Committee for assessing progress on implementing the recommendations of the institute of medicine report the future of nursing: leading change, advancing health

Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods—Writing group members were nominated by th...

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

This paper introduces the "separate spheres" bargaining model, a new model of distribution within marriage. It differs from divorce threat bargaining models (e.g., Manser-Brown, McElroy-Horney) in that the threat point is not divorce but a noncooperative equilibrium within marriage; this noncooperative equilibrium reflects traditional gender roles. The predictions of our model thus differ from those of divorce threat bargaining models; in the separate spheres model, cash transfer payments to the mother and payments to the father can--but need not--imply different equilibrium distributions in existing marriages. In the long run, the distributional effects of transfer policies may be substantially altered by changes in the marriage market equilibrium.

Separate spheres bargaining and the marriage market

Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology

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Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy

The Patient Protection and Affordable Care Act: Impact on Mental Health Services Demand and Provider Availability

In this paper we develop and estimate a model of domestic violence. We extend a noncooperative model of the family to include violence as a source of gratification and an instrument for controlling behavior. We estimate the model by robust methods since the violence process appears to have a heavy-tailed, nonnormal error distribution. We find that the properties of the equilibria depend on family income. For low/middle income families, our results indicate an equilibrium in which one person's reservation utility constraint is binding, whereas for higher income families both individuals may gain from the relationship.

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Domestic Violence: A Nonrandom Affair

In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality health care. In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13 percent in fall 2006 to 7 percent in fall 2007. At the same time, access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher-than-anticipated costs, most residents of the state continued to support reform.

On The Road To Universal Coverage: Impacts Of Reform In Massachusetts At One Year

Background National health reform is designed to reduce the number of uninsured adults. Currently, many uninsured individuals receive care at safety-net health care providers such as community health centers (CHCs) or safety-net hospitals. This project examined data from Massachusetts to assess how the demand for ambulatory and inpatient care and use changed for safety-net providers after the state's health care reform law was enacted in 2006, which dramatically reduced the number of individuals without health insurance coverage. Methods Multiple methods were used, including analyses of administrative data reported by CHCs and hospitals, case study interviews, and analyses of data from the 2009 Massachusetts Health Reform Survey, a state-representative telephone survey of adults. Results Between calendar years 2005 and 2009, the number of patients receiving care at Massachusetts CHCs increased by 31.0%, and the share of CHC patients who were uninsured fell from 35.5% to 19.9%. Nonemergency ambulatory care visits to clinics of safety-net hospitals grew twice as fast as visits to non–safety-net hospitals from 2006 to 2009. The number of inpatient admissions was comparable for safety-net and non–safety-net hospitals. Most safety-net patients reported that they used these facilities because they were convenient (79.3%) and affordable (73.8%); only 25.2% reported having had problems getting appointments elsewhere. Conclusions Despite the significant reduction in uninsurance levels in Massachusetts that occurred with health care reform, the demand for care at safety-net facilities continues to rise. Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there. It will continue to be important to support safety-net providers, even after health care reform programs are established.

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Safety-net providers after health care reform: lessons from Massachusetts.

Importance Under the Affordable Care Act (ACA), states can extend Medicaid eligibility to nearly all adults with income no more than 138% of the federal poverty level. Uncertainty exists regarding the scope of medical services required for new enrollees. Objective To document the health care needs and health risks of uninsured adults who could gain Medicaid coverage under the ACA. These data will help physicians, other clinicians, and state Medicaid programs prepare for the possible expansions. Design, Setting, and Patients Data from the National Health and Nutrition Examination Survey 2007-2010 were used to analyze health conditions among a nationally representative sample of 1042 uninsured adults aged 19 through 64 years with income no more than 138% of the federal poverty level, compared with 471 low-income adults currently enrolled in Medicaid. Main Outcomes and Measures Prevalence and control of diabetes, hypertension, and hypercholesterolemia based on examinations and laboratory tests, measures of self-reported health status including medical conditions, and risk factors such as measured obesity status. Results Compared with those already enrolled in Medicaid, uninsured adults were less likely to be obese and sedentary and less likely to report a physical, mental, or emotional limitation. They also were less likely to have several chronic conditions. For example, 30.1% (95% CI, 26.8%-33.4%) of uninsured adults had hypertension, hypercholesterolemia, or diabetes compared with 38.6% (95% CI, 32.0%-45.3%) of those enrolled in Medicaid (P = .02). However, if they had these conditions, uninsured adults were less likely to be aware of them and less likely to have them controlled. For example, 80.1% (95% CI, 75.2%-85.1%) of the uninsured adults with at least 1 of these 3 conditions had at least 1 uncontrolled condition, compared with 63.4% (95% CI, 53.7%-73.1%) of adults enrolled in Medicaid. Conclusion and Relevance Compared with adults currently enrolled in Medicaid, uninsured low-income adults potentially eligible to enroll in Medicaid under the ACA had a lower prevalence of many chronic conditions. A substantial proportion of currently uninsured adults with chronic conditions did not have good disease control; projections based on sample weighting suggest this may represent 3.5 million persons (95% CI, 2.9 million-4.2 million). These adults may need initial intensive medical care following Medicaid enrollment.

https://jamanetwork.com/journals/jama/articlepdf/1699906/joc130069_2579_2586.pdf

Health Status, Risk Factors, and Medical Conditions Among Persons Enrolled in Medicaid vs Uninsured Low-Income Adults Potentially Eligible for Medicaid Under the Affordable Care Act

Massachusetts continues to move forward on comprehensive health reform. Uninsurance is at historically low levels, despite the recent economic downturn. Building on that coverage expansion, access to and affordability of care in the commonwealth have improved. Notwithstanding these successes, some of the early gains in reducing barriers to care and improving the affordability of care had eroded by fall 2008, reflecting trends that predate health reform in Massachusetts: constraints on provider capacity and increasing health care costs. Because these are national concerns as well, Massachusetts continues to offer lessons for national reform efforts.

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Sharon K. Long

Papers

Domestic Violence: A Nonrandom Affair

On The Road To Universal Coverage: Impacts Of Reform In Massachusetts At One Year

Safety-net providers after health care reform: lessons from Massachusetts.

Health Status, Risk Factors, and Medical Conditions Among Persons Enrolled in Medicaid vs Uninsured Low-Income Adults Potentially Eligible for Medicaid Under the Affordable Care Act

Access And Affordability: An Update On Health Reform In Massachusetts, Fall 2008