quality and efficiency of specialist services. The key challenges in achieving this involve reducing excess hospital capacity, strengthening health-care management, use of evidence-based treatment and diagnostic procedures, and the development of more efficient financing mechanisms. Involving all stakeholders in the development of further reform planning and achieving consensus among them will be key to its success. PMID:24334702

  8. Sweden health system review.

    PubMed

    Anell, Anders; Glenngård, Anna H; Merkur, Sherry

    2012-01-01

    Life expectancy in Sweden is high and the country performs well in comparisons related to disease-oriented indicators of health service outcomes and quality of care. The Swedish health system is committed to ensuring the health of all citizens and abides by the principles of human dignity, need and solidarity, and cost-effectiveness. The state is responsible for overall health policy, while the funding and provision of services lies largely with the county councils and regions. The municipalities are responsible for the care of older and disabled people. The majority of primary care centres and almost all hospitals are owned by the county councils. Health care expenditure is mainly tax funded (80%) and is equivalent to 9.9% of gross domestic product (GDP) (2009). Only about 4% of the population has voluntary health insurance (VHI). User charges fund about 17% of health expenditure and are levied on visits to professionals, hospitalization and medicines. The number of acute care hospital beds is below the European Union (EU) average and Sweden allocates more human resources to the health sector than most OECD countries. In the past, the Achilles heel of Swedish health care included long waiting times for diagnosis and treatment and, more recently, divergence in quality of care between regions and socioeconomic groups. Addressing long waiting times remains a key policy objective along with improving access to providers. Recent principal health reforms over the past decade relate to: concentrating hospital services; regionalizing health care services, including mergers; improving coordinated care; increasing choice, competition and privatization in primary care; privatization and competition in the pharmacy sector; changing co-payments; and increasing attention to public comparison of quality and efficiency indicators, the value of investments in health care and responsiveness to patients needs. Reforms are often introduced on the local level, thus the pattern of

  9. Forecasting drug utilization and expenditure in a metropolitan health region

    PubMed Central

    2010-01-01

    Background New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning), forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011. Methods Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee. Results The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs. Conclusions The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate of adoption of new

  10. System health monitoring

    SciTech Connect

    Reneke, J.A.; Fryer, M.O.

    1995-08-01

    Well designed large systems include many instrument taking data. These data are used in a variety of ways. They are used to control the system and its components, to monitor system and component health, and often for historical or financial purposes. This paper discusses a new method of using data from low level instrumentation to monitor system and component health. The method uses the covariance of instrument outputs to calculate a measure of system change. The method involves no complicated modeling since it is not a parameter estimation algorithm. The method is iterative and can be implemented on a computer in real time. Examples are presented for a metal lathe and a high efficiency particulate air (HEPA) filter. It is shown that the proposed method is quite sensitive to system changes such as wear out and failure. The method is useful for low level system diagnostics and fault detection.

  11. Utilization of health insurance data in an environmental epidemiology

    PubMed Central

    Ha, Jongsik; Cho, Seongkyung

    2015-01-01

    Objectives In South Korea, health insurance data are used as material for the health insurance of national whole subject. In general, health insurance data could be useful for estimating prevalence or incidence rate that is representative of the actual value in a population. The purpose of this study was to apply the concept of episode of care (EoC) in the utilization of health insurance data in the field of environmental epidemiology and to propose an improved methodology through an uncertainty assessment of disease course and outcome. Methods In this study, we introduced the concept of EoC as a methodology to utilize health insurance data in the field of environmental epidemiology. The characterization analysis of the course and outcome of applying the EoC concept to health insurance data was performed through an uncertainty assessment. Results The EoC concept in this study was applied to heat stroke (International Classification of Disease, 10th revision, code T67). In the comparison of results between before and after applying the EoC concept, we observed a reduction in the deviation of daily claims after applying the EoC concept. After that, we categorized context, model, and input uncertainty and characterized these uncertainties in three dimensions by using uncertainty typology. Conclusions This study is the first to show the process of constructing episode data for environmental epidemiological studies by using health insurance data. Our results will help in obtaining representative results for the processing of health insurance data in environmental epidemiological research. Furthermore, these results could be used in the processing of health insurance data in the future. PMID:26796891

  12. Greece: Health system review.

    PubMed

    Economou, Charalambos

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The health status of the Greek population has strongly improved over the last few decades and seems to compare relatively favourably with other OECD and European Union (EU) countries. The health system is a mixture of public integrated, public contract and public reimbursement models, comprising elements from both the public and private sectors and incorporating principles of different organizational patterns. Access to services is based on citizenship as well as on occupational status.The system is financed by the state budget, social insurance contributions and private payments.The largest share of health expenditure constitutes private expenditure, mainly in the form of out of pocket payments which is also the element contributing most to the overall increase in health expenditure. The delivery of health care services is based on both public and private providers. The presence of private providers is more obvious in primary care,especially in diagnostic technologies, private physicians' practices and pharmaceuticals. Despite success in improving the health of the population, the Greek health care system faces serious structural problems concerning the organization, financing and delivery of services. It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits. The high percentage of private expenditure goes against the principle of fair

  13. Alcohol Dependence and Health Care Utilization in African Americans

    PubMed Central

    Marshall, Vanessa J.; Kalu, Nnenna; Kwagyan, John; Scott, Denise M.; Cain, Gloria E.; Hill, Karen; Hesselbrock, Victor; Ferguson, Clifford L.; Taylor, Robert E.

    2013-01-01

    Objective Ethnic and cultural differences in patterns of alcohol use disorders must be understood in order to address improvement in prevention of such disorders and accessibility to health care services. The purpose of this study was to evaluate factors that influence the utilization of medical and mental health services among alcohol-dependent and non alcohol–dependent African Americans. Method A cohort of 454 African Americans was evaluated. Alcohol-dependent participants were recruited from various inpatient treatment facilities in the Washington, DC, metropolitan area and through advertisement and word of mouth. Non–alcohol-dependent participants were recruited by advertisements. Each participant was administered the Semi-Structured Assessment for the Genetics of Alcoholism to assess alcohol dependency and the Family History Assessment module to access family history of alcoholism. χ2 Test and analysis of variance were used to analyze the data. Results Alcohol dependence was more prevalent among men, those with lower income, those with less education, and they utilized mental health counseling as opposed to medical-based therapy. Increased reports of medical conditions such as migraine (p < .001), loss of consciousness (p = .001), and sexually transmitted diseases (p < .001) were also associated with alcohol dependency. Other factors, including visits to inpatient treatment programs, were directly related to incidence of alcohol dependency regardless of gender status (p < .001). Conclusions This study suggests an association exists among alcohol dependence, medical conditions, health care, and mental care utilization among African Americans. Future research may benefit from investigating if an association exists between alcohol use disorders and health care utilization for other ethnic groups. PMID:23862295

  14. [Health system of Vietnam].

    PubMed

    Matsuda, S

    1994-01-01

    Vietnam's health system consists of four levels: national, provincial/special city, prefecture/ward, and basic unit of town or village. Health care is managed by the Health Department at the national level and by the health and welfare section of the People's Committee at all other levels. Actual medical services are provided by the National Central Hospital at the national level, by general hospitals at the provincial/special city level, by general hospitals and multi-purpose health clinics at the prefecture/ward level, and by health stations at the basic unit level. Health services provide not only doctors, nurses, and pharmacists, but also paramedical staff, especially at the basic unit level. Just as with other developing countries, infectious diseases are the most important priorities in health/medical care policies; especially malaria, which is the number one priority followed by diarrhea. Because of well-established health stations at the basic unit level throughout the country and a relatively sufficient supply of medication, the mortality rate due to the above is low. The maternal/infant health care index of 1988 shows the following: low birth weight (14%); maternal mortality (1.4/1000); neonatal mortality (33.5/1000); and perinatal mortality (22.5/1000). Malnutrition of children under 3 years of age in farming areas, insufficient supply of drinking water, and lack of industrial health insurance are some of the problems yet to be solved. It is hoped that medical services can be a significant part of the comprehensive economic development program within the framework of Japan's international cooperation/assistance. PMID:8111100

  15. Norway: health system review.

    PubMed

    Ringard, Ånen; Sagan, Anna; Sperre Saunes, Ingrid; Lindahl, Anne Karin

    2013-01-01

    Norways five million inhabitants are spread over nearly four hundred thousand square kilometres, making it one of the most sparsely populated countries in Europe. It has enjoyed several decades of high growth, following the start of oil production in early 1970s, and is now one of the richest countries per head in the world. Overall, Norways population enjoys good health status; life expectancy of 81.53 years is above the EU average of 80.14, and the gap between overall life expectancy and healthy life years is around half the of EU average. The health care system is semi decentralized. The responsibility for specialist care lies with the state (administered by four Regional Health Authorities) and the municipalities are responsible for primary care. Although health care expenditure is only 9.4% of Norways GDP (placing it on the 16th place in the WHO European region), given Norways very high value of GDP per capita, its health expenditure per head is higher than in most countries. Public sources account for over 85% of total health expenditure; the majority of private health financing comes from households out-of-pocket payments.The number of practitioners in most health personnel groups, including physicians and nurses, has been increasing in the last few decades and the number of health care personnel per 100 000 inhabitants is high compared to other EU countries. However, long waiting times for elective care continue to be a problem and are cause of dissatisfaction among the patients. The focus of health care reforms has seen shifts over the past four decades. During the 1970s the focus was on equality and increasing geographical access to health care services; during the 1980s reforms aimed at achieving cost containment and decentralizing health care services; during the 1990s the focus was on efficiency. Since the beginning of the millennium the emphasis has been given to structural changes in the delivery and organization of health care and to policies

  16. Variation in child health care utilization by medical complexity.

    PubMed

    Kuo, Dennis Z; Melguizo-Castro, Maria; Goudie, Anthony; Nick, Todd G; Robbins, James M; Casey, Patrick H

    2015-01-01

    Children with medical complexity (CMC) have multiple specialty need, technology dependence, and high health care utilization. The objective of this study is to profile types of pediatric health care utilization and costs by increasing levels of medical complexity. This is a cross-sectional study of the 2007, 2008 and 2009 Full-Year Data Sets from the Medical Expenditure Panel Survey. Medical complexity was defined by a higher number of positive items from the five question children with special health care needs (CSHCN) Screener. CMC were defined by ≥ 4 positive screener items. Outcomes included the number of inpatient, outpatient, and emergency department visits, associated costs and diagnoses, and reported satisfaction. ICD-9 codes were grouped by Clinical Classifications Software. Of 27,755 total study subjects ≤ 17 years, 4,851 had special needs and 541 were CMC. Older age, male gender, white/non-Hispanic race/ethnicity, and public insurance were all associated with medical complexity (all p < 0.001). CMC had an annual mean of 19 annual outpatient visits ($616) and 0.26 inpatient visits ($3,308), with other significant cost drivers including home health ($2,957) and prescriptions ($2,182). The most common reasons for non-CSHCN and less-complex CSHCN outpatient visits were viral illnesses, while the main reasons for CMC visits were for mental health. Compared to families without CSHCN, those with CMC have, on average, lower satisfaction with health care (8.4 vs. 8.9 out of 10, p < 0.001). Health care models for CMC should account for mental health conditions that may be driving high numbers of outpatient encounters. PMID:24740726

  17. Occupational safety and health implications of increased coal utilization.

    PubMed Central

    Bridbord, K; Costello, J; Gamble, J; Groce, D; Hutchison, M; Jones, W; Merchant, J; Ortmeyer, C; Reger, R; Wagner, W L

    1979-01-01

    An area of major concern in considering increased coal production and utilization is the health and safety of increased numbers of workers who mine, process, or utilize coal. Hazards related to mining activities in the past have been especially serious, resulting in many mine related accidental deaths, disabling injuries, and disability and death from chronic lung disease. Underground coal mines are clearly less safe than surface mines. Over one-third of currently employed underground miners experience chronic lung disease. Other stresses include noise and extremes of heat and cold. Newly emphasized technologies of the use of diesel powered mining equipment and the use of longwall mining techniques may be associated with serious health effects. Workers at coal-fired power plants are also potentially at risk of occupational diseases. Occupational safety and health aspects of coal mining are understood well enough today to justify implementing necessary and technically feasible and available control measures to minimize potential problems associated with increased coal production and use in the future. Increased emphasis on safety and health training for inexperienced coal miners expected to enter the work force is clearly needed. The recently enacted Federal Mine Safety and Health Act of 1977 will provide impetus for increased control over hazards in coal mining. PMID:540621

  18. M-Health: Emerging Mobile Health Systems

    NASA Astrophysics Data System (ADS)

    Istepanian, Robert; Laxminarayan, Swamy; Pattichis, Constantinos S.

    M-health can be defined as the "emerging mobile communications and network technologies for healthcare systems.' This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. M-Health: Emerging Mobile Health Systems presents a new and forward-looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare scenaria.

  19. COMMERCIAL UTILITY FLUE GAS DESULFURIZATION SYSTEMS

    EPA Science Inventory

    The article discusses the current status of commercial flue gas desulfurization (FGD) processes applied to coal-fired utility boilers in the U.S. Major objectives of the work were to examine the impacts of the 1979 New Source Performance Standards on FGD system design and operati...

  20. A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

    PubMed Central

    Peters, Melissa; Boeldt, Debra L.; Ariniello, Lauren; Kim, Ju Young; Sheard, Judith; Komatireddy, Ravi; Barrett, Paddy

    2016-01-01

    Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers–some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program–making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases

  1. A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors.

    PubMed

    Bloss, Cinnamon S; Wineinger, Nathan E; Peters, Melissa; Boeldt, Debra L; Ariniello, Lauren; Kim, Ju Young; Sheard, Judith; Komatireddy, Ravi; Barrett, Paddy; Topol, Eric J

    2016-01-01

    Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers-some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program-making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or

  2. Uzbekistan: health system review.

    PubMed

    Ahmedov, Mohir; Azimov, Ravshan; Mutalova, Zulkhumor; Huseynov, Shahin; Tsoyi, Elena; Rechel, Bernd

    2014-01-01

    Uzbekistan is a central Asian country that became independent in 1991 with the break-up of the Soviet Union. Since then, it has embarked on several major health reforms covering health care provision, governance and financing, with the aim of improving efficiency while ensuring equitable access. Primary care in rural areas has been changed to a two-tiered system, while specialized polyclinics in urban areas are being transformed into general polyclinics covering all groups of the urban population. Secondary care is financed on the basis of past expenditure and inputs (and increasingly self-financing through user fees), while financing of primary care is increasingly based on capitation. There are also efforts to improve allocative efficiency, with a slowly increasing share of resources devoted to the reformed primary health care system. Health care provision has largely remained in public ownership but nearly half of total health care expenditure comes from private sources, mostly in the form of out-of-pocket expenditure. There is a basic benefits package, which includes primary care, emergency care and care for certain disease and population categories. Yet secondary care and outpatient pharmaceuticals are not included in the benefits package for most of the population, and the reliance on private health expenditure results in inequities and catastrophic expenditure for households. While the share of public expenditure is slowly increasing, financial protection thus remains an area of concern. Quality of care is another area that is receiving increasing attention. PMID:25689490

  3. The Stigma of Reproductive Health Services Utilization by Unmarried Women

    PubMed Central

    Mohammadi, Fatemeh; Kohan, Shahnaz; Mostafavi, Firoozeh; Gholami, Ali

    2016-01-01

    Background: Fear of the stigma associated with reproductive health services has always been one of the reasons why youth and unmarried individuals avoid making use of such services. This stigma imposes a great deal of mental stress, fear, and depression on patients and causes delays in the diagnosis and treatment of their conditions. Objectives: This paper explores the concept of stigma in the context of the utilization of reproductive health services by unmarried women. Patients and Methods: This study is qualitative in nature. Purposive sampling was employed, and semi-structured interviews were conducted with 16 unmarried women, five midwives, and two physicians. The data were analyzed using the conventional content analysis method. Results: Four main categories constituted the general concept concerning the stigma suffered by unmarried women for using reproductive health services, i.e., prevalent stereotypical thinking patterns in society, the fear of being judged and labeled by others, discrimination, and feeling ashamed of seeking reproductive health services. Conclusions: The findings indicated that society associates reproductive health issues with sexual relations, which in turn shapes the stigma and places limitations on unmarried women for using reproductive health services. Thus, while reproductive health services are planned and provided to unmarried women, strategies are demanded for overcoming this stigma. PMID:27247794

  4. Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan

    PubMed Central

    Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Oweis, Arwa; Al Ward, Nada; Burton, Ann

    2016-01-01

    Introduction The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. Methods A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Results Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. Discussion Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs. PMID:27073930

  5. Is Dental Utilization Associated with Oral Health Literacy?

    PubMed

    Burgette, J M; Lee, J Y; Baker, A D; Vann, W F

    2016-02-01

    The objectives of this study were to examine the pattern of association between dental utilization and oral health literacy (OHL). As part of the Carolina Oral Health Literacy Project, clients in the Women, Infants, and Children's Special Supplemental Nutrition Program completed a structured 30-min in-person interview conducted by 2 trained interviewers at 9 sites in 7 counties in North Carolina. Data were collected on clients' OHL, sociodemographics, dental utilization, self-efficacy, and dental knowledge. The outcome, OHL, was measured with a dental word recognition test (30-item Rapid Estimate of Adult Literacy in Dentistry). Descriptive and multiple linear regression methods were used to examine the distribution of OHL and its association with covariates. After adjusting for age, education, race, marital status, self-efficacy, and dental knowledge, multiple linear regression showed that dental utilization was not a significant predictor of OHL (P > 0.05). Under the conditions of this study, dental utilization was not a significant predictor of OHL. PMID:26567035

  6. Health care access and utilization among ex-offenders in Baltimore: implications for policy.

    PubMed

    Hawkins, Anita Smith; O'Keefe, Anne Marie; James, Xanthia

    2010-05-01

    The U.S. has the highest rate of incarceration in the world, releasing 12 million ex-offenders each year. These ex-offenders are disproportionately male, Black, poor, under-educated, and unhealthy, and return to our nation's poorest neighborhoods. Through a survey questionnaire and focus groups, this study examined the health status, health needs, access to and utilization of health care services among a sample of ex-offenders living in transitional housing in Baltimore City. More than half reported at least two major, chronic health problems. Only 40% had any form of health coverage; even more predictive of the ability to obtain health services was being able to name a specific provider (doctor, clinic or health organization). Recommendations for halting the downward spiral of poverty and sickness for this population and their communities include providing assistance with accessing, understanding, and navigating our complex and consumer-unfriendly health care system. PMID:20453363

  7. High slot utilization systems for electric machines

    SciTech Connect

    Hsu, John S

    2009-06-23

    Two new High Slot Utilization (HSU) Systems for electric machines enable the use of form wound coils that have the highest fill factor and the best use of magnetic materials. The epoxy/resin/curing treatment ensures the mechanical strength of the assembly of teeth, core, and coils. In addition, the first HSU system allows the coil layers to be moved inside the slots for the assembly purpose. The second system uses the slided-in teeth instead of the plugged-in teeth. The power density of the electric machine that uses either system can reach its highest limit.

  8. Systems Science Methods in Public Health

    PubMed Central

    Luke, Douglas A.; Stamatakis, Katherine A.

    2012-01-01

    Complex systems abound in public health. Complex systems are made up of heterogeneous elements that interact with one another, have emergent properties that are not explained by understanding the individual elements of the system, persist over time and adapt to changing circumstances. Public health is starting to use results from systems science studies to shape practice and policy, for example in preparing for global pandemics. However, systems science study designs and analytic methods remain underutilized and are not widely featured in public health curricula or training. In this review we present an argument for the utility of systems science methods in public health, introduce three important systems science methods (system dynamics, network analysis, and agent-based modeling), and provide three case studies where these methods have been used to answer important public health science questions in the areas of infectious disease, tobacco control, and obesity. PMID:22224885

  9. Wearable Health Monitoring Systems

    NASA Technical Reports Server (NTRS)

    Bell, John

    2015-01-01

    The shrinking size and weight of electronic circuitry has given rise to a new generation of smart clothing that enables biological data to be measured and transmitted. As the variation in the number and type of deployable devices and sensors increases, technology must allow their seamless integration so they can be electrically powered, operated, and recharged over a digital pathway. Nyx Illuminated Clothing Company has developed a lightweight health monitoring system that integrates medical sensors, electrodes, electrical connections, circuits, and a power supply into a single wearable assembly. The system is comfortable, bendable in three dimensions, durable, waterproof, and washable. The innovation will allow astronaut health monitoring in a variety of real-time scenarios, with data stored in digital memory for later use in a medical database. Potential commercial uses are numerous, as the technology enables medical personnel to noninvasively monitor patient vital signs in a multitude of health care settings and applications.

  10. Impact of Individual-, Environmental-, and Policy-Level Factors on Health Care Utilization Among US Farmworkers

    PubMed Central

    Mayer, Joni A.; Gabbard, Susan; Kronick, Richard G.; Roesch, Scott C.; Malcarne, Vanessa L.; Zuniga, Maria L.

    2011-01-01

    Objectives. We examined individual-, environmental-, and policy-level correlates of US farmworker health care utilization, guided by the behavioral model for vulnerable populations and the ecological model. Methods. The 2006 and 2007 administrations of the National Agricultural Workers Survey (n = 2884) provided the primary data. Geographic information systems, the 2005 Uniform Data System, and rurality and border proximity indices provided environmental variables. To identify factors associated with health care use, we performed logistic regression using weighted hierarchical linear modeling. Results. Approximately half (55.3%) of farmworkers utilized US health care in the previous 2 years. Several factors were independently associated with use at the individual level (gender, immigration and migrant status, English proficiency, transportation access, health status, and non-US health care utilization), the environmental level (proximity to US–Mexico border), and the policy level (insurance status and workplace payment structure). County Federally Qualified Health Center resources were not independently associated. Conclusions. We identified farmworkers at greatest risk for poor access. We made recommendations for change to farmworker health care access at all 3 levels of influence, emphasizing Federally Qualified Health Center service delivery. PMID:21330594

  11. Overview of waste heat utilization systems

    NASA Technical Reports Server (NTRS)

    Bailey, M. M.

    1984-01-01

    The heavy truck diesel engine rejects a significant fraction of its fuel energy in the form of waste heat. Historically, the Department of Energy has supported technology efforts for utilization of the diesel exhaust heat. Specifically, the Turbocompound and the Organic Rankine Cycle System (ORCS) have demonstrated that meaningful improvements in highway fuel economy can be realized through waste heat utilization. For heat recovery from the high temperature exhaust of future adiabatic diesel engines, the DOE/NASA are investigating a variety of alternatives based on the Rankine, Brayton, and Stirling power cycles. Initial screening results indicate that systems of this type offer a fuel savings advantage over the turbocompound system. Capital and maintenance cost projections, however, indicate that the alternative power cycles are not competitive on an economic payback basis. Plans call for continued analysis in an attempt to identify a cost effective configuration with adequate fuel savings potential.

  12. Health status, socioeconomic status and utilization of outpatient services for members of a prepaid group practice.

    PubMed

    Freeborn, D K; Pope, C R; Davis, M A; Mullooly, J P

    1977-02-01

    When evaluating the effectiveness of medical care programs, one concern is whether receipt of care is based upon health care needs or upon socioeconomic status. This study describes the relation between health status and socioeconomic status and attempts to determine which has the greater effect on ambulatory care utilization. The study setting was an operating HMO serving a cross-sectional membership of nearly 200,000 persons. Outpatient utilization data were derived from the medical records of a five per cent sample of health plan members for 1969 and 1970. Social, economic, situational, and attitudinal data were provided by 2,603 respondents in a household interview survey. Since a population's perceived health status may reflect health need, information from the survey provided measures of health status that ranged from specific symptoms and complaints to a general measure of perceived health status. Although the findings varied somewhat according to which variables were considered, they generally showed health status to correlate more highly than socioeconomic factors with the utilization of services in this medical care system. An exception was the use of preventive services, which was not significantly related to health status measures but rather, for women, to education and, to a lesser extent, income. PMID:839867

  13. Canada: Health system review.

    PubMed

    Marchildon, Gregory

    2013-01-01

    Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas. PMID:23628429

  14. Self‐Rated Health Predicts Healthcare Utilization in Heart Failure

    PubMed Central

    Chamberlain, Alanna M.; Manemann, Sheila M.; Dunlay, Shannon M.; Spertus, John A.; Moser, Debra K.; Berardi, Cecilia; Kane, Robert L.; Weston, Susan A.; Redfield, Margaret M.; Roger, Véronique L.

    2014-01-01

    Background Heart failure (HF) patients experience impaired functional status, diminished quality of life, high utilization of healthcare resources, and poor survival. Yet, the identification of patient‐centered factors that influence prognosis is lacking. Methods and Results We determined the association of 2 measures of self‐rated health with healthcare utilization and skilled nursing facility (SNF) admission in a community cohort of 417 HF patients prospectively enrolled between October 2007 and December 2010 from Olmsted County, MN. Patients completed a 12‐item Short Form Health Survey (SF‐12). Low self‐reported physical functioning was defined as a score ≤25 on the SF‐12 physical component. The first question of the SF‐12 was used as a measure of self‐rated general health. After 2 years, 1033 hospitalizations, 1407 emergency department (ED) visits, and 19,780 outpatient office visits were observed; 87 patients were admitted to a SNF. After adjustment for confounding factors, an increased risk of hospitalizations (1.52 [1.17 to 1.99]) and ED visits (1.48 [1.04 to 2.11]) was observed for those with low versus moderate‐high self‐reported physical functioning. Patients with poor and fair self‐rated general health also experienced an increased risk of hospitalizations (poor: 1.73 [1.29 to 2.32]; fair: 1.46 [1.14 to 1.87]) and ED visits (poor: 1.73 [1.16 to 2.56]; fair: 1.48 [1.13 to 1.93]) compared with good‐excellent self‐rated general health. No association between self‐reported physical functioning or self‐rated general health with outpatient visits and SNF admission was observed. Conclusion In community HF patients, self‐reported measures of physical functioning predict hospitalizations and ED visits, indicating that these patient‐reported measures may be useful in risk stratification and management in HF. PMID:24870937

  15. Health service utilization patterns of primary care patients with osteoarthritis

    PubMed Central

    Rosemann, Thomas; Joos, Stefanie; Szecsenyi, Joachim; Laux, Gunter; Wensing, Michel

    2007-01-01

    Background To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). Methods Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. Results 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the “symptom” scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. Conclusion Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully. PMID:17956605

  16. Croatia: health system review.

    PubMed

    Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina

    2014-01-01

    Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope

  17. Smart data acquisition system for utilities metering

    NASA Astrophysics Data System (ADS)

    Ileana, I.; Risteiu, M.; Tulbure, A.; Rusu, M.

    2009-01-01

    The paper approaches the task of automatically reading and recognition of registered data on the utility meters of the users and is a part of a more complex project of our team concerning the remote data acquisition from industrial processes. A huge amount of utility meters in our country is of mechanical type without remote acquiring facilities and as an intermediate solution we propose an intelligent optical acquisition system which will store the read values in desktop and mobile devices. The main requirements of such a system are: portability, data reading accuracy, fast processing and energy independence. The paper analyses several solutions (including Artificial Neural Networks approach) tested by our team and present the experimental results and our conclusions.

  18. Workshop on electric utility systems modeling

    SciTech Connect

    Prasad, R.; Kittur, R.; Walker, R.; Marten, D.

    1992-01-01

    The primary objective of this workshop is to obtain a clear understanding of the various details involved in developing electric utility models from public-domain information. The workshop is aimed at providing a thorough tutorial and a hands-on exercise in developing a set of relational databases that can be used to analyze the behavior of selected power systems. Because of several modeling details that can be utility-specific, issues that are common among all systems need to be addressed. These common issues include: Data collection from public-domain sources; generation of connectivity diagrams; generation/load/tie-line MW assignments; parameter database creation (.DAT); development of one-line database (.OL); development of geographic database (.GEO); error-checking between databases; development of power-flow data files (.DCD and IEE); and power-flow analysis

  19. Workshop on electric utility systems modeling

    SciTech Connect

    Prasad, R.; Kittur, R.; Walker, R.; Marten, D.

    1992-12-31

    The primary objective of this workshop is to obtain a clear understanding of the various details involved in developing electric utility models from public-domain information. The workshop is aimed at providing a thorough tutorial and a hands-on exercise in developing a set of relational databases that can be used to analyze the behavior of selected power systems. Because of several modeling details that can be utility-specific, issues that are common among all systems need to be addressed. These common issues include: Data collection from public-domain sources; generation of connectivity diagrams; generation/load/tie-line MW assignments; parameter database creation (.DAT); development of one-line database (.OL); development of geographic database (.GEO); error-checking between databases; development of power-flow data files (.DCD and IEE); and power-flow analysis

  20. Mental Health Care Utilization: How Race, Ethnicity and Veteran Status are Associated with Seeking Help.

    PubMed

    De Luca, Susan M; Blosnich, John R; Hentschel, Elizabeth A W; King, Erika; Amen, Sally

    2016-02-01

    As veterans disproportionately experience higher rates of mental illness than civilians, conflicting results surround the impact of race/ethnicity on treatment utilization. This study utilized the CDC's Texas Behavioral Risk Factor Surveillance System data, a random-digit dialed telephone survey of non-institutionalized adults. A subset of Texas respondents (n = 8563) were asked questions related to mental health treatment, stigma, help-seeking attitudes and emotional support. While no differences were found in health care utilization between non-Hispanic white veterans and non-veterans, there were distinct patterns among racial/ethnic minority veterans and non-veterans. Black and Latino non-veterans reported significantly lower health care utilization compared to non-Hispanic white non-veterans. Among veterans, there were no differences in reported utilization rates comparing non-Hispanic whites and Latinos and also non-Hispanic whites and Blacks. Our study adds to the literature by examining health care utilization among a diverse group of veterans by focusing on Veterans Administration (VA) and non-VA services to veterans. PMID:26659853

  1. Inductive System Health Monitoring

    NASA Technical Reports Server (NTRS)

    Iverson, David L.

    2004-01-01

    The Inductive Monitoring System (IMS) software was developed to provide a technique to automatically produce health monitoring knowledge bases for systems that are either difficult to model (simulate) with a computer or which require computer models that are too complex to use for real time monitoring. IMS uses nominal data sets collected either directly from the system or from simulations to build a knowledge base that can be used to detect anomalous behavior in the system. Machine learning and data mining techniques are used to characterize typical system behavior by extracting general classes of nominal data from archived data sets. IMS is able to monitor the system by comparing real time operational data with these classes. We present a description of learning and monitoring method used by IMS and summarize some recent IMS results.

  2. Advanced Asia's health systems in comparison.

    PubMed

    Gauld, Robin; Ikegami, Naoki; Barr, Michael D; Chiang, Tung-Liang; Gould, Derek; Kwon, Soonman

    2006-12-01

    There is growing interest in comparing patterns of social and health service development in advanced Asian economies. Most publications concentrate broadly on a range of core social services such as education, housing, social security and health care. In terms of those solely focused on health, most discuss arrangements in specific countries and territories. Some take a comparative approach, but are focused on presentation and discussion of expenditure, resourcing and service utilization data. This article extends the comparative analysis of advanced Asian health systems, considering the cases of Japan, South Korea, Taiwan, Hong Kong and Singapore. The article provides basic background information, and delves into common concerns among the world's health systems today including primary care organization, rationing and cost containment, service quality, and system integration. Conclusions include that problems exist in 'classifying' the five diverse systems; that the systems face common pressures; and that there are considerable opportunities to enhance primary care, service quality and system integration. PMID:16517000

  3. [Job insecurity versus unemployment: unequal in socioeconomic status but comparable detrimental effects on mental health and health care utilization].

    PubMed

    Mewes, Ricarda; Rief, Winfried; Martin, Alexandra; Glaesmer, Heide; Brähler, Elmar

    2013-03-01

    Knowledge about differential effects of unemployment and job insecurity on mental health and health care utilization are of high relevance. There are no studies which compare unemployed persons and persons with an insecure job in terms of different mental health indicators, and which investigate the mediating effect of mental health on health care utilization. Somatoform symptoms, anxiety, depression, physical health, and health care utilization were assessed in 161 unemployed persons, 218 persons with an insecure job, and 957 securely employed persons. Unemployed persons and persons with an insecure job showed equally worse mental health than securely employed persons on average. They also had significantly higher health care utilization. Mental health was a full mediator between job insecurity and unemployment on the one hand and health care utilization on the other hand. An adequate mental health care is necessary for unemployed persons as well as for persons with an insecure job. PMID:23526088

  4. System for utilizing oil shale fines

    DOEpatents

    Harak, Arnold E.

    1982-01-01

    A system is provided for utilizing fines of carbonaceous materials such as particles or pieces of oil shale of about one-half inch or less diameter which are rejected for use in some conventional or prior surface retorting process, which obtains maximum utilization of the energy content of the fines and which produces a waste which is relatively inert and of a size to facilitate disposal. The system includes a cyclone retort (20) which pyrolyzes the fines in the presence of heated gaseous combustion products, the cyclone retort having a first outlet (30) through which vapors can exit that can be cooled to provide oil, and having a second outlet (32) through which spent shale fines are removed. A burner (36) connected to the spent shale outlet of the cyclone retort, burns the spent shale with air, to provide hot combustion products (24) that are carried back to the cyclone retort to supply gaseous combustion products utilized therein. The burner heats the spent shale to a temperature which forms a molten slag, and the molten slag is removed from the burner into a quencher (48) that suddenly cools the molten slag to form granules that are relatively inert and of a size that is convenient to handle for disposal in the ground or in industrial processes.

  5. Adaptable formations utilizing heterogeneous unmanned systems

    NASA Astrophysics Data System (ADS)

    Barnes, Laura E.; Garcia, Richard; Fields, MaryAnne; Valavanis, Kimon

    2009-05-01

    This paper addresses the problem of controlling and coordinating heterogeneous unmanned systems required to move as a group while maintaining formation. We propose a strategy to coordinate groups of unmanned ground vehicles (UGVs) with one or more unmanned aerial vehicles (UAVs). UAVs can be utilized in one of two ways: (1) as alpha robots to guide the UGVs; and (2) as beta robots to surround the UGVs and adapt accordingly. In the first approach, the UAV guides a swarm of UGVs controlling their overall formation. In the second approach, the UGVs guide the UAVs controlling their formation. The unmanned systems are brought into a formation utilizing artificial potential fields generated from normal and sigmoid functions. These functions control the overall swarm geometry. Nonlinear limiting functions are defined to provide tighter swarm control by modifying and adjusting a set of control variables forcing the swarm to behave according to set constraints. Formations derived are subsets of elliptical curves but can be generalized to any curvilinear shape. Both approaches are demonstrated in simulation and experimentally. To demonstrate the second approach in simulation, a swarm of forty UAVs is utilized in a convoy protection mission. As a convoy of UGVs travels, UAVs dynamically and intelligently adapt their formation in order to protect the convoy of vehicles as it moves. Experimental results are presented to demonstrate the approach using a fully autonomous group of three UGVs and a single UAV helicopter for coordination.

  6. Public health infrastructure and equity in the utilization of outpatient health care services in Peru.

    PubMed

    Valdivia, Martín

    2002-12-01

    This article analyzes the magnitude and nature of socioeconomic differences in the utilization of outpatient health care services in Peru. In particular, it explores the potential equity-enhancing effect of the expansion and improvements in the network of health centres during the 1990s. The Peruvian health reform made relatively little progress in terms of the reform agenda promoted internationally during the 1990s. Nevertheless, the expansion of the public network of health centres and the improvements in their equipment has been noteworthy during the same period. Using the 1997 survey of the Peruvian Living Standards Measurement Study (PLSMS), we find large differences in the utilization of outpatient health care services. The richest to poorest quintile ratio is 1.9, and even larger in rural areas. Estimating a probit model with random effects at the district level to control for the systematic geographic bias associated with the optimal public allocation of such infrastructure, we find the income effect to be very large, even after controlling for other socioeconomic characteristics. Finally, we also find that the expansion of the public network of health centres has indeed an equity-enhancing effect, but this is rather small. These results indicate that although the expansion of the public network of health facilities may be necessary, it is not sufficient to promote equity in the utilization of health care services by Peruvian adults, especially in rural areas. It is important to look deeper into the costs of consultations and drugs as economic barriers to the utilization of health services by the poor. In particular, the expansion of health insurance mechanisms for the poor should be carefully monitored and evaluated. PMID:12477737

  7. Expected utility theory and risky choices with health outcomes.

    PubMed

    Hellinger, F J

    1989-03-01

    Studies of people's attitude towards risk in the health sector often involve a comparison of the desirability of alternative medical treatments. Since the outcome of a medical treatment cannot be known with certainty, patients and physicians must make a choice that involves risk. Each medical treatment may be characterized as a gamble (or risky option) with a set of outcomes and associated probabilities. Expected utility theory (EUT) is the standard method to predict people's choices under uncertainty. The author presents the results of a survey that suggests people are very risk averse towards gambles involving health-related outcomes. The survey also indicates that there is significant variability in the risk attitudes across individuals for any given gamble and that there is significant variability in the risk attitudes of a given individual across gambles. The variability of risk attitudes of a given individual suggests that risk attitudes are not absolute but are functions of the parameters in the gamble. PMID:2927183

  8. Mobile health monitoring systems.

    PubMed

    Walker, William; Aroul, A L Praveen; Bhatia, Dinesh

    2009-01-01

    Advancements are being made towards a cheap and effective means for health monitoring. A mobile monitoring system is proposed for monitoring a bicycle rider using light weight, low power wireless sensors. Biometric and environmental information pertaining to the bicycle rider is captured, transmitted to, and stored in a remote database with little user interaction required. Remote users have real time access to the captured information through a web application. Possible applications for this system include the monitoring of a soldier in the battlefield and the monitoring of a patient during an ambulance ride. PMID:19965041

  9. Health Information Systems.

    PubMed

    Sirintrapun, S Joseph; Artz, David R

    2016-03-01

    This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. PMID:26851670

  10. Utility-Interconnected Photovoltaic Systems: Evaluating the Rationale for the Utility-Accessible External Disconnect Switch

    SciTech Connect

    Coddington, M.; Margolis, R.M.; Aabakken, J.

    2008-01-01

    The utility-accessible alternating current (AC) external disconnect switch (EDS) for distributed generators, including photovoltaic (PV) systems, is a hardware feature that allows a utility?s employees to manually disconnect a customer-owned generator from the electricity grid. This paper examines the utility-accessible EDS debate in the context of utility-interactive PV systems for residential and small commercial installations. It also evaluates the rationale for EDS requirements.

  11. The gender gap in primary health care resource utilization in Central Asia.

    PubMed

    Cashin, Cheryl E; Borowitz, Michael; Zuess, Olga

    2002-09-01

    There is a large gender gap in life expectancy in some countries of the former Soviet Union. Life expectancy of males is as much as 13 years less than that of females, and a significant portion of the excess male mortality is caused by cardiovascular disease. Although effective primary health care is necessary to manage cardiovascular disease and reduce acute episodes and mortality, the primary health care system is under-utilized by adult males in the region. This study combines disaggregated utilization data with cost data to analyze patterns of per capita primary care resource consumption in urban and rural regions of Kazakhstan and Uzbekistan. The results show that both in absolute and per capita terms, the principal users of primary health are women of reproductive age and children under five. Based on a combination of utilization and cost of services, women of reproductive age consume approximately 1.5 times the average per capita primary health care resources, while men in the same age group consume approximately one-half of the average. Children under five consume about three to five times the average per capita primary care resources. Based on the results of the study, regional government health purchasers worked together with providers to develop a new per capita payment system with age/sex adjustments and incentives for outreach to bring adult men into the primary care system. PMID:12135992

  12. Development and utilization of professional standards in health education and promotion: US and UK experiences.

    PubMed

    Speller, Viv; Smith, Becky J; Lysoby, Linda

    2009-06-01

    This article defines standards, discusses the components of standards development, and provides an overview of the use of standards in the credentialing processes of health promotion and education specialists. Credentialing or registering agencies related to health promotion and education in the US and UK are identified and their role in credentialing processes is discussed. Examples outlining the development and application of professional standards in both the UK and US are presented. In order to advance the development of international competencies in health promotion, and move towards agreement between different country accrediting systems, there needs to be additional clarification and/or standardization of health promotion terminology at the global level, and further in-depth work to review the implementation of different systems on the ground to enhance our common understanding of the standards employed and competencies required in order to assist the development and utilization of standards for health promotion and education specialists in various countries/regions. PMID:19477861

  13. Utilizing Internet Technologies in Observatory Control Systems

    NASA Astrophysics Data System (ADS)

    Cording, Dean

    2002-12-01

    The 'Internet boom' of the past few years has spurred the development of a number of technologies to provide services such as secure communications, reliable messaging, information publishing and application distribution for commercial applications. Over the same period, a new generation of computer languages have also developed to provide object oriented design and development, improved reliability, and cross platform compatibility. Whilst the business models of the 'dot.com' era proved to be largely unviable, the technologies that they were based upon have survived and have matured to the point were they can now be utilized to build secure, robust and complete observatory control control systems. This paper will describe how Electro Optic Systems has utilized these technologies in the development of its third generation Robotic Observatory Control System (ROCS). ROCS provides an extremely flexible configuration capability within a control system structure to provide truly autonomous robotic observatory operation including observation scheduling. ROCS was built using Internet technologies such as Java, Java Messaging Service (JMS), Lightweight Directory Access Protocol (LDAP), Secure Sockets Layer (SSL), eXtendible Markup Language (XML), Hypertext Transport Protocol (HTTP) and Java WebStart. ROCS was designed to be capable of controlling all aspects of an observatory and be able to be reconfigured to handle changing equipment configurations or user requirements without the need for an expert computer programmer. ROCS consists of many small components, each designed to perform a specific task, with the configuration of the system specified using a simple meta language. The use of small components facilitates testing and makes it possible to prove that the system is correct.

  14. Patterns of health care utilization for low back pain

    PubMed Central

    Stewart, Walter F; Yan, Xiaowei; Boscarino, Joseph A; Maeng, Daniel D; Mardekian, Jack; Sanchez, Robert J; Von Korff, Michael R

    2015-01-01

    Background The purpose of this study was to determine if primary care patients with low back pain (LBP) cluster into definable care utilization subgroups that can be explained by patient and provider characteristics. Materials and methods Adult primary care patients with an incident LBP encounter were identified from Geisinger Clinic electronic health records over 5 years. Two-thirds of the cohort had only one to two encounters. Principal component analysis was applied to the data from the remaining one-third on use of ambulatory, inpatient, emergency department, and surgery care and use of magnetic resonance imaging, injections, and opioids in 12 months following the incident encounter. Groups were compared on demographics, health behaviors, chronic and symptomatic disease burden, and a measure of physician efficiency. Results Six factors with eigenvalues >1.5 explained 71% of the utilization variance. Patient subgroups were defined as: 1–2 LBP encounters; 2+ surgeries; one surgery; specialty care without primary care; 3+ opioid prescriptions; laboratory dominant care; and others. The surgery and 3+ opioid subgroups, while accounting for only 10.4% of the cohort, had used disproportionately more magnetic resonance imaging, emergency department, inpatient, and injectable resources. The specialty care subgroup was characterized by heavy use of inpatient care and the lowest use of injectables. Anxiety disorder and depression were not more prevalent among the surgery patients than in the others. Surgery patients had features in common with specialty care patients, but were older, had higher prevalence of Fibromyalgia, and were associated primary care physicians with worse efficiency scores. Conclusion LBP care utilization is highly variable and concentrated in small subgroups using disproportionate amounts of potentially avoidable care that reflect both patient and provider characteristics. PMID:26316803

  15. OCLC Utilization in Health Sciences Libraries. CE 35, Revised Edition.

    ERIC Educational Resources Information Center

    Armes, Patti

    This syllabus for a continuing education course describes the OCLC system and considers how it can be used by health science libraries. The general governance and administrative structure of OCLC and its network affiliates are detailed, and the OCLC subsystems--online union catalog, serials, interlibrary loan, and acquisitions--and their major…

  16. Advancing health literacy measurement: a pathway to better health and health system performance.

    PubMed

    Pleasant, Andrew

    2014-12-01

    The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy-especially when combined with a focus on prevention and integrative health-is one of the most promising approaches to advancing public health. PMID:25491583

  17. Characteristics and VA Health Care Utilization of U.S. Veterans Who Completed Suicide in Oregon between 2000 and 2005

    ERIC Educational Resources Information Center

    Basham, Chandra; Denneson, Lauren M.; Millet, Lisa; Shen, Xun; Duckart, Jonathan; Dobscha, Steven K.

    2011-01-01

    Oregon Violent Death Reporting System data were linked with Veterans Affairs (VA) administrative data to identify and describe veterans who completed suicide in Oregon from 2000 to 2005 (n = 968), and to describe their VA health care utilization in the year prior to death. Twenty-two percent had received health care in the VA system. Of these, 57%…

  18. Potholes in the information highway: the use of health service utilization data by Alberta health care managers.

    PubMed

    Casebeer, A; Johnson, D

    2000-01-01

    Reviews and consultations with regional health authority decision makers have indicated that both data quality and access can limit effective use of health services information when assessing outcomes, planning changes, testing solutions and making decisions. To further a more system-wide understanding of these data utilization issues, we asked senior managers, board members and information analysts in Alberta regional health authorities (n = 111) about the availability of, organizational supports for and barriers to the use of health service utilization data. Eighty percent of respondents stated that the lack of data impeded problem resolution, and 83 percent of managers stated that health service data alerted them to new problems. Examples of useful data related to good standardization and linkage of data sets, or to capacity for valid comparison and trending. Given the limitations highlighted in relation to meeting even the simplest needs of standardization, linkage, comparison and trending, Alberta health care managers indicate frustration in trying to use health service data as currently construed and distributed, particularly within their current frameworks and fast-paced timelines for decision making. PMID:11182922

  19. Periodontal Health, Perceived Oral Health and Dental Care Utilization of Breast Cancer Survivors

    PubMed Central

    Taichman, L. Susan; Griggs, Jennifer J.; Inglehart, Marita R.

    2015-01-01

    OBJECTIVES This population-based analysis examined the prevalence of periodontal diseases along with the self-perceived oral health and patterns of dental care utilization of breast cancer survivors in the U.S. METHODS Data from the 1999–2004 NHANES were utilized, examining information from 3,354 women between 50–85 years of age. Primary outcomes were gingivitis and periodontitis, self-perceived oral health and dental care utilization. Logistic regression analyses were used to estimate relationships of breast cancer diagnosis and primary outcomes, while controlling for confounding factors. RESULTS Breast cancer survivors were more likely to be older than 55 years, white, non-smokers, have higher levels of education and income and a higher prevalence of osteoporosis. Breast cancer survivors were significantly less likely to have dental insurance (p=0.04). Utilization of dental services and reason for last dental visit did not significantly differ between groups. A history of a breast cancer diagnosis did not increase the odds of gingivitis (OR=1.32; 95% CI: 0.53–3.63), periodontitis (OR=1.82; 95% CI = 0.89–4.01) or poor self-perceived oral health (OR=0.89; 95% CI: 0.61–1.33) after adjusting for age, race, education, dental care utilization, and smoking status. CONCLUSIONS In this sample, a history of breast cancer does not significantly impact periodontal health, self-perceived oral health and dental care utilization. However, efforts should be made to assure that breast cancer survivors have dental insurance. PMID:25648337

  20. Hyperspectral imaging utility for transportation systems

    NASA Astrophysics Data System (ADS)

    Bridgelall, Raj; Rafert, J. Bruce; Tolliver, Denver

    2015-03-01

    The global transportation system is massive, open, and dynamic. Existing performance and condition assessments of the complex interacting networks of roadways, bridges, railroads, pipelines, waterways, airways, and intermodal ports are expensive. Hyperspectral imaging is an emerging remote sensing technique for the non-destructive evaluation of multimodal transportation infrastructure. Unlike panchromatic, color, and infrared imaging, each layer of a hyperspectral image pixel records reflectance intensity from one of dozens or hundreds of relatively narrow wavelength bands that span a broad range of the electromagnetic spectrum. Hence, every pixel of a hyperspectral scene provides a unique spectral signature that offers new opportunities for informed decision-making in transportation systems development, operations, and maintenance. Spaceborne systems capture images of vast areas in a short period but provide lower spatial resolution than airborne systems. Practitioners use manned aircraft to achieve higher spatial and spectral resolution, but at the price of custom missions and narrow focus. The rapid size and cost reduction of unmanned aircraft systems promise a third alternative that offers hybrid benefits at affordable prices by conducting multiple parallel missions. This research formulates a theoretical framework for a pushbroom type of hyperspectral imaging system on each type of data acquisition platform. The study then applies the framework to assess the relative potential utility of hyperspectral imaging for previously proposed remote sensing applications in transportation. The authors also introduce and suggest new potential applications of hyperspectral imaging in transportation asset management, network performance evaluation, and risk assessments to enable effective and objective decision- and policy-making.

  1. Report of health and environmental effects of increased coal utilization by the Committee on Health and Environmental Effects of Increased Coal Utilization.

    PubMed

    1980-06-01

    uncertainty and concern requiring further investigation if the nation is to minimize undesirable consequences of increased coal utilization now, and in the future. Two critical health issues of concern are air pollution health effects and coal mine worker health and safety. Two critical environmental issues are global effects of carbon dioxide in the atmosphere and acid fallout. Two additional important issues of concern are trace elements in the environment and reclamation of arid land.Finally, because of the inadequate data and methodology used in the study of these matters, the Committee strongly recommended the establishment of an improved national environmental data collection, modeling and monitoring system. PMID:6775943

  2. A systematic review of the application and utility of geographical information systems for exploring disease-disease relationships in paediatric global health research: the case of anaemia and malaria.

    PubMed

    Aimone, Ashley Mariko; Perumal, Nandita; Cole, Donald C

    2013-01-01

    Malaria and anaemia are important health problems among children globally. Iron deficiency anaemia may offer protection against malaria infection and iron supplementation may increase the risk of malaria-related hospitalization and mortality. The nature and mechanism of these relationships, however, remain largely unresolved, resulting in concern and uncertainty around policies for non-selective iron supplementation in malaria endemic areas. Use of geographical information systems (GIS) to investigate this disease-disease interaction could contribute important new information for developing safe and effective anaemia and malaria interventions. To assess the current state of knowledge we conducted a systematic review of peer-reviewed and grey literature. Our primary objective was to qualitatively assess the application and utility of geographical concepts or spatial analyses in paediatric global health research. The secondary objective was to identify geographical factors that may be associated with anaemia and malaria prevalence or incidence among children 0-5 years of age living in low- and middle-income countries. Evaluation tools for assessing the quality of geographical data could not be found in the peer-reviewed or grey literature, and thus adapted versions of the STROBE (Strengthening The Reporting of Observational Studies in Epidemiology) and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods were used to create reporting, and overall evidence quality scoring systems. Among the 20 included studies, we found that both malaria and anaemia were more prevalent in rural communities compared to urban areas. Geographical factors associated with malaria prevalence included regional transmission stability, and proximity to a mosquito breeding area. The prevalence of anaemia tended to vary inversely with greater or poorer access to community services such as piped water. Techniques for investigating geographic relationships ranged from

  3. A systematic review of the application and utility of geographical information systems for exploring disease-disease relationships in paediatric global health research: the case of anaemia and malaria

    PubMed Central

    2013-01-01

    Malaria and anaemia are important health problems among children globally. Iron deficiency anaemia may offer protection against malaria infection and iron supplementation may increase the risk of malaria-related hospitalization and mortality. The nature and mechanism of these relationships, however, remain largely unresolved, resulting in concern and uncertainty around policies for non-selective iron supplementation in malaria endemic areas. Use of geographical information systems (GIS) to investigate this disease-disease interaction could contribute important new information for developing safe and effective anaemia and malaria interventions. To assess the current state of knowledge we conducted a systematic review of peer-reviewed and grey literature. Our primary objective was to qualitatively assess the application and utility of geographical concepts or spatial analyses in paediatric global health research. The secondary objective was to identify geographical factors that may be associated with anaemia and malaria prevalence or incidence among children 0–5 years of age living in low- and middle-income countries. Evaluation tools for assessing the quality of geographical data could not be found in the peer-reviewed or grey literature, and thus adapted versions of the STROBE (Strengthening The Reporting of Observational Studies in Epidemiology) and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods were used to create reporting, and overall evidence quality scoring systems. Among the 20 included studies, we found that both malaria and anaemia were more prevalent in rural communities compared to urban areas. Geographical factors associated with malaria prevalence included regional transmission stability, and proximity to a mosquito breeding area. The prevalence of anaemia tended to vary inversely with greater or poorer access to community services such as piped water. Techniques for investigating geographic relationships ranged from

  4. Fuel cell power system for utility vehicle

    SciTech Connect

    Graham, M.; Barbir, F.; Marken, F.; Nadal, M.

    1996-12-31

    Based on the experience of designing and building the Green Car, a fuel cell/battery hybrid vehicle, and Genesis, a hydrogen/oxygen fuel cell powered transporter, Energy Partners has developed a fuel cell power system for propulsion of an off-road utility vehicle. A 10 kW hydrogen/air fuel cell stack has been developed as a prototype for future mass production. The main features of this stack are discussed in this paper. Design considerations and selection criteria for the main components of the vehicular fuel cell system, such as traction motor, air compressor and compressor motor, hydrogen storage and delivery, water and heat management, power conditioning, and control and monitoring subsystem are discussed in detail.

  5. Leadership attributes: a key to optimal utilization of the community health nursing workforce.

    PubMed

    Ganann, Rebecca; Underwood, Jane; Matthews, Sue; Goodyear, Rosemarie; Stamler, Lynnette Leeseberg; Meagher-Stewart, Donna Marie; Munroe, Val

    2010-05-01

    This research examined leadership attributes that support the optimal utilization and practice of community health nurses (CHNs). Community health nursing is facing challenges in workforce capacity and sustainability. To meet current and future demands on the community sector, it is essential to understand workplace attributes that facilitate effective utilization of existing human resources and recruitment of new nurses. This pan-Canadian, mixed-methods study included a demographic analysis of CHNs in Canada, a survey involving responses from approximately 6,700 CHNs to identify enablers and barriers to community health nursing practice and 23 focus groups to examine organizational attributes that "best" support optimal practice within the public health nursing subsector. Nursing leadership was identified as an important attribute in organizations' utilization and support of CHNs working to work effectively. This effectiveness, in turn, will enhance community health programs and overall healthcare system efficiency. This paper highlights findings related to the role of nursing leadership and leadership development in optimizing community health nursing practice. PMID:20530996

  6. Service utilization in community health centers in China: a comparison analysis with local hospitals

    PubMed Central

    Pan, Xilong; Dib, Hassan H; Wang, Xiaohang; Zhang, Hong

    2006-01-01

    Background Being an important part of China's Urban Health Care Reform System, Community Health Centers (CHCs) have been established throughout the entire country and are presently undergoing substantial reconstruction. However, the services being delivered by the CHCs are far from reaching their performance targets. In order to assess the role of the CHCs, we examined their performance in six cities located in regions of South-East China. The purpose of this investigation was to identify the utilization and the efficiency of community health resources that are able to provide basic medical and public health services. Methods The study was approved by Peking University Health Science Center Institutional Reviewing Board (NO: IRB00001052-T1). Data were collected from all the local health bureaux and processed using SPSS software. Methods of analysis mainly included: descriptive analysis, paired T-test and one-way ANOVA. Results The six main functions of the CHCs were not fully exploited and the surveys that were collected on their efficiency and utilization of resources indicate that they have a low level of performance and lack the trust of local communities. Furthermore, the CHCs seriously lack funding support and operate under difficult circumstances, and residents have less positive attitudes towards them. Conclusion The community health service must be adjusted according to the requirements of urban medical and health reform, taking into account communities' health needs. More research is required on the living standards and health needs of residents living within the CHC's range, taking into consideration the users' needs in expanding the newly implemented service, and at the same time revising the old service system so as to make the development of CHCs realistic and capable of providing a better service to patients. Several suggestions are put forward for an attainable scheme for developing a community health service. PMID:16887022

  7. Advancing Health Literacy Measurement: A Pathway to Better Health and Health System Performance

    PubMed Central

    Pleasant, Andrew

    2014-01-01

    The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and the performance of health systems. Numerous studies clearly link low levels of education, literacy, and health literacy with poor health, poor health care utilization, increased barriers to care, and early death. However, theoretical understandings and methods of measuring the complex social construct of health literacy have experienced a continual evolution that remains incomplete. As a result, the seemingly most-cited definition of health literacy proposed in the now-decade-old Institute of Medicine report on health literacy is long overdue for updating. Such an effort should engage a broad and diverse set of health literacy researchers, practitioners, and members of the public in creating a definition that can earn broad consensus through validation testing in a rigorous scientific approach. That effort also could produce the basis for a new universally applicable measure of health literacy. Funders, health systems, and policymakers should reconsider their timid approach to health literacy. Although the field and corresponding evidence base are not perfect, health literacy—especially when combined with a focus on prevention and integrative health—is one of the most promising approaches to advancing public health. PMID:25491583

  8. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    ERIC Educational Resources Information Center

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

  9. Health utility indexes in patients with acute coronary syndromes

    PubMed Central

    Gencer, Baris; Rodondi, Nicolas; Auer, Reto; Nanchen, David; Räber, Lorenz; Klingenberg, Roland; Pletscher, Mark; Jüni, Peter; Windecker, Stephan; Matter, Christian M; Lüscher, Thomas F; Mach, François; Perneger, Thomas V; Girardin, François R

    2016-01-01

    Background Acute coronary syndromes (ACS) have been associated with lower health utilities (HUs) compared with the general population. Given the prognostic improvements after ACS with the implementation of coronary angiography (eg, percutaneous coronary intervention (PCI)), contemporary HU values derived from patient-reported outcomes are needed. Methods We analysed data of 1882 patients with ACS 1 year after coronary angiography in a Swiss prospective cohort. We used the EuroQol five-dimensional questionnaire (EQ-5D) and visual analogue scale (VAS) to derive HU indexes. We estimated the effects of clinical factors on HU using a linear regression model and compared the observed HU with the average values of individuals of the same sex and age in the general population. Results Mean EQ-5D HU 1-year after coronary angiography for ACS was 0.82 (±0.16) and mean VAS was 0.77 (±0.18); 40.9% of participants exhibited the highest utility values. Compared with population controls, the mean EQ-5D HU was similar (expected mean 0.82, p=0.58) in patients with ACS, but the mean VAS was slightly lower (expected mean 0.79, p<0.001). Patients with ACS who are younger than 60 years had lower HU than the general population (<0.001). In patients with ACS, significant differences were found according to the gender, education and employment status, diabetes, obesity, heart failure, recurrent ischaemic or incident bleeding event and participation in cardiac rehabilitation (p<0.01). Conclusions At 1 year, patients with ACS with coronary angiography had HU indexes similar to a control population. Subgroup analyses based on patients' characteristics and further disease-specific instruments could provide better sensitivity for detecting smaller variations in health-related quality of life. PMID:27252878

  10. Heart failure in primary care: co-morbidity and utilization of health care resources

    PubMed Central

    Carmona, Montserrat; García-Olmos, Luis M; García-Sagredo, Pilar; Alberquilla, Ángel; López-Rodríguez, Fernando; Pascual, Mario; Muñoz, Adolfo; Salvador, Carlos H; Monteagudo, José L; Otero-Puime, Ángel

    2013-01-01

    Background. In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. Objective. To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. Methods. Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. Results. One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). Conclusions. Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity. PMID:23776041

  11. Utilization of village health workers within a primary health care programme in The Gambia.

    PubMed

    Menon, A

    1991-08-01

    The utilization of Village Health Workers (VHWs) was studied in a rural area of The Gambia 3 years after the introduction of a village-based Primary Health Care (PHC) programme. Of 23 children who died from conditions treatable at village level, only five were first seen by the VHW. Fourteen were seen elsewhere in the region by staff more qualified than the first tier workers. The implications of this pattern of utilization on the lack of impact of VHWs on mortality are discussed. Only half of the non-fatal illnesses were attended to by VHWs. Reasons for this included such factors as lack of knowledge of services available, shortages of money, absence of the VHW at critical periods and social or political disputes with VHWs. Attempts must be made to tackle these fundamental problems if VHWs are to be successfully incorporated into the health services. PMID:1880830

  12. Integrating Solar PV in Utility System Operations

    SciTech Connect

    Mills, A.; Botterud, A.; Wu, J.; Zhou, Z.; Hodge, B-M.; Heany, M.

    2013-10-31

    This study develops a systematic framework for estimating the increase in operating costs due to uncertainty and variability in renewable resources, uses the framework to quantify the integration costs associated with sub-hourly solar power variability and uncertainty, and shows how changes in system operations may affect these costs. Toward this end, we present a statistical method for estimating the required balancing reserves to maintain system reliability along with a model for commitment and dispatch of the portfolio of thermal and renewable resources at different stages of system operations. We estimate the costs of sub-hourly solar variability, short-term forecast errors, and day-ahead (DA) forecast errors as the difference in production costs between a case with “realistic” PV (i.e., subhourly solar variability and uncertainty are fully included in the modeling) and a case with “well behaved” PV (i.e., PV is assumed to have no sub-hourly variability and can be perfectly forecasted). In addition, we highlight current practices that allow utilities to compensate for the issues encountered at the sub-hourly time frame with increased levels of PV penetration. In this analysis we use the analytical framework to simulate utility operations with increasing deployment of PV in a case study of Arizona Public Service Company (APS), a utility in the southwestern United States. In our analysis, we focus on three processes that are important in understanding the management of PV variability and uncertainty in power system operations. First, we represent the decisions made the day before the operating day through a DA commitment model that relies on imperfect DA forecasts of load and wind as well as PV generation. Second, we represent the decisions made by schedulers in the operating day through hour-ahead (HA) scheduling. Peaking units can be committed or decommitted in the HA schedules and online units can be redispatched using forecasts that are improved

  13. Knowledge for better health: a conceptual framework and foundation for health research systems.

    PubMed Central

    Pang, Tikki; Sadana, Ritu; Hanney, Steve; Bhutta, Zulfiqar A.; Hyder, Adnan A.; Simon, Jonathon

    2003-01-01

    Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health. PMID:14758408

  14. [The health system of Peru].

    PubMed

    Alcalde-Rabanal, Jacqueline Elizabeth; Lazo-González, Oswaldo; Nigenda, Gustavo

    2011-01-01

    This paper describes the health conditions in Peru and, with greater detail, the Peruvian health system, including its structure and coverage, its financial sources, its physical, material and human resources, and its stewardship functions. It also discusses the activities developed in the information and research areas, as well as the participation of citizens in the operation and evaluation of the health system. The article concludes with a discussion of the most recent innovations, including the Comprehensive Health Insurance, the Health Care Enterprises system, the decentralization process and the Local Committees for Health Administration. The main challenge confronted by the Peruvian health system is the extension of coverage to more than I0% of the population presently lacking access to basic health care. PMID:21877089

  15. [The health system of Colombia].

    PubMed

    Guerrero, Ramiro; Gallego, Ana Isabel; Becerril-Montekio, Victor; Vásquez, Johanna

    2011-01-01

    This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes. PMID:21877080

  16. [The health system of Mexico].

    PubMed

    Gómez Dantés, Octavio; Sesma, Sergio; Becerril, Victor M; Knaul, Felicia M; Arreola, Héctor; Frenk, Julio

    2011-01-01

    This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women: diabetes, ischaemic heart disease, cerebrovascular diseases and cancer. Part two is devoted to the description of the basic structure of the system: its main institutions, the population coverage, the health benefits of those affiliated to the different heath institutions, its financial sources, the levels of financial protection in health, the availability of physical, material and human resources for health, and the stewardship functions displayed by the Ministry of Health and other actors. This part also discusses the role of citizens in the monitorization and evaluation of the health system, as well as the levels of satisfaction with the rendered health services. In part three the most recent innovations and its impact on the performance of the health system are discussed. Salient among them are the System of Social Protection in Health and the Popular Health Insurance. The paper concludes with a brief analysis of the short- and middle-term challenges faced by the Mexican health system. PMID:21877087

  17. "Remnants of feudalism"? Women's health and their utilization of health services in rural China.

    PubMed

    Anson, O; Haanappel, F W

    1999-01-01

    Almost five decades ago, the Chinese Communist Party wished to abolish all "remnants of feudalism," including the patriarchal social order. Just one year after the revolution, the Marriage Law endorsed women's rights within the family, but no operative measures were taken to enforce it. Some of the economic reforms since independence even strengthened patrilocality and, possibly, patriarchal values. The purpose of this study was to explore the degree to which patrilocality served to maintain the traditional patriarchal stratification among women in the household by exploring women's health patterns and utilization of health services. Data were collected from 3859 women residing in rural Hebei, and variation in health and help seeking of six categories of relation to household head--mothers, wives, daughters, daughters-in-law, family heads, and other relatives--were explored. Utilization of health services is not dependent on women's position in the household, but primarily on per-capita income. Health patterns seem to indicate that mothers of the head of the household still have a considerable power to define their roles and share of household work. Women head of family, most of whom are married, appear to be under strain, which could be a result of their culturally "deviant" position. We conclude that old patriarchal values are intertwined with values of equality in current rural China. PMID:10813270

  18. Predicting Health Care Utilization in Marginalized Populations: Black, Female, Street-based Sex Workers

    PubMed Central

    Varga, Leah M.; Surratt, Hilary L.

    2014-01-01

    Background Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. Methods The outcome variable was utilization of health care services in the previous 12 months. Using Andersen’s Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. Findings The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Conclusions Any type of resource, link, or connection to or with an institution, or any consistent point of care contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. PMID:24657047

  19. [Public health and public health systems sustainability].

    PubMed

    Repullo Labrador, José R; Segura Benedicto, Andreu

    2006-01-01

    Public health and healthcare originally started out separately from one another in the past, having later further developed taking different paths in modern times. The major development the health systems underwent in the last half of the 20th century entailed a heightening of the individual standpoint and a division of these two approaches despite the attempts made to bring them together as of the WHO Alma-Ata Conference in 1978. The waning of rationalism and other social phenomena had a hand the collective or population-oriented focus being focused on to a lesser degree in Public Health, but these trends also gave rise to a growing problem of rationality in individual healthcare and sustainability in the public health systems. The debate on the current scene stands to set out the sustainability-related problems mediated by internal and external agents and to revise Public Health's possible contribution to the improvement thereof by advocating yet a further attempt at bringing together and integrating these two diverging standpoints. PMID:17193811

  20. TRICARE, Military Health System

    MedlinePlus

    ... Change My Primary Care Manager Book Appointments Getting Care When Traveling Information about Quality, Patient Safety, and Access Costs Health Plan Costs Prescription Costs Dental Costs Pay My ...

  1. Renewable Energy Options for a Utility System

    NASA Astrophysics Data System (ADS)

    Ahmadi, Lena; Panjeshahi, M. Hassan; Perry, Simon

    2009-05-01

    In this paper, renewable energies have been re-addressed with respect to the potentials and feasibility of being incorporated in process industries. Within a process, utility system is considered to be the most appropriate place for using sustainable energies. For integrating the renewable energies, the pinch analysis is applied as the main tool to provide opportunity for energy conservation. The results demonstrated that the power generation by the wind is the most cost effective and environmentally friendly option for energy conservation in comparison to the other sustainable resources. However the tidal energy stands the least due to the long payback period. Also, a computer program has been developed, using MATLAB 7.3, to screen out different scenarios and perform economic study. The outcome data showed that, there are several different opportunities for the integration of alternative energies. Finally, this method has been applied to a case study and various retrofit projects have been identified, each of which has certain amount of CO2 reduction and estimated values for the required investment, saving potential and payback period.

  2. Access to Transportation and Health Care Utilization in a Rural Region

    ERIC Educational Resources Information Center

    Arcury, Thomas A.; Preisser, John S.; Gesler, Wilbert M.; Powers, James M.

    2005-01-01

    Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization. This analysis addresses the association of transportation and health care utilization in a rural…

  3. Correlates of Suicide among Home Health Care Utilizers Who Died by Suicide and Community Controls

    ERIC Educational Resources Information Center

    Rowe, Jennifer L.; Bruce, Martha L.; Conwell, Yeates

    2006-01-01

    Home health care patients often have several late-life risk factors for suicide and constitute a high risk group for suicidal behaviors. In this study, we examined the characteristics of 14 older adult home health care utilizers who died by suicide and four community controls who used similar services. Both groups of home health care utilizers had…

  4. Outpatient Health Care Utilization of Suicide Decedents in Their Last Year of Life

    ERIC Educational Resources Information Center

    Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

    2012-01-01

    The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901…

  5. Toolsets Maintain Health of Complex Systems

    NASA Technical Reports Server (NTRS)

    2010-01-01

    First featured in Spinoff 2001, Qualtech Systems Inc. (QSI), of Wethersfield, Connecticut, adapted its Testability, Engineering, and Maintenance System (TEAMS) toolset under Small Business Innovation Research (SBIR) contracts from Ames Research Center to strengthen NASA's systems health management approach for its large, complex, and interconnected systems. Today, six NASA field centers utilize the TEAMS toolset, including TEAMS-Designer, TEAMS-RT, TEAMATE, and TEAMS-RDS. TEAMS is also being used on industrial systems that generate power, carry data, refine chemicals, perform medical functions, and produce semiconductor wafers. QSI finds TEAMS can lower costs by decreasing problems requiring service by 30 to 50 percent.

  6. Engine health monitoring: An advanced system

    NASA Technical Reports Server (NTRS)

    Dyson, R. J. E.

    1981-01-01

    The advanced propulsion monitoring system is described. The system was developed in order to fulfill a growing need for effective engine health monitoring. This need is generated by military requirements for increased performance and efficiency in more complex propulsion systems, while maintaining or improving the cost to operate. This program represents a vital technological step in the advancement of the state of the art for monitoring systems in terms of reliability, flexibility, accuracy, and provision of user oriented results. It draws heavily on the technology and control theory developed for modern, complex, electronically controlled engines and utilizes engine information which is a by-product of such a system.

  7. Health Care System Accessibility

    PubMed Central

    Steinberg, Annie G; Barnett, Steven; Meador, Helen E; Wiggins, Erin A; Zazove, Philip

    2006-01-01

    BACKGROUND People who are deaf use health care services differently than the general population; little research has been carried out to understand the reasons. OBJECTIVE To better understand the health care experiences of deaf people who communicate in American Sign Language. DESIGN Qualitative analyses of focus group discussions in 3 U.S. cities. PARTICIPANTS Ninety-one deaf adults who communicate primarily in American Sign Language. MEASUREMENTS We collected information about health care communication and perceptions of clinicians' attitudes. We elicited stories of both positive and negative encounters, as well as recommendations for improving health care. RESULTS Communication difficulties were ubiquitous. Fear, mistrust, and frustration were prominent in participants' descriptions of health care encounters. Positive experiences were characterized by the presence of medically experienced certified interpreters, health care practitioners with sign language skills, and practitioners who made an effort to improve communication. Many participants acknowledged limited knowledge of their legal rights and did not advocate for themselves. Some participants believed that health care practitioners should learn more about sociocultural aspects of deafness. CONCLUSIONS Deaf people report difficulties using health care services. Physicians can facilitate change to improve this. Future research should explore the perspective of clinicians when working with deaf people, ways to improve communication, and the impact of programs that teach deaf people self-advocacy skills and about their legal rights. PMID:16499543

  8. Health Literacy Association With Health Behaviors and Health Care Utilization in Multiple Sclerosis: A Cross-Sectional Study

    PubMed Central

    Salter, Amber; Tyry, Tuula; Fox, Robert J; Cutter, Gary R

    2014-01-01

    Background Low health literacy is generally associated with poor health outcomes; however, health literacy has received little attention in multiple sclerosis (MS). Objective The aim of this study was to investigate the health literacy of persons with MS using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Methods In 2012, we conducted a cross-sectional study of health literacy among NARCOMS participants. Respondents completed the Medical Term Recognition Test (METER) which assesses the ability to distinguish medical and nonmedical words, and the Newest Vital Sign (NVS) instrument which evaluates reading, interpretation, and numeracy skills. Respondents reported their sociodemographic characteristics, health behaviors, comorbidities, visits to the emergency room (ER), and hospitalizations in the last 6 months. We used logistic regression to evaluate the characteristics associated with functional literacy, and the association between functional literacy and health care utilization. Results Of 13,020 eligible participants, 8934 (68.6%) completed the questionnaire and were US residents. Most of them performed well on the instruments with 81.04% (7066/8719) having functional literacy on the METER and 74.62% (6666/8933) having adequate literacy on the NVS. Low literacy on the METER or the NVS was associated with smoking, being overweight or obese (all P<.001). After adjustment, low literacy on the METER was associated with ER visits (OR 1.28, 95% CI 1.10-1.48) and hospitalizations (OR 1.19, 95% CI 0.98-1.44). Findings were similar for the NVS. Conclusions In the NARCOMS cohort, functional health literacy is high. However, lower levels of health literacy are associated with adverse health behaviors and greater health care utilization. PMID:24513479

  9. Predisposing, Enabling and Need Correlates of Mental Health Treatment Utilization Among Homeless Men

    PubMed Central

    Wenzel, Suzanne L.; Golinelli, Daniela; Tucker, Joan S.; Kennedy, David P.; Ewing, Brett

    2016-01-01

    There is significant unmet need for mental health treatment among homeless men, but little is known about the correlates of treatment utilization in this population. Within the framework of the Behavioral Model for Vulnerable Populations, this study examines predisposing, enabling and need factors that may be associated with mental health care utilization. Participants were a representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row region of LA. Logistic regression examined the association between predisposing, enabling and need factors and past 30 day mental health service utilization on Skid Row. Results indicated that while need, operationalized as positive screens for posttraumatic stress disorder or depression, was associated with recent mental health care utilization, predisposing and enabling factors were also related to utilization. African-American homeless men, and those men who also reported substance abuse treatment and drop-in center use, had increased odds of reporting mental health care utilization. PMID:24595594

  10. Predisposing, enabling and need correlates of mental health treatment utilization among homeless men.

    PubMed

    Rhoades, Harmony; Wenzel, Suzanne L; Golinelli, Daniela; Tucker, Joan S; Kennedy, David P; Ewing, Brett

    2014-11-01

    There is significant unmet need for mental health treatment among homeless men, but little is known about the correlates of treatment utilization in this population. Within the framework of the Behavioral Model for Vulnerable Populations, this study examines predisposing, enabling and need factors that may be associated with mental health care utilization. Participants were a representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row region of LA. Logistic regression examined the association between predisposing, enabling and need factors and past 30 day mental health service utilization on Skid Row. Results indicated that while need, operationalized as positive screens for posttraumatic stress disorder or depression, was associated with recent mental health care utilization, predisposing and enabling factors were also related to utilization. African-American homeless men, and those men who also reported substance abuse treatment and drop-in center use, had increased odds of reporting mental health care utilization. PMID:24595594

  11. Barriers to mental health services utilization in the Niger Delta region of Nigeria: service users’ perspectives

    PubMed Central

    Jack-Ide, Izibeloko Omi; Uys, Leana

    2013-01-01

    Introduction There is only one neuro-psychiatric hospital for over four million people in the Niger Delta region of Nigeria. Low-income groups in urban and rural areas who access care through public mental health clinics are at greater risk of not accessing the needed mental health care. This study aimed to explored barriers that prevent people from utilizing mental health services, and to identifies key factors to increase access and improved service delivery. Methods A qualitative study was conducted among 20 service users attending the outpatient clinic of Rumuigbo neuropsychiatric hospital. Ten participants were caregivers and 10 were clients, both having accessed services for at least one year. Results The mean age was 37.7 years, 60% were males, 40% were unemployed and only 15% had a regular monthly income, while 65% live in rural areas. Barriers observed in mental health services use were physical, financial and cultural. These include absence of service in rural communities, poor knowledge of mental health services, stigma, transportation problems, waiting time at the facility and cost of service. Conclusion Stigma remains a strong barrier to accessing mental health services, and extensive efforts need to be made to overcome ignorance and discrimination. Mental health services need to be provided throughout the health care system to enable people to access them locally and affordably, preventing the need to travel and promoting service uptake and treatment continuation. PMID:23785564

  12. SUTIL: system utilities routines programmer's reference manual

    NASA Technical Reports Server (NTRS)

    Harper, D.

    1976-01-01

    A package of FORTRAN callable subroutines which allows efficient communication of data between users and programs is described. Proper utilization of the SUTIL package to reduce program core requirements and expedite program development is emphasized.

  13. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools.

    PubMed

    Ung, Brian L; Mullins, C Daniel

    2015-01-01

    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability. PMID:25217142

  14. Pattern of health services utilization by adults of the Pelotas birth cohort from 1982 to 2004-5, Southern Brazil

    PubMed Central

    Dias-da-Costa, Juvenal S; Gigante, Denise P; Horta, Bernardo L; Barros, Fernando C; Victora, Cesar G

    2009-01-01

    OBJECTIVE To describe the pattern of health services utilization by young adults. METHODS Longitudinal study in Pelotas (Southern Brazil), in which the individuals were identified at birth in 1982 and followed up until 23 years of age. The outcome was defined by information collected about visits to health professionals that were attended in the year before the interview, between 2004 and 2005. The places where the visits occurred were categorized as public, private or belonging to health plan systems. Descriptive analyses were carried out for utilization and type of health service. Poisson Regression was employed in the adjusted analysis. RESULTS Of the interviewees, 72.0% visited health professionals in the year before the interview; 86.2% (95% CI 84.7;87.7) of the women and 59.3% (95% CI 57.3;61.3) of the men. Even when gynecological visits were excluded, the women still attended more visits than the men, 68.4% (95% CI 66.4;70.4). Health services utilization was more frequent among interviewees of better socioeconomic level. A difference of lower use in relation to non-white skin color was observed only among male youths. There were differences regarding the type of professional visited by men and women and also according to family income. Men and women used more frequently the public system, the health plan system and, in a smaller proportion, the private system. CONCLUSIONS The socioeconomic situation influenced the utilization and the type of health service, with men and women classified as “poor at the moment”, which indicates lower utilization of services. Such socioeconomic differences may indicate difficulties in the access to the health system. PMID:19142345

  15. Utilization and Limitations of the American College Health Association's National College Health Assessment Instrument: A Systematic Review

    ERIC Educational Resources Information Center

    Rahn, Rhonda N.; Pruitt, Buster; Goodson, Patricia

    2016-01-01

    Objective: To analyze the literature in which researchers have utilized the National College Health Assessment (NCHA) I or the NCHA II. Participants and Methods: The authors selected peer-reviewed articles published between 2004 and July 2013 utilizing a single search term: National College Health Assessment. Articles were assessed for instrument…

  16. Russian Federation. Health system review.

    PubMed

    Popovich, Larisa; Potapchik, Elena; Shishkin, Sergey; Richardson, Erica; Vacroux, Alexandra; Mathivet, Benoit

    2011-01-01

    The HiT reviews are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. At independence from the Soviet Union in 1991, the Russian health system inherited an extensive, centralized Semashko system, but was quick to reform health financing by adopting a mandatory health insurance (MHI) model in 1993. MHI was introduced in order to open up an earmarked stream of funding for health care in the face of severe fiscal constraints. While the health system has evolved and changed significantly since the early 1990 s, the legacy of having been a highly centralized system focused on universal access to basic care remains. High energy prices on world markets have ensured greater macroeconomic stability, a budget surplus and improvements in living standards for most of the Russian population. However, despite an overall reduction in the poverty rate, there is a marked urban rural split and rural populations have worse health and poorer access to health services than urban populations. The increase in budgetary resources available to policy-makers have led to a number of recent federal-level health programmes that have focused on the delivery of services and increasing funding for priority areas including primary care provision in rural areas. Nevertheless, public health spending in the Russian Federation remains relatively low given the resources available. However, it is also clear that, even with the current level of financing, the performance of the health system could be improved. Provider payment mechanisms are the main obstacle to improving technical efficiency in

  17. Equity of access to and utilization of reproductive health services in Thailand: national Reproductive Health Survey data, 2006 and 2009.

    PubMed

    Kongsri, Suratchada; Limwattananon, Supon; Sirilak, Supakit; Prakongsai, Phusit; Tangcharoensathien, Viroj

    2011-05-01

    This study assessed trends in equity of access to reproductive health services and service utilization in terms of coverage of family planning, antenatal care and skilled birth attendance in Thailand. Two health indicators were measured: the prevalence of low birthweight and exclusive breastfeeding. Equity was measured against the combined urban-rural areas and geographic regions, women's education level and quintiles of household assets index. The study used data from two nationally representative household surveys, the 2006 and 2009 Reproductive Health Surveys. Very high coverage of family planning (79.6%), universal antenatal care (98.9%) and skilled birth attendance (99.7%), with very small socioeconomic and geographic disparities, were observed. The public sector played a dominant role in maternity care (90.9% of all deliveries in 2009). The private sector also had a role among the higher educated, wealthier women living in urban areas. Public sector facilities, followed by drug stores, were a major supplier of contraception, which had a high use rate. High coverage and low inequity were the result of extensive investment in the health system by successive governments, in particular primary health care at district and sub-district levels, reaching universality by 2002. While maintaining these achievements, methodological improvements in measuring low birthweight and exclusive breastfeeding for future reproductive health surveys are recommended. PMID:21555089

  18. Utilization of open source electronic health record around the world: A systematic review

    PubMed Central

    Aminpour, Farzaneh; Sadoughi, Farahnaz; Ahamdi, Maryam

    2014-01-01

    Many projects on developing Electronic Health Record (EHR) systems have been carried out in many countries. The current study was conducted to review the published data on the utilization of open source EHR systems in different countries all over the world. Using free text and keyword search techniques, six bibliographic databases were searched for related articles. The identified papers were screened and reviewed during a string of stages for the irrelevancy and validity. The findings showed that open source EHRs have been wildly used by source limited regions in all continents, especially in Sub-Saharan Africa and South America. It would create opportunities to improve national healthcare level especially in developing countries with minimal financial resources. Open source technology is a solution to overcome the problems of high-costs and inflexibility associated with the proprietary health information systems. PMID:24672566

  19. Planning health care delivery systems.

    PubMed Central

    Baum, M A; Bergwall, D F; Reeves, P N

    1975-01-01

    The increasing concern and interest in the health delivery system in the United States has placed the health system planners in a difficult position. They are inadequately prepared, in many cases, to deal with the management techniques that have been designed for use with system problems. This situation has been compounded by the failure, until recently, of educational programs to train new health professionals in these techniques. Computer simulation is a technique that allows the planners dynamic feedback on his proposed plans. This same technique provides the planning student with a better understanding of the systems planning process. PMID:1115292

  20. Ozone risk assessment utilities (ORAMUS) user's manual and tutorial : Volume 2, Chronic health endpoints.

    SciTech Connect

    Clemmons, M. A.; Jusko, M. J.; Whitfield, R. G.

    1998-12-16

    The primary purpose of this manual is to provide instructions on how to install and use the ORAMUS (Ozone Risk AssessMent UtilitieS) software. ORAMUS is a DOS-based software system that allows you to calculate and view risk estimates for health effects attributable to short- and long-term exposure to tropospheric ozone. The system combines exposure estimates with exposure-response relationships and then calculates and displays estimates of the overall risk in the form of probability distributions. ORAMUS allows you to select from three basic models: headcount risk, benchmark risk, and hospital admissions. It calculates a wide range of risk results for 27 air quality scenarios, 9 urban areas, 33 acute health endpoints, 4 chronic health endpoints, and 3 populations of interest. This manual is a tutorial designed to guide you through a series of steps that will familiarize you with the features of the system. The manual consists of two volumes. Volume 1 addresses acute health endpoints, and Volume 2 covers chronic health endpoints. Acute results were used during the National Ambient Air Quality Standards review process for ozone. Chronic results were not used.

  1. Ozone risk assessment utilities (ORAMUS) user's manual and tutorial : Volume 1, Acute health endpoints.

    SciTech Connect

    Clemmons, M. A.; Jusko, M. J.; Whitfield, R. G.

    1998-12-16

    The primary purpose of this manual is to provide instructions on how to install and use the ORAMUS (Ozone Risk AssessMent UtilitieS) software. ORAMUS is a DOS-based software system that allows you to calculate and view risk estimates for health effects attributable to short- and long-term exposure to tropospheric ozone. The system combines exposure estimates with exposure-response relationships and then calculates and displays estimates of the overall risk in the form of probability distributions. ORAMUS allows you to select from three basic models: headcount risk, benchmark risk, and hospital admissions. It calculates a wide range of risk results for 27 air quality scenarios, 9 urban areas, 33 acute health endpoints, 4 chronic health endpoints, and 3 populations of interest. This manual is a tutorial designed to guide you through a series of steps that will familiarize you with the features of the system. The manual consists of two volumes. Volume 1 addresses acute health endpoints, and Volume 2 covers chronic health endpoints. Acute results were used during the National Ambient Air Quality Standards review process for ozone. Chronic results were not used.

  2. Knowledge and Utilization of Computers Among Health Professionals in a Developing Country: A Cross-Sectional Study

    PubMed Central

    2015-01-01

    Background Incorporation of information communication technology in health care has gained wide acceptance in the last two decades. Developing countries are also incorporating information communication technology into the health system including the implementation of electronic medical records in major hospitals and the use of mobile health in rural community-based health interventions. However, the literature on the level of knowledge and utilization of information communication technology by health professionals in those settings is scarce for proper implementation planning. Objective The objective of this study is to assess knowledge, computer utilization, and associated factors among health professionals in hospitals and health institutions in Ethiopia. Methods A quantitative cross-sectional study was conducted on 554 health professionals working in 7 hospitals, 19 primary health centers, and 10 private clinics in the Harari region of Ethiopia. Data were collected using a semi-structured, self-administered, and pre-tested questionnaire. Descriptive and logistic regression techniques using SPSS version 16.0 (IBM Corporation) were applied to determine the level of knowledge and identify determinants of utilization of information communication technology. Results Out of 554 participants, 482 (87.0%) of them responded to the questionnaire. Among them, 90 (18.7%) demonstrated good knowledge of computers while 142 (29.5%) demonstrated good utilization habits. Health professionals who work in the primary health centers were found to have lower knowledge (3.4%) and utilization (18.4%). Age (adjusted odds ratio [AOR]=3.06, 95% CI 0.57-5.37), field of study (AOR=3.08, 95% CI 1.65-5.73), level of education (AOR=2.78, 95% CI 1.43-5.40), and previous computer training participation (AOR=3.65, 95% CI 1.62-8.21) were found to be significantly associated with computer utilization habits of health professionals. Conclusions Computer knowledge and utilization habits of health

  3. A note on the nature of utility in time and health and implications for cost utility analysis.

    PubMed

    Buckingham, Ken J; Devlin, Nancy Joy

    2009-01-01

    Time Trade-Off (TTO) valuations of health are widely used in economic evaluation of health care. Current approaches to eliciting TTO values, and their use in economic evaluation, rest on specific assumptions about the way utility relates to time and health. Both the assumptions themselves and evidence of violations of them are discussed in the literature - yet the issues appear not to be widely appreciated by those using and applying TTO in economic evaluation. This paper adds to that literature by demonstrating both the requirements of TTO and violations of these assumptions in terms of the underlying indifference curve maps and utility functions. The advantage of this approach is that it demonstrates very clearly a number of fundamental problems for the way TTO values are currently elicited and used in cost utility analysis. In essence, it is extremely unwise to assume that the current 'tariffs' of TTO values, such as those widely used in cost utility analysis to inform health sector decisions in many countries can be applied irrespective of the duration of the health states to which they are assigned. The estimates of QALYs that result will, quite often, simply be wrong. We conclude by pointing to a number of possible solutions. PMID:19019518

  4. Kentucky Allied Health Project Final Report: A State System for Allied Health Education.

    ERIC Educational Resources Information Center

    Kentucky State Council on Higher Education, Frankfort.

    The accomplishments of the Kentucky Allied Health Project, which implemented a model articulated system of allied health education, are described. The system included plans to promote transition from one education level to another and articulation in educational planning and resource utilization. The project has greatly increased…

  5. Specific systems studies of battery energy storage for electric utilities

    SciTech Connect

    Akhil, A.A.; Lachenmeyer, L.; Jabbour, S.J.; Clark, H.K.

    1993-08-01

    Sandia National Laboratories, New Mexico, conducts the Utility Battery Storage Systems Program, which is sponsored by the US Department of Energy`s Office of Energy Management. As a part of this program, four utility-specific systems studies were conducted to identify potential battery energy storage applications within each utility network and estimate the related benefits. This report contains the results of these systems studies.

  6. Utility battery storage systems program report for FY 94

    SciTech Connect

    Butler, P.C.

    1995-03-01

    Sandia National Laboratories, New Mexico, conducts the Utility Battery Storage Systems Program, which is sponsored by the US Department of Energy`s Office of Energy Management. The goal of this program is to assist industry in developing cost-effective battery systems as a utility resource option by 2000. Sandia is responsible for the engineering analyses, contracted development, and testing of rechargeable batteries and systems for utility energy storage applications. This report details the technical achievements realized during fiscal year 1994.

  7. Test report light duty utility arm power distribution system (PDS)

    SciTech Connect

    Clark, D.A.

    1996-03-04

    The Light Duty Utility Arm (LDUA) Power Distribution System has completed vendor and post-delivery acceptance testing. The Power Distribution System has been found to be acceptable and is now ready for integration with the overall LDUA system.

  8. Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

    PubMed Central

    2011-01-01

    Background After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services? Methods A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics. Results Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector. Conclusions There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC

  9. Under-utilization of health care services for infectious diseases syndromes in rural Azerbaijan: A cross-sectional study

    PubMed Central

    2011-01-01

    Background Infectious diseases present a potentially substantial yet undefined burden on the health of the adult Azerbaijani population. Efforts to quantify this burden in Azerbaijan are currently based almost exclusively on passive disease surveillance, and therefore hinge on the health utilization practices of the population. Understanding the prevalence of infectious syndromes and health utilization practices is paramount to disease surveillance, public health planning, and health care system reform. Methods A two-stage, probability proportional to size sampling design was used to select a representative sample of three regions of northern Azerbaijan with village populations less than 500 people. Demographic, clinical, and epidemiologic parameters were assessed using prevalence odds ratios, chi-squared, and the Fisher exact test. Associations with p < 0.10 were included in the regression analysis and removed by backward elimination. Respondents included 796 adults from 39 villages. Results Self-medication with antibiotics was the predominant utilization practice reported (19.4%). Only 1.3% of respondents reported seeing a health care provider for an infection, and 3.4% missed work or stayed in bed during the day in the last 5 years. In contrast, 338 illness episodes were reported in a 5 year period. Antibiotic use was significantly associated with gender, region, history of febrile illness, sleep disturbances, and arthritis controlling for age, ethnicity, and education. Influenza-like illness was the most prevalent infectious syndrome reported (33.3%). Conclusions We observed a remarkably low utilization of health services, despite reported symptoms that would merit use. Widespread availability of antibiotics may deter health care use, and may contribute to the development of antibiotic resistance in this population. Information on utilization of health services during an infection is essential for development of effective intervention strategies, and data on

  10. The Meaningful Use of Electronic Health Records and Health Care Utilization.

    PubMed

    Kern, Lisa M; Edwards, Alison; Kaushal, Rainu

    2016-07-01

    This study sought to determine the effects on health care utilization of meaningful use (MU) of electronic health records (EHRs) compared to typical use of EHRs without MU. This was a cohort study of primary care physicians in New York State (2010-2011). A total of 7 outcomes (primary care visits, specialist visits, laboratory tests, radiology tests, emergency department visits, admissions and readmissions) and 11 potential confounders were considered. The study sample included 213 physicians (50% of whom had achieved MU) and 127 353 patients. There were 17 fewer primary care visits and 61 fewer laboratory tests for every 100 patients whose physicians achieved MU, compared with patients whose physicians did not achieve MU (P < .05 for each). There were no differences for other outcomes. Achieving stage 1 MU was associated with fewer primary care visits and laboratory tests, suggesting that effects of MU are distinct from effects of typical EHR use. PMID:25712134

  11. 24 CFR 3285.904 - Utility system connections.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... section. (d) Fuel supply system. (1) Conversion of gas appliances. A service person acceptable to the LAHJ... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Utility system connections. 3285... Manufacturer's Installation Instructions § 3285.904 Utility system connections. (a) It is recommended that...

  12. 24 CFR 3285.904 - Utility system connections.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... section. (d) Fuel supply system. (1) Conversion of gas appliances. A service person acceptable to the LAHJ... 24 Housing and Urban Development 5 2011-04-01 2011-04-01 false Utility system connections. 3285... Manufacturer's Installation Instructions § 3285.904 Utility system connections. (a) It is recommended that...

  13. 24 CFR 3285.904 - Utility system connections.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... section. (d) Fuel supply system. (1) Conversion of gas appliances. A service person acceptable to the LAHJ... 24 Housing and Urban Development 5 2012-04-01 2012-04-01 false Utility system connections. 3285... Manufacturer's Installation Instructions § 3285.904 Utility system connections. (a) It is recommended that...

  14. 24 CFR 3285.904 - Utility system connections.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... section. (d) Fuel supply system. (1) Conversion of gas appliances. A service person acceptable to the LAHJ... 24 Housing and Urban Development 5 2013-04-01 2013-04-01 false Utility system connections. 3285... Manufacturer's Installation Instructions § 3285.904 Utility system connections. (a) It is recommended that...

  15. Thinking shift on health systems: from blueprint health programmes towards resilience of health systems

    PubMed Central

    Blanchet, Karl

    2015-01-01

    International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks. PMID:25905481

  16. Fixed pitch wind turbine system utilizing aerodynamic stall

    SciTech Connect

    Migliori, A.; Humphrey, J.; Midyette, J. III

    1984-01-24

    A fixed-pitch wind turbine system utilizing a permanent magnet alternator. Optimum output power is achieved by controlling the load on the stator output armature of the permanent magnet alternator. Energy is stored in the ac utility grid utilizing a synchronous inverter which couples energy from the alternator for storage in the ac utility grid in a controlled manner to regulate the rotational speed of the wind turbine and thereby extract a substantially optimum amount of output power from the wind turbine.

  17. Focus on vulnerable populations and promoting equity in health service utilization ––an analysis of visitor characteristics and service utilization of the Chinese community health service

    PubMed Central

    2014-01-01

    Background Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Methods Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors. Results The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs. Conclusions The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened. PMID:24884542

  18. [The health economics of attention deficit hyperactivity disorder in Germany. Part 1: Health care utilization and cost of illness].

    PubMed

    Schlander, M; Trott, G-E; Schwarz, O

    2010-03-01

    In the German region of Nordbaden, 5% of children (aged 7-12 years) and 1.3% of adolescents (aged 13-19 years) were diagnosed with attention deficit hyperactivity disorder (ADHD) in 2003. About two thirds of these patients were not seen by a physician specialized in psychiatry. Now the National Association of Statutory Health Insurance Physicians in Germany (Kassenaerztliche Bundesvereinigung, KBV) has developed a proposal for the integrated provision of care for these patients, combining a guidelines-oriented multidisciplinary approach with a system of quality assurance. Against this background, currently available ADHD-related data are presented, covering epidemiology, comorbidity and differential diagnosis, health care utilization, and cost of illness. According to administrative data analyses from Nordbaden, direct medical costs for patients with ADHD, from the perspective of statutory health insurance (SHI), exceed those of matched controls by a factor of >2.5. On this basis, ADHD-related expenditures of the German SHI may be estimated at around EUR 260 million in 2003, and almost certainly will have continued to grow further since. In addition to this, a diagnosis of ADHD is associated with substantial indirect cost. Although the literature on the burden of ADHD is incomplete, it seems plausible that the cost of illness might be comparable to that reported for alcohol and addiction disorders. Thus we anticipate an increasing relevance of formal health economic evaluations of health care programs offered to patients with ADHD. PMID:20232510

  19. Utility of Psychosocial Screening at a School-based Health Center.

    ERIC Educational Resources Information Center

    Gall, Gail; Pagano, Maria E.; Desmond, M. Sheila; Perrin, James M.; Murphy, J. Michael

    2000-01-01

    Evaluated the utility of the Pediatric Symptom Checklist for youth when completed by adolescents at a school-based health center (SBHC), noting how identification of psychosocial dysfunction and referral to mental health services improved academic functioning. Results support the utility of psychosocial screening and referral in SBHCs in…

  20. Health Services Utilization between Older and Younger Homeless Adults.(author Abstract)

    ERIC Educational Resources Information Center

    Nakonezny, Paul A.; Ojeda, Michael

    2005-01-01

    Purpose: Our purpose in the current study was to examine the relationship between health services utilization delivered by means of the Homeless Outreach Medical Services (HOMES) program and health services utilization delivered by means of the Parkland emergency room and inpatient units among a sample of older and younger homeless adults being…

  1. The Netherlands: health system review.

    PubMed

    Schäfer, Willemijn; Kroneman, Madelon; Boerma, Wienke; van den Berg, Michael; Westert, Gert; Devillé, Walter; van Ginneken, Ewout

    2010-01-01

    The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems. They also describe the institutional framework, process, content, and implementation of health and health care policies, highlighting challenges and areas that require more in-depth analysis. Undoubtedly the dominant issue in the Dutch health care system at present is the fundamental reform that came into effect in 2006. With the introduction of a single compulsory health insurance scheme, the dual system of public and private insurance for curative care became history. Managed competition for providers and insurers became a major driver in the health care system. This has meant fundamental changes in the roles of patients, insurers, providers and the government. Insurers now negotiate with providers on price and quality and patients choose the provider they prefer and join a health insurance policy which best fits their situation. To allow patients to make these choices, much effort has been made to make information on price and quality available to the public. The role of the national government has changed from directly steering the system to safeguarding the proper functioning of the health markets. With the introduction of market mechanisms in the health care sector and the privatization of former sickness funds, the Dutch system presents an innovative and unique variant of a social health insurance system. Since the stepwise realization of the blueprint of the system has not yet been completed, the health care system in The Netherlands should be characterized as being in transition. Many measures have been taken to move from the old to the new system as smoothly as possible. Financial measures intended to prevent sudden budgetary

  2. Disability, Health Insurance Coverage, and Utilization of Acute Health Services in the United States. Disability Statistics Report 4.

    ERIC Educational Resources Information Center

    LaPlante, Mitchell P.

    This report uses data from the 1989 National Health Interview Survey to estimate health insurance coverage of children and nonelderly adults with disabilities and their utilization of physician and hospital care as a function of health insurance status. In part 1, national statistics on disability and insurance status are provided for different…

  3. How utilities can build quality into their energy management systems

    SciTech Connect

    Not Available

    1993-09-01

    Energy management systems (EMS) are computer-based systems designed to monitor, control, and analyze a utility company's generation and transmission power system. An EMS gathers real-time data from monitoring devices located throughout the power system, calculates a range of economic and operating results, and enables high-speed control of generation and transmission equipment to ensure the economic and reliable operation of the electrical system. Since the EMS is the mission-critical component of a utility's day-to-day operations, it should be a quality system. The following seven steps outline an approach that will help ensure a quality EMS: Change your mindset on how to develop an EMS; use a proven systems development methodology; form a working partnership with the vendor; improve continuously; maximize hands-on utility participation; incorporate change-management techniques; and employ staff-dedicated utility resources for utility tasks.

  4. Czechoslovakia's changing health care system.

    PubMed Central

    Raffel, M W; Raffel, N K

    1992-01-01

    Before World War II, Czechoslovakia was among the most developed European countries with an excellent health care system. After the Communist coup d'etat in 1948, the country was forced to adapt its existing health care system to the Soviet model. It was planned and managed by the government, financed by general tax money, operated in a highly centralized, bureaucratic fashion, and provided service at no direct charge at the time of service. In recent years, the health care system had been deteriorating as the health of the people had also been declining. Life expectancy, infant mortality rates, and diseases of the circulatory system are higher than in Western European countries. In 1989, political changes occurred in Czechoslovakia that made health care reform possible. Now health services are being decentralized, and the ownership of hospitals is expected to be transferred to communities, municipalities, churches, charitable groups, or private entities. Almost all health leaders, including hospital directors and hospital department heads, have been replaced. Physicians will be paid according to the type and amount of work performed. Perhaps the most important reform is the establishment of an independent General Health Care Insurance Office financed directly by compulsory contributions from workers, employers, and government that will be able to negotiate with hospitals and physicians to determine payment for services. PMID:1454975

  5. 42 CFR 457.490 - Delivery and utilization control systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... State that elects to obtain health benefits coverage through a separate child health program must include in its State plan a description of the child health assistance provided under the plan for... control systems. A State must— (a) Describe the methods of delivery of child health assistance...

  6. Utilization of mental health services among adolescents in community-based substance abuse outpatient clinics.

    PubMed

    Chan, Ya-Fen; Godley, Mark D; Godley, Susan H; Dennis, Michael L

    2009-01-01

    This study examined the rates and correlates of self-reported receipt for mental health services among 1,190 adolescents, aged 12-19, who were admitted to community-based substance abuse outpatient clinics and had a co-occurring mental health problem. Utilization of mental health service was ascertained 3 months post-intake. About one third (35%) of adolescents with a co-occurring mental health problem identified at intake received mental health service in the 3 months after treatment entry. After holding other correlates constant, history of mental health treatment, suicidal behavior, family history of mental disorder and insurance coverage at intake were associated with mental health service utilization at the 3-month follow up. Predictors of service utilization varied by gender and racial/ethnic status. Implications for integrated substance use and mental health services are discussed. PMID:18157641

  7. Utility Battery Storage Systems Program plan: FY 1994--FY 1998

    SciTech Connect

    Not Available

    1994-02-01

    The Utility Battery Storage Systems Program, sponsored by the US Department of Energy (DOE), is addressing needed improvements so that the full benefits of these systems can be realized. A key element of the Program is the quantification of the benefits of batteries used in utility applications. The analyses of the applications and benefits are ongoing, but preliminary results indicate that the widespread introduction of battery storage by utilities could benefit the US economy by more than $26 billion by 2010 and create thousands of new jobs. Other critical elements of the DOE Program focus on improving the batteries, power electronics, and control subsystems and reducing their costs. These subsystems are then integrated and the systems undergo field evaluation. Finally, the most important element of the Program is the communication of the capabilities and benefits of battery systems to utility companies. Justifiably conservative, utilities must have proven, reliable equipment that is economical before they can adopt new technologies. While several utilities are leading the industry by demonstrating battery systems, a key task of the DOE program is to inform the entire industry of the value, characteristics, and availability of utility battery systems so that knowledgeable decisions can be made regarding future investments. This program plan for the DOE Utility Battery Storage Systems Program describes the technical and programmatic activities needed to bring about the widespread use of batteries by utilities. By following this plan, the DOE anticipates that many of the significant national benefits from battery storage will be achieved in the near future.

  8. Corridor guided transport system utilizing permanent magnet levitation

    SciTech Connect

    Geraghty, J.J.; Poland, A.P.; Lombardi, J.A.

    1995-07-01

    The invention relates to a corridor guided transport system including a guided goods conveyance container utilizing permanent magnet levitation. The transport system of the invention eliminates the need for the wheel and track arrangement presently required by known and utilized conventional train systems and also required by some conventional magnetic levitation transport systems and, as a result, is safer to operate and maintain than either of these known transportation systems.

  9. [The health system of Venezuela].

    PubMed

    Bonvecchio, Anabelle; Becerril-Montekio, Victor; Carriedo-Lutzenkirchen, Angela; Landaeta-Jiménez, Maritza

    2011-01-01

    This paper describes the Venezuelan health system, including its structure and coverage, financial sources, human and material resources and its stewardship functions. This system comprises a public and a private sector. The public sector includes the Ministry of Popular Power for Health (MS) and several social security institutions, salient among them the Venezuelan Institute for Social Security (IVSS). The MH is financed with federal, state and county contributions. The IVSS is financed with employer, employee and government contributions. These two agencies provide services in their own facilities. The private sector includes providers offering services on an out-of-pocket basis and private insurance companies. The Venezuelan health system is undergoing a process of reform since the adoption of the 1999 Constitution which calls for the establishment of a national public health system. The reform process is now headed by the Barrio Adentro program. PMID:21877092

  10. Utility battery storage systems. Program report for FY95

    SciTech Connect

    Butler, P.C.

    1996-03-01

    Sandia National Laboratories, New Mexico, conducts the Utility Battery Storage Systems Program, which is sponsored by the U.S. Department of Energy`s Office of Utility Technologies. The goal of this program is to assist industry in developing cost-effective battery systems as a utility resource option by 2000. Sandia is responsible for the engineering analyses, contracted development, and testing of rechargeable batteries and systems for utility energy storage applications. This report details the technical achievements realized during fiscal year 1995.

  11. Integrated support systems for electric utility operations

    SciTech Connect

    Hong, H.W.; Imparato, C.F.; Becker, D.L.; Malinowski, J.H. )

    1992-01-01

    Power system dispatch, the real-time monitoring and coordination of transmission and generation facilities, is the focal point of power system operations. However, dispatch is just one of the many duties of the typical power system operations department. Many computer-based tools and systems are used in support of these duties. Energy management systems (EMS), the centralized, mainframe-, or mini-computer-based systems that support dispatch, have been widely publicized, but few of the other support systems have been given much notice. This article provides an overview of these support tools and systems, frames the major issues faced in systems integration, and describes the path taken to integrate EMS, workstations, desktop computers, networks and applications. Network architecture enables the distribution of real-time operations data throughout the company, from EMS to power plants to district offices, on an unprecedented scale.

  12. [Corruption and health care system].

    PubMed

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions. PMID:26016214

  13. African Americans: Disparities in Health Care Access and Utilization

    ERIC Educational Resources Information Center

    Copeland, Valire Carr

    2005-01-01

    Despite remarkable improvements in the overall health of the nation during the past two decades, compelling evidence suggests that the nation's racial and ethnic minority Americans suffer increasing disparities in the incidence, prevalence, mortality, and burden of diseases and adverse health outcomes compared with white Americans. The 1998…

  14. Update: Health Insurance and Utilization of Care among Rural Adolescents

    ERIC Educational Resources Information Center

    Probst, Janice C.; Moore, Charity G.; Baxley, Elizabeth G.

    2005-01-01

    Context: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences. Purpose: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents. Methods:…

  15. Remoteness and maternal and child health service utilization in rural Liberia: A population–based survey

    PubMed Central

    Kenny, Avi; Basu, Gaurab; Ballard, Madeleine; Griffiths, Thomas; Kentoffio, Katherine; Niyonzima, Jean Bosco; Sechler, G. Andrew; Selinsky, Stephen; Panjabi, Rajesh R.; Siedner, Mark J.; Kraemer, John D.

    2015-01-01

    Background This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa. Methods Cluster–sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS–measured distance from the nearest health facility and the odds of maternal (ANC, facility–based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data. Findings Living in the farthest quartile was associated with lower odds of attending 1–or–more ANC checkup (AOR = 0.04, P < 0.001), 4–or–more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility–based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers. Conclusions Within a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further

  16. Optimal Sensor Selection for Health Monitoring Systems

    NASA Technical Reports Server (NTRS)

    Santi, L. Michael; Sowers, T. Shane; Aguilar, Robert B.

    2005-01-01

    Sensor data are the basis for performance and health assessment of most complex systems. Careful selection and implementation of sensors is critical to enable high fidelity system health assessment. A model-based procedure that systematically selects an optimal sensor suite for overall health assessment of a designated host system is described. This procedure, termed the Systematic Sensor Selection Strategy (S4), was developed at NASA John H. Glenn Research Center in order to enhance design phase planning and preparations for in-space propulsion health management systems (HMS). Information and capabilities required to utilize the S4 approach in support of design phase development of robust health diagnostics are outlined. A merit metric that quantifies diagnostic performance and overall risk reduction potential of individual sensor suites is introduced. The conceptual foundation for this merit metric is presented and the algorithmic organization of the S4 optimization process is described. Representative results from S4 analyses of a boost stage rocket engine previously under development as part of NASA's Next Generation Launch Technology (NGLT) program are presented.

  17. Utility Battery Storage Systems Program report for FY93

    SciTech Connect

    Butler, P.C.

    1994-02-01

    Sandia National Laboratories, New Mexico, conducts the Utility Battery Storage Systems Program, which is sponsored by the US Department of Energy`s Office of Energy Management. In this capacity, Sandia is responsible for the engineering analyses, contract development, and testing of rechargeable batteries and systems for utility-energy-storage applications. This report details the technical achievements realized during fiscal year 1993.

  18. Case study: Automated utilities damage assessment (AUDA) system

    SciTech Connect

    Salavani, R.; Laventure, G.C.; Smith, M.D.

    1994-12-31

    A demonstration program of an automated utility damage assessment system (AUDA) at a United States Air Force facility (USAF) is described. The AUDA is designed to assess damage, in an efficient manner, to military equipment or utilities, such as electrical equipment, potable and waste water, HVAC systems, petroleum, oil and lubricants, and natural gas.

  19. The health heterogeneity of and health care utilization by the elderly in Taiwan.

    PubMed

    Liu, Li-Fan

    2014-02-01

    A good understanding of the health heterogeneity of elderly people, their characteristics, patterns of health care utilization and subsequent expenditures is necessary to adequately evaluate the policy options and interventions aimed at improving quality and efficiency of care for older people. This article reviews studies that used Latent Class Analysis to identify four health profiles among elderly people in Taiwan: High Comorbidity (HC), Functional Impairment (FI), Frail (FR), and Relatively Healthy (RH). Variables associated with increased likelihood of being in the FR group were older age, female gender, and living with one's family, and these also correlated with ethnicity and level of education. The HC group tended to use more ambulatory care services compared with those in the RH group. The HC group tended to be younger, better educated, and was more likely to live in urban areas than were people in the FI group. The FI group, apart from age and gender, was less likely be of Hakka ethnicity and more likely to live with others than were individuals in the RH group. The FI group had relatively high probabilities of needing assistance, and the FR group had higher healthcare expenditures. A person-centered approach would better satisfy current healthcare needs of elderly people and help forecast future expenditures. PMID:24473113

  20. Intelligent Integrated System Health Management

    NASA Technical Reports Server (NTRS)

    Figueroa, Fernando

    2012-01-01

    Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems

  1. Self-reported history of sexually transmissible infections (STIs) and STI-related utilization of the German health care system by men who have sex with men: data from a large convenience sample

    PubMed Central

    2011-01-01

    Background In Germany, testing and treatment of sexually transmissible infections (STIs) services are not provided by one medical discipline, but rather dispersed among many different providers. Common STIs like gonorrhoea or Chlamydia infection are not routinely reported. Although men who have sex with men (MSM) are particularly vulnerable to STIs, respective health care utilization among MSM is largely unknown. Methods A sexual behaviour survey among MSM was conducted in 2006. Questions on self-reported sexual behaviour, STI-related health care consultation and barriers to access, coverage of vaccination against hepatitis, screening for asymptomatic STIs, self-reported history of STIs, and partner notification were analysed. Analysis was stratified by HIV-serostatus (3,511 HIV-negative/unknown versus 874 positive). Results General Practitioners, particularly gay doctors, were preferred for STI-related health care. Low threshold testing in sex-associated venues was acceptable for most respondents. Shame and fear of homophobic reactions were the main barriers for STI-testing. More than half of the respondents reported vaccination against hepatitis A/B. HIV-positive MSM reported screening offers for STIs three to seven times more often than HIV-negative or untested MSM. Unlike testing for syphilis or hepatitis C, screening for asymptomatic pharyngeal and rectal infections was rarely offered. STIs in the previous twelve months were reported by 7.1% of HIV-negative/untested, and 34.7% of HIV-positive respondents. Conclusions Self-reported histories of STIs in MSM convenience samples differ significantly by HIV-serostatus. Higher rates of STIs among HIV-positive MSM may partly be explained by more testing. Communication between health care providers and their clients about sexuality, sexual practices, and sexual risks should be improved. A comprehensive STI screening policy for MSM is needed. PMID:21592342

  2. Self-reported morbidity and health service utilization in rural Tamil Nadu, India.

    PubMed

    Dodd, Warren; King, Nia; Humphries, Sally; Little, Matthew; Dewey, Cate

    2016-07-01

    In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability. PMID:27285663

  3. A Study on the Selection and Utilization of MEDLINE Search Systems.

    ERIC Educational Resources Information Center

    Bader, Shelley A.; Piemme, Thomas E.

    This report presents the objectives, methodology, and results of a study which assessed the selection and utilization of four MEDLINE search systems by faculty and medical residents at the George Washington University Medical Center. The four systems, which were provided or sponsored by the Himmelfarb Health Sciences Library, offer a wide range of…

  4. Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study

    PubMed Central

    Hu, Zhongkai; Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Wang, Yue; Zheng, Le; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank

    2015-01-01

    Background The increasing rate of health care expenditures in the United States has placed a significant burden on the nation’s economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. Objective This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. Methods In the HealthInfoNet, Maine’s health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient’s next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree–based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Results Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. Conclusions The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management

  5. Integrated Systems Health Management for Intelligent Systems

    NASA Technical Reports Server (NTRS)

    Figueroa, Fernando; Melcher, Kevin

    2011-01-01

    The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

  6. Systems Technology Laboratory (STL) compendium of utilities

    NASA Technical Reports Server (NTRS)

    Decker, W. J.; Smith, E. J.; Taylor, W. A.; Merwarth, P. D.; Stark, M. E.; Pajerski, R. S.; Mcgarry, F. E.; Green, A. L.

    1981-01-01

    Multipurpose programs, routines and operating systems are described. Data conversion and character string comparison subroutine are included. Graphics packages, and file maintenance programs are also included.

  7. Employment and family conditions are related to health care utilization among foreign-born farmworker men.

    PubMed

    López-Cevallos, Daniel F; Garside, Leda I

    2013-01-01

    Despite their increased vulnerability to disease and injury, farmworkers have limited access to health services. The purpose of this study was to analyze the influence of employment and family conditions on health care utilization among foreign-born farmworker men. Using the Hispanic Farmworker Health model as the theoretical framework, a secondary data analysis was conducted among 397 foreign-born vineyard and winery worker men who attended the ¡Salud! Services mobile health screenings during the summer of 2009. Working full time (odds ratio [OR] = 2.49), being employed directly by the vineyard or winery (OR = 1.96), and having immediate family members (children, spouse) living in Oregon (OR = 2.65) were positively associated with health care utilization. Findings suggest that despite the many barriers farmworker men face, supportive employment and family conditions may increase health care utilization for this population. Implications of these results are discussed in the context of health care reform. PMID:24831072

  8. Integrated Baseline System (IBS) Version 1.03: Utilities guide

    SciTech Connect

    Burford, M.J.; Downing, T.R.; Pottier, M.C.; Schrank, E.E.; Williams, J.R.

    1993-01-01

    The Integrated Baseline System (IBS) is an emergency management planning and analysis tool that was developed under the direction of the Federal Emergency Management Agency (FEMA). This Utilities Guide explains how to operate utility programs that are supplied as a part of the IBS. These utility programs are chiefly for managing and manipulating various kinds of IBS data and system administration files. Many of the utilities are for creating, editing, converting, or displaying map data and other data that are related to geographic location.

  9. Effect of Personality on the Use and Perceived Utility of Web-Based Health Resources

    ERIC Educational Resources Information Center

    Hruska, Natalie

    2012-01-01

    Studies document numerous threats to human health exacerbated by multiple factors, including inadequate access to health-related information. The Internet has developed as one resource to provide health information; however, there remains a significant gap in understanding how personality differences influence the use and perceived utility of the…

  10. Health Care Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

    ERIC Educational Resources Information Center

    Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B., Jr.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.

    2009-01-01

    Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant…

  11. The Rural-Urban Divide: Health Services Utilization among Older Mexicans in Mexico

    ERIC Educational Resources Information Center

    Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

    2010-01-01

    Context: Mexico. Purpose: Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods: The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health…

  12. [Utilization of expert systems in psychiatry].

    PubMed

    Ohayon, M M

    1993-04-01

    Are expert systems liable to be used as consultants in psychiatry? Most expert systems deal with an over-restricted part of psychiatry and cannot be a real help in everyday care. Moreover, most of them are not actually validated (the comparison between the system's and the expert's conclusions in a few cases is not enough). Another problem is that they reflect the uncertainties of nosographic problems. Validation of such systems needs the careful checking of the logical structure of the underlying nosography, the fitness of the structure's knowledge base and the fitness of the inference engine. Moreover, the naïve use of the system by untrained clinicians is the best means of validation since it provides real life proof of the ability of expert systems to make diagnoses in unselected cases where the need for a common diagnostic reference is clear (for example, epidemiologic, psychopharmacological ornosographic research). Some of the best known expert systems in the field of psychiatry are reviewed and another expert system, Adinfer, is presented. Developed since 1982, Adinfer is a forward-tracking level O system (in its simplified version for micro-computers). The knowledge base is a translation of the DSM-III-R into production rules. The program has been included in several software packages and used in many clinical studies, both among psychiatrists and physicians. The program has been validated with 1,141 unselected cases, and with 47 physicians: an 83% agreement rate was found between the system's and the physician's diagnoses, taking into account that the clinicians were asked to give their conclusions according to their usual nosography.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8500073

  13. Social capital and under-utilization of medication for financial reasons among elderly women: evidence from two Brazilian health surveys.

    PubMed

    Luz, Tatiana Chama Borges; de Loyola Filho, Antônio Ignácio; Lima-Costa, Maria Fernanda

    2013-12-01

    This cross-sectional study assesses the prevalence and examines the role of social and demographic factors, health conditions, health system characteristics and contextual factors of under-utilization of medication for financial reasons among elderly women. Participants in the Greater Metropolitan Belo Horizonte Health Survey (GMBH) and the eleventh phase of the Bambuí Cohort Study of the Elderly were assessed. Among elderly women in the GMBH, the prevalence of under-utilization was 11.4%, and in Bambuí, the rate was 5.4%. Self-perception of health (OR, 3.46; 95%CI, 1.32_9.10); daily life limitations (OR, 2.75; 95% CI, 1.31-5.78) and perception of help (OR, 2.36; 95% CI, 1.07-5.25) had independent associations with under-utilization among GMBH residents. A poor perception of both cohesion in the neighborhood (OR, 2.38; 95% CI, 1.02-5.56) and the physical environment (OR, 2.58; 95% CI, 1.10-6.03) significantly increased the likelihood of under-utilization among Bambuí residents. These results provide important clues to identifying possible risk factors for under-utilization, highlighting the need to develop strategies targeting the amplification of the involvement between elderly women and their community to reduce the extent of under-utilization in later life. PMID:24263888

  14. System Analysis on Absorption Chiller Utilizing Intermediate Wasted Heat

    NASA Astrophysics Data System (ADS)

    Yamada, Miki; Suzuki, Hiroshi; Usui, Hiromoto

    A system analysis has been performed for the multi-effect absorption chiller (MEAC) applied as a bottoming system of 30kW class hybrid system including micro gas turbine (MGT) and solid oxide fuel cell (SOFC) hybrid system. In this paper, an intermediate wasted heat utilization (IWHU) system is suggested for lifting up the energy efficiency of the whole system and coefficient of performance (COP) of MEAC. From the results, the suggested IWHU system was found to show the very high energy efficiency compared with a terminal wasted heat utilization (TWHU) system that uses only the heat exhausted from the terminal of MGT/SOFC system. When TWHU system is applied for MEAC, the utilized heat from the MGT/SOFC system is found to remain low because the temperature difference between the high temperature generator and the wasted heat becomes small. Then, the energy efficiency does not become high in spite of high COP of MEAC. On the other hand, the IWHU system could increase the utilized heat for MEAC as performs effectively. The exergy efficiency of IWHU system is also revealed to be higher than that of a direct gas burning system of MEAC, because the wasted heat is effectively utilized in the IWHU system.

  15. Introduction on health recommender systems.

    PubMed

    Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L

    2015-01-01

    People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described. PMID:25417084

  16. [National public health information system].

    PubMed

    Erceg, Marijan; Stevanović, Ranko; Babić-Erceg, Andrea

    2005-01-01

    Information production and its communication being a key public health activity, developing modern information systems is a precondition for its fulfilling these assignments. A national public health information system (NPHIS) is a set of human resources combined with computing and communication technologies. It enables data linkage and data coverage as well as undertaking information production and dissemination in an effective, standardized and safe way. The Croatian Institute of Public Health LAN/WAN modules are under development. Health Safety System, Health Workers Registry, and Digital Library are among the Institute's developmental priorities. Communication between NPHIS participants would unfold over the Internet by using every relevant data protection method. Web technology-based applications would be run on special servers. Between individual applications, use would be made of the transaction module of communication through an exchange of the HL7 standard-based xml messages. In the conditions of transition, the health system must make an optimal use of the resources, which is not feasible without applying modern information and communication technologies. PMID:16095199

  17. Security system helps utility stay competitive

    SciTech Connect

    1995-04-01

    Atlantic Electric is saving more than $750,000 annually in security costs by using an innovative closed-circuit television (CCTV) system to guard its remote sites electronically. Today, a single guard in the central security control room at Atlantic Electric`s headquarters electronically surveys and controls some 20 remote sites such as combustion turbine sites, material storage, administrative facilities and operating centers. Protecting these sites are CCTV cameras mounted around each yard, floodlighting, and a motion detection and signal transmission system called Adpro SiteWatch by vsion Systems Inc. The SiteWatch system automatically displays to the central guard any intrusion at a site, and captures and replays the intrusion events similar to an instant replay in a televised sporting event. Over the five year transition, Atlantic Electric saved nearly $2 million in security costs.

  18. Gross Motor Function Classification System: impact and utility.

    PubMed

    Morris, Christopher; Bartlett, Doreen

    2004-01-01

    In summary, the GMFCS has had, and continues to have, a major effect on the health care of children with CP. The number of citations of the GMFCS has been increasing every year, and the classification system has had good uptake internationally and across the spectrum of health professionals for use in research design and clinical practice by providing a system for clearly communicating about children's gross motor function. The utility of diagnostic labels such as diplegia has been questioned. However, although by definition CP is a disorder of posture and movement, the movement disability is often only one of the neurodevelopmental problems for many children with CP. When a complete description of a child's clinical presentation is required we recommend that the GMFCS be used together with the Surveillance of Cerebral Palsy in Europe classification indicating the type and topography of movement impairment. When appropriate the clinical profile will similarly be enhanced with details of other impairments and disabilities such as epilepsy or sensory, learning, feeding, or emotional disturbance. The observations in this annotation are constrained by the amount of information in the public domain. Although these sources adequately represent the effect of the GMFCS on research design, they are less likely to inform us of how the GMFCS is being used in administration, clinical practice, or education. It is not yet clear whether information is being used for these purposes or in assisting with case load management, as intended by the developers. By its localized nature, such information might remain difficult to gauge. We would therefore be interested to hear from others who are using the system for these or any other purposes. PMID:14974650

  19. Telemedicine for Gestational Diabetes Mellitus (TeleGDM): A Mixed-Method Study Protocol of Effects of a Web-Based GDM Support System on Health Service Utilization, Maternal and Fetal Outcomes, Costs, and User Experience

    PubMed Central

    Lim, Kwang; Blackberry, Irene; Gray, Kathleen; Furler, John

    2016-01-01

    Background Women with insulin-treated gestational diabetes mellitus (GDM) require close monitoring and support to manage their diabetes. Recent changes to the diagnostic criteria have implications for service provision stemming from increased prevalence, suggesting an increased burden on health services in the future. Telemedicine may augment usual care and mitigate service burdens without compromising clinical outcomes but evidence in GDM is limited. Objective The Telemedicine for Gestational Diabetes Mellitus (TeleGDM) trial aims to explore the use of telemedicine in supporting care and management of women with GDM treated with insulin. Methods The TeleGDM is a mixed-methods study comprising an exploratory randomized controlled trial (RCT) and a qualitative evaluation using semistructured interviews. It involves women with insulin-treated GDM who are up to 35 weeks gestation. Participating patients (n=100) are recruited face-to-face in outpatient GDM clinics at an outer metropolitan tertiary hospital with a culturally diverse catchment and a regional tertiary hospital. The second group of participants (n=8) comprises Credentialed Diabetes Educator Registered Nurses involved in routine care of the women with GDM at the participating clinics. The RCT involves use of a Web-based patient-controlled personal health record for GDM data sharing between patients and clinicians compared to usual care. Outcomes include service utilization, maternal and fetal outcomes (eg, glycemic control, 2nd and 3rd trimester fetal size, type of delivery, baby birth weight), diabetes self-efficacy, satisfaction, and costs. Semistructured interviews will be used to examine user experiences and acceptability of telemedicine. Results The trial recruitment is currently underway. Results are expected by the end of 2016 and will be reported in a follow-up paper. Conclusions Innovative use of technology in supporting usual care delivery in women with GDM may facilitate timely access to GDM

  20. Utilizing health information technology to improve vaccine communication and coverage

    PubMed Central

    Stockwell, Melissa S; Fiks, Alexander G

    2013-01-01

    Vaccination coverage is still below the Healthy People 2010 and 2020 goals. Technology use in the US is widespread by patients and providers including text message, email, internet, social media and electronic health records. Health information technology (IT) interventions can facilitate the rapid or real-time identification of children in need of vaccination and provide the foundation for vaccine-oriented parental communication or clinical alerts in a flexible and tailored manner. There has been a small but burgeoning field of work integrating IT into vaccination interventions including reminder/recall using non-traditional methods, clinical decision support for providers in the electronic health record, use of technology to affect work-flow and the use of social media. The aim of this review is to introduce and present current data regarding the effectiveness of a range of technology tools to promote vaccination, describe gaps in the literature and offer insights into future directions for research and intervention. PMID:23807361

  1. Utilizing health information technology to improve vaccine communication and coverage.

    PubMed

    Stockwell, Melissa S; Fiks, Alexander G

    2013-08-01

    Vaccination coverage is still below the Healthy People 2010 and 2020 goals. Technology use in the US is widespread by patients and providers including text message, email, internet, social media and electronic health records. Health information technology (IT) interventions can facilitate the rapid or real-time identification of children in need of vaccination and provide the foundation for vaccine-oriented parental communication or clinical alerts in a flexible and tailored manner. There has been a small but burgeoning field of work integrating IT into vaccination interventions including reminder/recall using non-traditional methods, clinical decision support for providers in the electronic health record, use of technology to affect work-flow and the use of social media. The aim of this review is to introduce and present current data regarding the effectiveness of a range of technology tools to promote vaccination, describe gaps in the literature and offer insights into future directions for research and intervention. PMID:23807361

  2. A telemedicine health care delivery system

    NASA Technical Reports Server (NTRS)

    Sanders, Jay H.

    1991-01-01

    The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.

  3. [The health system of Chile].

    PubMed

    Becerril-Montekio, Víctor; Reyes, Juan de Dios; Manuel, Annick

    2011-01-01

    This paper describes the Chilean health system, including its structure, financing, beneficiaries, and its physical, material and human resources. This system has two sectors, public and private. The public sector comprises all the organisms that constitute the National System of Health Services, which covers 70% of the population, including the rural and urban poor, the low middle-class, the retired, and the self-employed professionals and technicians.The private sector covers 17.5% of the population, mostly the upper middle-class and the high-income population. A small proportion of the population uses private health services and pays for them out-of-pocket. Around l0% of the population is covered by other public agencies, basically the Health Services for the Armed Forces. The system was recently reformed with the establishment of a Universal System of Explicit Entitlements, which operates through a Universal Plan of Explicit Entitlements (AUGE), which guarantees timely access to treatment for 56 health problems, including cancer in children, breast cancer, ischaemic heart disease, HIV/AIDS and diabetes. PMID:21877079

  4. Security for decentralized health information systems.

    PubMed

    Bleumer, G

    1994-02-01

    Health care information systems must reflect at least two basic characteristics of the health care community: the increasing mobility of patients and the personal liability of everyone giving medical treatment. Open distributed information systems bear the potential to reflect these requirements. But the market for open information systems and operating systems hardly provides secure products today. This 'missing link' is approached by the prototype SECURE Talk that provides secure transmission and archiving of files on top of an existing operating system. Its services may be utilized by existing medical applications. SECURE Talk demonstrates secure communication utilizing only standard hardware. Its message is that cryptography (and in particular asymmetric cryptography) is practical for many medical applications even if implemented in software. All mechanisms are software implemented in order to be executable on standard-hardware. One can investigate more or less decentralized forms of public key management and the performance of many different cryptographic mechanisms. That of, e.g. hybrid encryption and decryption (RSA+DES-PCBC) is about 300 kbit/s. That of signing and verifying is approximately the same using RSA with a DES hash function. The internal speed, without disk accesses etc., is about 1.1 Mbit/s. (Apple Quadra 950 (MC 68040, 33 MHz, RAM: 20 MB, 80 ns. Length of RSA modulus is 512 bit). PMID:8188407

  5. Health Systems Governance for health equity: critical reflections.

    PubMed

    Labonté, Ronald

    2010-01-01

    This article addresses several issues pertinent to health systems governance for health equity. It argues the importance of health systems using measures of positive health (well-being), discriminating in favour of historically less advantaged groups and weighing the costs of health care against investments in the social determinants of health. It cautions that the concept of governance could weaken the role of government, with disequalizing effects, while emphasizing the importance of two elements of good governance (transparency and participation) in health systems decision-making. It distinguishes between participation as volunteer labour and participation as exercising political rights, and questions the assumption that decentralization in health systems is necessarily empowering. It then identifies five health system roles to address issues of equity (educator/watchdog, resource broker, community developer, partnership developer and advocate/catalyst) and the implications of these roles for practice. Drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers' roles, noting the importance of health workers claiming their identity as citizens. The article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other. PMID:20963302

  6. Emission abatement system utilizing particulate traps

    DOEpatents

    Bromberg, Leslie; Cohn, Daniel R.; Rabinovich, Alexander

    2004-04-13

    Emission abatement system. The system includes a source of emissions and a catalyst for receiving the emissions. Suitable catalysts are absorber catalysts and selective catalytic reduction catalysts. A plasma fuel converter generates a reducing gas from a fuel source and is connected to deliver the reducing gas into contact with the absorber catalyst for regenerating the catalyst. A preferred reducing gas is a hydrogen rich gas and a preferred plasma fuel converter is a plasmatron. It is also preferred that the absorber catalyst be adapted for absorbing NO.sub.x.

  7. Cost analysis of energy storage systems for electric utility applications

    SciTech Connect

    Akhil, A.; Swaminathan, S.; Sen, R.K.

    1997-02-01

    Under the sponsorship of the Department of Energy, Office of Utility Technologies, the Energy Storage System Analysis and Development Department at Sandia National Laboratories (SNL) conducted a cost analysis of energy storage systems for electric utility applications. The scope of the study included the analysis of costs for existing and planned battery, SMES, and flywheel energy storage systems. The analysis also identified the potential for cost reduction of key components.

  8. Mobile technology in health information systems - a review.

    PubMed

    Zhang, X-Y; Zhang, P-Y

    2016-05-01

    Mobile technology is getting involved in every sphere of life including medical health care. There has been an immense upsurge in mobile phone-based health innovations these days. The expansion of mobile phone networks and the proliferation of inexpensive mobile handsets have made the digital information and communication technology capabilities very handy for the people to exploit if for any utility including health care. The mobile phone based innovations are able to transform weak and under performing health information system into more modern and efficient information system. The present review article will enlighten all these aspects of mobile technology in health care. PMID:27249615

  9. Food Insecurity and Health Care Utilization Among Older Adults in the United States.

    PubMed

    Bhargava, Vibha; Lee, Jung Sun

    2016-01-01

    This study examined the relationships between food insecurity and utilization of four health services among older Americans: office visits, inpatient hospital nights, emergency department visits, and home health care. Nationally representative data from the 2011 and 2012 National Health Interview Survey were used (N = 13,589). Nearly 83.0% of the sample had two or more office visits, 17.0% reported at least one hospital night, 23.0% had at least one emergency room visit, and 8.1% used home health care during the past 12 months. Adjusting for confounders, food-insecure older adults had higher odds of using more office visits, inpatient hospital nights, and emergency department visits than food-secure older adults, but similar odds of home health care utilization. The findings of this study suggest that programs and policies aimed at reducing food insecurity among older adults may have a potential to reduce utilization of health care services. PMID:27559853

  10. Utilizing JUSUR in an Information Systems Course

    ERIC Educational Resources Information Center

    Zouhair, Jalila

    2010-01-01

    The aims of this paper are to report the perceptions of both faculty and students when JUSUR, a web based Learning Management System, is used to supplement the teaching inside and outside the classroom during one academic subject; and to compare the experience of the instructor who had previously taught the same course using a course website to…

  11. Social Factors Related to the Utilization of Health Care Among Prison Inmates.

    PubMed

    Nowotny, Kathryn M

    2016-04-01

    This study examines the demographic and social factors related to health care utilization in prisons using the 2004 Survey of Inmates in State Correctional Facilities. The findings show that education and employment, strong predictors of health care in the community, are not associated with health care in prisons. Although female inmates have a higher disease burden than male inmates, there are no sex differences in health care usage. The factors associated with health care, however, vary for women and men. Notably, Black men are significantly more likely to utilize health care compared to White and Latino men. The findings suggest that, given the constitutionally mandated health care for inmates, prisons can potentially minimize racial disparities in care and that prisons, in general, are an important context for health care delivery in the United States. PMID:26984136

  12. Utilizing Codes of Ethics in Health Professions Education

    ERIC Educational Resources Information Center

    Dahnke, Michael D.

    2014-01-01

    Codes of ethics abound in health care, the aims and purposes of which are multiple and varied, from operating as a decision making tool to acting as a standard of practice that can be operational in a legal context to providing a sense of elevated seriousness and professionalism within a field of practice. There is some doubt and controversy,…

  13. Provider Types Utilized and Recency of Mental Health Service Use among African American Emerging Adults

    PubMed Central

    Williams, Sha-Lai

    2014-01-01

    Objective This study examined factors associated with mental health service utilization among African American emerging adults, specifically, when services were used (recency) and the types of providers utilized (mental health/non-mental health). Methods Guided by the Behavioral Model for Vulnerable Populations, secondary analysis of the National Survey of American Life (2001-2003) was conducted. A nationally representative sample of African American emerging adults, ages 18-29 (n=806), were assessed using the Composite International Diagnostic Interview. “Evaluated need” was determined by endorsement for one of four DSM-IV diagnosis types (mood, anxiety, substance use, impulse control). Respondents who reported a need for services for emotional/substance use problems were considered to have a “perceived need”. Those who reported voluntary use of mental health/health services to address these problems were considered to have utilized services. Results 25%of the sample utilized services in their lifetime, while 9% utilized services in the past 12 months. Females were more likely than males to utilize services in three of the four service use categories (lifetime, mental health sector, and non-mental health sector).Respondents with an evaluated need for services were 2-12 times more likely to have utilized services compared to those without a need. Conclusions Little is known about why African American emerging adults underutilize mental health services. These findings indicate that being female and having an evaluated need for services were associated with greater odds of service use among this sample. This suggests the need for additional examination of gender differences in service utilization and greater mental health outreach/education among African American males. PMID:24981778

  14. Utilizing feedback in adaptive SAR ATR systems

    NASA Astrophysics Data System (ADS)

    Horsfield, Owen; Blacknell, David

    2009-05-01

    Existing SAR ATR systems are usually trained off-line with samples of target imagery or CAD models, prior to conducting a mission. If the training data is not representative of mission conditions, then poor performance may result. In addition, it is difficult to acquire suitable training data for the many target types of interest. The Adaptive SAR ATR Problem Set (AdaptSAPS) program provides a MATLAB framework and image database for developing systems that adapt to mission conditions, meaning less reliance on accurate training data. A key function of an adaptive system is the ability to utilise truth feedback to improve performance, and it is this feature which AdaptSAPS is intended to exploit. This paper presents a new method for SAR ATR that does not use training data, based on supervised learning. This is achieved by using feature-based classification, and several new shadow features have been developed for this purpose. These features allow discrimination of vehicles from clutter, and classification of vehicles into two classes: targets, comprising military combat types, and non-targets, comprising bulldozers and trucks. The performance of the system is assessed using three baseline missions provided with AdaptSAPS, as well as three additional missions. All performance metrics indicate a distinct learning trend over the course of a mission, with most third and fourth quartile performance levels exceeding 85% correct classification. It has been demonstrated that these performance levels can be maintained even when truth feedback rates are reduced by up to 55% over the course of a mission.

  15. Treatment patterns, health state, and health care resource utilization of patients with radioactive iodine refractory differentiated thyroid cancer

    PubMed Central

    Gianoukakis, Andrew G; Flores, Natalia M; Pelletier, Corey L; Forsythe, Anna; Wolfe, Gregory R; Taylor, Matthew H

    2016-01-01

    Background Patients with differentiated thyroid cancer (DTC) often respond well to treatment but some become refractory to radioactive iodine (RAI) treatment, and treatment options are limited. Despite the humanistic and economic burden RAI refractory disease imposes on patients, published research concerning treatment patterns and health care resource utilization is sparse. Methods Data were collected from an online retrospective chart review study in the US and five European Union (EU) countries (France, Germany, Italy, Spain, and UK) with physicians recruited from an online panel. Physicians (N=211) provided demographics, disease history, treatment information, and health care resource utilization for one to four of their patients with radioactive iodine refractory differentiated thyroid cancer (RR-DTC). Results The majority of the patients with RR-DTC (N=623) were female (56%), and their mean age was 58.2 years. In this sample, 63.2% had papillary thyroid cancer and 57.0% were in Stage IV when deemed RAI refractory. Patients with RR-DTC experienced regional recurrence in the thyroid bed/central neck area (25.3%) and had distant metastatic disease (53.6%). At the time data were collected, 50.7% were receiving systemic treatment. Of those, 78.5% were on first-line treatment and 62.7% were receiving multikinase inhibitors. Regional differences for prescribed treatments were observed; the US was more likely to have patients receiving multikinase inhibitors (79.2%) compared with UK (41.2%) and Italy (17.1%). Additional details regarding treatment patterns and resource utilization are discussed. Conclusion The current study aimed to obtain a greater understanding of RR-DTC treatment globally. These results can assist in the development and implementation of treatment guidelines and ultimately enhance the care of patients with RR-DTC. PMID:27313476

  16. [Public health and the health system. SESPAS Report 2010].

    PubMed

    Aboal-Viñas, José Luis

    2010-12-01

    Analysis of the relationship between public health and the health system requires definition of a conceptual framework and the choice of a particular context. The chosen context of this discussion is the management of public organizations. With this in mind, functions will be associated with organizational macroprocesses. From this point of view, this article identifies the functions-processes that any health system should develop and their goals. The current situation of public health in the health system is analyzed through the study of public health budgets and the place they occupy in the hierarchy of the health departments of the autonomous communities. The "public health" budget program represents an average of 1.34% of health expenditure in the autonomous communities in 2010. Over 20% of public health organizations of the autonomous communities have a rank lower than general directorate. These data indicate the low weight assigned to public health in the health systems of the Spanish state. To change this situation, consensus must be reached on the desired relationship between public health and the health system. Such a consensus would then have to be accepted and work would have to be undertaken to improve results. Three alternatives are proposed: (i) public health would be an organization that would be above or outside the health system; (ii) public health would be synonymous with the public health system; and (iii) public health would form part of the health system with a range of assigned functions. Finally, we provide some recommendations to help define the most effective and efficient relationship between public health and the health system. PMID:20970219

  17. Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans

    ERIC Educational Resources Information Center

    Weeks, William B.; Bott, David M.; Lamkin, Rebecca P.; Wright, Steven M.

    2005-01-01

    Older veterans often use both the Veterans Health Administration (VHA) and Medicare to obtain health care services. The authors sought to compare outpatient medical service utilization of Medicare-enrolled rural veterans with their urban counterparts in New England. The authors combined VHA and Medicare databases and identified veterans who were…

  18. College Health Surveillance Network: Epidemiology and Health Care Utilization of College Students at US 4-Year Universities

    ERIC Educational Resources Information Center

    Turner, James C.; Keller, Adrienne

    2015-01-01

    Objective: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Participants: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Methods: Participating schools uploaded…

  19. The Associations between Health Literacy, Reasons for Seeking Health Information, and Information Sources Utilized by Taiwanese Adults

    ERIC Educational Resources Information Center

    Wei, Mi-Hsiu

    2014-01-01

    Objective: To determine the associations between health literacy, the reasons for seeking health information, and the information sources utilized by Taiwanese adults. Method: A cross-sectional survey of 752 adults residing in rural and urban areas of Taiwan was conducted via questionnaires. Chi-squared tests and logistic regression were used for…

  20. Mental health service utilization in sub-Saharan Africa: is public mental health literacy the problem? Setting the perspectives right.

    PubMed

    Atilola, Olayinka

    2016-06-01

    The severely constrained resources for mental health service in less-developed regions like sub-Saharan Africa underscore the need for good public mental health literacy as a potential additional mental health resource. Several studies examining the level of public knowledge about the nature and dynamics of mental illness in sub-Saharan Africa in the last decade had concluded that such knowledge was poor and had called for further public enlightenment. What was thought to be mental health 'ignorance' has also been blamed for poor mainstream service utilization. These views however assume that non-alignment of the views of community dwellers in sub-Saharan Africa with the biomedical understanding of mental illness connotes 'ignorance', and that correcting such 'ignorance' will translate to improvements in service utilization. Within the framework of contemporary thinking in mental health literacy, this paper argues that such assumptions are not culturally nuanced and may have overrated the usefulness of de-contextualized public engagement in enhancing mental health service utilization in the region. The paper concludes with a discourse on how to contextualize public mental health enlightenment in the region and the wider policy initiatives that can improve mental health service utilization. PMID:25749253

  1. Allied health: untapped potential in the Australian health system.

    PubMed

    Philip, Kathleen

    2015-06-01

    Although comprising around 20 per cent ofAustralia's health care workforce, allied health and its contribution to improving health outcomes remains poorly understood and largely invisible in the Australian health policy and reform environment. There is strong evidence demonstrating the benefits of allied health in improving patient outcomes, minimising risk and harm from illness and improving health system efficiency and capacity to meet increased demand cost effectively. Despite this, the existing health model, funding and culture prevent us from effectively accessing these benefits at a system level. The untapped potential of allied health represents a major underutilised resource to address many of the challenges facing Australia's health system today. A transformational change in the Australian health system in how, where and by whom care is provided is necessary. Australia's health model and culture needs to shift, to genuinely involve the consumer and make fill use of all three pillars of the patient care workforce. PMID:26629583

  2. Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty.

    PubMed

    Al, Maiwenn J; Feenstra, Talitha L; Hout, Ben A van

    2005-07-01

    This paper addresses the problem of how to value health care programmes with different ratios of costs to effects, specifically when taking into account that these costs and effects are uncertain. First, the traditional framework of maximising health effects with a given health care budget is extended to a flexible budget using a value function over money and health effects. Second, uncertainty surrounding costs and effects is included in the model using expected utility. Other approaches to uncertainty that do not specify a utility function are discussed and it is argued that these also include implicit notions about risk attitude. PMID:15678518

  3. Health risks of energy systems.

    PubMed

    Krewitt, W; Hurley, F; Trukenmüller, A; Friedrich, R

    1998-08-01

    Health risks from fossil, renewable and nuclear reference energy systems are estimated following a detailed impact pathway approach. Using a set of appropriate air quality models and exposure-effect functions derived from the recent epidemiological literature, a methodological framework for risk assessment has been established and consistently applied across the different energy systems, including the analysis of consequences from a major nuclear accident. A wide range of health impacts resulting from increased air pollution and ionizing radiation is quantified, and the transferability of results derived from specific power plants to a more general context is discussed. PMID:9775447

  4. A layman's guide to the U.S. health care system

    PubMed Central

    De Lew, Nancy; Greenberg, George; Kinchen, Kraig

    1992-01-01

    This article provides an overview of the U.S. health care system and recent proposals for health system reform. Prepared for a 15-nation comparative study for the Organization for Economic Cooperation and Development (OECD), the article summarizes descriptive data on the financing, utilization, access, and supply of U.S. health services; analyzes health system cost growth and trends; reviews health reforms adopted in the 1980s; and discusses proposals in the current health system reform debate. PMID:10124436

  5. Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality.

    PubMed

    Squires, David A

    2012-05-01

    This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation. PMID:22582452

  6. Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality.

    PubMed

    Squires, David A

    2012-05-01

    This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation. PMID:22619775

  7. Women's veteran identity and utilization of VA health services.

    PubMed

    Di Leone, Brooke A L; Wang, Joyce M; Kressin, Nancy; Vogt, Dawne

    2016-02-01

    Women have participated in the United States military since its founding. However, until the mid-20th century, there had been limited recognition of women as official members of the military, and women remain a statistical minority within military and veteran populations. It is therefore important to better understand women's veteran identity (which we define here as one's self-concept as derived from their veteran status) and associated implications for service use and experiences in the Department of Veterans Affairs (VA) health care setting. The present research examined the centrality of, and positive regard for, women's veteran identity among 407 female veterans deployed in support of the recent wars in Iraq and Afghanistan. Data were collected via a mailed national survey. Positive regard for veteran identity, but not veteran identity centrality,was positively associated with participants' age and length of time spent in the military. Results also showed that the centrality of women's veteran identity was positively related to their choice to use VA for health care and their feelings of belonging within VA, and that veteran identity centrality and positive regard for veteran identity are differentially associated with participants' military experiences (e.g., combat exposure, deployment sexual harassment) and mental health symptomatology (e.g., depression). PMID:25729892

  8. Health care utilization patterns in developing countries: role of the technology environment in "deriving" the demand for health care.

    PubMed Central

    Wouters, A. V.

    1992-01-01

    Health care services, in combination with several intermediate (proximate) determinants of health such as environmental sanitation and nutrition, directly influence health status. In the economics literature, this is referred to as the health production technology. Although many studies recognize that demand for health care depends on the health production technology, otherwise known as a "derived" demand, this review indicates that few of them have so far been able to fully incorporate this technology in estimating significant determinants of health care use. Understanding the technology environment could help explain why substantial portions of the population do not gain access to care even when financial factors do not appear to be a barrier. Also, low utilization of health services may simply reflect the low productivity of these services when other complementary factors such as nutrition or clean water and sanitation are lacking. Finally, since health-producing technology is often a multistep (multivisit) process, health care demand studies generally offer an incomplete picture of health care utilization patterns because they focus on a single event such as the first visit of an illness episode. Researchers should obtain more complete information on the interaction between all health production inputs, their availability and access to them. Multidisciplinary methodologies are likely to be useful. PMID:1638667

  9. Portable Health Algorithms Test System

    NASA Technical Reports Server (NTRS)

    Melcher, Kevin J.; Wong, Edmond; Fulton, Christopher E.; Sowers, Thomas S.; Maul, William A.

    2010-01-01

    A document discusses the Portable Health Algorithms Test (PHALT) System, which has been designed as a means for evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT system allows systems health management algorithms to be developed in a graphical programming environment, to be tested and refined using system simulation or test data playback, and to be evaluated in a real-time hardware-in-the-loop mode with a live test article. The integrated hardware and software development environment provides a seamless transition from algorithm development to real-time implementation. The portability of the hardware makes it quick and easy to transport between test facilities. This hard ware/software architecture is flexible enough to support a variety of diagnostic applications and test hardware, and the GUI-based rapid prototyping capability is sufficient to support development execution, and testing of custom diagnostic algorithms. The PHALT operating system supports execution of diagnostic algorithms under real-time constraints. PHALT can perform real-time capture and playback of test rig data with the ability to augment/ modify the data stream (e.g. inject simulated faults). It performs algorithm testing using a variety of data input sources, including real-time data acquisition, test data playback, and system simulations, and also provides system feedback to evaluate closed-loop diagnostic response and mitigation control.

  10. A structured review of health utility measures and elicitation in advanced/metastatic breast cancer

    PubMed Central

    Hao, Yanni; Wolfram, Verena; Cook, Jennifer

    2016-01-01

    Background Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Methods Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives. Results A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy – General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified

  11. Motion Estimation System Utilizing Point Cloud Registration

    NASA Technical Reports Server (NTRS)

    Chen, Qi (Inventor)

    2016-01-01

    A system and method of estimation motion of a machine is disclosed. The method may include determining a first point cloud and a second point cloud corresponding to an environment in a vicinity of the machine. The method may further include generating a first extended gaussian image (EGI) for the first point cloud and a second EGI for the second point cloud. The method may further include determining a first EGI segment based on the first EGI and a second EGI segment based on the second EGI. The method may further include determining a first two dimensional distribution for points in the first EGI segment and a second two dimensional distribution for points in the second EGI segment. The method may further include estimating motion of the machine based on the first and second two dimensional distributions.

  12. Utilization of artificial intelligence techniques for the Space Station power system

    NASA Technical Reports Server (NTRS)

    Evatt, Thomas C.; Gholdston, Edward W.

    1988-01-01

    Due to the complexity of the Space Station Electrical Power System (EPS) as currently envisioned, artificial intelligence/expert system techniques are being investigated to automate operations, maintenance, and diagnostic functions. A study was conducted to investigate this technology as it applies to failure detection, isolation, and reconfiguration (FDIR) and health monitoring of power system components and of the total system. Control system utilization of expert systems for load scheduling and shedding operations was also researched. A discussion of the utilization of artificial intelligence/expert systems for Initial Operating Capability (IOC) for the Space Station effort is presented along with future plans at Rocketdyne for the utilization of this technology for enhanced Space Station power capability.

  13. Health in cities: is a systems approach needed?

    PubMed

    Diez Roux, Ana V

    2015-11-01

    This paper reviews the potential utility of using the concepts and tools of systems to understand and act on health in cities. The basic elements of systems approaches and the links between cities as systems and population health as emerging from the functioning of a system are reviewed. The paper also discusses implications of systems thinking for urban health including the development of dynamic conceptual models, the use of new tools, the integration of data in new ways and the identification of data gaps, and the formulation of different kinds of questions and identification of new policies. The paper concludes with a review of caveats and challenges. PMID:26648353

  14. Interconnecting Single-Phase Generation to the Utility Distribution System

    SciTech Connect

    Dugan, R.C.

    2001-12-05

    One potentially large source of underutilized distributed generation (DG) capacity exists in single-phase standby backup gensets on farms served from single-phase feeder laterals. Utilizing the excess capacity would require interconnecting to the utility system. Connecting single-phase gensets to the utility system presents some interesting technical issues that have not been previously investigated. This paper addresses several of the interconnection issues associated with this form of DG including voltage regulation, harmonics, overcurrent protection, and islanding. A significant amount of single-phase DG can be accommodated by the utility distribution system, but there are definite limitations due to the nature and location of the DG. These limitations may be more restrictive than is commonly assumed for three-phase DG installed on stronger parts of the electric distribution system.

  15. Utility-scale system preventive and failure-related maintenance

    SciTech Connect

    Jennings, C.; Hutchinson, P.

    1995-11-01

    This paper describes the design and performance background on PVUSA utility-scale systems at Davis and Kerman, California, and reports on a preventative and failure-related maintenance approach and costs.

  16. Advanced fuel system technology for utilizing broadened property aircraft fuels

    NASA Technical Reports Server (NTRS)

    Reck, G. M.

    1980-01-01

    Possible changes in fuel properties are identified based on current trends and projections. The effect of those changes with respect to the aircraft fuel system are examined and some technological approaches to utilizing those fuels are described.

  17. Health-weighted Composite Quality Metrics Offer Promise to Improve Health Outcomes in a Learning Health System.

    PubMed

    Braithwaite, Scott; Stine, Nicholas

    2013-01-01

    Health system leaders sometimes adopt quality metrics without robust supporting evidence of improvements in quality and/or quantity of life, which may impair rather than facilitate improved health outcomes. In brief, there is now no easy way to measure how much "health" is conferred by a health system. However, we argue that this goal is achievable. Health-weighted composite quality metrics have the potential to measure "health" by synthesizing individual evidence-based quality metrics into a summary measure, utilizing relative weightings that reflect the relative amount of health benefit conferred by each constituent quality metric. Previously, it has been challenging to create health-weighted composite quality metrics because of methodological and data limitations. However, advances in health information technology and mathematical modeling of disease progression promise to help mitigate these challenges by making patient-level data (eg, from the electronic health record and mobile health (mHealth) more accessible and more actionable for use. Accordingly, it may now be possible to use health information technology to calculate and track a health-weighted composite quality metric for each patient that reflects the health benefit conferred to that patient by the health system. These health-weighted composite quality metrics can be employed for a multitude of important aims that improve health outcomes, including quality evaluation, population health maximization, health disparity attenuation, panel management, resource allocation, and personalization of care. We describe the necessary attributes, the possible uses, and the likely limitations and challenges of health-weighted composite quality metrics using patient-level health data. PMID:25848572

  18. Acculturation and health care utilization among Mexican heritage women in the United States.

    PubMed

    Bermúdez-Parsai, Mónica; Mullins Geiger, Jennifer L; Marsiglia, Flavio F; Coonrod, Dean V

    2012-08-01

    With the increasing Latino population in the United States, it is critical to examine the influence of the process of acculturation on health care practices and utilization. The purpose of this study was to evaluate the relationship between acculturation level and post-partum visit (PPV) compliance among Latinas participating in a larger psycho-educational intervention aimed at encouraging women to engage in positive healthcare practices. Acculturation was measured with the Bicultural Involvement Questionnaire which assigned participants to five categories: Assimilated, Separated, Moderate, Bicultural and Alienation. Logistic Regression analyses were conducted to predict post-partum visit attendance. Odds ratios and relative risk of not attending the post-partum visit are presented. Results suggest women in the Separation and Assimilation groups were less likely than bicultural group members to attend the PPV. The only other variable that was significant in this analysis is the group condition, indicating that the intervention group was more likely to attend the PPV than the control group. Women identifying as bicultural seem to participate more actively in their own healthcare as they draw on the cultural assets that have a positive influence on informal health practices, such as healthy eating and refraining from drug use. Bicultural group members can also use formal skills related to language and knowledge of the dominant culture to help effectively navigate the healthcare system. Implications for research, intervention and practice are discussed to improve healthcare practices and increase utilization among Latinas. PMID:21725624

  19. Medicare-Certified Home Health Care: Urban-Rural Differences in Utilization

    ERIC Educational Resources Information Center

    Hartman, Lacey; Jarosek, Stephanie L.; Virnig, Beth A.; Durham, Sara

    2007-01-01

    Context: Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail. Purpose: To examine urban-rural differences in Medicare HHC utilization. Methods: The 2002 100% Medicare HHC claims and denominator files were…

  20. Transfer and utilization of government technology assets to the private sector in the fields of health care and information technologies

    NASA Astrophysics Data System (ADS)

    Kun, Luis G.

    1995-10-01

    During the first Health Care Technology Policy conference last year, during health care reform, four major issues were brought up in regards to the efforts underway to develop a computer based patient record (CBPR), the National Information Infrastructure (NII) as part of the high performance computers and communications (HPCC), and the so-called 'patient card.' More specifically it was explained how a national information system will greatly affect the way health care delivery is provided to the United States public and reduce its costs. These four issues were: (1) Constructing a national information infrastructure (NII); (2) Building a computer based patient record system; (3) Bringing the collective resources of our national laboratories to bear in developing and implementing the NII and CBPR, as well as a security system with which to safeguard the privacy rights of patients and the physician-patient privilege; (4) Utilizing government (e.g., DOD, DOE) capabilities (technology and human resources) to maximize resource utilization, create new jobs, and accelerate technology transfer to address health care issues. This year a section of this conference entitled: 'Health Care Technology Assets of the Federal Government' addresses benefits of the technology transfer which should occur for maximizing already developed resources. This section entitled: 'Transfer and Utilization of Government Technology Assets to the Private Sector,' will look at both health care and non-health care related technologies since many areas such as information technologies (i.e. imaging, communications, archival/retrieval, systems integration, information display, multimedia, heterogeneous data bases, etc.) already exist and are part of our national labs and/or other federal agencies, i.e., ARPA. These technologies although they are not labeled under health care programs they could provide enormous value to address technical needs. An additional issue deals with both the technical

  1. Integrated Baseline System (IBS) Version 2.0: Utilities Guide

    SciTech Connect

    Burford, M.J.; Downing, T.R.; Williams, J.R.; Bower, J.C.

    1994-03-01

    The Integrated Baseline System (IBS) is an emergency management planning and analysis tool being developed under the direction of the US Army Nuclear and Chemical Agency. This Utilities Guide explains how you can use the IBS utility programs to manage and manipulate various kinds of IBS data. These programs include utilities for creating, editing, and displaying maps and other data that are referenced to geographic location. The intended audience for this document are chiefly data managers but also system managers and some emergency management planners and analysts.

  2. Community perceptions and factors influencing utilization of health services in Uganda

    PubMed Central

    Bakeera, Solome K; Wamala, Sarah P; Galea, Sandro; State, Andrew; Peterson, Stefan; Pariyo, George W

    2009-01-01

    Background Healthcare utilization has particular relevance as a public health and development issue. Unlike material and human capital, there is little empirical evidence on the utility of social resources in overcoming barriers to healthcare utilization in a developing country context. We sought to assess the relevance of social resources in overcoming barriers to healthcare utilization. Study Objective To explore community perceptions among three different wealth categories on factors influencing healthcare utilization in Eastern Uganda. Methods We used a qualitative study design using Focus Group Discussions (FGD) to conduct the study. Community meetings were initially held to identify FGD participants in the different wealth categories, ('least poor', 'medium' and 'poorest') using poverty ranking based on ownership of assets and income sources. Nine FGDs from three homogenous wealth categories were conducted. Data from the FGDs was analyzed using content analysis revealing common barriers as well as facilitating factors for healthcare service utilization by wealth categories. The Health Access Livelihood Framework was used to examine and interpret the findings. Results Barriers to healthcare utilization exist for all the wealth categories along three different axes including: the health seeking process; health services delivery; and the ownership of livelihood assets. Income source, transport ownership, and health literacy were reported as centrally useful in overcoming some barriers to healthcare utilization for the 'least poor' and 'poor' wealth categories. The 'poorest' wealth category was keen to utilize free public health services. Conversely, there are perceptions that public health facilities were perceived to offer low quality care with chronic gaps such as shortages of essential supplies. In addition to individual material resources and the availability of free public healthcare services, social resources are perceived as important in overcoming

  3. Power System State of Health

    NASA Astrophysics Data System (ADS)

    Carpenter, P.

    2012-12-01

    Understanding the state of a polar station's power system can be critical to a successful long-term deployment. Knowing how the system is functioning, prior to service, is key to proper logistics, scheduling and the service performed during a visit. A full record of power system performance is key to proper analysis of the health of the power system. The design of a power system with monitoring is a balance of components to gather information while still trying to keep complexity low. To properly incorporate a system to analyze a stations power system a firm understanding of how the power components function in polar environments as well as communication to data acquisition and / or telemetry is needed. For example designers will need to know how a station's power storage system will change in colder environments then manufactures standard design criteria. This would include the reduced available capacity, change in the mean time between failure and possible new failure modes. This understanding coupled with a system that would collect key information on the state of health of the power system will provide crucial insight in to what service is needed to keep the station functioning.

  4. Trends in Mental Health Services Utilization and Stigma in US Soldiers From 2002 to 2011

    PubMed Central

    Wilk, Joshua E.; Thomas, Jeffrey L.; Bray, Robert M.; Rae Olmsted, Kristine L.; Brown, Janice M.; Williams, Jason; Kim, Paul Y.; Clarke-Walper, Kristina; Hoge, Charles W.

    2014-01-01

    Objectives. We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. Methods. We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12 835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22 627). Results. HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Conclusions. Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention. PMID:25033143

  5. Optimal Wonderful Life Utility Functions in Multi-Agent Systems

    NASA Technical Reports Server (NTRS)

    Wolpert, David H.; Tumer, Kagan; Swanson, Keith (Technical Monitor)

    2000-01-01

    The mathematics of Collective Intelligence (COINs) is concerned with the design of multi-agent systems so as to optimize an overall global utility function when those systems lack centralized communication and control. Typically in COINs each agent runs a distinct Reinforcement Learning (RL) algorithm, so that much of the design problem reduces to how best to initialize/update each agent's private utility function, as far as the ensuing value of the global utility is concerned. Traditional team game solutions to this problem assign to each agent the global utility as its private utility function. In previous work we used the COIN framework to derive the alternative Wonderful Life Utility (WLU), and experimentally established that having the agents use it induces global utility performance up to orders of magnitude superior to that induced by use of the team game utility. The WLU has a free parameter (the clamping parameter) which we simply set to zero in that previous work. Here we derive the optimal value of the clamping parameter, and demonstrate experimentally that using that optimal value can result in significantly improved performance over that of clamping to zero, over and above the improvement beyond traditional approaches.

  6. Local public health system partnerships.

    PubMed Central

    Zahner, Susan J.

    2005-01-01

    OBJECTIVES: Interorganizational collaboration aimed at community health improvement is an expectation of local public health systems. This study assessed the extent to which such collaboration occurred within one state (Wisconsin), described the characteristics of existing partnerships, and identified factors associated with partnership effectiveness. METHODS: In Stage 1, local health department (LHD) directors in Wisconsin were surveyed (93% response rate). In Stage 2, LHDs completed self-administered mailed surveys for each partnership identified in Stage 1 (85% response rate). Two-level hierarchical logit regression methods were used to model relationships between partnership and LHD variables and partnership outcomes. Data from 924 partnerships associated with 74 LHDs were included in the analysis. RESULTS: Partnerships most frequently addressed tobacco prevention and control, maternal and child health, emergency planning, community assessment and planning, and immunizations. Partnering was most frequent with other government agencies, hospitals, medical practices or clinics, community-based organizations, and schools. Partnership effectiveness was predicted by having a budget, having more partners contributing financially, having a broader array of organizations involved, and having been in existence for a longer period of time. A government mandate to start the partnership was inversely related to successful outcomes. Characteristics of LHDs did not predict partnership effectiveness. CONCLUSIONS: Financial support, having a broader array of partners, and allowing sufficient time for partnerships to succeed contribute to partnership effectiveness. Further study-using objective outcome measures-is needed to examine the effects of organizational and community characteristics on the effectiveness of local public health system partnerships. PMID:15736335

  7. Population prevalence of personality disorder and associations with physical health comorbidities and health care service utilization: A review.

    PubMed

    Quirk, Shae E; Berk, Michael; Chanen, Andrew M; Koivumaa-Honkanen, Heli; Brennan-Olsen, Sharon L; Pasco, Julie A; Williams, Lana J

    2016-04-01

    Personality disorder (PD), outcomes of diverse comorbid physical health conditions, and the associated burden on health service resources have seldom been studied at a population level. Consequently, there is limited evidence that might inform a public health approach to managing PD and associated mental and physical disability. A review was conducted of population-based studies examining the prevalence of PD and associations between physical comorbidities and service utilization. The prevalence of any PDs were common (4.4% -21.5%) among populations spanning England, Wales, Scotland, Western Europe, Norway, Australia, and the United States. Preliminary evidence supports associations between PDs from Clusters A and B and physical comorbidities, namely cardiovascular diseases and arthritis. PD appears to increase health care utilization, particularly in primary care. In order to facilitate rational population health planning, further population studies are required. (PsycINFO Database Record PMID:26461047

  8. College Health Surveillance Network: Epidemiology and Health Care Utilization of College Students at US 4-Year Universities

    PubMed Central

    Turner, James C.; Keller, Adrienne

    2015-01-01

    Abstract Objective: This description of the College Health Surveillance Network (CHSN) includes methodology, demography, epidemiology, and health care utilization. Participants: Twenty-three universities representing approximately 730,000 enrolled students contributed data from January 1, 2011, through May 31, 2014. Methods: Participating schools uploaded de-identified electronic health records from student health services monthly. Results: During this study, just over 800,000 individuals used the health centers, comprising 4.17 million patient encounters. Sixty percent of visits included primary care, 13% mental health, 9% vaccination, and 31% other miscellaneous services. The 5 most common specific diagnostic categories (with annual rates per 100 enrolled students) were preventive (16); respiratory (12); skin, hair, and nails; infectious non–sexually transmitted infection (5 each); and mental health (4). Utilization and epidemiologic trends are identified among subpopulations of students. Conclusions: CHSN data establish trends in utilization and epidemiologic patterns by college students and the importance of primary and behavioral health care services on campuses. PMID:26086428

  9. Outness, Stigma, and Primary Health Care Utilization among Rural LGBT Populations

    PubMed Central

    Whitehead, J.; Shaver, John; Stephenson, Rob

    2016-01-01

    Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405

  10. A multichannel EEG telemetry system utilizing a PCM subcarrier

    NASA Technical Reports Server (NTRS)

    Fryer, T. B.

    1974-01-01

    A multichannel personal-type telemetry system is described that utilizes PCM encoding for the most effective range with minimum RF bandwidth and noise interference. Recent IC developments (COS MOS) make it possible to implement a sophisticated encoding system (PCM) within the low power and size constraints necessary for a personal biotelemetry system. This system includes low-level high-impedance preamplifiers to make the system suitable for EEG recording.

  11. Integrating homoeopathy in health systems.

    PubMed Central

    Poitevin, B.

    1999-01-01

    Homoeopathy is a therapy which involves many components and three main agents: the patient, with his or her condition and personal characteristics; the medication used, with its composition and manufacturing procedure; and the physician, with his or her approach to treatment and concepts of health. The development of research and evaluation structures, combined with a critical education in the discipline, would help to improve practices and define homoeopathy's potential role in relation to the other therapies, both conventional and unconventional, used in Western health systems. PMID:10083716

  12. Caregiver Factors Predicting Service Utilization among Youth Participating in a School-Based Mental Health Intervention

    ERIC Educational Resources Information Center

    Burnett-Zeigler, Inger; Lyons, John S.

    2010-01-01

    Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention…

  13. Behavioral Health Services Utilization among Older Adults Identified within a State Abuse Hotline Database

    ERIC Educational Resources Information Center

    Schonfeld, Lawrence; Larsen, Rebecca G.; Stiles, Paul G.

    2006-01-01

    Purpose: This study examined the extent to which older adults identified in a statewide abuse hotline registry utilized behavioral health services. This is important as mental health issues have been identified as a high priority for filling gaps in services for victims of mistreatment. Design and Methods: We compared Medicaid and Medicare claims…

  14. Home Health Care Utilization: A Review of the Research for Social Work

    ERIC Educational Resources Information Center

    Kadushin, Goldie

    2004-01-01

    The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing,…

  15. Increased Health Service Utilization Costs in the Year Prior to Institutionalization: Findings from the Canadian Study of Health and Aging

    PubMed Central

    Naslund, John A.; Sauter, Agnes H.; Gutman, Gloria; Beattie, B. Lynn

    2014-01-01

    Objectives The objective of this study was to characterize patterns of formal health service utilization costs during older adults’ transition from community to institutional care. Methods Participants were 127 adults (age ≥ 65) from the British Columbia sample (N = 2,057) of the Canadian Study of Health and Aging who transitioned from community to institutional care between 1991 and 2001. Health service utilization costs were measured using Cost-Per-Day-At-Risk at five time points: > 12 months, 6–12 months, and ≤ 6 months preinstitutionalization, and ≤ 6 months and 6–12 months postinstitutionalization. Cost-Per-Day-At-Risk was measured for Continuing Care, Medical Services Plan, and PharmaCare costs by calculating total health service use over time, divided by the number of days the participant was alive. Results Significant differences in Cost-Per-Day-At-Risk were observed for Continuing Care, Medical Services Plan, and PharmaCare costs over time. All health service utilization costs increased significantly during the 6–12 months and ≤ 6 months prior to institutionalization. Postinstitutionalization Continuing Care costs continued to increase at ≤ 6 months before decreasing at 6–12 months, while decreases occurred for Medical Services Plan and PharmaCare costs relative to preinstitutionalization costs. Conclusions The increases in costs observed during the year prior to institutionalization, characterized by a flurry of health service utilization, provide evidence of distinct cost patterns over the transition period. PMID:24883162

  16. Integrated Systems Health Management for Intelligent Systems

    NASA Technical Reports Server (NTRS)

    Figueroa, Fernando; Melcher, Kevin

    2011-01-01

    The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. Management implies storage, distribution, sharing, maintenance, processing, reasoning, and presentation. ISHM is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this chapter, concepts, procedures, and approaches are presented as a foundation for implementing an ISHM capability relevant to intelligent systems. The capability stresses integration of DIaK from all elements of a system, emphasizing an advance toward an on-board, autonomous capability. Both ground-based and on-board ISHM capabilities are addressed. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.

  17. Access, utilization, and interest in mHealth applications among veterans receiving outpatient care for PTSD.

    PubMed

    Erbes, Christopher R; Stinson, Rebecca; Kuhn, Eric; Polusny, Melissa; Urban, Jessica; Hoffman, Julia; Ruzek, Josef I; Stepnowsky, Carl; Thorp, Steven R

    2014-11-01

    Mobile health (mHealth) refers to the use of mobile technology (e.g., smartphones) and software (i.e., applications) to facilitate or enhance health care. Several mHealth programs act as either stand-alone aids for Veterans with post-traumatic stress disorder (PTSD) or adjuncts to conventional psychotherapy approaches. Veterans enrolled in a Veterans Affairs outpatient treatment program for PTSD (N = 188) completed anonymous questionnaires that assessed Veterans' access to mHealth-capable devices and their utilization of and interest in mHealth programs for PTSD. The majority of respondents (n = 142, 76%) reported having access to a cell phone or tablet capable of running applications, but only a small group (n = 18) reported use of existing mHealth programs for PTSD. Age significantly predicted ownership of mHealth devices, but not utilization or interest in mHealth applications among device owners. Around 56% to 76% of respondents with access indicated that they were interested in trying mHealth programs for such issues as anger management, sleep hygiene, and management of anxiety symptoms. Findings from this sample suggest that Veterans have adequate access to, and interest in, using mHealth applications to warrant continued development and evaluation of mobile applications for the treatment of PTSD and other mental health conditions. PMID:25373044

  18. Systemic diseases and oral health.

    PubMed

    Tavares, Mary; Lindefjeld Calabi, Kari A; San Martin, Laura

    2014-10-01

    The US population is at the beginning of a significant demographic shift; the American geriatric population is burgeoning, and average longevity is projected to increase in the coming years. Elder adults are affected by numerous chronic conditions, such as diabetes, hypertension, osteoarthritis, osteoporosis, cardiovascular diseases, and cerebrovascular diseases. These older adults need special dental care and an improved understanding of the complex interactions of oral disease and systemic chronic diseases that can complicate their treatment. Oral diseases have strong associations with systemic diseases, and poor oral health can worsen the impact of systemic diseases. PMID:25201543

  19. Health service utilization and access to medicines among Syrian refugee children in Jordan

    PubMed Central

    Lyles, Emily; Akhu‐Zaheya, Laila; Burton, Ann; Weiss, William

    2016-01-01

    Summary Background With over one million Syrian refugee children in the region, we undertook this study to characterize care‐seeking behaviors and health service utilization for child refugees with the aim of informing humanitarian programming for non‐camp settings in Jordan. Methods A survey of Syrian refugees living outside of camps in Jordan was conducted using a 125 × 12 cluster design with probability proportional to size sampling to obtain a representative sample. The questionnaire focused on access to health services, including a module on care seeking for children. Results Care seeking was high with 90.9% of households with a child less than 18 years seeking medical care the last time it was needed. Households most often sought care for children in the public sector (54.6%), followed by private (36.5%) and charity sectors (8.9%). Among child care seekers, 88.6% were prescribed medication during the most recent visit, 90.6% of which obtained the medication. Overall, 49.4% of households reported out‐of‐pocket expenditures for either the consultation or prescribed medications at the most recent visit (mean $US21.1 and median $US0). Conclusions Syrian refugees had good access to care for their sick children at the time of the survey; however, this has likely deteriorated since the survey because of the withdrawal of free access for refugees. The number of refugees in Jordan and relative accessibility of care has resulted in a large burden on the health system; the Jordanian government will require additional support if current levels of health access are to be maintained for Syrian refugees. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd. PMID:26799158

  20. Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s.

    PubMed

    Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro

    2016-03-15

    We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health. PMID:26946395

  1. Capacity Utilization Study for Aviation Security Cargo Inspection Queuing System

    SciTech Connect

    Allgood, Glenn O; Olama, Mohammed M; Lake, Joe E; Brumback, Daryl L

    2010-01-01

    In this paper, we conduct performance evaluation study for an aviation security cargo inspection queuing system for material flow and accountability. The queuing model employed in our study is based on discrete-event simulation and processes various types of cargo simultaneously. Onsite measurements are collected in an airport facility to validate the queuing model. The overall performance of the aviation security cargo inspection system is computed, analyzed, and optimized for the different system dynamics. Various performance measures are considered such as system capacity, residual capacity, throughput, capacity utilization, subscribed capacity utilization, resources capacity utilization, subscribed resources capacity utilization, and number of cargo pieces (or pallets) in the different queues. These metrics are performance indicators of the system s ability to service current needs and response capacity to additional requests. We studied and analyzed different scenarios by changing various model parameters such as number of pieces per pallet, number of TSA inspectors and ATS personnel, number of forklifts, number of explosives trace detection (ETD) and explosives detection system (EDS) inspection machines, inspection modality distribution, alarm rate, and cargo closeout time. The increased physical understanding resulting from execution of the queuing model utilizing these vetted performance measures should reduce the overall cost and shipping delays associated with new inspection requirements.

  2. Capacity utilization study for aviation security cargo inspection queuing system

    NASA Astrophysics Data System (ADS)

    Allgood, Glenn O.; Olama, Mohammed M.; Lake, Joe E.; Brumback, Daryl

    2010-04-01

    In this paper, we conduct performance evaluation study for an aviation security cargo inspection queuing system for material flow and accountability. The queuing model employed in our study is based on discrete-event simulation and processes various types of cargo simultaneously. Onsite measurements are collected in an airport facility to validate the queuing model. The overall performance of the aviation security cargo inspection system is computed, analyzed, and optimized for the different system dynamics. Various performance measures are considered such as system capacity, residual capacity, throughput, capacity utilization, subscribed capacity utilization, resources capacity utilization, subscribed resources capacity utilization, and number of cargo pieces (or pallets) in the different queues. These metrics are performance indicators of the system's ability to service current needs and response capacity to additional requests. We studied and analyzed different scenarios by changing various model parameters such as number of pieces per pallet, number of TSA inspectors and ATS personnel, number of forklifts, number of explosives trace detection (ETD) and explosives detection system (EDS) inspection machines, inspection modality distribution, alarm rate, and cargo closeout time. The increased physical understanding resulting from execution of the queuing model utilizing these vetted performance measures should reduce the overall cost and shipping delays associated with new inspection requirements.

  3. Fission Technology for Exploring and Utilizing the Solar System

    NASA Technical Reports Server (NTRS)

    Houts, Mike; VanDyke, Melissa; Godfroy, Tom; Pedersen, Kevin; Martin, James; Dickens, Ricky; Salvail, Pat; Hrbub, Ivana; Schmidt, George R. (Technical Monitor)

    2000-01-01

    Fission technology can enable rapid, affordable access to any point in the solar system. Potential fission-based transportation options include bimodal nuclear thermal rockets, high specific energy propulsion systems, and pulsed fission propulsion systems. In-space propellant re-supply enhances the effective performance of all systems, but requires significant infrastructure development. Safe, timely, affordable utilization of first-generation space fission propulsion systems will enable the development of more advanced systems. First generation space systems will build on over 45 years of US and international space fission system technology development to minimize cost,

  4. Measuring Health Utilities in Children and Adolescents: A Systematic Review of the Literature

    PubMed Central

    Thorrington, Dominic; Eames, Ken

    2015-01-01

    Background The objective of this review was to evaluate the use of all direct and indirect methods used to estimate health utilities in both children and adolescents. Utilities measured pre- and post-intervention are combined with the time over which health states are experienced to calculate quality-adjusted life years (QALYs). Cost-utility analyses (CUAs) estimate the cost-effectiveness of health technologies based on their costs and benefits using QALYs as a measure of benefit. The accurate measurement of QALYs is dependent on using appropriate methods to elicit health utilities. Objective We sought studies that measured health utilities directly from patients or their proxies. We did not exclude those studies that also included adults in the analysis, but excluded those studies focused only on adults. Methods and Findings We evaluated 90 studies from a total of 1,780 selected from the databases. 47 (52%) studies were CUAs incorporated into randomised clinical trials; 23 (26%) were health-state utility assessments; 8 (9%) validated methods and 12 (13%) compared existing or new methods. 22 unique direct or indirect calculation methods were used a total of 137 times. Direct calculation through standard gamble, time trade-off and visual analogue scale was used 32 times. The EuroQol EQ-5D was the most frequently-used single method, selected for 41 studies. 15 of the methods used were generic methods and the remaining 7 were disease-specific. 48 of the 90 studies (53%) used some form of proxy, with 26 (29%) using proxies exclusively to estimate health utilities. Conclusions Several child- and adolescent-specific methods are still being developed and validated, leaving many studies using methods that have not been designed or validated for use in children or adolescents. Several studies failed to justify using proxy respondents rather than administering the methods directly to the patients. Only two studies examined missing responses to the methods administered with

  5. [Professional health cards (CPS): informatic health care system in France].

    PubMed

    Fortuit, P

    2005-09-01

    The Professional Health Card Public interest group (Groupement d'Intérêt Public-Carte de professionnel de Santé (GIP-CPS)) was founded in 1993 as a joint initiative by the different parties involved in health care in France: the state, the representatives of the health care professions and the compulsory and complementary health insurance organizations. The CPS system enables safe exchange and electronic sharing of medical data. Via Intranet connections and Extranet hosting of medical files, databases, the CPS system enables health care professionals who access servers to be identified with certainty. For email exhanges, the CPS systems guarantees the sender's identity and capacity. The electronic signature gives legal value to the email. The system also enables confidential email. The health card system (CPS) contributes to making the health service efficient. Shared medical files, health care networks, health warning systems or electronic requests for reimbursement of health insurance expenses all use the CPS system. More than 300,000 health care professionals use it regularly. The freedom of movement of patients throughout Europe has led to the growth of exchanges and information sharing between health professionals in the States of the Union. More and more health professionals will be leaving their own countries to work in foreign countries in the future. It is essential that their freedom of movement is accompanied by the ability to prove their rights to practice. PMID:16385785

  6. [The health system of Argentina].

    PubMed

    Belló, Mariana; Becerril-Montekio, Victor M

    2011-01-01

    This paper describes the health system of Argentina.This system has three sectors: public, social security and private.The public sector includes the national and provincial ministries as well as the network of public hospitals and primary health care units which provide care to the poor and uninsured population. This sector is financed with taxes and payments made by social security beneficiaries that use public health care facilities. The social security sector or Obras Sociales (OS) covers all workers of the formal economy and their families. Most OS operate through contracts with private providers and are financed with payroll contributions of employers and employees. Finally, the private sector includes all those private providers offering services to individuals, OS beneficiaries and all those with private health insurance.This sector also includes private insurance agencies called Prepaid Medicine Enterprises, financed mostly through premiums paid by families and/or employers.This paper also discusses some of the recent innovations implemented in Argentina, including the program Remediar. PMID:21877098

  7. Energy Systems and Population Health

    SciTech Connect

    Ezzati, Majid; Bailis, Rob; Kammen, Daniel M.; Holloway, Tracey; Price, Lynn; Cifuentes, Luis A.; Barnes, Brendon; Chaurey, Akanksha; Dhanapala, Kiran N.

    2004-04-12

    It is well-documented that energy and energy systems have a central role in social and economic development and human welfare at all scales, from household and community to regional and national (41). Among its various welfare effects, energy is closely linked with people s health. Some of the effects of energy on health and welfare are direct. With abundant energy, more food or more frequent meals can be prepared; food can be refrigerated, increasing the types of food items that are consumed and reducing food contamination; water pumps can provide more water and eliminate the need for water storage leading to contamination or increased exposure to disease vectors such as mosquitoes or snails; water can be disinfected by boiling or using other technologies such as radiation. Other effects of energy on public health are mediated through more proximal determinants of health and disease. Abundant energy can lead to increased irrigation, agricultural productivity, and access to food and nutrition; access to energy can also increase small-scale income generation such as processing of agricultural commodities (e.g., producing refined oil from oil seeds, roasting coffee, drying and preserving fruits and meats) and production of crafts; ability to control lighting and heating allows education or economic activities to be shielded from daily or seasonal environmental constraints such as light, temperature, rainfall, or wind; time and other economic resources spent on collecting and/or transporting fuels can be used for other household needs if access to energy is facilitated; energy availability for transportation increases access to health and education facilities and allow increased economic activity by facilitating the transportation of goods and services to and from markets; energy for telecommunication technology (radio, television, telephone, or internet) provides increased access to information useful for health, education, or economic purposes; provision of energy

  8. Distributed photovoltaic systems: Utility interface issues and their present status

    NASA Technical Reports Server (NTRS)

    Hassan, M.; Klein, J.

    1981-01-01

    Major technical issues involving the integration of distributed photovoltaics (PV) into electric utility systems are defined and their impacts are described quantitatively. An extensive literature search, interviews, and analysis yielded information about the work in progress and highlighted problem areas in which additional work and research are needed. The findings from the literature search were used to determine whether satisfactory solutions to the problems exist or whether satisfactory approaches to a solution are underway. It was discovered that very few standards, specifications, or guidelines currently exist that will aid industry in integrating PV into the utility system. Specific areas of concern identified are: (1) protection, (2) stability, (3) system unbalance, (4) voltage regulation and reactive power requirements, (5) harmonics, (6) utility operations, (7) safety, (8) metering, and (9) distribution system planning and design.

  9. Penetration of wind electric conversion systems into the utility grid

    SciTech Connect

    Vachtsevanos, G.J.; Kalaitzakis, K.C.

    1985-07-01

    This paper is concerned with the development of appropriate models for the interconnected operation of wind generator clusters with an autonomous power system and simulation techniques for the study of the degree of penetration of such wind electric conversion devices when operating in parallel with the utility grid. The quality of the interconnected system performance is specified in terms of operational constraints and the resultant penetration strategy is implemented via a microprocessor-based control scheme. The strategy assures a satisfactory level of system performance while optimizing the available energy transfer from the wind generators to the utility grid.

  10. The potential benefit of an advanced integrated utility system

    NASA Technical Reports Server (NTRS)

    Wolfer, B. M.

    1975-01-01

    The applicability of an advanced integrated utility system based on 1980 technology was investigated. An example of such a system, which provides electricity, heating and air conditioning, solid waste disposal, and water treatment in a single integrated plant, is illustrated for a hypothetical apartment complex. The system requires approximately 50 percent of the energy and approximately 55 percent of the water that would be required by a typical current conventional system.

  11. FIELD EVALUATION OF A UTILITY DRY SCRUBBING SYSTEM

    EPA Science Inventory

    The report gives results of the first independent evaluation of a full-scale utility spray-dryer/baghouse dry flue gas desulfurization (FGD) system. The system treats flue gas from a nominal 100 MW of coal-fired power generation. The test program, conducted during July-October 19...

  12. Veterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriers

    PubMed Central

    McCarthy, John F; Blow, Frederic C; Valenstein, Marcia; Fischer, Ellen P; Owen, Richard R; Barry, Kristen L; Hudson, Teresa J; Ignacio, Rosalinda V

    2007-01-01

    Objective We examine the impact of two dimensions of access—geographic accessibility and availability—on VA health system and mental health treatment retention among patients with serious mental illness (SMI). Methods Among 156,631 patients in the Veterans Affairs (VA) health care system with schizophrenia or bipolar disorder in fiscal year 1998 (FY98), we used Cox proportional hazards regression to model time to first 12-month gap in health system utilization, and in mental health services utilization, by the end of FY02. Geographic accessibility was operationalized as straight-line distance to nearest VA service site or VA psychiatric service site, respectively. Service availability was assessed using county-level VA hospital beds and non-VA beds per 1,000 county residents. Patients who died without a prior gap in care were censored. Results There were 32, 943 patients (21 percent) with a 12-month gap in health system utilization; 65,386 (42 percent) had a 12-month gap in mental health services utilization. Gaps in VA health system utilization were more likely if patients were younger, nonwhite, unmarried, homeless, nonservice-connected, if they had bipolar disorder, less medical morbidity, an inpatient stay in FY98, or if they lived farther from care or in a county with fewer VA inpatient beds. Similar relationships were observed for mental health, however being older, female, and having greater morbidity were associated with increased risks of gaps, and number of VA beds was not significant. Conclusions Geographic accessibility and resource availability measures were associated with long-term continuity of care among patients with SMI. Increased distance from providers was associated with greater risks of 12-month gaps in health system and mental health services utilization. Lower VA inpatient bed availability was associated with increased risks of gaps in health system utilization. Study findings may inform efforts to improve treatment retention. PMID

  13. US patterns of mental health service utilization for transition-age youth and young adults.

    PubMed

    Pottick, Kathleen J; Bilder, Scott; Vander Stoep, Ann; Warner, Lynn A; Alvarez, Mike F

    2008-10-01

    This study examines rates of admission and patterns of mental health service use by persons of transition age (16-25 years) in the USA based on the nationally representative 1997 Client/Patient Sample Survey and population data from the US Census Bureau. A precipitous decline in utilization was observed at the age of emancipation: the yearly admission rate for inpatient, outpatient, and residential services was 34 per 1,000 for 16- and 17-year-olds and 18 per 1,000 for 18- and 19-year-olds. Among 20- and 21-year-olds, more were referred from criminal justice and fewer from family or friends and social services, and proportionately more were Medicaid recipients. Targeting resources to enhance shared planning between child and adult systems may facilitate continuity of care for young adult clients who are aging out of child mental health systems, as well as for those who experience their first episodes of mental disorder in early adulthood. PMID:18026842

  14. From physician to consumer: the effectiveness of strategies to manage health care utilization.

    PubMed

    Flynn, Kathryn E; Smith, Maureen A; Davis, Margaret K

    2002-12-01

    Many strategies are commonly used to influence physician behavior in managed care organizations. This review examines the effectiveness of three mechanisms to influence physician behavior: financial incentives directed at providers or patients, policies/procedures for managing care, and the selection/education of both providers and patients. The authors reach three conclusions. First, all health care systems use financial incentives, but these mechanisms are shifting away from financial incentives directed at the physician to those directed at the consumer. Second, heavily procedural strategies such as utilization review and gatekeeping show some evidence of effectiveness but are highly unpopular due to their restrictions on physician and patient choice. Third, a future system built on consumer choice is contradicted by mechanisms that rely solely on narrow networks of providers or the education of physicians. If patients become the new locus of decision making in health care, provider-focused mechanisms to influence physician behavior will not disappear but are likely to decline in importance. PMID:12508705

  15. Assessing the utilization of maternal and child health care among married adolescent women: evidence from India.

    PubMed

    Singh, Lucky; Rai, Rajesh Kumar; Singh, Prashant Kumar

    2012-01-01

    This study explores the prevalence and factors associated with the utilization of maternal and child health care services among married adolescent women in India using the third round of the National Family Health Survey (2005-06). The findings suggest that the utilization of maternal and child health care services among adolescent women is far from satisfactory in India. A little over 10% of adolescent women utilized antenatal care, about 50% utilized safe delivery services and about 41% of the children of adolescent women received full immunization. Large differences by urban-rural residence, educational attainment, religion, economic status and region were evident. Both gross effect and fixed effect binary logit models yielded statistically significant socioeconomic and demographic factors. Women's education, wealth quintile and region are the most important determinants for the utilization of maternal and child health care services. Health care programmes should focus more on educating adolescents, providing financial support, creating awareness and counselling households with married adolescent women. Moreover, there should be substantial financial assistance for the provision of delivery and child care for married women below the age of 19 years. PMID:21933465

  16. User fees, health staff incentives, and service utilization in Kabarole District, Uganda.

    PubMed Central

    Kipp, W.; Kamugisha, J.; Jacobs, P.; Burnham, G.; Rubaale, T.

    2001-01-01

    OBJECTIVE: To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District, western Uganda. METHODS: Of the 38 government health units that had introduced user-fee financing schemes, 11 were included in the study. Outpatient utilization was assessed as the median number of visits per month before and after cost sharing began. FINDINGS: After the introduction of cost sharing, overall utilization of general outpatient services, assessed by combining the data from all the participating units, dropped by 21.3%. Utilization increased, however, in facilities located in remote areas, while it decreased in those located in urban or semi-urban areas. The increased utilization in remote facilities was considered to be largely attributable to health workers' incentive payments derived from cost-sharing revenues. CONCLUSIONS: Incentive payments led the health workers to offer improved services. Other factors may also have been influential, such as an improved drug supply to health facilities and increased public identification with community projects in remote areas. PMID:11731810

  17. Awareness and utilization of preventive care services among the elderly under National Health Insurance.

    PubMed

    Chen, Chun-Chih; Lin, Yen-Ju; Lin, Ying-Tzu

    2013-12-01

    This empirical study investigates the factors affecting the awareness and the utilization of preventive care among the elderly in Taiwan. We use data obtained from the 2005 National Health Interview Survey. A recursive bivariate probit model is adopted to analyze the factors affecting the awareness and the utilization of preventive care. The probability of awareness of free preventive care under the National Health Insurance is higher for those who are younger, Mainlanders, have received more education, have a spouse, exercise regularly, have better self-rated health status, and have chronic diseases; the probability of awareness is lower for those who are aborigines and who live in the south and the east. Awareness of preventive care services, having a spouse, living alone, having better health status, and the existence of chronic diseases increase the probability of preventive care utilization; working reduces the probability of preventive care utilization. Our result supports the views in Arrow (Am Econ Rev 53(5):941-973, 1963) that health information is an important factor determining the demand for medical care. Policymakers may enhance such preventive care service utilization by increasing the awareness of such services among the elderly. PMID:23754318

  18. Did Copayment Changes Reduce Health Service Utilization among CHIP Enrollees? Evidence from Alabama

    PubMed Central

    Sen, Bisakha; Blackburn, Justin; Morrisey, Michael A; Kilgore, Meredith L; Becker, David J; Caldwell, Cathy; Menachemi, Nir

    2012-01-01

    Objective To explore whether health care utilization changed among enrollees in Alabama's CHIP program, ALL Kids, following copayment increases at the beginning of fiscal year 2004. Data Sources Data on all ALL Kids enrollees over 1999–2009 are obtained from claims files and the state's administrative database. Study Design We use pooled month-level data for all enrollees and conduct covariate-adjusted segmented regression models. Health services considered are inpatient care, emergency department (ED) visits, brand-name prescription drugs, generic prescription drugs, physician office visits and outpatient-services, ambulance services, allergy treatments, and non-preventive dental services. Physician well-visits, preventive dental services, and service use by Native-Americans—which saw no copayment increases—serve as counterfactuals. Principal Findings There are significant declines in utilization for inpatient care, physician visits, brand-name medications, and ED visits following the copayment increases. By and large, utilization did not decline, or declined only temporarily, for those services and for those enrollees that who not subject to increased copayments. Conclusions Copayment increases reduced utilization of many health services among ALL Kids enrollees. Concerns remain regarding the long-term health consequences to low-income children of copayment-induced reductions in health care utilization. PMID:22352979

  19. Bioelectrocatalytic systems for health applications.

    PubMed

    Sekretaryova, Alina N; Eriksson, Mats; Turner, Anthony P F

    2016-01-01

    We present a brief overview of bioelectrocatalytic devices for in vitro health applications, including food safety and environmental analysis, focusing on microelectrode- and microfluidic-based biosensors, paper-based point-of-care devices and wearable biosensors. The main hurdles and future perspectives are discussed. We then consider the role of electron transfer between a biocatalyst and an electrode in biosensor design. Brief descriptions of indirect, direct and mediated mechanisms are given. The principal strategies, as well as recent developments for modulation of electron transfer in biocatalytic systems are summarised. In conclusion, we highlight some of the challenges associated with improving these redox systems. PMID:26724183

  20. Posttraumatic stress disorder symptoms, physical health, and health care utilization 50 years after repeated exposure to a toxic gas.

    PubMed

    Ford, Julian D; Schnurr, Paula P; Friedman, Matthew J; Green, Bonnie L; Adams, Gary; Jex, Steve

    2004-06-01

    The posttraumatic sequelae of contaminant exposure are a contemporary international concern due to the threats posed to military personnel and civilians by war and bioterrorism. The role of PTSD symptoms as a mediator between potentially traumatic toxin exposure and physical health outcomes was examined with structural equation modeling in a probability sample of 302 male World War II-era U.S. military veterans 50 years after exposure to mustard gas tests. Controlling for age and psychological distress, the most parsimonious structural model involved PTSD symptoms mediating the relationship between toxin exposure and physical health problems, and physical health problems mediating the relationship between PTSD symptoms and outpatient health care utilization. Implications for researchers, mental health clinicians, and health care providers are discussed. PMID:15253090

  1. Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation

    PubMed Central

    2016-01-01

    Objectives: The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. Methods: Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. Results: The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. Conclusions: It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation. PMID:26841887

  2. The SF-6D health utility index in carpal tunnel syndrome.

    PubMed

    Atroshi, I; Gummesson, C; McCabe, S J; Ornstein, E

    2007-04-01

    Cost effectiveness is an important factor to consider when choosing between various hand surgical interventions. Health utility measures can be used to determine cost effectiveness. The SF-6D is a health utility index derived from 11 items of the SF-36 quality of life questionnaire; values range from 0.296 to 1.0 ("perfect" health). We evaluated the validity of the SF-6D in patients with carpal tunnel syndrome (CTS) who completed the SF-36 and the CTS symptom severity and functional status questionnaire before and 3 months after carpal tunnel release. Complete responses to the SF-6D items were available for 100 patients at baseline and 95 patients at baseline and follow-up. The mean SF-6D health utility index was 0.69 (SD 0.13) before surgery and 0.77 (SD 0.13) after surgery (moderate effect size). The SF-6D could discriminate between patient groups differing in self-rated global health and in whether, or not, they had a minimal clinically important improvement in CTS symptom severity after surgery. The SF-6D appears to be a valid measure of health utilities in patients with CTS and can be used in cost effectiveness studies. PMID:17223234

  3. The Health Extension Program and Its Association with Change in Utilization of Selected Maternal Health Services in Tigray Region, Ethiopia: A Segmented Linear Regression Analysis

    PubMed Central

    Gebrehiwot, Tesfay Gebregzabher; San Sebastian, Miguel; Edin, Kerstin; Goicolea, Isabel

    2015-01-01

    Background In 2003, the Ethiopian Ministry of Health established the Health Extension Program (HEP), with the goal of improving access to health care and health promotion activities in rural areas of the country. This paper aims to assess the association of the HEP with improved utilization of maternal health services in Northern Ethiopia using institution-based retrospective data. Methods Average quarterly total attendances for antenatal care (ANC), delivery care (DC) and post-natal care (PNC) at health posts and health care centres were studied from 2002 to 2012. Regression analysis was applied to two models to assess whether trends were statistically significant. One model was used to estimate the level and trend changes associated with the immediate period of intervention, while changes related to the post-intervention period were estimated by the other. Results The total number of consultations for ANC, DC and PNC increased constantly, particularly after the late-intervention period. Increases were higher for ANC and PNC at health post level and for DC at health centres. A positive statistically significant upward trend was found for DC and PNC in all facilities (p<0.01). The positive trend was also present in ANC at health centres (p = 0.04), but not at health posts. Conclusion Our findings revealed an increase in the use of antenatal, delivery and post-natal care after the introduction of the HEP. We are aware that other factors, that we could not control for, might be explaining that increase. The figures for DC and PNC are however low and more needs to be done in order to increase the access to the health care system as well as the demand for these services by the population. Strengthening of the health information system in the region needs also to be prioritized. PMID:26218074

  4. Horizontal equity in health care utilization evidence from three high-income Asian economies.

    PubMed

    Lu, Jui-fen R; Leung, Gabriel M; Kwon, Soonman; Tin, Keith Y K; Van Doorslaer, Eddy; O'Donnell, Owen

    2007-01-01

    This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong . There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions. PMID:17014944

  5. Gas dilution system results and application to acid rain utilities

    SciTech Connect

    Jolley-Souders, K.; Geib, R.; Dunn, C.

    1997-12-31

    In 1997, the United States EPA will remove restrictions preventing acid rain utilities from using gas dilution systems for calibration or linearity studies for continuous emissions monitoring, Test Method 205 in 40CFR51 requires that a gas dilution system must produce calibration gases whose measured values are within {+-}2% of predicted values. This paper presents the evaluation of the Environics/CalMat 2020 Dilution System for use in calibration studies. Internal studies show that concentrations generated by this unit are within {+-}0.5% of predicted values. Studies are being conducted by several acid rain utilities to evaluate the Environics/CalMat system using single minor component calibration standards. In addition, an internally generated study is being performed to demonstrate the system`s accuracy using a multi-component gas mixture. Data from these tests will be presented in the final version of the paper.

  6. Waste heat utilization in an anaerobic digestion system

    NASA Astrophysics Data System (ADS)

    Boissevain, Brett

    Anaerobic digestion has great potential as an energy source. Not only does it provide an effective method for waste mitigation, but it has the potential to generate significant quantities of fuel and electricity. In order to ensure efficient digestion and biomass utilization, however, the system must be continuously maintained at elevated temperatures. It is technically feasible to supplement such a system with outside energy, but it is more cost effective to heat the system using only the produced biogas. While there is considerable literature covering the theory of anaerobic digestion, there are very few practical studies to show how heat utilization affects system operation. This study considers the effect of major design variables (i.e. heat exchanger efficiencies and biogas conditioning) on promoting a completely self-sustaining digestion system. The thesis considers a real world system and analyzes how it can be improved to avoid the need of an external energy source.

  7. Impact of angina frequency on health utility values of patients with chronic stable angina

    PubMed Central

    2014-01-01

    Background Chronic angina is a profoundly symptomatic disease. We evaluated the relationship between angina frequency and health utility. Methods We used data from stable angina patients reporting ≥3 attacks/week enrolled in the Efficacy of Ranolazine in Chronic Angina (ERICA) trial. Angina frequency was classified using the Seattle Angina Questionnaire angina frequency (SAQAF) domain into no (100); monthly (61-99); weekly (31-60); and daily (0-30) angina. EuroQol (EQ)-5D health utility scores were derived from SAQ data using two mapping equations. Median EQ-5D utility scores for each SAQAF classification after the 6-week trial period were calculated (reported as: Equation 1/Equation 2). Changes in EQ-5D utility scores from baseline to end-of-trial for patients achieving and not achieving a ≥20-point improvement in SAQAF score and improving and not improving ≥1 SAQAF classification were compared. Results Median EQ-5D utility scores (n = 548) were 0.68/0.60. Compared to patients reporting no angina symptoms (n = 28; 0.89/0.87) patients reporting monthly (n = 188; 0.80/0.76), weekly (n = 283; 0.72/0.65) and daily (n = 49; 0.65/0.54) symptoms had poorer health utility (p < 0.001 for both equations). Patients improving ≥1SAQAF classification (n = 254/541, 47%) experienced a median 0.05/0.07 greater improvement in EQ-5D health utility compared to those not improving ≥1 classification (p < 0.001 for both equations). Patients improving ≥20-points on the SAQAF (n = 355/541, 66%) experienced a median 0.06/0.07 greater improvement in health utility compared to those not achieving a ≥20-point improvement (p < 0.001 for both). Conclusions Chronic angina patient health utility decreases as angina frequency increases. Patients reporting clinically important improvement in angina frequency experience a tangible improvement in health utility. Clinical trial registration NCT00091429 PMID:24628859

  8. Consulting report on the NASA technology utilization network system

    NASA Technical Reports Server (NTRS)

    Hlava, Marjorie M. K.

    1992-01-01

    The purposes of this consulting effort are: (1) to evaluate the existing management and production procedures and workflow as they each relate to the successful development, utilization, and implementation of the NASA Technology Utilization Network System (TUNS) database; (2) to identify, as requested by the NASA Project Monitor, the strengths, weaknesses, areas of bottlenecking, and previously unaddressed problem areas affecting TUNS; (3) to recommend changes or modifications of existing procedures as necessary in order to effect corrections for the overall benefit of NASA TUNS database production, implementation, and utilization; and (4) to recommend the addition of alternative procedures, routines, and activities that will consolidate and facilitate the production, implementation, and utilization of the NASA TUNS database.

  9. Methods for measuring utilization of mental health services in two epidemiologic studies

    PubMed Central

    NOVINS, DOUGLAS K.; BEALS, JANETTE; CROY, CALVIN; MANSON, SPERO M.

    2015-01-01

    Objectives of Study Psychiatric epidemiologic studies often include two or more sets of questions regarding service utilization, but the agreement across these different questions and the factors associated with their endorsement have not been examined. The objectives of this study were to describe the agreement of different sets of mental health service utilization questions that were included in the American Indian Service Utilization Psychiatric Epidemiology Risk and Protective Factors Project (AI-SUPERPFP), and compare the results to similar questions included in the baseline National Comorbidity Survey (NCS). Methods Responses to service utilization questions by 2878 AI-SUPERPFP and 5877 NCS participants were examined by calculating estimates of service use and agreement (κ) across the different sets of questions. Logistic regression models were developed to identify factors associated with endorsement of specific sets of questions. Results In both studies, estimates of mental health service utilization varied across the different sets of questions. Agreement across the different question sets was marginal to good (κ = 0.27–0.69). Characteristics of identified service users varied across the question sets. Limitations Neither survey included data to examine the validity of participant responses to service utilization questions. Recommendations for Further Research Question wording and placement appear to impact estimates of service utilization in psychiatric epidemiologic studies. Given the importance of these estimates for policy-making, further research into the validity of survey responses as well as impacts of question wording and context on rates of service utilization is warranted. PMID:18767205

  10. A Review of Acculturation Measures and Their Utility in Studies Promoting Latino Health

    PubMed Central

    Wallace, Phyllis M.; Pomery, Elizabeth A.; Latimer, Amy E.; Martinez, Josefa L.; Salovey, Peter

    2010-01-01

    The authors reviewed the acculturation literature with the goal of identifying measures used to assess acculturation in Hispanic populations in the context of studies of health knowledge, attitudes, and behavior change. Twenty-six acculturation measures were identified and summarized. As the Hispanic population continues to grow in the United States, there is a need to develop rigorous acculturation measures that include health indicators. Findings suggest that multidimensional acculturation scales are robust measurement tools when assessing nationality, cultural awareness, media and language preferences, and health status. Furthermore, aspects of Hispanic cultural lifestyle, such as beliefs about nutrition and physical activity, affect health care utilization, treatment, and prevention. Health communication researchers should consider aspects of cultural values and beliefs, and their impact on health status, for future research and health promotion interventions. PMID:20582238

  11. Predicting Health Care Utilization among Latinos: Health Locus of Control Beliefs or Access Factors?

    ERIC Educational Resources Information Center

    De Jesus, Maria; Xiao, Chenyang

    2014-01-01

    There are two competing research explanations to account for Latinos' underutilization of health services relative to non-Latino Whites in the United States. One hypothesis examines the impact of health locus of control (HLOC) beliefs, while the other focuses on the role of access factors on health care use. To date, the relative strength of…

  12. VA Community Mental Health Service Providers' Utilization of and Attitudes toward Telemental Health Care: The Gatekeeper's Perspective

    ERIC Educational Resources Information Center

    Jameson, John Paul; Farmer, Mary Sue; Head, Katharine J.; Fortney, John; Teal, Cayla R.

    2011-01-01

    Context: Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined. Purpose: The purpose of this study was to investigate the…

  13. Health without wealth? Costa Rica's health system under economic crisis.

    PubMed

    Morgan, L M

    1987-01-01

    The recent history of Costa Rica's health system is reviewed, emphasizing the health-related effects of the economic crisis of the 1980s. This economic crisis has stopped and in some instances reversed the marked health improvements Costa Rica realized during the decade of the 1970s. The effects of the economic crisis emerge in 4 areas: deterioration in health status, as poverty contributed to higher disease rates; reductions in the government's ability to maintain public health and medical services; increased reliance on foreign aid to finance the health system; and growing national debate over the role of the state in health care. The result of the economic crisis was a reduction in health services and a questioning of the Costa Rican health model. This occurred following the implementation of an expensive health infrastructure and at a time when people most needed health services. During the 1941-70 period, domestic initiative can account for much of the expansion of Costa Rica's social security system, but also at this time international agencies such as the US Agency for International Development (USAID) and the Inter-American Development began to assist in the expansion of the health system. In 1971 a plan was initiated to create a nationalized health system. By 1980 the success of the health sector reorganization was evident in the statistics: marked improvements in life expectancy, infant mortality, and infectious disease mortality had surpassed the goals set by the Pan American Health Organization (PAHO) and the Ministry of Health. Costa Rica's success was a vindication of both policy goals and funding priorities, for it has been "proved" that primary health care was capable of improving health indices, particularly where the agencies had the active and conscientious support of the national government. By 1977, foreign contracts for aid had expired, and the Ministry declared that the rural health program would be supported totally by the government. The

  14. Development of the Choctaw Health Delivery System.

    ERIC Educational Resources Information Center

    Nguyen, Binh N.

    The Choctaw Tribe is the first and only tribe to develop a health delivery system to take over an existing Indian Health Service inpatient facility. The takeover was accomplished in January 1984 under the Indian Self-Determination Act through a contract with the Indian Health Service. The Choctaw Health Delivery System includes a 35-bed general…

  15. Cognitive Appraisals of Specialty Mental Health Services and Their Relation to Mental Health Service Utilization in the Rural Population

    ERIC Educational Resources Information Center

    Deen, Tisha L.; Bridges, Ana J.; McGahan, Tara C.; Andrews, Arthur R., III

    2012-01-01

    Purpose: Rural individuals utilize specialty mental health services (eg, psychiatrists, psychologists, counselors, and social workers) at lower rates than their urban counterparts. This study explores whether cognitive appraisals (ie, individual perceptions of need for services, outcome expectancies, and value of a positive therapeutic outcome) of…

  16. Estimation of utility values from visual analog scale measures of health in patients undergoing cardiac surgery

    PubMed Central

    Oddershede, Lars; Andreasen, Jan Jesper; Ehlers, Lars

    2014-01-01

    Introduction In health economic evaluations, mapping can be used to estimate utility values from other health outcomes in order to calculate quality adjusted life-years. Currently, no methods exist to map visual analog scale (VAS) scores to utility values. This study aimed to develop and propose a statistical algorithm for mapping five dimensions of health, measured on VASs, to utility scores in patients suffering from cardiovascular disease. Methods Patients undergoing coronary artery bypass grafting at Aalborg University Hospital in Denmark were asked to score their health using the five VAS items (mobility, self-care, ability to perform usual activities, pain, and presence of anxiety or depression) and the EuroQol 5 Dimensions questionnaire. Regression analysis was used to estimate four mapping models from patients’ age, sex, and the self-reported VAS scores. Prediction errors were compared between mapping models and on subsets of the observed utility scores. Agreement between predicted and observed values was assessed using Bland–Altman plots. Results Random effects generalized least squares (GLS) regression yielded the best results when quadratic terms of VAS scores were included. Mapping models fitted using the Tobit model and censored least absolute deviation regression did not appear superior to GLS regression. The mapping models were able to explain approximately 63%–65% of the variation in the observed utility scores. The mean absolute error of predictions increased as the observed utility values decreased. Conclusion We concluded that it was possible to predict utility scores from VAS scores of the five dimensions of health used in the EuroQol questionnaires. However, the use of the mapping model may be inappropriate in more severe conditions. PMID:24453497

  17. The Effect of Antiretroviral Treatment on Health Care Utilization in Rural South Africa: A Population-Based Cohort Study

    PubMed Central

    Tanser, Frank C.; Naidu, Kevindra K.; Pillay, Deenan; Bärnighausen, Till

    2016-01-01

    Background The effect of the rapid scale-up of vertical antiretroviral treatment (ART) programs for HIV in sub-Saharan Africa on the overall health system is under intense debate. Some have argued that these programs have reduced access for people suffering from diseases unrelated to HIV because ART programs have drained human and physical resources from other parts of the health system; others have claimed that the investments through ART programs have strengthened the general health system and the population health impacts of ART have freed up health care capacity for the treatment of diseases that are not related to HIV. To establish the population-level impact of ART programs on health care utilization in the public-sector health system, we compared trends in health care utilization among HIV-infected people receiving and not receiving ART with HIV-uninfected people during a period of rapid ART scale-up. Methods and Findings We used data from the Wellcome Trust Africa Centre for Population Health, which annually elicited information on health care utilization from all surveillance participants over the period 2009–2012 (N = 32,319). We determined trends in hospitalization, and public-sector and private-sector primary health care (PHC) clinic visits for HIV-infected and -uninfected people over a time period of rapid ART scale-up (2009–2012) in this community. We regressed health care utilization on HIV status and ART status in different calendar years, controlling for sex, age, and area of residence. The proportion of people who reported to have visited a public-sector primary health care (PHC) clinic in the last 6 months increased significantly over the period 2009–2012, for both HIV-infected people (from 59% to 67%; p<0.001), and HIV-uninfected people (from 41% to 47%; p<0.001). In contrast, the proportion of HIV-infected people visiting a private-sector PHC clinic declined from 22% to 12% (p<0.001) and hospitalization rates declined from 128 to 82 per

  18. Utility of the ESSENCE Surveillance System in Monitoring the H1N1 Outbreak.

    PubMed

    Holtry, Rekha S; Hung, Lang M; Lewis, Sheri H

    2010-01-01

    The Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) enables health care practitioners to detect and monitor health indicators of public health importance. ESSENCE is used by public health departments in the National Capital Region (NCR); a cross-jurisdictional data sharing agreement has allowed cooperative health information sharing in the region since 2004. Emergency department visits for influenza-like illness (ILI) in the NCR from 2008 are compared to those of 2009. Important differences in the rates, timing, and demographic composition of ILI visits were found. By monitoring a regional surveillance system, public health practitioners had an increased ability to understand the magnitude and character of different ILI outbreaks. This increased ability provided crucial community-level information on which to base response and control measures for the novel 2009 H1N1 influenza outbreak. This report underscores the utility of automated surveillance systems in monitoring community-based outbreaks. There are several limitations in this study that are inherent with syndrome-based surveillance, including utilizing chief complaints versus confirmed laboratory data, discerning real disease versus those healthcare-seeking behaviors driven by panic, and reliance on visit counts versus visit rates. PMID:23569593

  19. Patterns of analgesic adherence predict health care utilization among outpatients with cancer pain

    PubMed Central

    Meghani, Salimah H; Knafl, George J

    2016-01-01

    Background Studies in chronic noncancer pain settings have found that opioid use increases health care utilization. Despite the key role of analgesics, specifically opioids, in the setting of cancer pain, there is no literature to our knowledge about the relationship between adherence to prescribed around-the-clock (ATC) analgesics and acute health care utilization (hospitalization) among patients with cancer pain. Purpose To identify adherence patterns over time for cancer patients taking ATC analgesics for pain, cluster these patterns into adherence types, combine the types into an adherence risk factor for hospitalization, identify other risk factors for hospitalization, and identify risk factors for inconsistent analgesic adherence. Materials and methods Data from a 3-month prospective observational study of patients diagnosed with solid tumors or multiple myeloma, having cancer-related pain, and having at least one prescription of oral ATC analgesics were collected. Adherence data were collected electronically using the medication event-monitoring system. Analyses were conducted using adaptive modeling methods based on heuristic search through alternative models controlled by likelihood cross-validation scores. Results Six adherence types were identified and combined into the risk factor for hospitalization of inconsistent versus consistent adherence over time. Twenty other individually significant risk factors for hospitalization were identified, but inconsistent analgesic adherence was the strongest of these predictors (ie, generating the largest likelihood cross-validation score). These risk factors were adaptively combined into a model for hospitalization based on six pairwise interaction risk factors with exceptional discrimination (ie, area under the receiver-operating-characteristic curve of 0.91). Patients had from zero to five of these risk factors, with an odds ratio of 5.44 (95% confidence interval 3.09–9.58) for hospitalization, with a unit

  20. Utilization of maternal health care services in post-conflict Nepal

    PubMed Central

    Bhandari, Tulsi Ram; Sarma, Prabhakaran Sankara; Kutty, Vellappillil Raman

    2015-01-01

    Background Despite a decade-long armed conflict in Nepal, the country made progress in reducing maternal mortality and is on its way to achieve the Millennium Development Goal Five. This study aimed to assess the degree of the utilization of maternal health care services during and after the armed conflict in Nepal. Methods This study is based on Nepal Demographic and Health Survey data 2006 and 2011. The units of analysis were women who had given birth to at least one child in the past 5 years preceding the survey. First, we compared the utilization of maternal health care services of 2006 with that of 2011. Second, we merged the two data sets and applied logistic regression to distinguish whether the utilization of maternal health care services had improved after the peace process 2006 was underway. Results In 2011, 85% of the women sought antenatal care at least once. Skilled health workers for delivery care assisted 36.1% of the women, and 46% of the women attended postnatal care visit at least once. These figures were 70%, 18.7%, and 16%, respectively, in 2006. Similarly, women were more likely to utilize antenatal care at least once (odds ratio [OR] =2.18, confidence interval [CI] =1.95–2.43), skilled care at birth (OR =2.58, CI =2.36–2.81), and postnatal care at least once (OR =4.13, CI =3.75–4.50) in 2011. Conclusion The utilization of maternal health care services tended to increase continuously during both the armed conflict and the post-conflict period in Nepal. However, the increasing proportion of the utilization was higher after the Comprehensive Peace Process Agreement 2006. PMID:26346111

  1. Utilizing expert systems for satellite monitoring and control

    NASA Technical Reports Server (NTRS)

    Hughes, Peter M.

    1991-01-01

    Spacecraft analysts in the spacecraft control center for the Cosmic Background Explorer (COBE) satellite are currently utilizing a fault-isolation expert system developed to assist in the isolation and correction of faults in the communications link. This system, the communication link expert assistance resource (CLEAR), monitors real time spacecraft and ground systems performance parameters in search of configuration discrepancies and communications link problems. If such a discrepancy or problem is isolated, CLEAR alerts the analyst and provides advice on how to resolve the problem swiftly and effectively. The CLEAR system is the first real time expert system to be used in the operational environment of a satellite control center at the NASA Goddard Space Flight Center. Clear has not only demonstrated the utility and potential of an expert system in the demanding environment of a satellite control center, but also has revealed many of the pitfalls and deficiencies of development of expert systems. One of the lessons learned from this and other initial expert system projects is that prototypes can often be developed quite rapidly, but operational expert systems require considerable effort. Development is generally a slow, tedious process that typically requires the special skills of trained programmers. Due to the success of CLEAR and several other systems in the control center domain, a large number of expert systems will certainly be developed to support control center operations during the early 1990's. To facilitate the development of these systems, a project was initiated to develop an integrated, domain-specific tool, the generic spacecraft analyst assistent (GenSAA), that alows the spacecraft analysts to rapidly create simple expert systems themselves. By providing a highly graphical point-and-select method of system development, GenSAA allows the analyst to utilize and/or modify previously developed rule bases and system components; thus, facilitating

  2. Health state utility valuation in radioactive iodine-refractory differentiated thyroid cancer

    PubMed Central

    Fordham, Beth A; Kerr, Cicely; de Freitas, Hayley M; Lloyd, Andrew J; Johnston, Karissa; Pelletier, Corey L; Tremblay, Gabriel; Forsythe, Anna; McIver, Bryan; Cohen, Ezra EW

    2015-01-01

    Purpose The aim of this study was to elicit utilities for radioactive iodine-refractory differentiated thyroid cancer (RR-DTC) and evaluate the impact of treatment response and toxicities on quality of life. Patients and methods RR-DTC health states were developed based on data from a previous qualitative study and iterative review by clinical experts. Following piloting, health states underwent valuation by 100 members of the UK public during time trade-off interviews. Mean utilities and descriptive distribution statistics were calculated, and a logistic regression analysis was conducted. Results The demographic characteristics of the study sample were generally reflective of the UK population. Clear differentiation in valuation between health states was observed. No response/stable disease had an adjusted utility value of 0.87, with a corresponding gain of +0.04 following a treatment response and a decline of −0.35 for disease progression. Adverse events were associated with utility decrements between −0.47 (grade III diarrhea) and −0.05 (grade I/II alopecia). Conclusion The trade-off interviews derived utility weights show clear differentiation between RR-DTC health states in response to treatment. The values reported in this study are suitable for cost-effectiveness evaluations for new treatments in RR-DTC. PMID:26604709

  3. Psychocultural Correlates of Mental Health Service Utilization Among African American and European American Girls.

    PubMed

    Yasui, Miwa; Hipwell, Alison E; Stepp, Stephanie D; Keenan, Kate

    2015-11-01

    Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization. PMID:25380787

  4. Psychocultural Correlates of Mental Health Service Utilization Among African American and European American Girls

    PubMed Central

    Hipwell, Alison E.; Stepp, Stephanie D.; Keenan, Kate

    2015-01-01

    Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization. PMID:25380787

  5. Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care

    PubMed Central

    Brown, George R.; Shipherd, PhD, Jillian C.; Kauth, Michael; Piegari, Rebecca I.; Bossarte, Robert M.

    2013-01-01

    Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk. Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care. PMID:23947310

  6. Family coverage expansions: impact on insurance coverage and health care utilization of parents.

    PubMed

    Busch, Susan H; Duchovny, Noelia

    2005-09-01

    With the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Medicaid eligibility ceased to be tied to receipt of cash assistance. Since then, states have had a growing number of opportunities to expand health coverage to low-income working families beyond previous AFDC limits. As of 2001, 20 states have raised income eligibility limits for parents to or beyond 100% of the Federal Poverty Level. First, we use the Current Population Survey to study the effect of states' expansions on the insurance rates of adults and to estimate the crowd-out of private insurance. We find that eligible adults living in a state that expanded coverage are more likely to be insured. We find a take-up rate of 14.8%. Our results suggest that 24% of this increase is due to a reduction in private coverage. Next, we use the Behavioral Risk Factor Surveillance System to examine changes in health care utilization. We find that these expansions increased cancer-screening rates. Of previously uninsured mothers not receiving cancer screening, 29% now receive these screens. Finally, our results indicate the expansions decreased the likelihood that a parent needed to see a doctor but did not because of cost. PMID:15998548

  7. New partnership for health? Business groups on health and health systems agencies.

    PubMed

    Bradbury, R C

    1983-01-01

    The experience of the Central Massachusetts Health Systems Agency (CMHSA) and the Central Massachusetts Business Group on Health (CMBGH) demonstrates the feasibility of cooperation between HSAs and BGHs. Objectives and strategies of the two groups in carrying out community health planning and working for health systems change are compared. Nearly two decades of government-sponsored community health planning programs, first through comprehensive health planning agencies and then through HSAs, have had less impact than many had anticipated because neither the technical nor political basis for such planning was sufficiently established. The CMHSA experience is typical, although it is credited with developing a hospital systems plan that is based on sound planning methods and statistical data. It is in the implementation of plans that the CMHSA has made slow progress, reflecting its inadequate community power base. The CMBGH, 1 of more than 90 groups that have developed recently across the country to attack high health care costs, was formed in 1981 by business leaders to address these rising costs. The principal strategy adopted by the CMBGH involves fostering a competitive health care market by creating a critical number of competing health plans. The providers in each plan will then have incentives to provide effective care in an efficient manner to keep the premium competitive and attract enrollees. Cooperation between the CMBGH and CMHSA is based on each organization's emphasizing its strengths. The CMHSA's data base and analyses have been the primary resources used by the CMBGH to identify problems. Each organization has developed its own set of goals and objectives, while keeping in mind those of the other organization. The CMBGH adopted a subset of theCMHSA's goals-those that focus on hospital capacity and utilization. Although the CMHSA's regulatory strategies differ greatly from the CMBGH's competition strategies, they do not necessarily conflict

  8. Software for Intelligent System Health Management

    NASA Technical Reports Server (NTRS)

    Trevino, Luis C.

    2004-01-01

    This viewgraph presentation describes the characteristics and advantages of autonomy and artificial intelligence in systems health monitoring. The presentation lists technologies relevant to Intelligent System Health Management (ISHM), and some potential applications.

  9. Can Walmart make us healthier? Prescription drug prices and health care utilization.

    PubMed

    Borrescio-Higa, Florencia

    2015-12-01

    This paper analyzes how prices in the retail pharmaceutical market affect health care utilization. Specifically, I study the impact of Walmart's $4 Prescription Drug Program on utilization of antihypertensive drugs and on hospitalizations for conditions amenable to drug therapy. Identification relies on the change in the availability of cheap drugs introduced by Walmart's program, exploiting variation in the distance to the nearest Walmart across ZIP codes in a difference-in-differences framework. I find that living close to a source of cheap drugs increases utilization of antihypertensive medications by 7 percent and decreases the probability of an avoidable hospitalization by 6.2 percent. PMID:26376457

  10. Comparison of Health Care Resource Utilization by Immigrants Versus Native Elderly People.

    PubMed

    Franchi, Carlotta; Baviera, Marta; Sequi, Marco; Cortesi, Laura; Tettamanti, Mauro; Roncaglioni, Maria Carla; Pasina, Luca; Dignefa, Codjo Djade; Fortino, Ida; Bortolotti, Angela; Merlino, Luca; Mannucci, Pier Mannuccio; Nobili, Alessandro

    2016-02-01

    To compare the utilization of health care resources (drug prescriptions, hospital admissions and health care services) by immigrant versus native elderly people (65 years or more), by using administrative database of the Lombardy Region. For each immigrant (an older people born out of Italy), one person born in Lombardy (native) was randomly selected and matched by age, sex and general practitioner. The 25,508 immigrants selected were less prescribed with at least one drug (OR 0.72, 95 % CI 0.67-0.76) and had a lesser use of health care services (OR 0.79, 95 % CI 0.75-0.84) than natives. No statistically significant differences were found for hospital admission rates (OR 0.99, 95 % CI 0.99-1.04). A lower rate of health care resource utilization was observed in elderly immigrants who had been living in the host region for as many as 10 years. PMID:25576178

  11. The Relationship between Commercial Health Care Prices and Medicare Spending and Utilization

    PubMed Central

    Romley, John A; Axeen, Sarah; Lakdawalla, Darius N; Chernew, Michael E; Bhattacharya, Jay; Goldman, Dana P

    2015-01-01

    Objective To explore the relationship between commercial health care prices and Medicare spending/utilization across U.S. regions. Data Sources Claims from large employers and Medicare Parts A/B/D over 2007–2009. Study Design We compared prices paid by commercial health plans to Medicare spending and utilization, adjusted for beneficiary health and the cost of care, across 301 hospital referral regions. Principal Findings A 10 percent lower commercial price (around the average level) is associated with 3.0 percent higher Medicare spending per member per year, and 4.3 percent more specialist visits (p < .01). Conclusions Commercial health care prices are negatively associated with Medicare spending across regions. Providers may respond to low commercial prices by shifting service volume into Medicare. Further investigation is needed to establish causality. PMID:25429755

  12. CURRENT STATUS OF COMMERCIAL UTILITY FLUE GAS DESULFURIZATION SYSTEMS

    EPA Science Inventory

    The report discusses the current status of commercial flue gas desulfurization (FGD) processes applied to coal-fired utility boilers in the U.S. Major objectives of the work were to examine the impacts of the 1979 New Source Performance Standards on FGD system design and operatio...

  13. Visual-Tutorial System for Teaching Media Utilization.

    ERIC Educational Resources Information Center

    Butler, Lucius

    1979-01-01

    Discusses a self-instructional programed Visual-Tutorial learning system, designed to teach preservice elementary school teachers both theory and skills related to effective classroom utilization of audiovisual materials and equipment. An outline of the course, "Media Practicum," is included. (RAO)

  14. Electric utility applications of hydrogen energy storage systems

    SciTech Connect

    Swaminathan, S.; Sen, R.K.

    1997-10-15

    This report examines the capital cost associated with various energy storage systems that have been installed for electric utility application. The storage systems considered in this study are Battery Energy Storage (BES), Superconducting Magnetic Energy Storage (SMES) and Flywheel Energy Storage (FES). The report also projects the cost reductions that may be anticipated as these technologies come down the learning curve. This data will serve as a base-line for comparing the cost-effectiveness of hydrogen energy storage (HES) systems in the electric utility sector. Since pumped hydro or compressed air energy storage (CAES) is not particularly suitable for distributed storage, they are not considered in this report. There are no comparable HES systems in existence in the electric utility sector. However, there are numerous studies that have assessed the current and projected cost of hydrogen energy storage system. This report uses such data to compare the cost of HES systems with that of other storage systems in order to draw some conclusions as to the applications and the cost-effectiveness of hydrogen as a electricity storage alternative.

  15. Factors associated with the utilization and costs of health and social services in frail elderly patients

    PubMed Central

    2012-01-01

    Background Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. Methods Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization. Results The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure. Conclusions The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in the long run, result in

  16. Economic evaluation of mental health interventions: an introduction to cost-utility analysis.

    PubMed

    Luyten, Jeroen; Naci, Huseyin; Knapp, Martin

    2016-05-01

    Finite resources need to be allocated over an ever-increasing range of competing health policies and interventions. Economic evaluation has been developed as a methodology to inform decision makers on the efficiency of particular resource allocations. In this paper we summarize cost-utility analysis, one of the most widely-used forms of economic evaluation in healthcare. We discuss its main elements, interpretation, limitations and relevance to the domain of mental health. PMID:27075444

  17. Utilization of the Primary Health Care Services in the Tshwane Region of Gauteng Province, South Africa

    PubMed Central

    Nteta, Thembi P.; Mokgatle-Nthabu, Matilda; Oguntibeju, Oluwafemi O.

    2010-01-01

    Background In South Africa, the provision of primary health care is a basic service designed to be cost effective and bring healthcare as close as possible to the population, particularly to those people of low economic status. It is a service which is provided free of charge by the South African government and as part of the millennium health goals, it is intended that the service should be accessible to the populace and be effectively utilized. Objective This study was designed to investigate the accessibility and utilization of the primary health care services in three community health care centres in the Tshwane of the Gauteng Province, South Africa. Methodology Data were obtained from participants attending three Community Health Care Centres in the Tshwane Region using self-administered structured questionnaires. A document review of the Community Health Care Centres records was conducted to investigate the utilization trends of the services provided and descriptive statistics were used to analyze the data obtained. Results The results showed that the Community Health Care Centres in the Tshwane Region are accessible to most participants who lived within 5 km of such centres and who traveled 30 minutes or less to the clinic. Using a taxi or walking were found to be the most common means of transport used to gain access to such a clinic. The findings showed that generally, participants were satisfied with the services provided. Conclusion Participants of this study have access to the community health care centres in the Tshwane Region and there seems to be effective utilization by patients attending them. PMID:21085475

  18. Explaining the link between access-to-care factors and health care resource utilization among individuals with COPD

    PubMed Central

    Kim, Minchul; Ren, Jinma; Tillis, William; Asche, Carl V; Kim, Inkyu K; Kirkness, Carmen S

    2016-01-01

    Background Limited accessibility to health care may be a barrier to obtaining good care. Few studies have investigated the association between access-to-care factors and COPD hospitalizations. The objective of this study is to estimate the association between access-to-care factors and health care utilization including hospital/emergency department (ED) visits and primary care physician (PCP) office visits among adults with COPD utilizing a nationally representative survey data. Methods We conducted a pooled cross-sectional analysis based upon a bivariate probit model, utilizing datasets from the 2011–2012 Behavioral Risk Factor Surveillance System linked with the 2014 Area Health Resource Files among adults with COPD. Dichotomous outcomes were hospital/ED visits and PCP office visits. Key covariates were county-level access-to-care factors, including the population-weighted numbers of pulmonary care specialists, PCPs, hospitals, rural health centers, and federally qualified health centers. Results Among a total of 9,332 observations, proportions of hospital/ED visits and PCP office visits were 16.2% and 44.2%, respectively. Results demonstrated that access-to-care factors were closely associated with hospital/ED visits. An additional pulmonary care specialist per 100,000 persons serves to reduce the likelihood of a hospital/ED visit by 0.4 percentage points (pp) (P=0.028). In contrast, an additional hospital per 100,000 persons increases the likelihood of hospital/ED visit by 0.8 pp (P=0.008). However, safety net facilities were not related to hospital utilizations. PCP office visits were not related to access-to-care factors. Conclusion Pulmonary care specialist availability was a key factor in reducing hospital utilization among adults with COPD. The findings of our study implied that an increase in the availability of pulmonary care specialists may reduce hospital utilizations in counties with little or no access to pulmonary care specialists and that since

  19. Uninsurance, Underinsurance, and Health Care Utilization in Mexico by US Border Residents

    PubMed Central

    Su, Dejun; Pratt, William; Stimpson, Jim P.; Wong, Rebeca; Pagán, José A.

    2013-01-01

    Using data from the 2008 Cross-Border Utilization of Health Care Survey, we examined the relationship between United States (US) health insurance coverage plans and the use of health care services in Mexico by US residents of the US-Mexico border region. We found immigrants were far more likely to be uninsured than their native-born counterparts (63 versus 27.8 percent). Adults without health insurance coverage were more likely to purchase medications or visit physicians in Mexico compared to insured adults. However, adults with Medicaid coverage were more likely to visit dentists in Mexico compared to uninsured adults. Improving health care access for US residents in the southwestern border region of the country will require initiatives that target not only providing coverage to the large uninsured population but also improving access to health care services for the large underinsured population. PMID:23624848

  20. Operating health analysis of electric power systems

    NASA Astrophysics Data System (ADS)

    Fotuhi-Firuzabad, Mahmud

    The required level of operating reserve to be maintained by an electric power system can be determined using both deterministic and probabilistic techniques. Despite the obvious disadvantages of deterministic approaches there is still considerable reluctance to apply probabilistic techniques due to the difficulty of interpreting a single numerical risk index and the lack of sufficient information provided by a single index. A practical way to overcome difficulties is to embed deterministic considerations in the probabilistic indices in order to monitor the system well-being. The system well-being can be designated as healthy, marginal and at risk. The concept of system well-being is examined and extended in this thesis to cover the overall area of operating reserve assessment. Operating reserve evaluation involves the two distinctly different aspects of unit commitment and the dispatch of the committed units. Unit commitment health analysis involves the determination of which unit should be committed to satisfy the operating criteria. The concepts developed for unit commitment health, margin and risk are extended in this thesis to evaluate the response well-being of a generating system. A procedure is presented to determine the optimum dispatch of the committed units to satisfy the response criteria. The impact on the response wellbeing being of variations in the margin time, required regulating margin and load forecast uncertainty are illustrated. The effects on the response well-being of rapid start units, interruptible loads and postponable outages are also illustrated. System well-being is, in general, greatly improved by interconnection with other power systems. The well-being concepts are extended to evaluate the spinning reserve requirements in interconnected systems. The interconnected system unit commitment problem is decomposed into two subproblems in which unit scheduling is performed in each isolated system followed by interconnected system evaluation

  1. Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

    ERIC Educational Resources Information Center

    Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

    2010-01-01

    Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

  2. CLASSIFICATION OF THE MGR OFF-SITE UTILITIES SYSTEM

    SciTech Connect

    J.A. Ziegler

    1999-08-31

    The purpose of this analysis is to document the Quality Assurance (QA) classification of the Monitored Geologic Repository (MGR) offsite utilities system structures, systems and components (SSCs) performed by the MGR Safety Assurance Department. This analysis also provides the basis for revision of YMP/90-55Q, Q-List (YMP 1998). The Q-List identifies those MGR SSCs subject to the requirements of DOE/RW-0333P, ''Quality Assurance Requirements and Description'' (QARD) (DOE 1998).

  3. Measurement of patient-derived utility values for periodontal health using a multi-attribute scale.

    PubMed

    Bellamy, C A; Brickley, M R; McAndrew, R

    1996-09-01

    Periodontal health states are difficult to quantify and no formal scale quantifying patients' utilities for periodontal health states exits. Multi-attribute utility (MAU) techniques were used to develop such a scale. The MAU scale may be used to quantify patients' assessment of their current periodontal health and that of possible treatment outcomes. Such data, combined with probability values in formal decision analysis techniques would result in improved rationality of treatment planning for periodontal disease. 20 patients attending for routine undergraduate care were interviewed. Data from these interviews were sorted into groups of common interest (domains). Intra-domain health statements were complied from the interview content. 21 patients ranked the intra-domain statements on a scale of 0-100. This same group of patients also performed an inter-domain weighting. Mean results showed that patients were 2X as concerned with how they felt and with the prognosis of possible outcomes, than with how they looked and what facts they knew about their oral health. However, the real value of utilities research lies in application of individual results to treatment planning as there is a wide range of opinion regarding outcome health states. PMID:8891929

  4. The influence of women's empowerment on maternal health care utilization: evidence from Albania.

    PubMed

    Sado, Lantona; Spaho, Alma; Hotchkiss, David R

    2014-08-01

    Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health. PMID:24929918

  5. Solar photovoltaic power systems: an electric utility R & d perspective.

    PubMed

    Demeo, E A; Taylor, R W

    1984-04-20

    Solar photovoltaic technology is receiving increasing attention as a prospective source of bulk, electric utility power within the next 10 to 20 years. Successful development will require solar energy conversion efficiencies of about 15 percent for photovoltaic flat-plate modules, or about 25 percent for photovoltaic cells using highly concentrated sunlight. Three different cell technologies have a better than even chance of achieving these target efficiencies with costs and operating lifetimes that would allow significant use by electric utilities. The challenge for the next decade is to push photovoltaic technology to its physical limits while expanding markets and user confidence with currently available systems. PMID:17734901

  6. Improvement in Health State Utility after Sacroiliac Joint Fusion: Comparison to Normal Populations

    PubMed Central

    Cher, Daniel J.; Polly, David W.

    2015-01-01

    Study Design Prospective cohort study. Objective The sacroiliac joint (SIJ) is an important cause of lower back pain. The degree to which minimally invasive surgical fusion of the SIJ improves health state utility has not been previously documented. Methods Health state utility values were calculated using the EuroQOL-5D (EQ-5D) and Short Form-36 (SF-36) at baseline and 6 and 12 months after SIJ fusion surgery in subjects participating in a prospective, multicenter clinical trial (n = 172). Values were compared with individuals who participated in a nationally representative cross-sectional survey (National Health Measurement Study [NHMS], n = 3,844). Health utility values in the SIJ cohort were compared with those of the NMHS participants using both weighted linear regression and calculation of “health quantile” (i.e., percentile of health normalized to the NHMS cohort adjusted for age and gender). Results Baseline health state utility was significantly depressed in SIJ patients compared with normal subjects (SF-6D 0.509 versus 0.789, SF-36 physical component summary 31.7 versus 49.2, SF-36 mental component summary 8.5 versus 53.8, EQ-5D 0.433 versus 0.868; all p < 0.0001 after adjustment for age and gender). In the SIJ cohort, all the measures improved by 6 months postoperatively, and improvements were sustained at 12 months. Baseline health quantile was low (fifth percentile) in the SIJ cohort and improved significantly at follow-up. Conclusions Quality of life is markedly impaired in patients with SIJ pain compared with age- and gender-matched cohorts. SIJ fusion in this cohort resulted in a substantial improvement in health state utility, bringing the population back toward the expected levels of overall health. The quantile approach helps to explain the degree to which health is improved compared with age- and gender-matched cohorts. PMID:26933610

  7. Manufactured residential utility wall system (ResCore), overview

    SciTech Connect

    Wendt, R.; Lundell, C.; Lau, T.M.

    1997-05-01

    This paper provides an overview of the design and development of a manufactured residential utility wall system referred to as ResCore. ResCore is a self-contained, manufactured, residential utility wall that provides complete rough-in of utilities (power, gas, water, and phone) and other functions (exhaust, combustion make-up air, refrigerant lines, etc.) to serve the residential kitchen, bath, utility, and laundry rooms. Auburn University, Department of Industrial Design faculty and students, supported by a team of graduate student researchers and the project`s advisory team, developed the ResCore. The project was accomplished through a research subcontract from the US Department of Energy administered by the Oak Ridge National Laboratory. The ResCore wall system features a ``layered`` manufacturing technique that allows each major component group--structural, cold water, hot water, drain, gas, electric, etc.--to be built as a separate subassembly and easily brought together for final assembly. The two structural layers are reinforced with bridging that adds strength and also permits firm attachment of plumbing pipes and other systems to the wall frame.

  8. Manufactured Residential Utility Wall System (ResCore),

    SciTech Connect

    Wendt, Robert; Lundell, Clark; Lau, Tin Man

    1997-12-31

    This paper describes the design and development of a manufactured residential utility wall system referred to as ResCore. ResCore is a self contained, manufactured, residential utility wall that provides complete rough-in of utilities (power, gas, water, and phone) and other functions (exhaust, combustion make-up air, refrigerant lines, etc.) to serve the kitchen, bath, utility, and laundry rooms. Auburn University, Department of Industrial Design faculty, students, supported by a team of graduate student researchers and the project`s advisory team, developed the ResCore. The project was accomplished through a research subcontract from the U.S. Department of Energy administered by the Oak Ridge National Laboratory. The ResCore wall system features a layered manufacturing technique that allows each major component group: structural, cold water, hot water, drain, gas, electric, etc. to be built as a separate subassembly and easily brought together for final assembly. The two structural layers are reinforced with bridging that adds strength and also permits firm attachment of plumbing pipes and other systems to the wall frame.

  9. [A Maternal Health Care System Based on Mobile Health Care].

    PubMed

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals. PMID:27382731

  10. Incarceration and Women's Health: The Utility of Effective Health Education Programming--A Commentary

    ERIC Educational Resources Information Center

    Robertson-James, Candace; Nunez, Ana

    2012-01-01

    The health and well-being of incarcerated women is a significant public health concern. Compared with non-incarcerated women, incarcerated women in the United States are more often from minority populations, younger (between the ages of 18 and 34 years), of low socioeconomic status, unemployed and mothers to children under 18 years of age. More…

  11. Sexual and reproductive health and rights in changing health systems.

    PubMed

    Sen, Gita; Govender, Veloshnee

    2015-01-01

    Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities). PMID:25536851

  12. Sexual and reproductive health and rights in changing health systems

    PubMed Central

    Sen, Gita; Govender, Veloshnee

    2015-01-01

    Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities). PMID:25536851

  13. The interconnection of photovoltaic power systems with the utility grid: An overview for utility engineers

    SciTech Connect

    Wills, R.H.

    1994-06-01

    Utility-interactive (UI) photovoltaic power systems mounted on residences and commercial buildings are likely to become a small, but important source of electric generation in the next century. This is a new concept in utility power production--a change from large-scale central generation to small-scale dispersed generation. As such, it requires a re-examination of many existing standards and practices to enable the technology to develop and emerge into the marketplace. Much work has been done over the last 20 years to identify and solve the potential problems associated with dispersed power generation systems. This report gives an overview of these issues and also provides a guide to applicable codes, standards and other related documents. The main conclusion that can be drawn from this work is that there are no major technical barriers to the implementation of dispersed PV generating systems. While more technical research is needed in some specific areas, the remaining barriers are fundamentally price and policy.

  14. Couples’ reports of household decision-making and the utilization of maternal health services in Bangladesh

    PubMed Central

    Story, William T.; Burgard, Sarah A.

    2012-01-01

    This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service use focus on women’s reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands’ involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. PMID:23068556

  15. Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil

    PubMed Central

    2013-01-01

    key features were emphasized as important. Conclusions The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users’ social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also. PMID:24373346

  16. Direct-to-consumer advertising and its utility in health care decision making: a consumer perspective.

    PubMed

    Deshpande, Aparna; Menon, Ajit; Perri, Matthew; Zinkhan, George

    2004-01-01

    The growth in direct-to-consumer advertising(DTCA)over the past two decades has facilitated the communication of prescription drug information directly to consumers. Data from a 1999 national survey are employed to determine the factors influencing consumers' opinions of the utility of DTC ads for health care decision making. We also analyze whether consumers use DTC ad information in health care decision making and who are the key drivers of such information utilization. The study results suggest that consumers have positive opinions of DTCA utility, varying across demographics and perceptions of certain advertisement features. Specifically, consumers value information about both risks and benefits, but the perception of risk information is more important in shaping opinions of ad utility than the perception of benefit information. Consumers still perceive, however that the quality of benefit information in DTC ads is better than that of risk information. Opinions about ad utility significantly influence whether information from DTC ads is used in health care decision making. PMID:15764449

  17. Understanding utilization of outpatient clinics for children with special health care needs in southern Israel.

    PubMed

    Peres, Hagit; Glazer, Yael; Landau, Daniella; Marks, Kyla; Abokaf, Hana'a; Belmaker, Ilana; Cohen, Arnon; Shoham-Vardi, Ilana

    2014-10-01

    To understand the pattern of utilization of ambulatory care by parents of children with special health care needs (CSHCN) and to explore parental challenges in coping with health maintenance of their infants after discharge from a neonatal intensive care unit (NICU). CSHCN require frequent utilization of outpatient ambulatory clinics especially in their first years of life. Multiple barriers are faced by families in disadvantaged populations which might affect adherence to medical referrals. Our study attempts to go beyond quantitative assessment of adherence rates, and capture the influence of parental agency as a critical factor ensuring optimal utilization of healthcare for CSHCN. A prospective, mixed-methods, cohort study followed 158 Jewish and Bedouin-Arab infants in the first year post discharge from NICU in southern Israel. Rates of utilization of ambulatory clinics were obtained from medical records, and quantitative assessment of factors affecting it was based on structured interviews with parents at baseline. Qualitative analysis was based on home visits or telephone in-depth interviews conducted about 1 year post-discharge, to obtain a rich, multilayered, experiential perspectives and explained perceptions by parents. Adherence to post-discharge referrals was generally good, but environmental, cultural, and financial obstacles to healthcare, magnified by communication barriers, forced parents with limited resources to make difficult choices affecting utilization of healthcare services. Improving concordance between primary caregivers and health care providers is crucial, and further development of supportive healthcare for CSHCN in concordance with parental limitations and preferences is needed. PMID:24414986

  18. Comparison of General Population, Patient, and Carer Utility Values for Dementia Health States

    PubMed Central

    Mulhern, Brendan; Banerjee, Sube; Tait, Rhian; Watchurst, Caroline; Smith, Sarah C.; Young, Tracey A.; Knapp, Martin; Brazier, John E.

    2015-01-01

    Utility values to estimate quality-adjusted life years (QALYs) for use in cost-utility analyses are usually elicited from members of the general population. Public attitudes and understanding of dementia in particular may mean that values elicited from the general population may differ from patients and carers for dementia health states. This study examines how the population impacts utility values elicited for dementia health states using interviewer-administered time tradeoff valuation of health states defined by the dementia-specific preference-based measures DEMQOL-U (patient-report) and DEMQOL-Proxy-U (carer-report). Eight DEMQOL-U states were valued by 78 members of the UK general population and 71 patients with dementia of mild severity. Eight DEMQOL-Proxy-U states were valued by 77 members of the UK general population and 71 carers of patients with dementia of mild severity. Random-effects generalized least squares regression estimated the impact of population, dementia health state, and respondent sociodemographic characteristics on elicited values, finding that values for dementia health states differed by population and that the difference varied across dementia health states. Patients with dementia and carers of patients with dementia gave systematically lower values than members of the general population that were not due to differences in the sociodemographic characteristics of the populations. Our results suggest that the population used to produce dementia health state values could impact the results of cost-utility analyses and potentially affect resource allocation decisions; yet, currently, only general population values are available for usage. PMID:25385749

  19. Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.

    PubMed

    Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R

    2016-05-01

    Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p <0.0001). In conclusion, remote monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care. PMID:26996767

  20. Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

    PubMed Central

    2013-01-01

    Background The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective. Methods A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework. Results Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care. Conclusion Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices

  1. Utilization of agricultural by-products in healthful food products: Organogelators, antioxidants, and spreadable products

    Technology Transfer Automated Retrieval System (TEKTRAN)

    It was found that several agricultural by-products could be utilized for healthful food products. Three major applications that our research group has been focusing on will be discussed: 1) plant waxes for trans-fat free, low saturated fat-containing margarine and spread products, 2) extracts of cor...

  2. Kindergarten Screening and Parent Engagement to Enhance Mental Health Service Utilization

    ERIC Educational Resources Information Center

    Girio, Erin L.

    2010-01-01

    The majority of youth in need of mental health services do not receive intervention as many are not identified as having a problem or their families experience practical or attitudinal barriers that interfere with service utilization. The school environment provides a unique point of access to reach all children, yet this setting has been…

  3. Trends in the Utilization of Specific Health Care Services among Older Manitobans: 1985 to 2000

    ERIC Educational Resources Information Center

    Finlayson, Marcia; Lix, Lisa; Finlayson, Greg; Fong, Terry

    2005-01-01

    This paper examines 16-year trends in the utilization of hospital and physician services by Manitobans aged 75 and more, using data from the Manitoba Population Health Research Data Repository. Trends are examined across five measures of hospital services (separations, short-stay days, long-stay days, cataract surgeries, and hip/knee replacements)…

  4. Implementation and Utilization Characteristics of a Rural, School-Linked Mental Health Program

    ERIC Educational Resources Information Center

    Evans, Garret D.; Radunovich, Heidi Liss; Cornette, Michelle M.; Wiens, Brenda A.; Roy, Antara

    2008-01-01

    We examined variables associated with treatment engagement in a real-world therapeutic setting. The model of care examined involved school-linked mental health care for children and their families in a rural county. Service utilization characteristics, as well as child- and treatment-specific variables were examined in relation to their impact on…

  5. Online Health Information (OHI) Utilization among Selected Worksite Employees in Taiwan

    ERIC Educational Resources Information Center

    Hou, Su-I; Hsiao, Tun-Jen; Hou, Peng-Hsi

    2012-01-01

    Purpose: This study compared Internet and online health information (OHI) utilization among selected employees age 40-49 and 50-64 years, and examined the influence of age, gender, education, and worksite. Methods: A questionnaire was administered to participants from two worksites in Taiwan. Results: A total of 527 employees completed the survey…

  6. The Effects on Student Utilization of Moving an On-Campus Health Center Off Campus.

    ERIC Educational Resources Information Center

    Klotz, Addie L.

    The effects of moving the San Fernando Valley State College Student Health Services to a professional medical building two miles off-campus are assessed. Anticipating a series reduction in student utilization, an intensive publicity program was undertaken to make students aware of the service and its new location. Unexpected positive results of…

  7. Major Differences: Variations in Undergraduate and Graduate Student Mental Health and Treatment Utilization across Academic Disciplines

    ERIC Educational Resources Information Center

    Lipson, Sarah Ketchen; Zhou, Sasha; Wagner, Blake, III; Beck, Katie; Eisenberg, Daniel

    2016-01-01

    This article explores variations in mental health and service utilization across academic disciplines using a random sample of undergraduate and graduate students (N = 64,519) at 81 colleges and universities. We report prevalence of depression, anxiety, suicidality, and self-injury, and rates of help-seeking across disciplines, including results…

  8. Graduate Student Mental Health: Needs Assessment and Utilization of Counseling Services

    ERIC Educational Resources Information Center

    Hyun, Jenny K.; Quinn, Brian C.; Madon, Temina; Lustig, Steve

    2006-01-01

    This study examined the mental health needs, knowledge, and utilization of counseling services among graduate students at a large university in the western United States. Almost half of graduate student respondents reported having had an emotional or stress related problem over the past year, and over half reported knowing a colleague who had an…

  9. Study of Lyndon B. Johnson Space Center utility systems

    NASA Technical Reports Server (NTRS)

    Redding, T. E.; Huber, W. C.

    1977-01-01

    The results of an engineering study of potential energy saving utility system modifications for the NASA Lyndon B. Johnson Space Center are presented. The objective of the study was to define and analyze utility options that would provide facility energy savings in addition to the approximately 25 percent already achieved through an energy loads reduction program. A systems engineering approach was used to determine total system energy and cost savings resulting from each of the ten major options investigated. The results reported include detailed cost analyses and cost comparisons of various options. Cost are projected to the year 2000. Also included are a brief description of a mathematical model used for the analysis and the rationale used for a site survey to select buildings suitable for analysis.

  10. Drawing the Line: The Cultural Cartography of Utilization Recommendations for Mental Health Problems

    ERIC Educational Resources Information Center

    Olafsdottir, Sigrun; Pescosolido, Bernice A.

    2009-01-01

    In the 1990s, sociologists began to rethink the failure of utilization models to explain whether and why individuals accessed formal treatment systems. This effort focused on reconceptualizing the underlying assumptions and processes that shaped utilization patterns. While we have built a better understanding of how social networks structure…

  11. [Human resources for local health systems].

    PubMed

    Linger, C

    1989-01-01

    The economic and social crises affecting Latin America have had a profound social and political effect on its structures. This paper analyzes this impact from 2 perspectives: 1) the impact on the apparatus of the state, in particular on its health infra-structures; and 2) the direction of the democratic process in the continent and the participatory processes of civil societies. The institutionalization of the Local Health Systems (SILOS) is an effort to analyze the problem from within the health sector and propose solutions. This paper discusses the issues of human resource development in health systems; training in human resource development and human resource development in local health care systems. There are 3 strategies used to change health systems: 1) The judicial-political system: The state's apparatus 2) The political-administrative system: the national health care system; and 3) the political-operative system: local health care systems. To assure implementation of SILOS there are 4 steps to be followed: 1) create political conditions that allow the transformation and development of local health systems; 2) development of high-level institutional and political initiatives to develop health care networks; 3) offer key players institutional space and social action to develop the SILOS process; 4) rapidly develop SILOS in regions to assure its integration with other development efforts. The labor force in the health sector and organized communities play critical roles in proposing and institutionalizing health programs. PMID:2766984

  12. Health Care Service Utilization of Dementia Patients before and after Institutionalization: A Claims Data Analysis

    PubMed Central

    Schwarzkopf, Larissa; Hao, Yi; Holle, Rolf; Graessel, Elmar

    2014-01-01

    Background Community-based and institutional dementia care has been compared in cross-sectional studies, but longitudinal information on the effect of institutionalization on health care service utilization is sparse. Methods We analyzed claims data from 651 dementia patients via Generalized Estimation Equations to assess health care service utilization profiles and corresponding expenditures from four quarters before to four quarters after institutionalization. Results In all domains, utilization increased in the quarter of institutionalization. Afterwards, the use of drugs, medical aids, and non-physician services (e.g., occupational therapy and physiotherapy) remained elevated, but use of in- and outpatient treatment decreased. Cost of care showed corresponding profiles. Conclusion Institutional dementia care seems to be associated with an increased demand for supportive services but not necessarily for specialized medical care. PMID:25337076

  13. Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam

    PubMed Central

    Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur

    2015-01-01

    Objective: This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Methods: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household’s ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Results: Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. Conclusions: More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery

  14. Investing in health systems for universal health coverage in Africa

    PubMed Central

    2014-01-01

    Background This study focused on the 47 Member States of the World Health Organization (WHO) African Region. The specific objectives were to prepare a synthesis on the situation of health systems¿ components, to analyse the correlation between the interventions related to the health Millennium Development Goals (MDGs) and some health systems¿ components and to provide overview of four major thrusts for progress towards universal health coverage (UHC). Methods The WHO health systems framework and the health-related MDGs were the frame of reference. The data for selected indicators were obtained from the WHO World Health Statistics 2014 and the Global Health Observatory. Results African Region¿s average densities of physicians, nursing and midwifery personnel, dentistry personnel, pharmaceutical personnel, and psychiatrists of 2.6, 12, 0.5, 0.9 and 0.05 per 10 000 population were about five-fold, two-fold, five-fold, five-fold and six-fold lower than global averages. Fifty-six percent of the reporting countries had fewer than 11 health posts per 100 000 population, 88% had fewer than 11 health centres per 100 000 population, 82% had fewer than one district hospital per 100 000 population, 74% had fewer than 0.2 provincial hospitals per 100 000 population, and 79% had fewer than 0.2 tertiary hospitals per 100 000 population. Some 83% of the countries had less than one MRI per one million people and 95% had fewer than one radiotherapy unit per million population. Forty-six percent of the countries had not adopted the recommendation of the International Taskforce on Innovative Financing to spend at least US$ 44 per person per year on health. Some of these gaps in health system components were found to be correlated to coverage gaps in interventions for maternal health (MDG 5), child health (MDG 4) and HIV/AIDS, TB and malaria (MDG 6). Conclusions Substantial gaps exist in health systems and access to MDG-related health interventions. It is imperative that countries

  15. Mental health utilization of new-to-care Iraq and Afghanistan Veterans following suicidal ideation assessment.

    PubMed

    Denneson, Lauren M; Corson, Kathryn; Helmer, Drew A; Bair, Matthew J; Dobscha, Steven K

    2014-07-30

    We evaluated the impact of brief structured suicidal ideation (SI) assessments on mental health care among new-to-care Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans. National datasets provided military, demographic, and clinical information. For all new-to-care OEF/OIF veterans administered depression screens (PHQ-2: Patient Health Questionnaire-2) and structured SI assessments in primary care or ambulatory mental health settings of three Veterans Affairs (VA) Medical Centers between April 2008 and September 2009 (N=465), generalized estimating equations were used to examine associations between SI and number of subsequent-year specialty mental health visits and antidepressant prescriptions. Approximately one-third of the veterans reported SI. In multivariate models, PTSD and anxiety diagnoses, severe depression symptoms, being married, and SI assessment by a mental health clinician were associated with more mental health visits in the subsequent year. Depression, PTSD, and anxiety diagnoses, and SI assessment by a mental health clinician were associated with receiving antidepressants. Presence of SI did not significantly affect subsequent year mental health utilization when adjusting for diagnostic and clinician variables, but inaugural visits involving mental health clinicians were consistently associated with subsequent mental health care. PMID:24726814

  16. Eliciting health state utilities for Dupuytren’s contracture using a discrete choice experiment

    PubMed Central

    2013-01-01

    Background and purpose An internet-based discrete choice experiment (DCE) was conducted to elicit preferences for a wide range of Dupuytren’s contracture (DC)-related health states. An algorithm was subsequently developed to convert these preferences into health state utilities that can be used to assess DC’s impact on quality of life and the value of its treatments. Methods Health state preferences for varying levels of DC hand severity were elicited via an internet survey from a sample of the UK adult population. Severity levels were defined using a combination of contractures (0, 45, or 90 degrees) in 8 proximal interphalangeal and metacarpophalangeal joints of the index, middle, ring, and little fingers. Right-handed, left-handed, and ambidextrous respondents indicated which hand was preferable in each of the 10 randomly-selected hand-pairings comparing different DC severity levels. For consistency across comparisons, anatomically precise digital hand drawings were used. To anchor preferences onto the traditional 0–1 utility scale used in health economic evaluations, unaffected hands were assigned a utility of 1.0 whereas the utility for a maximally affected hand (i.e., all 8 joints set at 90 degrees of contracture) was derived by asking respondents to indicate what combination of attributes and levels of the EQ-5D-5L profile most accurately reflects the impact of living with such hand. Conditional logistic models were used to estimate indirect utilities, then rescaled to the anchor points on the EQ-5D-5L. Results Estimated utilities based on the responses of 1,745 qualified respondents were 0.49, 0.57, and 0.63 for completely affected dominant hands, non-dominant hands, or ambidextrous hands, respectively. Utility for a dominant hand with 90-degree contracture in t h e metacarpophalangeal joints of the ring and little fingers was estimated to be 0.89. Separately, reducing the contracture of metacarpophalangeal joint for a little finger from 50 to 12

  17. Assigning values to intermediate health states for cost-utility analysis: theory and practice.

    PubMed

    Cohen, B J

    1996-01-01

    Cost-utility analysis (CUA) was developed to guide the allocation of health care resources under a budget constraint. As the generally stated goal of CUA is to maximize aggregate health benefits, the philosophical underpinning of this method is classic utilitarianism. Utilitarianism has been criticized as a basis for social choice because of its emphasis on the net sum of benefits without regard to the distribution of benefits. For example, it has been argued that absolute priority should be given to the worst off when making social choices affecting basic needs. Application of classic utilitarianism requires use of strength-of-preference utilities, assessed under conditions of certainty, to assign quality-adjustment factors to intermediate health states. The two methods commonly used to measure strength-of-preference utility, categorical scaling and time tradeoff, produce rankings that systematically give priority to those who are better off. Alternatively, von Neumann-Morgenstern utilities, assessed under conditions of uncertainty, could be used to assign values to intermediate health states. The theoretical basis for this would be Harsanyi's proposal that social choice be made under the hypothetical assumption that one had an equal chance of being anyone in society. If this proposal is accepted, as well as the expected-utility axioms applied to both individual choice and social choice, the preferred societal arrangement is that with the highest expected von Neumann-Morgenstern utility. In the presence of risk aversion, this will give some priority to the worst-off relative to classic utilitarianism. Another approach is to raise the values obtained by time-tradeoff assessments to a power a between 0 and 1. This would explicitly give priority to the worst off, with the degree of priority increasing as a decreases. Results could be presented over a range of a. The results of CUA would then provide useful information to those holding a range of philosophical points

  18. A comparison of four different approaches to measuring health utility in depressed patients

    PubMed Central

    2013-01-01

    Background A variety of instruments are used to measure health related quality of life. Few data exist on the performance and agreement of different instruments in a depressed population. The aim of this study was to investigate agreement between, and suitability of, the EQ-5D-3L, EQ-5D Visual Analogue Scale (EQ-5D VAS), SF-6D and SF-12 new algorithm for measuring health utility in depressed patients. Methods The intraclass correlation coefficient (ICC) and Bland and Altman approaches were used to assess agreement. Instrument sensitivity was analysed by: (1) plotting utility scores for the instruments against one another; (2) correlating utility scores and depressive symptoms (Beck Depression Inventory (BDI)); and (3) using Tukey’s procedure. Receiver Operating Characteristic (ROC) analysis assessed instrument responsiveness to change. Acceptability was assessed by comparing instrument completion rates. Results The overall ICC was 0.57. Bland and Altman plots showed wide limits of agreement for each pair wise comparison, except between the SF-6D and SF-12 new algorithm. Plots of utility scores displayed ’ceiling effects’ in the EQ-5D-3L index and ’floor effects’ in the SF-6D and SF-12 new algorithm. All instruments showed a negative monotonic relationship with BDI, but the EQ-5D-3L index and EQ-5D VAS could not differentiate between depression severity sub-groups. The SF-based instruments were better able to detect changes in health state over time. There was no difference in completion rates of the four instruments. Conclusions There was a lack of agreement between utility scores generated by the different instruments. According to the criteria of sensitivity, responsiveness and acceptability that we applied, the SF-6D and SF-12 may be more suitable for the measurement of health related utility in a depressed population than the EQ-5D-3L, which is the instrument currently recommended by NICE. PMID:23659557

  19. Health and health systems in the Commonwealth of Independent States.

    PubMed

    Rechel, Bernd; Roberts, Bayard; Richardson, Erica; Shishkin, Sergey; Shkolnikov, Vladimir M; Leon, David A; Bobak, Martin; Karanikolos, Marina; McKee, Martin

    2013-03-30

    The countries of the Commonwealth of Independent States differ substantially in their post-Soviet economic development but face many of the same challenges to health and health systems. Life expectancies dropped steeply in the 1990s, and several countries have yet to recover the levels noted before the dissolution of the Soviet Union. Cardiovascular disease is a much bigger killer in the Commonwealth of Independent States than in western Europe because of hazardous alcohol consumption and high smoking rates in men, the breakdown of social safety nets, rising social inequality, and inadequate health services. These former Soviet countries have embarked on reforms to their health systems, often aiming to strengthen primary care, scale back hospital capacities, reform mechanisms for paying providers and pooling funds, and address the overall shortage of public funding for health. However, major challenges remain, such as frequent private out-of-pocket payments for health care and underdeveloped systems for improvement of quality of care. PMID:23541055

  20. Effect of diabetic case management intervention on health service utilization in Korea.

    PubMed

    Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George

    2015-12-01

    This study is to estimate the effectiveness of a diabetic case management programme on health-care service utilization. The study population included 6007 as the intervention group and 956,766 as the control group. As the indicators of health-care service utilization, numbers of medical ambulatory consultations, days of medication prescribed and medical expenses for one year were used, and we analysed the claim data of the health insurance from 2005 to 2007. The study population was classified into three subgroups based on the number of medical ambulatory consultations per year before this intervention. In the under-serviced subgroup, the intervention group showed a significant increase in the number of consultations (3.2), days of prescribed medication (66.4) and medical expenses (287,900 KRW) compared with the control group. Conversely, in the over-serviced subgroup, the intervention group showed a less decrease days of prescribed medication (1.6) compared with the control group. This showed that the case management programme led the intervention group to optimize their utilization of health-care services by subgroups. It is necessary to evaluate the appropriateness of health-care usage and clinical outcome to show the direct effectiveness of the case management programme by subgroups. PMID:24821209

  1. Explaining health care utilization for panic attacks using cusp catastrophe modeling.

    PubMed

    Katerndahl, David

    2008-10-01

    Despite increased health care utilization, patients with panic disorder continue to report unmet needs. The objective was to compare the fit of linear and Cusp Catastrophe Modeling in explaining changes in utilization of emergency, general and mental health settings, and self-treatments for panic symptoms. This community-based study surveyed 97 subjects with panic attacks drawn from a sample of randomly-selected adults from randomly-selected households. The stressor (splitting) variable used was Phobic Anxiety while predisposing variables included Family Health Care Utilization, Perceived Life Threat and Need For Treatment, and Treatment Experience. Outcomes consisted of the number of sites and self-treatments used for panic symptoms when first seeking care and during the 2 months prior to survey. Use of mental health sites and self-treatments demonstrated superior modeling with cusp catastrophe approaches using treatment experience as the predisposing variable, accounting for 47% and 38% of variances respectively, improving the fit by over 20% compared to the best linear models in both cases. Cusp catastrophe modeling accounted for more variance than all linear models when describing use of mental health settings and self-treatments. Cusp catastrophe may explain bimodal distributions in behavior, delays in behavior change, and sudden shifts in behavior in stressful situations. PMID:18765074

  2. Community energy systems and the law of public utilities

    SciTech Connect

    Feurer, D.A.; Weaver, C.L.

    1981-01-01

    A detailed description is given of the laws and programs of the State of Nebraska governing the regulation of public energy utilities, the siting of energy generating and transmission facilities, the municipal franchising of public energy utilities, and the prescription of rates to be charged by utilities including attendant problems of cost allocations, rate base and operating expense determinations, and rate of return allowances. These laws and programs are analyzed to identify impediments which they may present to the implementation of Integrated Community Energy Systems (ICES). This report is one of fifty-one separate volumes which describe such regulatory programs at the Federal level and in each state as background to the report entitiled ''Community Energy Systems and the Law of Public Utilities--Volume One: An Overview.'' This report also contains a summary of a strategy described in Volume One - An Overview for overcoming these impediments by working within the existing regulatory framework and by making changes in the regulatory programs to enhance the likelihood of ICES implementation.

  3. VA Health Service Utilization for Homeless and Low-income Veterans

    PubMed Central

    Gabrielian, Sonya; Yuan, Anita H.; Andersen, Ronald M.; Rubenstein, Lisa V.; Gelberg, Lillian

    2016-01-01

    Background The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program—the VA’s Housing First effort—is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. Objectives We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. Research Design We performed a secondary database analysis of Veterans (n = 62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. Results HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Conclusions Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care. PMID:24714583

  4. The Influence of Parenting on Early Childhood Health and Health Care Utilization

    PubMed Central

    Hubert, Michele; Hastings, Paul D.; Stack, Dale M.; Schwartzman, Alex E.

    2014-01-01

    Objective This study examined whether parenting, specifically parental support, structure, and behavioral control, predicted early childhood health care use and moderated the negative effects of socioeconomic disadvantage. Methods A sample of 250 parent–child dyads from a longitudinal intergenerational research program participated. Results Greater parental support was associated with increased rates of nonemergency care and a higher ratio of outpatient to emergency room (ER) services, a pattern reflecting better health and service use. Support also moderated the negative effects of disadvantaged family background. Greater behavioral control by parents predicted lower rates of both nonemergency care and ER visits. Structured parenting and behavioral control were associated with lower rates of respiratory illness. Conclusions This study highlights the importance of considering parenting practices when examining variations in early childhood health and health care, and the relevance of parental behavior in designing interventions for high-risk populations. PMID:25016605

  5. Utility of the International Classification of Functioning, Disability and Health (ICF) for educational psychologists’ work

    PubMed Central

    Aljunied, Mariam; Frederickson, Norah

    2014-01-01

    Despite embracing a bio-psycho-social perspective, the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) assessment framework has had limited application to date with children who have special educational needs (SEN). This study examines its utility for educational psychologists’ work with children who have Autism Spectrum Disorders (ASD). Mothers of 40 children with ASD aged eight to 12 years were interviewed using a structured protocol based on the ICF framework. The Diagnostic Interview for Social and Communication Disorder (DISCO) was completed with a subset of 19 mothers. Internal consistency and inter-rater reliability of the interview assessments were found to be acceptable and there was evidence for concurrent and discriminant validity. Despite some limitations, initial support for the utility of the ICF model suggests its potential value across educational, health and care fields. Further consideration of its relevance to educational psychologists in new areas of multi-agency working is warranted. PMID:26157197

  6. Psychosocial Predictors of Mental Health Service Utilization among Women During their Mid-Sixties

    PubMed Central

    Pahl, Kerstin; Brook, Judith S.; Zhang, Chenshu; Brook, David W.

    2014-01-01

    This longitudinal study examined the longitudinal pathways to the utilization of mental health services among women in their mid-sixties. Earlier educational level, psychological symptoms, cigarette use, and physical diseases, and later psychological symptoms were examined as predictors of mental health services utilization. The sample consisted of a prospective cohort of women (N=511) who were followed from young adulthood (mean age = 32) to late midlife (mean age = 65). Using structural equation modeling, the results supported a mediational model showing that earlier low educational level and greater psychological symptoms predicted increased cigarette smoking. Cigarette smoking predicted later physical diseases and symptoms. Physical diseases and symptoms were related to financial difficulty and later psychological symptoms and, ultimately, the use of mental health services. PMID:24878632

  7. Psychosocial Predictors of Mental Health Service Utilization Among Women During their Mid-Sixties.

    PubMed

    Pahl, Kerstin; Brook, Judith S; Zhang, Chenshu; Brook, David W

    2016-04-01

    This prospective study examined the longitudinal pathways to the utilization of mental health services among women in their mid-sixties. Earlier educational level, psychological symptoms, cigarette use, and physical diseases and later psychological symptoms were examined as predictors of mental health services utilization. The sample consisted of a prospective cohort of women (N = 511) who were followed from young adulthood (mean age = 32) to late midlife (mean age = 65). Using structural equation modeling, the results supported a mediational model showing that earlier low educational level and greater psychological symptoms predicted increased cigarette smoking. Cigarette smoking predicted later physical diseases and symptoms. Physical diseases and symptoms were related to financial difficulty and later psychological symptoms and, ultimately, the use of mental health services by women in the mid-sixties. PMID:24878632

  8. Utility and limitations of measures of health inequities: a theoretical perspective

    PubMed Central

    Alonge, Olakunle; Peters, David H.

    2015-01-01

    Summary box What is already known on this subject? Various measures have been used in quantifying health inequities among populations in recent times; most of these measures were derived to capture the socioeconomic inequalities in health. These different measures do not always lend themselves to common interpretation by policy makers and health managers because they each reflect limited aspects of the concept of health inequities. What does this study add? To inform a more appropriate application of the different measures currently used in quantifying health inequities, this article explicates common theories underlying the definition of health inequities and uses this understanding to show the utility and limitations of these different measures. It also suggests some key features of an ideal indicator based on the conceptual understanding, with the hope of influencing future efforts in developing more robust measures of health inequities. The article also provides a conceptual ‘product label’ for the common measures of health inequities to guide users and ‘consumers’ in making more robust inferences and conclusions. This paper examines common approaches for quantifying health inequities and assesses the extent to which they incorporate key theories necessary for explicating the definition of health inequity. The first theoretical analysis examined the distinction between inter-individual and inter-group health inequalities as measures of health inequities. The second analysis considered the notion of fairness in health inequalities from different philosophical perspectives. To understand the extent to which different measures of health inequities incorporate these theoretical explanations, four criteria were used to assess each measure: 1) Does the indicator demonstrate inter-group or inter-individual health inequalities or both; 2) Does it reflect health inequalities in relation to socioeconomic position; 3) Is it sensitive to the absolute transfer of

  9. Materials selection guidelines for geothermal energy utilization systems

    SciTech Connect

    Ellis, P.F. II; Conover, M.F.

    1981-01-01

    This manual includes geothermal fluid chemistry, corrosion test data, and materials operating experience. Systems using geothermal energy in El Salvador, Iceland, Italy, Japan, Mexico, New Zealand, and the United States are described. The manual provides materials selection guidelines for surface equipment of future geothermal energy systems. The key chemical species that are significant in determining corrosiveness of geothermal fluids are identified. The utilization modes of geothermal energy are defined as well as the various physical fluid parameters that affect corrosiveness. Both detailed and summarized results of materials performance tests and applicable operating experiences from forty sites throughout the world are presented. The application of various non-metal materials in geothermal environments are discussed. Included in appendices are: corrosion behavior of specific alloy classes in geothermal fluids, corrosion in seawater desalination plants, worldwide geothermal power production, DOE-sponsored utilization projects, plant availability, relative costs of alloys, and composition of alloys. (MHR)

  10. Integrated System Health Management Development Toolkit

    NASA Technical Reports Server (NTRS)

    Figueroa, Jorge; Smith, Harvey; Morris, Jon

    2009-01-01

    This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.

  11. A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial

    PubMed Central

    Emerson, John F.; Welch, Madelyn; Rossman, Whitney E.; Carek, Stephen; Ludden, Thomas; Templin, Megan; Moore, Charity G.; Tapp, Hazel; Dulin, Michael; McWilliams, Andrew

    2015-01-01

    Advances in technology are likely to provide new approaches to address healthcare disparities for high-risk populations. This study explores the feasibility of a new approach to health disparities research using a multidisciplinary intervention and advanced communication technology to improve patient access to care and chronic disease management. A high-risk cohort of uninsured, poorly-controlled diabetic patients was identified then randomized pre-consent with stratification by geographic region to receive either the intervention or usual care. Prior to enrollment, participants were screened for readiness to make a behavioral change. The primary outcome was the feasibility of protocol implementation, and secondary outcomes included the use of patient-centered medical home (PCMH) services and markers of chronic disease control. The intervention included a standardized needs assessment, individualized care plan, intensive management by a multidisciplinary team, including health coach-facilitated virtual visits, and the use of a cloud-based glucose monitoring system. One-hundred twenty-seven high-risk, potentially eligible participants were randomized. Sixty-one met eligibility criteria after an in-depth review. Due to limited resources and time for the pilot, we only attempted to contact 36 participants. Of these, we successfully reached 20 (32%) by phone and conducted a readiness to change screen. Ten participants screened in as ready to change and were enrolled, while the remaining 10 were not ready to change. Eight enrolled participants completed the final three-month follow-up. Intervention feasibility was demonstrated through successful implementation of 13 out of 14 health coach-facilitated virtual visits, and 100% of participants indicated that they would recommend the intervention to a friend. Protocol feasibility was demonstrated as eight of 10 participants completed the entire study protocol. At the end of the three-month intervention, participants had a

  12. A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial.

    PubMed

    Emerson, John F; Welch, Madelyn; Rossman, Whitney E; Carek, Stephen; Ludden, Thomas; Templin, Megan; Moore, Charity G; Tapp, Hazel; Dulin, Michael; McWilliams, Andrew

    2016-01-01

    Advances in technology are likely to provide new approaches to address healthcare disparities for high-risk populations. This study explores the feasibility of a new approach to health disparities research using a multidisciplinary intervention and advanced communication technology to improve patient access to care and chronic disease management. A high-risk cohort of uninsured, poorly-controlled diabetic patients was identified then randomized pre-consent with stratification by geographic region to receive either the intervention or usual care. Prior to enrollment, participants were screened for readiness to make a behavioral change. The primary outcome was the feasibility of protocol implementation, and secondary outcomes included the use of patient-centered medical home (PCMH) services and markers of chronic disease control. The intervention included a standardized needs assessment, individualized care plan, intensive management by a multidisciplinary team, including health coach-facilitated virtual visits, and the use of a cloud-based glucose monitoring system. One-hundred twenty-seven high-risk, potentially eligible participants were randomized. Sixty-one met eligibility criteria after an in-depth review. Due to limited resources and time for the pilot, we only attempted to contact 36 participants. Of these, we successfully reached 20 (32%) by phone and conducted a readiness to change screen. Ten participants screened in as ready to change and were enrolled, while the remaining 10 were not ready to change. Eight enrolled participants completed the final three-month follow-up. Intervention feasibility was demonstrated through successful implementation of 13 out of 14 health coach-facilitated virtual visits, and 100% of participants indicated that they would recommend the intervention to a friend. Protocol feasibility was demonstrated as eight of 10 participants completed the entire study protocol. At the end of the three-month intervention, participants had a

  13. Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data

    PubMed Central

    Saxena, Deepak; Vangani, Ruchi; Mavalankar, Dileep V.; Thomsen, Sarah

    2013-01-01

    Background Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007–2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes – Institutional delivery, antenatal care (ANC), and use of modern contraception – and selected intermediary and structural determinants of health using multiple logistic regression. Results Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and

  14. The Rural – Urban Divide: Health Services Utilization Among Older Mexicans in Mexico

    PubMed Central

    Salinas, Jennifer J.; Al Snih, Soham; Markides, Kyriakos; Ray, Laura A.; Angel, Ronald J.

    2010-01-01

    Context Mexico Purpose Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen’s “model of health services” of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Findings Results showed that older Mexicans living in the most rural areas (populations of 2500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health. PMID:21029168

  15. Longitudinal Analysis of Changes in Illicit Drug Use and Health Services Utilization

    PubMed Central

    French, Michael T; Fang, Hai; Balsa, Ana I

    2011-01-01

    Objective To analyze the relationships between illicit drug use and three types of health services utilization: emergency room utilization, hospitalization, and medical attention required due to injury(s). Data Waves 1 and 2 (11,253 males and 13,059 females) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Study Design We derive benchmark estimates by employing standard cross-sectional data models to pooled waves of NESARC data. To control for potential bias due to time-invariant unobserved individual heterogeneity, we reestimate the relationships with fixed-effects models. Principal Findings The cross-sectional data models suggest that illicit drug use is positively and significantly related to health services utilization in almost all specifications. Conversely, the only significant (p<.05) relationships in the fixed-effects models are the odds of receiving medical attention for an injury and the number of injuries requiring medical attention for men, and the number of times hospitalized for men and women. Conclusions Failing to control for time-invariant individual heterogeneity could lead to biased coefficients when estimating the effects of illicit drug use on health services utilization. Moreover, it is important to distinguish between types of drug user (casual versus heavy) and estimate gender-specific models. PMID:21143479

  16. Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

    PubMed Central

    Memon, Zahid; Zaidi, Shehla; Riaz, Atif

    2016-01-01

    Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers.

  17. Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey

    PubMed Central

    2014-01-01

    Background Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Methods Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Results Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women’s autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by

  18. Health Care Utilization and Receipt of Preventive Care for Patients Seen at Federally Funded Health Centers Compared to Other Sites of Primary Care

    PubMed Central

    Laiteerapong, Neda; Kirby, James; Gao, Yue; Yu, Tzy-Chyi; Sharma, Ravi; Nocon, Robert; Lee, Sang Mee; Chin, Marshall H; Nathan, Aviva G; Ngo-Metzger, Quyen; Huang, Elbert S

    2014-01-01

    Objective To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. Data Sources A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004–2008). Study Design HC patients were defined as those with ≥50 percent of outpatient visits at HCs in the first panel year. Outcomes included utilization and preventive care receipt from the second panel year. We used negative binomial and logistic regression models with propensity score adjustment for confounding differences between HC and non-HC patients. Principal Findings Compared to non-HC patients, HC patients had fewer office visits (adjusted incidence rate ratio [aIRR], 0.63) and hospitalizations (aIRR, 0.43) (both p < .001). HC patients were more likely to receive breast cancer screening than non-HC patients (adjusted odds ratio [aOR] 2.78, p < .01). In subgroup analyses, uninsured HC patients had fewer outpatient and emergency room visits and were more likely to receive dietary advice and breast cancer screening compared to non-HC patients. Conclusions Health centers add value to the health care system by providing socially and medically disadvantaged patients with care that results in lower utilization and maintained or improved preventive care. PMID:24779670

  19. Building health research systems to achieve better health

    PubMed Central

    Hanney, Stephen R; González Block, Miguel A

    2006-01-01

    Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS) provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics related to the above

  20. Quality improvement in population health systems.

    PubMed

    Inkelas, Moira; McPherson, Marianne E

    2015-12-01

    Quality improvement methods have achieved large sustainable changes in health care quality and health outcomes. Transforming health care into a population health system requires methods for innovation and improvement that can work across professions and sectors. It may be possible to replicate improvement successes in healthcare settings within and across the broader systems of social, educational, and other human services that influence health outcomes in communities. Improvement methods could translate the rhetoric of collaboration, integration and alignment into practice across the fragmented health and human service sectors in the U.S. PMID:26699349

  1. Utilization and Cost of Health Services in Individuals With Traumatic Brain Injury

    PubMed Central

    Dismuke, Clara E.; Walker, Rebekah J.; Egede, Leonard E.

    2015-01-01

    Traumatic Brain Injury (TBI) has gained attention in the past decade as a “signature injury” in the conflicts in Iraq and Afghanistan. TBI is a major burden for both the military and civilian population in the US and worldwide. It is a leading cause of death and disability in the US and a major health services resource burden. We seek to answer two questions. What is the evidence regarding the association of TBI with health services utilization and costs in the US and worldwide? What is the evidence regarding racial/ethnic, gender, geographic, socio-economic and other disparities in health services utilization and cost in the US and worldwide? To attain this goal we searched several databases using key words to perform a systematic review of the literature since 2000. We found 36 articles to be eligible for inclusion in the review. The evidence demonstrates a wide variation in health services utilization and costs depending on population of study and severity of TBI. The evidence also supports the existence of racial/ethnic, gender, insurance, geographic disparities in the US as well as other unique disparities worldwide. PMID:26153156

  2. Does distrust in providers affect health-care utilization in China?

    PubMed Central

    Duckett, Jane; Hunt, Kate; Munro, Neil; Sutton, Matt

    2016-01-01

    How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence. PMID:27117483

  3. An intelligent approach to machine component health prognostics by utilizing only truncated histories

    NASA Astrophysics Data System (ADS)

    Lu, Chen; Tao, Laifa; Fan, Huanzhen

    2014-01-01

    Numerous techniques and methods have been proposed to reduce the production downtime, spare-part inventory, maintenance cost, and safety hazards of machineries and equipment. Prognostics are regarded as a significant and promising tool for achieving these benefits for machine maintenance. However, prognostic models, particularly probabilistic-based methods, require a large number of failure instances. In practice, engineering assets are rarely being permitted to run to failure. Many studies have reported valuable models and methods that engage in maximizing both truncated and failure data. However, limited studies have focused on cases where only truncated data are available, which is common in machine condition monitoring. Therefore, this study develops an intelligent machine component prognostics system by utilizing only truncated histories. First, the truncated Minimum Quantization Error (MQE) histories were obtained by Self-organizing Map network after feature extraction. The chaos-based parallel multilayer perceptron network and polynomial fitting for residual errors were adopted to generate the predicted MQEs and failure times following the truncation times. The feed-forward neural network (FFNN) was trained with inputs both from the truncated MQE histories and from the predicted MQEs. The target vectors of survival probabilities were estimated by intelligent product limit estimator using the truncation times and generated failure times. After validation, the FFNN was applied to predict the machine component health of individual units. To validate the proposed method, two cases were considered by using the degradation data generated by bearing testing rig. Results demonstrate that the proposed method is a promising intelligent prognostics approach for machine component health.

  4. Explanation of inequality in utilization of ambulatory care before and after universal health insurance in Thailand.

    PubMed

    Yiengprugsawan, V; Carmichael, Ga; Lim, Ll-Y; Seubsman, S; Sleigh, Ac

    2011-03-01

    Thailand implemented a Universal Coverage Scheme (UCS) of national health insurance in April 2001 to finance equitable access to health care. This paper compares inequalities in health service use before and after the UCS, and analyses the trend and determinants of inequality. The national Health and Welfare Surveys of 2001 and 2005 are used for this study. The concentration index for use of ambulatory care among the population reporting a recent illness is used as a measure of health inequality, decomposed into contributing demographic, socio-economic, geographic and health insurance determinants. As a result of the UCS, the uninsured group fell from 24% in 2001 to 3% in 2005 and health service patterns changed. Use of public primary health care facilities such as health centres became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off. Decomposition analysis shows that the increasingly common use of health centres among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the UCS. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes. Although the UCS scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required. PMID:20736414

  5. Primary health care and public health: foundations of universal health systems.

    PubMed

    White, Franklin

    2015-01-01

    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. PMID:25591411

  6. Trust in the Health Care System and the Use of Preventive Health Services by Older Black and White Adults

    PubMed Central

    Schulz, Richard; Harris, Roderick; Silverman, Myrna; Thomas, Stephen B.

    2009-01-01

    Objectives. We sought to find racial differences in the effects of trust in the health care system on preventive health service use among older adults. Methods. We conducted a telephone survey with 1681 Black and White older adults. Survey questions explored respondents' trust in physicians, medical research, and health information sources. We used logistic regression and controlled for covariates to assess effects of race and trust on the use of preventive health services. Results. We identified 4 types of trust through factor analysis: trust in one's own personal physician, trust in the competence of physicians' care, and trust in formal and informal health information sources. Blacks had significantly less trust in their own physicians and greater trust in informal health information sources than did Whites. Greater trust in one's own physician was associated with utilization of routine checkups, prostate-specific antigen tests, and mammograms, but not with flu shots. Greater trust in informal information sources was associated with utilization of mammograms. Conclusions. Trust in one's own personal physician is associated with utilization of preventive health services. Blacks' relatively high distrust of their physicians likely contributes to health disparities by causing reduced utilization of preventive services. Health information disseminated to Blacks through informal means is likely to increase Blacks' utilization of preventive health services. PMID:18923129

  7. Mental Health Information Systems: Some National Trends

    PubMed Central

    Hedlund, James L.

    1978-01-01

    Results of a national survey indicate that approximately 90 percent of all state departments of mental health utilize computer support for at least some administrative and clinical functions. Nearly all indicated planning for considerably increased use; very few reported neither current use of computers nor active plans for future use. Both this survey and a similar one concerning community mental health centers indicate extensive development and strong acceptance of computer applications in administrative and documentation areas, in program evaluation, utilization review and research, but rather weak endorsement and proliferation concerning more clinically-oriented computer applications that involve the monitoring of individual patient care, clinical decision making and clinical predictions.

  8. Effect of Health Literacy on the Utilization of Advance Directives Based on the Health Belief Model

    ERIC Educational Resources Information Center

    Henkelman, Wallace J.

    2010-01-01

    Research has demonstrated that only a small proportion of individuals in the United States complete advance directives as part of their planning for end-of-life care. This study sought to determine if health literacy is a significant factor in advance directive completion as has been posited by previous researchers. Analysis of the data collected…

  9. Health information systems: the foundations of public health.

    PubMed Central

    AbouZahr, Carla; Boerma, Ties

    2005-01-01

    Public health decision-making is critically dependent on the timely availability of sound data. The role of health information systems is to generate, analyse and disseminate such data. In practice, health information systems rarely function systematically. The products of historical, social and economic forces, they are complex, fragmented and unresponsive to needs. International donors in health are largely responsible for the problem, having prioritized urgent needs for data over longer-term country capacity-building. The result is painfully apparent in the inability of most countries to generate the data needed to monitor progress towards the Millennium Development Goals. Solutions to the problem must be comprehensive; money alone is likely to be insufficient unless accompanied by sustained support to country systems development coupled with greater donor accountability and allocation of responsibilities. The Health Metrics Network, a global collaboration in the making, is intended to help bring such solutions to the countries most in need. PMID:16184276

  10. Health Extension Workers' and Mothers' Attitudes to Maternal Health Service Utilization and Acceptance in Adwa Woreda, Tigray Region, Ethiopia

    PubMed Central

    Jackson, Ruth; Tesfay, Fisaha Haile; Godefay, Hagos; Gebrehiwot, Tesfay Gebregzabher

    2016-01-01

    Background The maternal health system in Ethiopia links health posts in rural communities (kebeles) with district (woreda) health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs) assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs’ and mother’s attitudes to maternal health services in Adwa Woreda, Tigray Region. Methods In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women’s social status and mobility; and women’s perceptions of skilled birth attendant’s care. All data were analyzed thematically. Findings There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women), and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women’s Development Groups (WDGs), and referral by ambulance to health facilities either before a woman’s Expected Due Date (EDD) or if labour started at home. Conclusion With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women’s groups to improve maternal

  11. [Perspectives of the Tunisian health system reform].

    PubMed

    Achouri, H

    2001-05-01

    Perspectives of development of the Tunisian health system are presented, in reference to the conceptual framework recommended by the World Health Organization, while a project of health insurance reform of the social security regimes is submitted to a dialogue with the different concerned parts. Recommended orientations articulate around five axes: 1. The promotion of care provision by improving the accessibility to services, notably in zones under served, by introducing new modes of dispensation, organization and management of care provision in the framework of a continuous quality assurance strategy. 2. The financing of health care, with the implementation of the health insurance reform, has to allow an improvement of the financial accessibility of the population to health care, while supervising the evolution of total health expenditures and by developing the system's management capacities. 3. Proposals relative to the mobilization of resources are advanced in areas of medicine, training of health professionals and research on the health system. 4. Adaptation of the health system governance to the new context is necessary and would have to be developed around evolving standards for the health system, on evaluation of its performances and on information and communication with its users. 5. The health system responsiveness, new motion whose contours are again blurred, would have to be analysed and adapted to the specific context of the country. PMID:11515474

  12. Health care utilization among rural women of child-bearing age: a Nigerian experience

    PubMed Central

    Odetola, Titilayo Dorothy

    2015-01-01

    Introduction Despite the availability of primary health care services in virtually every community and village in Nigeria, clients travel long distances to reach secondary and tertiary health care institutions. Against this backdrop, the researcher sought to find the factors that influence choice of health institutions among pregnant women. Methods A descriptive study was carried out across three levels of health care institutions with a total sample size of 160 clients who were randomly selected. A thoroughly validated 45- item questionnaire was used to explore clients’ perceptions about what factors influence where they access health care services. Results Major findings revealed that level of education, proximity to place of residence, affordability and quality of services rendered, spousal and significant other's influences were active determinants of choice for health institutions among pregnant women in Nigeria. Conclusion This study elicited information on why some types of institutions were preferred. The study has implications for community health nurses and policy makers on what should be done to make health institutions appropriately utilized by community in Nigeria.

  13. The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits.

    PubMed

    Lipton, Brandy J; Decker, Sandra L

    2015-12-01

    Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p<0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p<0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p<0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p<0.01) less likely to have a functional limitation due to vision. PMID:26588999

  14. Food Systems and Public Health Disparities

    PubMed Central

    Neff, Roni A.; Palmer, Anne M.; Mckenzie, Shawn E.; Lawrence, Robert S.

    2009-01-01

    The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments—and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture. PMID:23173027

  15. Health Care Costs, Utilization and Patterns of Care following Lyme Disease

    PubMed Central

    Adrion, Emily R.; Aucott, John; Lemke, Klaus W.; Weiner, Jonathan P.

    2015-01-01

    Background Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. Objectives 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. Methods This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Results Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses. Conclusions Lyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care

  16. Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population.

    PubMed

    Marks, A; Malizio, J; Hoch, J; Brody, R; Fisher, M

    1983-03-01

    We investigated whether adolescents living in a middle-class suburb believed that their health needs were being met, and the extent to which they were willing to utilize local health care resources for a range of problems. Self-administered, anonymous questionnaires were completed by 649 students in grades 9 through 12. The mean age of respondents was 15.4 years; 52% were female, and 95% white. They had ready access to medical care: 90% used a specific private physician. From a list of 15 health problems, 60% indicated that they had seen a health provider for at least one of them, most often for stomach pains (22%), headaches (18%), and coughing (16%). From an identical list, 48% indicated that there was at least one problem for which they had never seen a health provider but would like to, most often for a weight problem (14%), birth control (10%), and emotional upset (9%). Although 20% regularly used illegal drugs, 24% were sexually active, and 38% thought they had a weight problem, only 1%, 4%, and 10%, respectively, had sought care for these matters. A majority of students would not choose to go to a private physician for care related to sexuality, substance abuse, or emotional upset, and would not be willing to seek care for these problems with their parents' knowledge. Ready access to private primary care did not assure attention to important health needs among these suburban adolescents. PMID:6827422

  17. Population Preferences for Health Care in Liberia: Insights for Rebuilding a Health System

    PubMed Central

    Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

    2011-01-01

    Objective To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. Data Sources/Study Setting Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. Data Collection The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. Principal Findings Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. Conclusions Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. PMID:21517835

  18. Population preferences for health care in liberia: insights for rebuilding a health system.

    PubMed

    Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

    2011-12-01

    OBJECTIVE. To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. DATA SOURCES/STUDY SETTING. Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. DATA COLLECTION. The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. PRINCIPAL FINDINGS. Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. CONCLUSIONS. Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. PMID:21517835

  19. [Information systems in health and health indicators: an integrating perspective].

    PubMed

    Canela-Soler, Jaume; Elvira-Martínez, David; Labordena-Barceló, María Jesús; Loyola-Elizondo, Enrique

    2010-02-01

    Health Information Systems (HIS) are the core support to decision-making in health organizations. Within HIS, health indicators (HI) reflect, numerically, events measured in the health-illness continuum. The integrated health information system is intended to standardize, integrate and organize all the information available in health information systems through an accessible and secure repository, and to conveniently distribute information for decision-making. To standardize information it is necessary to define standards and semantic information to enable us to identify concepts and relate them uniquely to each other. The definition of a catalog of entities (DEA) with concepts, attributes and domains will enable the configuration of the information system, so there will be a catalog of entities (concepts of information and domains). Based on operational systems, analytical systems enabling management and strategy in the management of organizations will be built. The maximum level of analysis is the Balanced Score Card (BSC), which is established as the strategic tool for managers. It is necessary for the organization an integrated information system to plan, manage, evaluate and therefore provide managers with a decision tool for strategic and tactical decision-making in short and medium term. PMID:20211346

  20. Hybrid energy storage systems utilizing redox active organic compounds

    DOEpatents

    Wang, Wei; Xu, Wu; Li, Liyu; Yang, Zhenguo

    2015-09-08

    Redox flow batteries (RFB) have attracted considerable interest due to their ability to store large amounts of power and energy. Non-aqueous energy storage systems that utilize at least some aspects of RFB systems are attractive because they can offer an expansion of the operating potential window, which can improve on the system energy and power densities. One example of such systems has a separator separating first and second electrodes. The first electrode includes a first current collector and volume containing a first active material. The second electrode includes a second current collector and volume containing a second active material. During operation, the first source provides a flow of first active material to the first volume. The first active material includes a redox active organic compound dissolved in a non-aqueous, liquid electrolyte and the second active material includes a redox active metal.

  1. Utilizing social networking sites to promote adolescents' health: a pragmatic review of the literature.

    PubMed

    Francomano, Jesse A; Harpin, Scott B

    2015-01-01

    Social networking site use has exploded among youth in the last few years and is being adapted as an important tool for healthcare interventions and serving as a platform for adolescents to gain access to health information. The aim of this study was to examine the strengths, weaknesses, and best practices of utilizing Facebook in adolescent health promotion and research via pragmatic literature review. We also examine how sites can facilitate ethically sound healthcare for adolescents, particularly at-risk youth. We conducted a literature review of health and social sciences literature from the past 5 years related to adolescent health and social network site use. Publications were grouped by shared content then categorized by themes. Five themes emerged: access to healthcare information, peer support and networking, risk and benefits of social network site use in care delivery, overcoming technological barriers, and social network site interventions. More research is needed to better understand how such Web sites can be better utilized to provide access to adolescents seeking healthcare. Given the broad reach of social network sites, all health information must be closely monitored for accurate, safe distribution. Finally, consent and privacy issues are omnipresent in social network sites, which calls for standards of ethical use. PMID:25393833

  2. Utility of qualitative research findings in evidence-based public health practice.

    PubMed

    Jack, Susan M

    2006-01-01

    Epidemiological data, derived from quantitative studies, provide important information about the causes, prevalence, risk correlates, treatment and prevention of diseases, and health issues at a population level. However, public health issues are complex in nature and quantitative research findings are insufficient to support practitioners and administrators in making evidence-informed decisions. Upshur's Synthetic Model of Evidence (2001) situates qualitative research findings as a credible source of evidence for public health practice. This article answers the following questions: (1) where does qualitative research fit within the paradigm of evidence-based practice and (2) how can qualitative research be used by public health professionals? Strategies for using qualitative research findings instrumentally, conceptually, and symbolically are identified by applying Estabrooks' (1999) conceptual structure of research utilization. Different research utilization strategies are illustrated through the use of research examples from the field of work on intimate partner violence against women. Recommendations for qualitative researchers disseminating findings and for public health practitioners/policy makers considering the use of qualitative findings as evidence to inform decisions are provided. PMID:16684207

  3. The role of military social support in understanding the relationship between PTSD, physical health, and healthcare utilization in women veterans.

    PubMed

    Lehavot, Keren; Der-Martirosian, Claudia; Simpson, Tracy L; Shipherd, Jillian C; Washington, Donna L

    2013-12-01

    Posttraumatic stress disorder (PTSD) is a significant predictor of both poorer physical health and increased health care utilization, whereas adequate social support is associated with better physical health and less health care utilization. However, research has not previously examined the simultaneous effects of PTSD and social support on health and health care utilization. This study examined both the independent and interactive effects of PTSD and a particular type of social support (postactive-duty social support from military friends) on self-reported physical health and number of Veterans Health Administration (VHA) visits in the last year. These relationships were examined in a representative, national sample of 3,524 women veterans who completed telephone interviews as part of the National Survey of Women Veterans in 2008-2009. Regression analyses were conducted using these cross-sectional data to examine main effects of PTSD and military social support on physical health and VHA utilization and their interaction. Screening positive for PTSD was associated with poorer health (B = -3.19, SE = 1.47) and increased VHA utilization (B = 0.98, SE = 0.16), whereas greater military social support was associated with better health (B = 0.97, SE = 0.44) and less frequent VHA utilization (B = -0.15, SE = 0.05). Neither moderation model was significant, such that military social support behaved in a similar way regardless of PTSD status. PMID:24203114

  4. Utilizing the CIPP Model as a Means to Develop an Integrated Service-Learning Component in a University Health Course

    ERIC Educational Resources Information Center

    Powell, Brent; Conrad, Eric

    2015-01-01

    Purpose: To examine the enhancement of a university health course through the utilization of the CIPP Model as a means to develop an integrated service-learning component. Methods: The CIPP model was utilized in two concurrent semesters of an undergraduate health course in order to design and evaluate the implementation of a drug and alcohol…

  5. Effect of health system reforms in Turkey on user satisfaction

    PubMed Central

    Stokes, Jonathan; Gurol–Urganci, Ipek; Hone, Thomas; Atun, Rifat

    2015-01-01

    In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP), to achieve universal health coverage (UHC). The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9–year period analyzed (2004–2012), there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001) increase in user satisfaction with health services in almost every year (bar 2006) from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% confidence interval (CI) of 2.01–3.24) times that in 2004, having peaked at 3.58 (95% CI 2.82–4.55) times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05) more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first–contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey. PMID:26528391

  6. Health research systems: promoting health equity or economic competitiveness?

    PubMed Central

    Loff, Bebe

    2012-01-01

    Abstract International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public–private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries. PMID:22271965

  7. Financial Incentives, Workplace Wellness Program Participation, and Utilization of Health Care Services and Spending.

    PubMed

    Fronstin, Paul; Roebuck, M Christopher

    2015-08-01

    This paper analyzes data from a large employer that enhanced financial incentives to encourage participation in its workplace wellness programs. It examines, first, the effect of financial incentives on wellness program participation, and second, it estimates the impact of wellness program participation on utilization of health care services and spending. The Patient Protection and Affordable Care Act of 2010 (PPACA) allows employers to provide financial incentives of as much as 30 percent of the total cost of coverage when tied to participation in a wellness program. Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive, and increased 22 percentage points among non-union employees. Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found. The largest increase in medication utilization as a result of biometric screening was for statins, which are widely used to treat high cholesterol. This therapeutic class accounted for one-sixth of the overall increase in prescription drug utilization. Second were antidepressants, followed by ACE inhibitors (for hypertension), and thyroid hormones (for hypothyroidism). Biometric screening also led to significantly higher utilization of biologic response modifiers and immunosuppressants. These specialty medications are used to treat autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, and are relatively expensive compared with non-specialty medications. The added spending associated with the combined increase in fills of 0.02 was $27 per member per year--about one-half of the

  8. A systems approach to understanding and improving health systems.

    PubMed

    Erazo, Álvaro

    2015-09-01

    Health systems face the challenge of helping to improve health conditions. They occupy a priority place in middle- and lower-income countries, since the absence or fragility of health systems adversely impacts expected health outcomes. Thus, due to the direct relationship between programs and systems, the absence or weakness of either will result in a consequent deficiency in public health and the very execution of the programs. In the same vein, weakened health systems are one of the main bottlenecks to attaining the Millennium Development Goals. Systems thinking is one of the "four revolutions in progress" that are helping to transform health and health care systems. Within that framework, this article identifies conceptual and operational elements of systems applicable to health systems that contribute to overcoming the obstacles and inertia that hinder health activities and outcomes. It discusses relevant concepts characteristic of systems thinking, such as structural variables and dynamic complexity, the relationship between programs and health systems, and the monitoring and evaluation function, together with the role of innovation and systems integration as high-priority elements. This will aid in the development of designs that also stress the context of the components that guide management, identifying processes and outcomes in a health management continuum. PMID:26758004

  9. Predictors of and health services utilization related to depressive symptoms among elderly Koreans.

    PubMed

    Shin, Jin Hee; Do, Young Kyung; Maselko, Joanna; Brouwer, Rebecca J N; Song, Sang Wook; Østbye, Truls

    2012-07-01

    While the prevalence, comorbidity, risk profile and health care utilization for late-life depression have been described for many Western countries, much less is known about the recent epidemiology of late-life depression in East Asian countries such as Korea. We investigated predictors for depressive symptoms and the association between depressive symptoms and the utilization of both medical care and preventive services in elderly Koreans. Data were obtained from a nationally representative sample of Koreans aged 60 and above (2226 men, 2911 women) who participated in the 2008 wave of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression scale. Risk factors considered included sociodemographics, health behaviors, chronic diseases, and physical function. Health care utilization factors included hospitalization, outpatient clinic use and basic medical checkup. Being female, being unmarried, and having less education, lower household income, physical inactivity and lower weight were associated with depressive symptoms. Presence of chronic diseases and limited physical function also showed a significant association with depressive symptoms. Depressive symptoms were associated with increased odds of hospitalization and outpatient visits, but decreased the odds of utilization of basic medical checkup after controlling for potential confounders. Findings on most risk factors, except lower weight, were consistent with reports from Western countries. It is important to recognize the burden of depressive symptoms in the elderly. The interaction of such symptoms with chronic diseases should be acknowledged and considered in the clinical setting as well as in health care planning and policymaking. PMID:22531571

  10. Veterans Affairs databases are accurate for gout-related health care utilization: a validation study

    PubMed Central

    2013-01-01

    Introduction The aim of this study was to assess the accuracy of Veterans Affairs (VA) databases for gout-related health care utilization. Methods This retrospective study utilized VA administrative and clinical databases. A random sample of gout patients with visits (outpatient, inpatient or emergent/urgent care) with or without the diagnosis of gout (International Classification of Diseases, ninth revision, common modification ICD-9-CM code of 274.x or 274.xx) at the Birmingham VA hospital was selected. A blinded abstractor performed a review of VA electronic health records for the documentation of gout or gout-related terms (gouty arthritis, tophaceous gout, tophus/tophi, acute gout, chronic gout, podagra, urate stones, urate or uric acid crystals and so on) in the chief complaint, history of present illness or assessment and plan for the visit; this constituted the gold standard for gout-related utilization. The accuracy of database-derived gout-related claims was assessed by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV). Results Of 108 potential visits, 85 outpatient, inpatient or urgent care/emergency room visits to a health care provider (85 patients: 84 men and 1 woman with a mean age of 63 years) and retrievable data from medical records constituted the analyzed dataset. Administrative claims for gout-related utilization with ICD-9 code for gout were accurate with a PPV of 86%, specificity of 95%, sensitivity of 86% and NPV of 95%. Conclusions VA databases are accurate for gout-related visits. These findings support their use for studies of health services and outcome studies. It remains to be seen if these findings are generalizable to other settings and databases. PMID:24377421

  11. Urban Aboriginal mobility in Canada: examining the association with health care utilization.

    PubMed

    Snyder, Marcie; Wilson, Kathi

    2012-12-01

    In recent decades, Indigenous peoples across the globe have become increasingly urbanized. Growing urbanization has been associated with high rates of geographic mobility between rural areas and cities, as well as within cities. In Canada, over 54 percent of Aboriginal peoples are urban and change their place of residence at a higher rate than the non-Aboriginal population. High rates of mobility may affect the delivery and use of health services. The purpose of this paper is to examine the association between urban Aboriginal peoples' mobility and conventional (physician/nurse) as well as traditional (traditional healer) health service use in two distinct Canadian cities: Toronto and Winnipeg. Using data from Statistics Canada's 2006 Aboriginal Peoples Survey, this analysis demonstrates that mobility is a significant predisposing correlate of health service use and that the impact of mobility on health care use varies by urban setting. In Toronto, urban newcomers were more likely to use a physician or nurse compared to long-term residents. This was in direct contrast to the effect of residency on physician and nurse use in Winnipeg. In Toronto, urban newcomers were less likely to use a traditional healer than long-term residents, indicating that traditional healing may represent an unmet health care need. The results demonstrate that distinct urban settings differentially influence patterns of health service utilization for mobile Aboriginal peoples. This has important implications for how health services are planned and delivered to urban Aboriginal movers on a local, and potentially global, scale. PMID:23078674

  12. Utilization of health care services by patients with chronic obstructive pulmonary disease.

    PubMed

    O'Brien, J A; Ward, A J; Jones, M K C; McMillan, C; Lordan, N

    2003-01-01

    In order to identify healthcare resource use patterns associated with chronic obstructive pulmonary disease (COPD), resource utilization (RU) data collection was integrated into a randomized, double-blind placebo-controlled study of Viozan (sibenadet HCl). This study enrolled patients with symptomatic, smoking-related COPD, randomized to receive sibenadet or placebo for a 52-week treatment period. A questionnaire establishing typical pre-trial, COPD-related RU was completed by each patient. Subsequent data were collected by means of an Interactive Voice Response System (IVRS) at 30-day intervals (14 time points) during the study and in the follow-up period. The IVRS system facilitated data collection and minimized inconvenience to the patient. Compliance with the requirement to record details of the healthcare services during the year-long study was high. No overall trend for lower RU was associated with sibenadet therapy, which correlates with the lack of sustained clinical effect seen in studies conducted concurrently. These data do, however, provide valuable information on RU associated with COPD and insights into adjustments associated with changes in disease course. Physicians were seen to be the most common source of care for patients with COPD and more of the patients with severe COPD (stage III) than mild (stage I) were seen to utilize the most expensive resources (e.g. inpatient hospital care). For those patients who experienced an exacerbation during the trial (irrespective of treatment group), resource use was increased during the periods when an exacerbation was reported when compared with the periods before or after an exacerbation. The proportion of cases attending the physician doubled and with a trip to the Emergency Room (ER) increased approximately ninefold during the reporting period in which the exacerbation occurred compared with the previous month. This study has shown that use of an IVRS, even in elderly patients, is an effective means of

  13. Evaluation of Social Media Utilization by Latino Adolescents: Implications for Mobile Health Interventions

    PubMed Central

    Vyas, Amita; Turner, Monique; Glick, Sara; Wood, Susan

    2015-01-01

    Background Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation. Objectives The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation. Methods This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex and acculturation categories, was examined using generalized estimating equations. Results Women are more likely to use SMS, but men are significantly more likely to SMS a girl/boyfriend (P=.03). The use of Internet by men and women to research health information increased over time. Facebook use declined over time (P<.001), whereas use of YouTube (P=.03) and Instagram (P<.001) increased, especially among women and more US acculturated youths. Conclusion Social media is ubiquitous in Latino adolescents’ lives and may be a powerful mode for public health intervention delivery. PMID:26420553

  14. NATIONAL ORAL HEALTH SURVEILLANCE SYSTEM (NOHSS)

    EPA Science Inventory

    National Oral Health Surveillance System (NOHSS) is a collaborative effort between CDC's Division of Oral Health and The Association of State and Territorial Dental Directors (ASTDD). NOHSS is designed to help public health programs monitor the burden of oral disease, use of the ...

  15. Homebound older adults: Prevalence, characteristics, health care utilization and quality of care.

    PubMed

    Musich, Shirley; Wang, Shaohung S; Hawkins, Kevin; Yeh, Charlotte S

    2015-01-01

    The purpose of this study was to estimate prevalence rates of homebound older adults, their characteristics and the impact of homebound status on health care utilization, expenditures and quality of medical care measures. Surveys were sent to new enrollees (n = 25,725) in AARP(®) Medicare Supplement plans (insured through UnitedHealthcare) to screen for serious chronic conditions, ambulatory disabilities and eligibility for care coordination programs. Health care utilization and expenditures were determined from paid claims. Member-level quality measures considered compliance with medication adherence and care patterns. Among survey respondents, 19.6% were classified as being homebound. The strongest predictors of being homebound included serious memory loss, being older, having more chronic conditions, taking more prescription medications and having multiple hospitalizations. Homebound had significantly higher health care utilization and expenditures. Homebound were more likely to be noncompliant with medication adherence and care pattern rules. Ongoing screening and subsequent interventions for new enrollees classified as homebound may be warranted. PMID:26254815

  16. The military health system's personal health record pilot with Microsoft HealthVault and Google Health

    PubMed Central

    Barnhill, Rick; Heermann-Do, Kimberly A; Salzman, Keith L; Gimbel, Ronald W

    2011-01-01

    Objective To design, build, implement, and evaluate a personal health record (PHR), tethered to the Military Health System, that leverages Microsoft® HealthVault and Google® Health infrastructure based on user preference. Materials and methods A pilot project was conducted in 2008–2009 at Madigan Army Medical Center in Tacoma, Washington. Our PHR was architected to a flexible platform that incorporated standards-based models of Continuity of Document and Continuity of Care Record to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft® HealthVault and Google® Health based on user preference. The project design and implementation were guided by provider and patient advisory panels with formal user evaluation. Results The pilot project included 250 beneficiary users. Approximately 73.2% of users were <65 years of age, and 38.4% were female. Of the users, 169 (67.6%) selected Microsoft® HealthVault, and 81 (32.4%) selected Google® Health as their PHR of preference. Sample evaluation of users reflected 100% (n=60) satisfied with convenience of record access and 91.7% (n=55) satisfied with overall functionality of PHR. Discussion Key lessons learned related to data-transfer decisions (push vs pull), purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow, and decisions on information patients may choose to share with their provider. Conclusion Currently PHRs are being viewed as empowering tools for patient activation. Design and implementation issues (eg, technical, organizational, information security) are substantial and must be thoughtfully approached. Adopting standards into design can enhance the national goal of portability and interoperability. PMID:21292705

  17. National Maglev initiative: California line electric utility power system requirements

    NASA Technical Reports Server (NTRS)

    Save, Phil

    1994-01-01

    The electrical utility power system requirements were determined for a Maglev line from San Diego to San Francisco and Sacramento with a maximum capacity of 12,000 passengers an hour in each direction at a speed of 300 miles per hour, or one train every 30 seconds in each direction. Basically the Maglev line requires one 50-MVA substation every 12.5 miles. The need for new power lines to serve these substations and their voltage levels are based not only on equipment loading criteria but also on limitations due to voltage flicker and harmonics created by the Maglev system. The resulting power system requirements and their costs depend mostly on the geographical area, urban or suburban with 'strong' power systems, or mountains and rural areas with 'weak' power systems. A reliability evaluation indicated that emergency power sources, such as a 10-MW battery at each substation, were not justified if sufficient redundancy is provided in the design of the substations and the power lines serving them. With a cost of $5.6 M per mile, the power system requirements, including the 12-kV DC cables and the inverters along the Maglev line, were found to be the second largest cost component of the Maglev system, after the cost of the guideway system ($9.1 M per mile), out of a total cost of $23 M per mile.

  18. Health Services Utilization among Children with and without Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Cummings, Janet R.; Lynch, Frances L.; Rust, Kristal C.; Coleman, Karen J.; Madden, Jeanne M.; Owen-Smith, Ashli A.; Yau, Vincent M.; Qian, Yinge; Pearson, Kathryn A.; Crawford, Phillip M.; Massolo, Maria L.; Quinn, Virginia P.; Croen, Lisa A.

    2016-01-01

    Using data from multiple health systems (2009-2010) and the largest sample to date, this study compares health services use among youth with and without an autism spectrum disorder (ASD)--including preventive services not previously studied. To examine these differences, we estimated logistic and count data models, controlling for demographic…

  19. [The national health system in Peru].

    PubMed

    Sánchez-Moreno, Francisco

    2014-01-01

    In 1975, a group of professionals in Peru who were experts on national health systems began a process that led the country to be the first in South America to initiate a modern organization of the health system. This pioneering development meant that the creation of the National Health Services System [in Peru] in 1978 occurred before the health system reforms in Chile (1980), Brazil (1990), Colombia (1993), and Ecuador (2008). This encouraging start has had permanent reformist fluctuations since then, with negative development because of the lack of a State policy. Current features of the Peruvian system are inefficient performance, discontinuity, and lack of assessment, which creates a major setback in comparison with other health systems in America. In the 21st century, significant technical efforts have been missed to modernize the system and its functions. The future is worrying and the role of new generations will be decisive. PMID:25597729

  20. Mental Health Systems in Scandinavia.

    ERIC Educational Resources Information Center

    Vail, David J.

    The guidebook is introduced by general observations on the Scandinavian countries concerning history, social policy, medicine, mental health, and psychiatric diagnosis. Discussed individually for Norway, Sweden, and Denmark are the following areas: mental health programs and statistics; mental illness programs, regional, hospital, aftercare,…

  1. HEALTH EFFECTS OF A WASTEWATER TREATMENT SYSTEM

    EPA Science Inventory

    Data obtained as part of a comprehensive community health study conducted during 1965-1971 were utilized to examine the incidence of acute illness in a population surrounding an activated sludge wastewater treatment plant and a control location in Tecumseh, Michigan. Study partic...

  2. Utility advanced turbine systems (ATS) technology readiness testing

    SciTech Connect

    2000-09-15

    The overall objective of the Advanced Turbine System (ATS) Phase 3 Cooperative Agreement between GE and the US Department of Energy (DOE) is the development of a highly efficient, environmentally superior, and cost-competitive utility ATS for base-load utility-scale power generation, the GE 7H (60 Hz) combined cycle power system, and related 9H (50 Hz) common technology. The major effort will be expended on detail design. Validation of critical components and technologies will be performed, including: hot gas path component testing, sub-scale compressor testing, steam purity test trials, and rotational heat transfer confirmation testing. Processes will be developed to support the manufacture of the first system, which was to have been sited and operated in Phase 4 but will now be sited and operated commercially by GE. This change has resulted from DOE's request to GE for deletion of Phase 4 in favor of a restructured Phase 3 (as Phase 3R) to include full speed, no load (FSNL) testing of the 7H gas turbine. Technology enhancements that are not required for the first machine design but will be critical for future ATS advances in performance, reliability, and costs will be initiated. Long-term tests of materials to confirm design life predictions will continue. A schematic of the GE H machine is shown.

  3. Bandwidth utilization maximization of scientific RF communication systems

    SciTech Connect

    Rey, D.; Ryan, W.; Ross, M.

    1997-01-01

    A method for more efficiently utilizing the frequency bandwidth allocated for data transmission is presented. Current space and range communication systems use modulation and coding schemes that transmit 0.5 to 1.0 bits per second per Hertz of radio frequency bandwidth. The goal in this LDRD project is to increase the bandwidth utilization by employing advanced digital communications techniques. This is done with little or no increase in the transmit power which is usually very limited on airborne systems. Teaming with New Mexico State University, an implementation of trellis coded modulation (TCM), a coding and modulation scheme pioneered by Ungerboeck, was developed for this application and simulated on a computer. TCM provides a means for reliably transmitting data while simultaneously increasing bandwidth efficiency. The penalty is increased receiver complexity. In particular, the trellis decoder requires high-speed, application-specific digital signal processing (DSP) chips. A system solution based on the QualComm Viterbi decoder and the Graychip DSP receiver chips is presented.

  4. Optimizing bandwidth utilization in packet based telemetry systems

    SciTech Connect

    Kalibjian, J.R.

    1995-10-17

    A consistent theme in spacecraft telemetry system design is the desire to obtain maximum bandwidth utilization given a fixed transmission capability (usually due to cost/weight criteria). Extensions to basic packetization telemetry architectures are discussed which can facilitate a reduction in the amount of actual data telemetered, without loss of data quality. Central to the extensions are the establishment of an ``intelligent`` telemetry process, which can evaluate pending data to be telemetered, and act to compress, discard, or re-formulate data before actual transmission to ground stations.

  5. RS-34 Phoenix (Peacekeeper Post Boost Propulsion System) Utilization Study

    NASA Technical Reports Server (NTRS)

    Esther, Elizabeth A.; Kos, Larry; Burnside, Christopher G.; Bruno, Cy

    2013-01-01

    The Advanced Concepts Office (ACO) at the NASA Marshall Space Flight Center (MSFC) in conjunction with Pratt & Whitney Rocketdyne conducted a study to evaluate potential in-space applications for the Rocketdyne produced RS-34 propulsion system. The existing RS-34 propulsion system is a remaining asset from the de-commissioned United States Air Force Peacekeeper ICBM program, specifically the pressure-fed storable bipropellant Stage IV Post Boost Propulsion System, renamed Phoenix. MSFC gained experience with the RS-34 propulsion system on the successful Ares I-X flight test program flown in October 2009. RS-34 propulsion system components were harvested from stages supplied by the USAF and used on the Ares I-X Roll control system (RoCS). The heritage hardware proved extremely robust and reliable and sparked interest for further utilization on other potential in-space applications. MSFC is working closely with the USAF to obtain RS-34 stages for re-use opportunities. Prior to pursuit of securing the hardware, MSFC commissioned the Advanced Concepts Office to understand the capability and potential applications for the RS-34 Phoenix stage as it benefits NASA, DoD, and commercial industry. As originally designed, the RS-34 Phoenix provided in-space six-degrees-of freedom operational maneuvering to deploy multiple payloads at various orbital locations. The RS-34 Phoenix Utilization Study sought to understand how the unique capabilities of the RS-34 Phoenix and its application to six candidate missions: 1) small satellite delivery (SSD), 2) orbital debris removal (ODR), 3) ISS re-supply, 4) SLS kick stage, 5) manned GEO servicing precursor mission, and an Earth-Moon L-2 Waypoint mission. The small satellite delivery and orbital debris removal missions were found to closely mimic the heritage RS-34 mission. It is believed that this technology will enable a small, low-cost multiple satellite delivery to multiple orbital locations with a single boost. For both the small

  6. RS-34 Phoenix (Peacekeeper Post Boost Propulsion System) Utilization Study

    NASA Technical Reports Server (NTRS)

    Esther, Elizabeth A.; Kos, Larry; Bruno, Cy

    2012-01-01

    The Advanced Concepts Office (ACO) at the NASA Marshall Space Flight Center (MSFC) in conjunction with Pratt & Whitney Rocketdyne conducted a study to evaluate potential in-space applications for the Rocketdyne produced RS-34 propulsion system. The existing RS-34 propulsion system is a remaining asset from the decommissioned United States Air Force Peacekeeper ICBM program; specifically the pressure-fed storable bipropellant Stage IV Post Boost Propulsion System, renamed Phoenix. MSFC gained experience with the RS-34 propulsion system on the successful Ares I-X flight test program flown in October 2009. RS-34 propulsion system components were harvested from stages supplied by the USAF and used on the Ares I-X Roll control system (RoCS). The heritage hardware proved extremely robust and reliable and sparked interest for further utilization on other potential in-space applications. Subsequently, MSFC is working closely with the USAF to obtain all the remaining RS-34 stages for re-use opportunities. Prior to pursuit of securing the hardware, MSFC commissioned the Advanced Concepts Office to understand the capability and potential applications for the RS-34 Phoenix stage as it benefits NASA, DoD, and commercial industry. Originally designed, the RS-34 Phoenix provided in-space six-degrees-of freedom operational maneuvering to deploy multiple payloads at various orbital locations. The RS-34 Phoenix Utilization Study sought to understand how the unique capabilities of the RS-34 Phoenix and its application to six candidate missions: 1) small satellite delivery (SSD), 2) orbital debris removal (ODR), 3) ISS re-supply, 4) SLS kick stage, 5) manned GEO servicing precursor mission, and an Earth-Moon L-2 Waypoint mission. The small satellite delivery and orbital debris removal missions were found to closely mimic the heritage RS-34 mission. It is believed that this technology will enable a small, low-cost multiple satellite delivery to multiple orbital locations with a single

  7. [Informatics in the Croatian health care system].

    PubMed

    Kern, Josipa; Strnad, Marija

    2005-01-01

    Informatization process of the Croatian health care system started relatively early. Computer processing of data of persons not covered by health insurance started in 1968 in Zagreb. Remetinec Health Center served as a model of computer data processing (CDP) in primary health care and Sveti Duh General Hospital in inpatient CDP, whereas hospital administration and health service were first introduced to Zagreb University Hospital Center and Sestre Milosrdnice University Hospital. At Varazdin Medical Center CDP for health care services started in 1970. Several registries of chronic diseases have been established: cancer, psychosis, alcoholism, and hospital registries as well as pilot registries of lung tuberculosis patients and diabetics. Health statistics reports on healthcare services, work accidents and sick-leaves as well as on hospital mortality started to be produced by CDP in 1977. Besides alphanumeric data, the modern information technology (IT) can give digital images and signals. Communication i