Measuring hospital efficiency: a comparison of two approaches. (33/1417)

OBJECTIVE: To compare the results of scoring hospital efficiency by means of two new types of frontier models, Data Envelopment Analysis (DEA) and stochastic frontier regression (SFR). STUDY SETTING: Financial records of Florida acute care hospitals in continuous operation over the period 1982-1993. STUDY DESIGN: Comparable DEA and SFR models are specified, and these models are then estimated to obtain the efficiency indexes yielded by each. The empirical results are subsequently examined to ascertain the extent to which they serve the needs of hospital policymakers. DATA COLLECTION: A longitudinal or panel data set is assembled, and a common set of output, input, and cost indicators is constructed to support the estimation of comparable DEA and SFR models. PRINCIPAL FINDINGS: DEA and SFR models yield convergent evidence about hospital efficiency at the industry level, but divergent portraits of the individual characteristics of the most and least efficient facilities. CONCLUSIONS: Hospital policymakers should not be indifferent to the choice of the frontier model used to score efficiency relationships. They may be well advised to wait until additional research clarifies reasons why DEA and SFR models yield divergent results before they introduce these methods into the policy process.  (+info)

The geography of health insurance regulation. (34/1417)

The health insurance market consists of three distinct segments--individual, small group, and large group--each governed by different economic and regulatory structures. A number of border-crossing techniques have arisen for avoiding the burdens of one segment and capitalizing on the benefits of others. Drawing from extensive qualitative research into the functioning of existing market structures, this paper describes these techniques and their purposes and effects. This road map helps to identify which reform proposals seek to produce true economic efficiencies and which have the potential to undermine previous reform objectives.  (+info)

Diet, smoking and anthropometric indices and postmenopausal bone fractures: a prospective study. (35/1417)

OBJECTIVE: Bone fractures are an important cause of morbidity and mortality among the elderly in the US. The present study assesses the possible role of a number of risk factors for postmenopausal bone fractures. METHODS: We analysed the relationships of anthropometric, demographic and lifestyle factors with the risk of bone fracture among 6250 postmenopausal women in a prospective cohort study, the New York University Women's Health Study. RESULTS: After an average of 7.6 years of follow-up, 1025 new incident bone fractures were reported, including 34 hip and 159 wrist fractures (incidence rates; 71.6 and 334.7 per 105 woman-years, respectively). The risk of fracture increased with increasing age, body height and total fat intake, while it was significantly lower among obese and African American women. The relative risk among African Americans was 0.45 (95% CI: 0.32-0.63) compared with non-African Americans. Women taller than 170 cm had a 64% increase in risk of fractures, as compared with those under 155 cm. These associations were generally more pronounced when fractures were limited to those at the hip and wrist. CONCLUSIONS: The present study provides an indication for a potential role of dietary fat in the development of postmenopausal fractures and further evidence to support protective effects of obesity, short stature and African American ethnicity.  (+info)

Related strains of Mycobacterium avium cause disease in children with AIDS and in children with lymphadenitis. (36/1417)

Sequence analysis of the ribosomal internal transcribed spacer of 56 Mycobacterium avium complex isolates from pediatric patients with AIDS or lymphadenitis revealed (similar to the situation in adults) that the closely related Mav-B and Mav-A sequevars caused the vast majority of disease. IS1245 restriction fragment-polymorphism analysis and pulsed-field gel electrophoresis revealed sets of isolates with closely related patterns among strains from patients in the Boston area and among isolates from Los Angeles and Miami patients. The finding of related strains that cause disease in epidemiologically unrelated patients is most consistent with one of two hypotheses: (1) a limited subset of M. avium strains is more virulent and therefore more likely to cause disease in humans, or (2) pathogenic strains are more prevalent in the environment.  (+info)

Patient acceptance of endovaginal ultrasound. (37/1417)

OBJECTIVE: To assess women's experiences and attitudes regarding endovaginal ultrasound. METHODS: Women attending the obstetrics and gynecology clinics at the University of Florida were asked to complete an anonymous questionnaire. RESULTS: Of respondents who had had a prior endovaginal ultrasound examination, 26% reported that 'it hurt a lot' and 50% reported that 'it hurt a little'. In contrast, only 23% of patients had experienced any pain with a prior abdominal ultrasound (P < 0.001). Multivariate analysis showed that discomfort with a prior vaginal ultrasound was related to patient age category, with less discomfort being experienced with increasing ages (P = 0.001). A history of unwanted sex, sexual or physical abuse, or dyspareunia was not associated with more painful examinations. Most patients were willing to undergo a future vaginal ultrasound investigation if it were recommended by their doctor. Multivariate analysis showed that more willingness was associated with older age category (P = 0.004), a history of dyspareunia (P = 0.03) and bleeding in a current pregnancy (P = 0.005). Of the patients (less than half) who had a preference, most preferred a female sonographer for endovaginal sonography (P < 0.001) and most preferred that a doctor, rather than a nurse or technician, perform the examination (P < 0.001). CONCLUSIONS: The majority of women who had experienced a vaginal ultrasound examination found it somewhat uncomfortable, but almost all women who returned the questionnaire expressed a willingness to undergo endovaginal ultrasound if it were recommended.  (+info)

Response to hypo- and hyperglycemia in adolescents with type I diabetes. (38/1417)

OBJECTIVE: To assess the appropriateness of adolescents' responses to hypo- and hyperglycemia and to examine the relationship of patient age, gender, diabetes duration, diabetes knowledge, parental supervision, and glycemic control to response appropriateness. METHODS: We assessed 125 adolescents' responses to daily episodes of hypo- and hyperglycemia by 24-hour recall interviews; responses were coded for type and appropriateness. RESULTS: Adolescents responded inappropriately to 38% of hypoglycemic and 29% of hyperglycemic episodes. Parental supervision of blood glucose testing did not increase the likelihood of an appropriate response; in the case of hyperglycemic episodes, it appeared to be counterproductive. Adolescents who responded inappropriately to hyperglycemia were also older but not different from those who responded appropriately by gender, disease duration, diabetes knowledge, or glycemic control. CONCLUSIONS: Health providers and family members may underestimate adolescents' difficulty managing hypo- and hyperglycemia appropriately. The presence of parental supervision does not ensure an appropriate response; parents may be particularly misinformed about the management of hyperglycemia.  (+info)

Editing data: what difference do consistency checks make? (39/1417)

In 1998, the Florida Department of Health undertook a self-administered school-based survey of tobacco use, attitudes, and behaviors among nearly 23,000 public school students in grades 6-12. The survey design did not use skip patterns; therefore, students had multiple opportunities to contradict themselves. By using examples from the high school portion (grades 9-12) of the survey, the authors examined five possible approaches to handling data inconsistencies and the effect that each has on point estimates. Use of these approaches resulted in point estimates of current cigarette use ranging from 25.6% to 29.7%. The number of missing respondents varied from 33 (less than 1%) to 1,374 (13%), depending on which approach was used. After stratification by gender and race, the prevalence estimates changed marginally for girls but strikingly for boys. Non-Hispanic White students were substantially more likely than non-Hispanic Black students to report current cigarette use, but the magnitude of this difference varied significantly according to the analytical approach used. The approach used to check data consistency may influence point estimates and comparability with other studies. Therefore, this issue should be addressed when findings are reported.  (+info)

Failure to defend a successful state tobacco control program: policy lessons from Florida. (40/1417)

OBJECTIVES: This investigation sought to define policy and political factors related to the undermining of Florida's successful Tobacco Pilot Program in 1999. METHODS: Data were gathered from interviews with public health lobbyists, tobacco control advocates, and state officials; news reports; and public documents. RESULTS: As a result of a recent legal settlement with Florida, the tobacco industry agreed to fund a youth anti-smoking pilot program. The program combined community-based interventions and advertisements. In less than 1 year, the teen smoking prevalence rate dropped from 23.3% to 20.9%. The program also enjoyed high public visibility and strong public support. Nevertheless, in 1999, the state legislature cut the program's funding from $70.5 million to $38.7 million, and the Bush administration dismantled the program's administrative structure. Voluntary health agencies failed to publicly hold specific legislators and the governor responsible for the cuts. CONCLUSIONS: The legislature and administration succeeded in dismantling this highly visible and successful tobacco control program because pro-health forces limited their activities to behind-the-scenes lobbying and were unwilling to confront the politicians who made these decisions in a public forum.  (+info)