An approach to an index of hospital performance.
(9/2176)
Two indexes are described, based on measures of administrative effectiveness and patient care effectiveness. The measures used were selected and ranked by a Delphi panel from a list of 30 measures drawn from the literature. Weights were assigned by the panel to 19 selected measures. The resulting indexes did well in a test on data collected from 32 Texas hospitals. (+info)
Infectious diseases and anemia in a sample of out-of-treatment drug users.
(10/2176)
OBJECTIVE: To understand how the prevalence of anemia, human immunodeficiency virus (HIV), and syphilis in a sample of out-of-treatment drug users affected delivery of care in a managed care model. STUDY DESIGN: A snowball sampling design with multiple zero order contacts was used in targeted census tracts with a high incidence of illicit drug use and sexually transmitted diseases. PATIENTS AND METHODS: Out-of-treatment drug users were recruited as part of a national multisite study of HIV risk behaviors in this population. Subjects were recruited using targeted community-based sampling. RESULTS: The rate of individuals who tested positive for both syphilis and HIV was 2.5 times greater than those who tested positive for syphilis only and 2.8 times greater than those who tested positive for HIV only. Of the men, 16.1% were anemic, and 33.3% of women were anemic. Rates of HIV (10.7%) and syphilis (19.8%) were found to be high among both male and female drug users. These statistics, coupled with the prevalence of anemia, indicate that drug users have many more problems other than drug use, a conclusion which can have an impact on how managed care plans approach drug users. CONCLUSION: A multipronged interdisciplinary approach may be warranted for both the patient and the managed care organization. (+info)
The rationale for skin cancer screening and prevention.
(11/2176)
Skin cancer, the most common malignancy in the United States, accounts for considerable morbidity and mortality. Efforts at lessening the burden of this disease are possible through both primary and secondary prevention, although some barriers may detract from the ability of primary care physicians to perform skin cancer screening. Public education combined with increased vigilance by physicians and other health professionals may significantly alter the morbidity and mortality associated with this disease entity. (+info)
Improving access to disability benefits among homeless persons with mental illness: an agency-specific approach to services integration.
(12/2176)
OBJECTIVES: This study evaluated a joint initiative of the Social Security Administration (SSA) and the Department of Veterans Affairs (VA) to improve access to Social Security disability benefits among homeless veterans with mental illness. METHODS: Social Security personnel were colocated with VA clinical staff at 4 of the VA's Health Care for Homeless Veterans (HCHV) programs. Intake assessment data were merged with SSA administrative data to determine the proportion of veterans who filed applications and who received disability awards at the 4 SSA-VA Joint Outreach Initiative sites (n = 6709) and at 34 comparison HCHV sites (n = 27 722) during the 2 years before and after implementation of the program. RESULTS: During the 2 years after the initiative began, higher proportions of veterans applied for disability (18.9% vs 11.1%; P < .001) and were awarded benefits (11.4% vs 7.2%, P < .001) at SSA-VA Joint Initiative sites. CONCLUSION: A colocation approach to service system integration can improve access to disability entitlements among homeless persons with mental illness. Almost twice as many veterans were eligible for this entitlement as received it through a standard outreach program. (+info)
An epidemic of congenital syphilis in Jefferson County, Texas, 1994-1995: inadequate prenatal syphilis testing after an outbreak in adults.
(13/2176)
OBJECTIVES: After a syphilis epidemic in Jefferson County, Texas, in 1993 and 1994, congenital syphilis prevalence and risk factors were determined and local prenatal syphilis screening practices were assessed. METHODS: Medical records were reviewed, pregnant women with syphilis were interviewed, and prenatal care providers were surveyed. RESULTS: Of 91 women, 59 (65%) had infants with congenital syphilis. Among African Americans, the prevalence per 1000 live births was 24.1 in 1994 and 17.9 in 1995. Of the 50 women with at least 2 prenatal care visits who had infants with congenital syphilis, 15 (30%) had received inadequate testing. Only 16% of 31 providers obtained an early third-trimester syphilis test on all patients. CONCLUSIONS: Inadequate prenatal testing contributed to this outbreak of congenital syphilis. (+info)
Norwalk-like viral gastroenteritis in U.S. Army trainees--Texas, 1998.
(14/2176)
During August 27-September 1, 1998, 99 (12%) of 835 soldiers in one unit at a U.S. Army training center in El Paso, Texas, were hospitalized for acute gastroenteritis (AGE). Their symptoms included acute onset of vomiting, abdominal pain, diarrhea, and fever. Review of medical center admission records for AGE during the previous year indicated that fewer than five cases occurred each month. This report describes the outbreak investigation initiated on August 30 by a U.S. Army Epidemiologic Consultation Service (EPICON) team; the findings indicated the outbreak was caused by a Norwalk-like virus (NLV). (+info)
Maternal peripartum complications associated with vaginal group B streptococci colonization.
(15/2176)
The study was done to determine the risk of clinically diagnosed intra-amniotic infection (IAI) and postpartum endometritis (PPE) associated with vaginal group B streptococci (GBS) colonization. Pregnant women were enrolled in a cross-sectional, observational study from 1992 to 1996 in Houston (n=908), Seattle (n=2676), and Pittsburgh (n=4338). Swab samples were obtained from the lower vagina of participants at admission for delivery and inoculated into selective broth and onto blood agar media. At the combined centers, 2.9% of the women (231/7922) had IAI, and 2.0% (157/7922) had PPE. The risk of IAI was higher for women with heavy GBS colonization (odds ratio [OR], 2.0; 95% confidence interval [95% CI], 1.1-3.7) than for those with light colonization (OR, 1.2; 95% CI, 0.7-1.8). The risk of GBS-associated PPE was not influenced by density of colonization (OR, 1.8; 95% CI, 1.3-2.7). These findings provide further evidence that GBS is associated with maternal intrapartum complications. (+info)
Demographic variation in cancer in relation to industrial and environmental influence.
(16/2176)
Mortality data (183,064 deaths in a 30-year period, 1940-1969) by sex and three ethnic groups (white excluding Spanish-surnamed, nonwhite, and Spanish-surnamed) in 15 regions within the city (Houston), grouped around the air pollution sample collection stations have been analyzed. Valid contrast studies were possible in only one region within the city for all three groups and in six regions for white excluding Spanish-surnamed and nonwhite. There is evidence that the environmental factors of exposure over time to air and industrial pollutants in Houston has had a demonstrable effect in increasing regional mortality from cancer of the respiratory tract as well as from all other diseases and conditions of the respiratory tract and heart disease. This study points out the need for mutually sustained collaboration of effort of the scientific and industrial communities to redirect their attention and research efforts to the exploration of the carcinogenic potential of the microchemical environment. (+info)