Showing papers on "Health care published in 1990"

Health Behavior and Health Education

Abstract: Health behavior and health education , Health behavior and health education , کتابخانه دیجیتال جندی شاپور اهواز

Medical Futility: Its Meaning and Ethical Implications

Abstract: The notion of medical futility has quantitative and qualitative roots that offer a practical approach to its definition and application. Applying these traditions to contemporary medical practice, we propose that when physicians conclude (either through personal experience, experiences shared with colleagues, or consideration of published empiric data) that in the last 100 cases a medical treatment has been useless, they should regard that treatment as futile. If a treatment merely preserves permanent unconsciousness or cannot end dependence on intensive medical care, the treatment should be considered futile. Unlike decision analysis, which defines the expected gain from a treatment by the joint product of probability of success and utility of outcome, our definition of futility treats probability and utility as independent thresholds. Futility should be distinguished from such concepts as theoretical impossibility, such expressions as "uncommon" or "rare," and emotional terms like "hopelessness." In judging futility, physicians must distinguish between an effect, which is limited to some part of the patient's body, and a benefit, which appreciably improves the person as a whole. Treatment that fails to provide the latter, whether or not it achieves the former, is "futile". Although exceptions and cautions should be borne in mind, we submit that physicians can judge a treatment to be futile and are entitled to withhold a procedure on this basis. In these cases, physicians should act in concert with other health care professionals, but need not obtain consent from patients or family members.

Development of the Geriatric Oral Health Assessment Index

Abstract: The development of measures for assessing oral health status is essential to the evolution and maturation of a scientific knowledge base in geriatric dentistry. The literature suggests a high prevalence of dental diseases in older adults, yet valid and reliable instruments to assess the impact of oral diseases on older individuals or populations are lacking. This paper describes the rationale for and the development of the Geriatric Oral Health Assessment Index (GOHAI), a self-reported measure designed to assess the oral health problems of older adults. Following a review of the literature and consultation with health care providers and patients, a pilot instrument was developed. The GOHAI was initially tested on a convenience sample of 87 older adults. A revised instrument was then administered to a sample of 1755 Medicare recipients in Los Angeles County. The GOHAI demonstrated a high level of internal consistency and reliability as measured by a Cronbach's alpha of 0.79. Associations of the GOHAI with a single-item rating of dental health and with clinical and sociodemographic supported the construct validity of the index. Having fewer teeth, wearing a removable denture and perceiving the need for dental treatment were significantly related to a worse (lower) GOHAI score. Respondents who were white, well educated, and with a higher annual household income were more likely to have a high GOHAI score, indicating fewer dental problems. Additional applications of the GOHAI are necessary to further evaluate the instrument's validity and reliability, and to establish population norms of oral health in older adult populations as measured by the GOHAI.

The aging of America. Impact on health care costs.

Abstract: The rapid growth of the oldest age groups will have a major impact on future health care costs We use current US Census Bureau projections for the growth of our oldest age groups to project future costs for Medicare, nursing homes, dementia, and hip fractures Without major changes in the health of our older population, these health care costs will escalate enormously, in large part as a result of the projected growth of the "oldest old," those aged 85 years and above Medicare costs for the oldest old may increase sixfold by the year 2040 (in constant 1987 dollars) It is unlikely that these projected increases in health care costs will be restrained solely by cost-containment strategies Successful containment of these health care costs will be related to our ability to prevent and/or cure those age-dependent diseases and disorders that will produce the greatest needs for long-term care (JAMA 1990;263:2335-2340)

A clinician's guide to cost-effectiveness analysis.

Abstract: Cost-effectiveness analysis can be used to help set priorities for funding health care programs. For each intervention, the costs and clinical outcomes associated with that strategy must be compared with an alternate strategy for treating the same patients. If an intervention results in improved outcomes but also costs more, the incremental cost per incremental unit of clinical outcome should be calculated. The incremental cost-effectiveness ratios for various programs can be ranked to set funding priorities. By using this list, the person responsible for allocating resources can maximize the net health benefit for a target population derived from a fixed budget. Clinicians may not share this objective because, individually, they are appropriately concerned solely with the effectiveness of a specific intervention for their patients and are not concerned with the benefit derived from spending those resources on other patients in the target population. In addition, allocation may be driven by distributional and political objectives. Nevertheless, cost-effectiveness analysis demonstrates the consequences of allocation decisions. Because clinicians should participate in policy making, they must understand d the role of this technique in setting funding priorities.

The seven pillars of quality.

Abstract: Seven attributes of health care define its quality: (1) efficacy: the ability of care, at its best, to improve health; (2) effectiveness: the degree to which attainable health improvements are realized; (3) efficiency: the ability to obtain the greatest health improvement at the lowest cost; (4) optimality: the most advantageous balancing of costs and benefits; (5) acceptability: conformity to patient preferences regarding accessibility, the patient-practitioner relation, the amenities, the effects of care, and the cost of care; (6) legitimacy: conformity to social preferences concerning all of the above; and (7) equity: fairness in the distribution of care and its effects on health. Consequently, health care professionals must take into account patient preferences as well as social preferences in assessing and assuring quality. When the two sets of preference disagree the physician faces the challenge of reconciling them.

Producing Health, Consuming Health Care

Abstract: In this paper we propose a conplexe framework to present a wide range of relationships among the determinants of health.

The Handbook of Health Behavior Change

Abstract: Demands of managed care and wellness programs require that practitioners and researchers find effective models for behavior change. This Handbook has been updated to direct both care providers and policy makers to the most promising prevention and wellness therapies. This third edition has been extensively revised, updated, and expanded, with new chapters added and outdated chapters omitted. Together the editors and an array of expert contributors have made an excellent and necessary reference even better.

Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84.

Abstract: Use of preventive health services (physical, dental, and eye examinations, Pap smear and breast examinations) among Mexican American, Cuban American, and Puerto Rican adults (ages 20-74) was investigated with data from the HHANES. Analyses focused on the relative importance of two predictors of recency of screening: access to services (health insurance coverage, having a routine place for care, type of facility used, having a regular provider, travel time) and acculturation (spoken and written language, ethnic identification). Regression analyses controlling for age, education, and income indicated that utilization of the preventive services was predicted more strongly by access to care than by acculturation. For each Hispanic group, having a routine place for health care, health insurance coverage, and a regular provider were each significantly associated with greater recency of screening. Type of facility used and travel time produced less consistent effects. These results replicate past studies that ha...

The willingness to pay for medical care : evidence from two developing countries

Abstract: The rising cost of health care presses hard on developing and industrial countries alike. The burden is heavier in the developing world, however, because resources are scarcer, people tend to be in poorer health, and health services are less advanced and more inequitably distributed. This book documents these problems by analyzing data from the Living Standards Measurement Surveys in Cote d'Ivoire and Peru. Although improving health care strengthens a country's human resources, governments have been reluctant to improve health services because of high costs. One way of recovering these costs is to introduce or increase user fees - that is, to let patients pay a greater share of the cost of health care. But how does price affect the demand for health care? What are people willing to pay for medical treatment? By analyzing the level of health care chosen in rural communities in Cote d'Ivoire and Peru, the authors conclude that demand is price sensitive and that children and the poor are hurt more by the introduction of user fees than is the population in general. To raise revenue and protect the poor simultaneously governments need to protect vulnerable groups from the adverse effects of user fees. The authors suggest that policymakers introduce modest fees, maintain greater subsidies for poorer communities and for lower levels of health care, and carefully evaluate how fees affect decisions of individuals about whether and where to seek medical care.

Death Clustering, Mothers' Education and the Determinants of Child Mortality in Rural Punjab, India

Abstract: In this paper the behavioural factors which make for continuing high levels of child mortality in rural Punjab, despite favourable conditions in terms of nutrition, income, women's literacy and health care facilities are examined. A major factor is that inadequate attention has been paid to improved health care practices within the home. Women's autonomy, social class, and mothers' education significantly influence child survival. One of the pathways by which mothers' education affects child survival is through improved child care. In this society, a woman's autonomy is lowest during that part of her life-cycle which also contains her peak childbearing years: this perverse overlap raises child mortality. The risk of dying is distributed very unevenly amongst children, as the majority of child deaths are clustered amongst a small proportion of the families. The death-clustering variable remained significant even after several possible biological and socio-economic reasons for clustering had been controlled...

Health Promotion: Models and Values

Abstract: Part 1 Models: health - defining health, negative health, well-being, positive health, the goal of health promotion health education - who are the educators?, approaches and ingredients health promotion - prevention, health protection evaluation models in action - health education and a risk factor topic, health promotion and a disease topic. Part 2 Values: attitudes, beliefs and behaviour - the three aspects of attitudes, measuring attitudes strategies for changing attitudes - providing information, changing behaviour values - necessary social values, necessary individual or personal values, linking social and personal values liberalism, autonomy and health - assumptions of liberalism, health as a value, government interventions justice, health and society - health, health care and health determinants, social justice, explaining the health divide, community and citizenship.

Behavioral Risk Factor Surveillance, 1988.

Abstract: In 1988, 36 states (including the District of Columbia) participated in the Behavioral Risk Factor Surveillance System (BRFSS). This report provides state-specific estimates of the prevalence of certain health-risk behaviors and of the delivery of clinical preventive services as measured by the BRFSS during 1988. Because estimates vary considerably from state to state, national estimates are not always suitable for states to use in planning local programs. Therefore, the BRFSS will continue to provide state-specific data about health behaviors and the use of preventive health services. These data can be used to monitor trends in health behaviors that affect the burden of chronic diseases in the United States and to assess progress toward the year 2000 objectives for the nation. Language: en

Functional status II(R): A measure of child health status.

Abstract: Few measures are available to assess the health status of the growing numbers of children who now survive long-term with chronic physical disorders. A Functional Status Measure, FS I, that had considerable promise for measuring individual child health status and characterizing populations was develo

In Care of the State: Health Care, Education, and Welfare in Europe and the USA in the Modern Era

Abstract: Chapter 1 Introduction Chapter 2 Local Charity, Regional Vagrancy and National Assistance Chapter 3 The Elementary Curriculum as a Code for National Communication Chapter 4 Medical Police, Public Works and Urban Health Chapter 5 Worker's Mutualism: An Interlude on Self-Management Chapter 6 Social Security as the Accumulation of Transfer Capital Chapter 7 Conclusion: The Collectivizing Process and Its Consequences Index.

Prevention of work-related psychological disorders. A national strategy proposed by the National Institute for Occupational Safety and Health (NIOSH).

Abstract: The National Institute for Occupational Safety and Health (NIOSH) recognizes psychological disorders as a leading occupational health problem. This document, developed by a NIOSH working group led by the present authors, represents a first attempt to fashion a comprehensive national strategy to protect and promote the psychological health of workers. Roles are identified for industry, labor, government, and academia. Key initiatives include (a) steps to improve working conditions and employee mental health services and (b) increased research and surveillance to advance understanding of the problem. Because work-related psychological disorders appear to be a rapidly developing problem lacking complete definition in terms of scope and etiology, this strategy is not to be considered a final statement of NIOSH policy.

A Strategy for Quality Assurance in Medicare

Abstract: The Institute of Medicine of the National Academy of Sciences has just released a report on quality assurance for the Medicare program.1 The legislation authorizing the study called for an ambitious and far-reaching strategic plan for assessing and ensuring the quality of medical care for elderly people during the next decade. The deliberations and fact finding of the study's 17-member committee included the review of commissioned and staff-produced papers, public hearings, panels, site visits, focus groups, and many meetings. The resulting report indicates that although the current quality of medical care for Medicare enrollees is not bad, it could be . . .

Institutions, Veto Points, and Policy Results: A Comparative Analysis of Health Care

Abstract: The medical profession is reputed to control decision-making in medical care to such an extent that one can speak of professional dominance. Yet West European health policies have radically changed the working conditions and incomes of doctors in many countries. Why have some governments been able to ‘socialize’ medicine? This article seeks to refute the view that the medical profession exercises a universal veto power. In contrast to scholars who explain medical influence in terms of singular characteristics of the medical profession or through the historical process of professionalization, this essay focuses on the properties of distinct political systems that make them vulnerable to medical influence. It argues that we have veto points within political systems and not veto groups within societies. By comparing the lobbying efforts of medical associations in Switzerland, France, and Sweden, the article analyses the role of political institutions in accounting for different patterns of medical association influence on health policy.

MEASUREMENT OF HEALTH STATUS IN THE 1990s

Abstract: The use of health-related quality of life measures, especially those based on function, are likely to increase during the next decade. This increase, however, is most likely to occur in clinical research and clinical practice. Unless the necessary political will, resources, data, and policy researchers coexist, there will be relatively little advance in the use of health status measures for decision-making and policy. This prediction is based on the observation that policy research tends to rely on available national data, that currently these data provide limited information about health status, and that there appears to be insufficient interest and resources to broaden data collection or to develop methods that incorporate a broad spectrum of health outcomes (e.g. death, impairment, functional status, and perceptions) into a single instrument or measure of health on large populations and communities. This state of affairs is particularly unfortunate as we face a decade in which available health and medical care may become more limited and social inequity in access and health status may become more marked. The effect of social inequities and restrictions to health care on the health of the nation cannot continue to be determined with reference only to the structure and process of the health care system. Health and quality of life outcomes are what count. And, these outcomes cannot be determined without appropriate and inclusive measures of health-related quality of life. Of course, we hope our prediction is wrong and that the motivation and resources will be found to help resolve methodologic issues in the measurement of population health status and quality of life and to provide the necessary data. We hope that government agencies, employers, and private providers will begin to collect health-related quality of life data on the constituents and populations they serve. Even if these data are imperfect or primitive, the effects of improving accessibility and quality of health care can only be assessed adequately in terms of the health-related quality of life of the nation.

Practice Guidelines: A New Reality in Medicine: I. Recent Developments

Abstract: • There is growing interest in the use of practice guidelines for physicians as a means of reducing inappropriate care, controlling geographic variations in practice patterns, and making more effective use of health care resources. Recent developments at the national health policy level suggest that practice guidelines will play an increasingly prominent role in the practice of medicine. The federal government has created a new US Public Health Service agency with responsibility for practice guidelines. Guidelines have been developed by more than 35 physician organizations and specialty societies. The American Medical Association and the Council of Medical Specialty Societies have endorsed practice guidelines and are organizing specialty societies to set policy on the subject. Academic medical centers have formed a research consortium on practice guidelines. Independent research centers (eg, the RAND Corporation and the Institute of Medicine) are developing methods for assessing appropriateness and setting guidelines. Other groups, such as hospitals, insurers, managed care plans, and private enterprises, are also directly involved. The implications of these developments are far reaching. (Arch Intern Med. 1990;150:1811-1818)

Health System Decentralization : Concepts, issues and country experience

Abstract: Health system decentralization:concepts,issues,and country experience , Health system decentralization:concepts,issues,and country experience , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

Producing Health, Consuming Health Care

Abstract: In this paper we propose a conplexe framework to present a wide range of relationships among the determinants of health.

Cancer patient satisfaction with care.

Abstract: A diagnosis of cancer places considerable stress on patients and requires them to make major adjustments in many areas of their lives. As a consequence, considerable demands are placed on health care providers to satisfy the complex care needs of cancer patients. Currently, there is little available information to indicate the extent to which cancer patients are satisfied with the quality of care they receive. The present study assessed the perceptions of 232 ambulatory cancer patients about the importance of and satisfaction with the following aspects of care: doctors technical competence and interpersonal and communication skills, accessibility and continuity of care, hospital and clinic care, nonmedical care, family care, and finances. The results indicate that all 60 questionnaire items used were considered to reflect important aspects of care, but that greater importance was given to the technical quality of medical care, the interpersonal and communication skills of doctors, and the accessibility of care. Most patients were satisfied with the opportunities provided to discuss their needs with doctors, the interpersonal support of doctors, and the technical competence of doctors. However, few patients were satisfied with the provision of information concerning their disease, treatment, and symptom control and the provision of care in the home and to family and friends.