Showing papers by "Urban Institute published in 2012"
TL;DR: The Affordable Care Act's financial penalty for “excessive” readmissions may be too weak to overcome the substantial counterincentives currently at work, but a “warranty” payment would provide a stronger business case for hospitals to get with the program.
Abstract: The Affordable Care Act's financial penalty for “excessive” readmissions may be too weak to overcome the substantial counterincentives currently at work. But a “warranty” payment would provide a stronger business case for hospitals to get with the program.
226 citations
TL;DR: The Economic Security Index (ESI) as discussed by the authors assesses the individual-level occurrence of substantial year-to-year declines in available household resources, accounting for fluctuations not only in income but also in out-of-pocket medical expenses.
Abstract: This article presents the Economic Security Index (ESI), a new measure of economic insecurity. The ESI assesses the individual-level occurrence of substantial year-to-year declines in available household resources, accounting for fluctuations not only in income but also in out-of-pocket medical expenses. It also assesses whether those experiencing such declines have sufficient liquid financial wealth to buffer against these shocks. We find that insecurity—the share of individuals experiencing substantial resource declines without adequate financial buffers—has risen steadily since the mid-1980s for virtually all subgroups of Americans, albeit with cyclical fluctuation. At the same time, we find that there is substantial disparity in the degree to which different subgroups are exposed to economic risk. As the ESI derives from a data-independent conceptual foundation, it can be measured using different panel datasets. We find that the degree and disparity by which insecurity has risen is robust across the best available sources.
125 citations
TL;DR: Race/ethnicity disparities among adults of similar incomes, while important, were dwarfed by the disparities identified between high- and low-income populations within each racial/ethnic group.
Abstract: The literature on health disparities in the United States typically focuses on race/ethnicity or on socioeconomic status (SES) separately, but not often together The purpose of the study was to assess the separate effects of race/ethnicity and SES on health status, health behaviors, and health care utilization Cross-sectional analyses were conducted using the 2008 National Health Interview Survey (n = 17,337 non-elderly adults) SES disparities within specific racial groups were examined, as were race disparities within high and low SES groups Within each racial/ethnic group, a greater proportion of low versus high SES individuals were in poor health, a lower proportion had healthy behaviors, and a lower proportion had access to care In both SES groups, blacks and Hispanics had poorer health outcomes than whites While whites were more likely to exercise than blacks and Hispanics, they are more likely to be smokers and less likely to have no or moderate alcohol consumption Blacks had similar or better health care use than whites, especially for cancer screening; Hispanics had lower use within each SES group Race/ethnicity disparities among adults of similar incomes, while important, were dwarfed by the disparities identified between high- and low-income populations within each racial/ethnic group
117 citations
TL;DR: Findings from 38 rigorous studies published in the peer-reviewed literature of the impact of the Medicaid/Children’s Health Insurance Program (CHIP) expansions on children can provide insights for evaluating the coming expansions for adults under the Affordable Care Act.
Abstract: This article reviews findings from 38 rigorous studies published in the peer-reviewed literature of the impact of the Medicaid/Children's Health Insurance Program (CHIP) expansions on children. There is strong evidence for increases in enrollment in public programs and reductions in uninsurance following eligibility expansions. Medicaid enrollment continued to increase during the CHIP era (a "spillover effect"). Evidence for improved access to and use of services, particularly for dental care, is also very strong. There are fewer studies of health status impacts, and the evidence is mixed. There is a very wide range in the size of effects estimated in the studies reviewed because of the methods used and the populations studied. The review identifies several important research gaps on this topic, particularly the small number of studies of the effects on health status. Both research methods and findings from the child expansions can provide insights for evaluating the coming expansions for adults under the Affordable Care Act.
109 citations
TL;DR: The results suggest that the quality of male fertility data is strongly linked to survey design and that it has implications for models of early male fertility.
Abstract: Researchers continue to question fathers’ willingness to report their biological children in surveys and the ability of surveys to adequately represent fathers. To address these concerns, this study evaluates the quality of men’s fertility data in the 1979 and 1997 cohorts of the National Longitudinal Survey of Youth (NLSY79 and NLSY97) and in the 2002 National Survey of Family Growth (NSFG). Comparing fertility rates in each survey with population rates based on data from Vital Statistics and the U.S. Census Bureau, we document how the incomplete reporting of births in different surveys varies according to men’s characteristics, including their age, race, marital status, and birth cohort. In addition, we use Monte Carlo simulations based on the NSFG data to demonstrate how birth underreporting biases associations between early parenthood and its antecedents. We find that in the NSFG, roughly four out of five early births were reported; but in the NLSY79 and NLSY97, almost nine-tenths of early births were reported. In all three surveys, incomplete reporting was especially pronounced for nonmarital births. Our results suggest that the quality of male fertility data is strongly linked to survey design and that it has implications for models of early male fertility.
103 citations
TL;DR: If uninsurance is reduced to the extent projected in this analysis, sizable reductions in long-standing racial and ethnic differentials in access to health care and health status are likely to follow.
Abstract: There are large differences in US health insurance coverage by racial and ethnic groups, yet there have been no estimates to date on how implementation of the Affordable Care Act will affect the distribution of coverage by race and ethnicity. We used a microsimulation model to show that racial and ethnic differentials in coverage could be greatly reduced, potentially cutting the eight-percentage-point black-white differential in uninsurance rates by more than half and the nineteen-percentage-point Hispanic-white differential by just under one-quarter. However, blacks and Hispanics are still projected to remain more likely to be uninsured than whites. Achieving low uninsurance under the Affordable Care Act will depend on effective state policies to attain high enrollment in Medicaid and the Children’s Health Insurance Program and the new insurance exchanges. Coverage gains among Hispanics will probably depend on adoption of strategies that address language and related barriers to enrollment and retention i...
86 citations
TL;DR: A range of market and regulatory approaches should be examined in any attempt to address the consequences of growing provider market clout, according to interviews in twelve US communities.
Abstract: In the constant attention paid to what drives health care costs, only recently has scrutiny been applied to the power that some health care providers, particularly dominant hospital systems, wield to negotiate higher payment rates from insurers. Interviews in twelve US communities indicated that so-called must-have hospital systems and large physician groups—providers that health plans must include in their networks so that they are attractive to employers and consumers—can exert considerable market power to obtain steep payment rates from insurers. Other factors, such as offering an important, unique service or access in a particular geographic area, can contribute to provider leverage as well. Even in markets with dominant health plans, insurers generally have not been aggressive in constraining rate increases, perhaps because the insurers can simply pass along the costs to employers and their workers. Although government intervention—through rate setting or antitrust enforcement—has its place, our find...
84 citations
TL;DR: This first effort to quantify the contribution of different factors in explaining racial difference in low birthweight rate by applying a nonlinear extension of the Oaxaca-Blinder method proposed by Fairlie to decompose this gap into the portion explained by differences in observed characteristics and the portion that remains unexplained.
Abstract: SUMMARY
This is a first effort to quantify the contribution of different factors in explaining racial difference in low birthweight rate (LBW). Mother's health, child characteristics, prenatal care, socioeconomic status (SES), and the socioeconomic and healthcare environment of mother's community are important inputs into the birthweight production function, and a vast literature has delved into obtaining causal estimates of their effect on infant health. What is unknown is how much of the racial gap in LBW is explained by all these inputs together. We apply a nonlinear extension of the Oaxaca–Blinder method proposed by Fairlie to decompose this gap into the portion explained by differences in observed characteristics and the portion that remains unexplained. Data are obtained from several sources in order to capture as many observables as possible, although the primary data source is the Natality Detail Files. Results show that of the 6.8 percentage point racial gap in LBW, only 0.9–1.9 points are explained by white–black differences in endowments across those measures, and of those endowments, most of the gap in LBW is explained by the differences in SES. The unexplained difference is attributed to racial differences in the returns to or the marginal product of investments in infant health. Copyright © 2011 John Wiley & Sons, Ltd.
74 citations
TL;DR: In this paper, the authors explore the ideas of vulnerability, precariousness, and resilience as they apply to people, housing, neighborhoods, and metropolitan areas, and propose that people might be more vulnerable to shocks or strains if they are members of racial/ethnic minorities, recent immigrants, non-high school graduates, are children or over 75 years old, disabled, recent veterans, living in poverty, or living in single-parent households.
Abstract: This article has two purposes. First, it explores the ideas of vulnerability, precariousness, and resilience as they apply to people, housing, neighborhoods, and metropolitan areas. People might be more vulnerable to shocks or strains, we propose, if they are members of racial/ethnic minorities, recent immigrants, non-high school graduates, are children or over 75 years old, disabled, recent veterans, living in poverty, or living in single-parent households. Housing may be more precarious, we propose, when it is rented, multi-family, manufactured, crowded, or subject to overpayment. The article goes on to document the relationships between potential personal or household vulnerability and potentially precarious housing conditions. Microdata from the 2005–2007 American Community Survey suggest that an important minority of people have multiple vulnerabilities; these vulnerabilities associate with residence in precarious housing. We suggest that policy be directed toward precarious situations most likely to...
73 citations
01 Dec 2012
TL;DR: European countries have smaller shares of undocumented migrants than does the United States, but these individuals have substantial needs for medical care and present difficult policy challenges even in countries with universal health insurance systems.
Abstract: European countries have smaller shares of undocumented migrants than does the United States, but these individuals have substantial needs for medical care and present difficult policy challenges even in countries with universal health insurance systems. Recent European studies show that policies in most countries provide for no more than emergency services for undocumented migrants. Smaller numbers of countries provide more services or allow undocumented migrants who meet certain requirements access to the same range of services as nationals. These experiences show it is possible to improve access to care for undocumented migrants. Strategies vary along three dimensions: (1) focusing on segments of the population, like children or pregnant women; (2) focusing on types of services, like preventive services or treatment of infectious diseases; or (3) using specific funding policies, like allowing undocumented migrants to purchase insurance.
59 citations
TL;DR: This paper analyzed the response of single women's housework, labor supply, and other time to variation in tax and transfer schedules across income levels, number of children, states, and time.
Abstract: The classic model of Becker (1965) suggests that labor supply decisions should be analyzed within the broader context of time allocation and market good consumption choices, but most empirical work on policy has focused exclusively on measuring impacts on market work. This paper examines how income taxes affect time allocation during the entire day, and how these time allocation decisions interact with expenditure patterns. Using the Panel Study of Income Dynamics from 1975 to 2004, we analyze the response of single women's housework, labor supply, and other time to variation in tax and transfer schedules across income levels, number of children, states, and time. We find that when the economic reward to participating in the labor force increases, market work increases and housework decreases, with the decrease in housework accounting for approximately two-thirds of the increase in market work. Analysis of repeated cross-sections of time diary data from 1975 to 2004 shows that "home production" decreases substantially when market hours of work increase in response to policy changes. Data on expenditures from the Consumer Expenditure Survey from 1980 to 2003 show some evidence that expenditures on market goods likely to substitute for housework increase in response to a greater incentive to join the labor force. The baseline estimates imply that the elasticity of substitution between consumption of home and market goods is 2.61. The results are consistent with the Becker model. Meanwhile, single men show little response to changes in tax policy, and we are able to rule out an elasticity of substitution between home and market goods for this group of more than 1.52.
TL;DR: It is revealed that more than half of the published studies using BCG as a prime combined with a novel boost vaccine give better efficacy than BCG alone and that the greatest reduction in Mycobacterium tuberculosis (M.tb.) colonization of animal tissues is provided by viral vectored vaccines delivered intranasally.
TL;DR: The marketplace and regulatory forces that influence HITECH's success are examined and evidence that care is improving, at least in areas with robust systems, will be essential to persuade stakeholders that the initiative is progressing well and warrants continued investment.
Abstract: In enacting the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act, Congress set ambitious goals for the nation to integrate information technology into health care delivery. The provisions called for the electronic exchange of health information and the adoption and meaningful use of health information technology in health care practices and hospitals. We examined the marketplace and regulatory forces that influence HITECH's success and identify outstanding challenges, some beyond the provisions' control. To reach HITECH's goals, providers and patients must be persuaded of the value of health information exchange and support its implementation. Privacy concerns and remaining technical challenges must also be overcome. Achieving HITECH's goals will require well-aligned incentives, both visionary and practical pursuit of exchange infrastructure, and realistic assumptions about how quickly such wholesale change can be accomplished. The use of metrics to show adoption proceeding at a reasonable pace, increased flow of data across parties, and evidence that care is improving, at least in areas with robust systems, will be essential to persuade stakeholders that the initiative is progressing well and warrants continued investment.
TL;DR: This paper's analysis of national survey estimates found that access to health care and use of health services for adults ages 19-64--the primary targets of the Affordable Care Act--deteriorated between 2000 and 2010, particularly among those who were uninsured.
Abstract: The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper’s analysis of national survey estimates found that access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist. We also found that children—many of whom qualify for public coverage through Medicaid and the Children’s Health Insurance Program—generally maintained or improved their access to care during the same period. This provides a reason for optimism about the ability of the coverage expansion in the Affordable Care Act to improve access for adults, but it suggests that eliminating the law...
TL;DR: In this paper, the authors present findings from a three-year qualitative study of the childcare choices of low-income working families, many of whom were immigrants, had limited English proficiency, were parents of children with special needs, or represented some combination of these factors.
Abstract: Regardless of their economic background, most working parents face the task of arranging childcare at some point. The decision-making process they experience is often complex, and this complexity is intensified for particular groups of families with limited financial and social resources. In this paper, we present findings from a three-year qualitative study of the childcare choices of low-income working families, many of whom were immigrants, had limited English proficiency, were parents of children with special needs, or represented some combination of these factors. The study explored families' current care arrangements, their reasons for selecting a particular form of childcare, and the characteristics of their ideal arrangements. Data were coded to identify themes in parental preferences, decision factors, and the barriers families faced in accessing their preferred care arrangements. Most significantly, the parents studied described their preferences for an environment where their children could lea...
TL;DR: Although the population is indeed costly, it is found nearly 40 percent of dual eligibles had lower average per capita spending than non-dual-eligible Medicare beneficiaries, and decision makers should tailor reform initiatives to account for subpopulations ofDual eligibles, their costs, and their service use.
Abstract: The nearly nine million people who receive Medicare and Medicaid benefits, known as dual eligibles, constitute one of the nation’s most vulnerable and costly populations. Several initiatives authorized by the Affordable Care Act are intended to improve the health care delivered to dual eligibles and, at the same time, to achieve greater control of spending growth for the two government programs. We examined the 2007 costs and service use associated with dual eligibles. Although the population is indeed costly, we found nearly 40 percent of dual eligibles had lower average per capita spending than non-dual-eligible Medicare beneficiaries. In addition, we found that about 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending on the dual-eligible population. But even among these high-cost dual eligibles, we found subgroups. For example, fewer than 1 percent of dual eligibles were in high-cost categories for both Medicare and Medicaid. These findings sugges...
TL;DR: This work uses the 2009 American Community Survey to model pre-ACA eligibility for comprehensive Medicaid coverage among nonelderly adults and finds a Medicaid participation rate of 67% for adults that varies substantially across socioeconomic and demographic subgroups and across states.
Abstract: Steep declines in the uninsured population under the Affordable Care Act (ACA) will depend on high enrollment among newly Medicaid-eligible adults. We use the 2009 American Community Survey to model pre-ACA eligibility for comprehensive Medicaid coverage among nonelderly adults. We identify 4.5 million eligible but uninsured adults. We find a Medicaid participation rate of 67% for adults; the rate is 17 percentage points lower than the national Medicaid participation rate for children, and it varies substantially across socioeconomic and demographic subgroups and across states. Achieving substantial increases in coverage under the ACA will require sharp increases in Medicaid participation among adults in some states.
TL;DR: Five leading safety-net hospitals have begun preparing for reform, and their preparations include improving the efficiency and quality of care delivery, retaining current and attracting new patients, and expanding the medical home model.
Abstract: Safety-net hospitals will continue to play a critical role in the US health care system, as they will need to care for the more than twenty-three million people who are estimated to remain uninsured after the Affordable Care Act is implemented. Yet such hospitals will probably have less federal and state support for uncompensated care. At the same time, safety-net hospitals will need to reposition themselves in the marketplace to compete effectively for newly insured people who will have a choice of providers. We examine how five leading safety-net hospitals have begun preparing for reform. Building upon strong organizational attributes such as health information technology and system integration, the study hospitals’ preparations include improving the efficiency and quality of care delivery, retaining current and attracting new patients, and expanding the medical home model.
Posted Content•
TL;DR: It is found that, in absolute terms, retirement incomes offuture cohorts will increase over time, and poverty rates will fall, however, projected income gains are larger for higher than for lower socioeconomic groups, leading to increased income inequality among future retirees.
Abstract: This article examines how retirement income at age 67 is likely to change for baby boomers and persons born in generation X (GenX) compared with current retirees. We use the Social Security Administration's Modeling Income in the Near Term (MINT) model to project retirement income and assets, poverty rates, and replacement rates for current and future retirees at age 67. We find that, in absolute terms, retirement incomes of future cohorts will increase over time, and poverty rates will fall. However, projected income gains are larger for higher than for lower socioeconomic groups, leading to increased income inequality among future retirees. Finally, because postretirement incomes are not expected to rise as much as preretirement incomes, baby boomers and GenXers are less likely to have enough postretirement income to maintain their preretirement standard of living compared with current retirees.
TL;DR: For instance, the authors found that people attend live performing arts events with a focus on demographic explanations, such as the age or income of patrons, rather than demographic factors such as demographics.
Abstract: Previous research seeking to explain why people attend live performing arts events has focused primarily on demographic explanations, such as the age or income of patrons. Recent research reinvigor...
TL;DR: Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation.
Abstract: While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.
TL;DR: The authors examined whether and how the Early Head Start (EHS) program benefited African American children at the end of the program, when they were 36 months of age, as well as the parenting these children experienced and how this affected their developmental outcomes.
TL;DR: It is found that many hospital systems--some with facilities in geographically undesirable areas--have expanded to compete for better-insured patients by building or buying facilities and physician practices in nearby, more affluent communities.
Abstract: The emphasis that hospitals place on cutting-edge technology and niche specialty services to attract physicians and patients has set the stage for health care’s most recent competitive trend: an increased level of targeted, geographic service expansion to “capture” well-insured patients. We conducted interviews in twelve US communities in 2010 and found that many hospital systems—some with facilities in geographically undesirable areas—have expanded to compete for better-insured patients by building or buying facilities and physician practices in nearby, more affluent communities. Along with extending services to new markets, these hospital outposts often serve to pull well-insured patients to flagship facilities. The acceleration and expansion of such geographically competitive strategies by hospitals has implications for cost and access. Although payers and competitors contend such strategies will lead to higher costs, hospitals assert the expansions will increase efficiency, increase access, and improv...
TL;DR: In this article, the authors examined 25 four-year-old pre-school classrooms from a random sample of 15 schools within a large urban city in southern Spain and found that on average, classroom quality was low in regards to space and materials, developmentally appropriate activities and instruction; however, classrooms were relatively high on positive climate and productivity, and teachers demonstrated positive relationships with families.
Abstract: We examined 25 four-year-old pre-school classrooms from a random sample of 15 schools within a large urban city in southern Spain. Observational measures of classroom quality included the Early Childhood Environment Rating Scale-Revised, the Classroom Assessment Scoring System and the Observation of Activities in Pre-school. Findings revealed that, on average, classroom quality was low in regards to space and materials, developmentally appropriate activities and instruction; however, classrooms were relatively high on positive climate and productivity, and teachers demonstrated positive relationships with families. The observed ratio of children to teachers was high across classrooms. Results from regression analyses indicate that a higher ratio was associated with lower quality language modelling, teacher feedback and personal care routines available in these settings. Qualitative data from teacher interviews highlighted the importance of a pre-school education for children's development and sch...
TL;DR: One in six newborns were born poor over the past 40 years, and nearly half remained poor half their childhoods as mentioned in this paper, and persistently poor children are nearly 90 percent more likely than never-poor children to enter their 20s without completing high school and are four times more likely to give birth outside of marriage during their teenage years.
Abstract: One in six newborns were born poor over the past 40 years, and nearly half remained poor half their childhoods. These persistently poor children are nearly 90 percent more likely than never-poor children to enter their 20s without completing high school and are four times more likely to give birth outside of marriage during their teenage years. Children whose parents did not complete high school are less likely to complete high school themselves. This paper examines the magnitude of child poverty, family characteristics related to childhood poverty persistence, and childhood poverty’s lasting consequences.
TL;DR: African-American children with asthma were significantly less likely than white, non-Hispanic children to have taken preventive asthma medication, but more likely to have had an asthma management plan, while Mexican-American and Puerto Rican and other Hispanic children did not differ significantly in either receiving preventive asthma medications or having an asthma Management plan.
Abstract: Objectives. We examined racial and ethnic differences in the management of childhood asthma in the United States and the extent that care conformed to clinical best practices. Methods. Two years of pooled data from the National Health Interview Survey were analyzed using logistic regression. The sample included all children between ages 2 and 17 years who had asthma currently and had been diagnosed with asthma by a doctor or health professional (n = 1757; 465 African-American, 212 Mexican-American, 190 Puerto Rican and other Hispanic, 806 white, non-Hispanic, and 84 children of other and multiple races and ethnicities). Results. African-American children with asthma were significantly less likely than white, non-Hispanic children to have taken preventive asthma medication, but more likely to have had an asthma management plan. Mexican-American and Puerto Rican and other Hispanic children did not differ significantly from white, non-Hispanic children in either receiving preventive asthma medication or havi...
TL;DR: In this article, the authors examined Social Security claiming behavior of older Americans and found that early claiming has declined over the past decade, after increasing over the previous 10 years, and the recent trend toward delayed claiming is evident among all educational groups, not just college graduates.
Abstract: This study examines Social Security claiming behavior, which has important implications for older Americans and for the system itself. Retirees may begin collecting benefits as early as age 62, but early claimants receive lower monthly benefits for the rest of their lives. Our data come from Survey of Income and Program Participation (SIPP) files from 1984 to 2009 linked to administrative records on earnings and benefits. The sample is restricted to respondents with 40 quarters of covered employment who did not claim benefits before age 62. Results indicate that early claiming has declined over the past decade, after increasing over the previous 10 years. For men, the share claiming at age 62 fell from 55.3 percent in the 1930-34 birth cohort to 46.4 percent in the 1940-44 cohort. Over the same period, the share of women claiming at 62 fell from 59.3 to 49.0 percent. The recent trend toward delayed claiming is evident among all educational groups, not just college graduates. Hazard models show that high unemployment boosts Social Security claiming among men with limited education. A 1 percentage point increase in the state unemployment rate is associated with a 0.4 percentage point increase in the likelihood each month that men who never attended college will claim benefits, a relative increase of 6 percent. This estimate implies that the Great Recession increased claiming for men with limited education by about 40 percent. Claiming behavior among women and well-educated men is not significantly correlated with the state unemployment rate, however.
TL;DR: High marginal tax rates can make moving above poverty very difficult for low-income families as discussed by the authors, and these high tax rates result from increasing direct taxes (both state and federal) as well as decreasing...
Abstract: High marginal tax rates can make moving above poverty very difficult for low-income families. These high tax rates result from increasing direct taxes (both state and federal) as well as decreasing...
TL;DR: The aim was to systematically review phase II HILP trials, assess tumor response, limb salvage (LS), and quality of scientific publications on this technique.
Abstract: Background and Objectives: Extremity soft tissue sarcomas (STS) are managed with radiotherapy and limb-sparing surgery however aggressive or recurrent cases require amputation Hyperthermic isolated limb perfusion (HILP) has been proposed as an alternative Our aim was to systematically review phase II HILP trials, assess tumor response, limb salvage (LS), and quality of scientific publications on this technique Methods: We conducted a literature search of electronic databases (MEDLINE, EMBASE, Scopus, Cochrane Library) and clinical trial registries for phase II HILP trials on non-resectable extremity STS Outcomes of interest were complete response (CR), partial response (PR), and LS rates Quality of published trials was assessed using a quality checklist Results: Of 518 patients across 12 studies, 408 had some response (CR or PR), and 428 had the limb spared Median CR, PR, and LS rates were 31%, 535%, and 825%, respectively Median Wieberdink loco-regional toxicity rates were 38%, 455%, 17%, 1%, and 0% for levels 1–5, respectively No trial fulfilled either all ideal or essential quality criteria Seven trials did not include statistical methodology Conclusion: HILP seems effective in treating advanced extremity STS However, poor publication quality hinders results validity Technical and methodological standardization, well-designed, multi-institutional trials are warranted J Surg Oncol 2012 Wiley Periodicals, Inc
TL;DR: The outcomes for LA's HOPE clients suggest that this very challenged population can achieve improved work outcomes if programs devote adequate and appropriate resources to help them.
Abstract: Objective: This study examined the impact of a federally funded housing and employment demonstration program (Los Angeles’ Homeless Opportunity Providing Employment [LA’s HOPE]) for homeless adults with mental illness Methods: The sample included all participants enrolled between July 1, 2004, and May 17, 2005, in one of 18 Los Angeles County community mental health centers offering a state-funded program (AB2034) to reduce homelessness among people with serious mental illness Fifty-six demonstration clients enrolled in three centers received housing and special employment supports Their outcomes were compared with those of 415 clients enrolled in the county’s other 15 AB2034 programs during the same period Data included demographic characteristics, circumstances at enrollment and in the previous 12 months, and outcomes for at least 13 months after enrollment Outcomes analyses used propensity score matching Results: Demonstration clients got and kept housing and worked in paid employment and employment-related activities at rates significantly higher than those of the comparison group Other than client group, no personal characteristics made any systematic difference to employment outcomes Several personal characteristics— race and ethnicity, preenrollment length of homelessness, and whether the client had a co-occurring substance use disorder—affected housing outcomes independently of client group Conclusions: The demonstration provided the structure and resources to help clients achieve better housing and employment outcomes than the comparison group had The outcomes for LA’s HOPE clients suggest that this very challenged population can achieve improved work outcomes if programs devote adequate and appropriate resources to help them (Psychiatric Services 63:209–215,