Bill may require automation of patient records

Hospitals that have been delaying investments in clinical information systems may not be able to wait much longer. A bill drafted by HHS and introduced in the Senate last month would require hospitals to computerize their medical records by Jan. 1, 1996. Although the bill has some loopholes to give some facilities until 1998, it certainly would turn hospitals into motivated buyers of such systems.     

Impact of an all-or-nothing assignment requirement under Medicare.

In an effort to raise assignment rates, some policymakers have considered dropping Medicare's case-by-case assignment option. Physicians would have to decide whether to accept all of their patients on assignment, or none of them. In a 1976 national survey, over two-thirds of the physicians stated they would take none of their patients on assignment if forced to choose. Simulation analysis showed that in that event, assignment rates nationwide would fall almost 10 percent. The mean supply of assigned visits would actually increase 11 percent for general practitioners, while decreasing 12-25 percent for general surgeons, internists, and obstetricians/gynecologists.     

Pregnancy resolution and family formation. Understanding gender differences in adolescents' preferences and beliefs

Notably absent from the literature on pregnancy resolution and family formation decision making in adolescence is research conducted at the couple level. This limits researchers' assessment of how partners deal conjointly with the dilemma of unintended adolescent pregnancy and arrive at decisions with life-long implications. In this study, 577 male and female high school students (208 of whom were black) from a large midwestern city were asked a series of questions about a hypothetical vignette in which an unintended pregnancy occurs in the context of a long-term, committed relationship. When race was controlled, males and females gave almost identical responses in terms of pregnancy resolution preferences: abortion (18%), adoption (12%), and some form of parental rearing (63%). Among teenaged males who opted for some form of parental custodial care, 21% indicated they would marry and 46@ would cohabited with their partner. In contrast, only 11% of the teenaged females who chose the parental rearing option wished to marry their partner and only 30% would cohabited. 52% of females compared to 28% of males preferred a single parent arrangement in which the female assumed custody and the male paid child support. Logistic regression indicated that both male and female high school students were less likely to opt for an arrangement that involved living with both their partner and child when they perceived that their parents and closest friends would react negatively to such an arrangement and when they believed that forming a 2-parent household would limit their educational goals. The finding that young females were significantly more likely then their male counterparts to envision living alone with their child reflects the culturally based assumption that women are more committed to the custodial aspects of parenting.     

Evaluating men's involvement as a strategy in sexual and reproductive health promotion

Nearly 10 years has passed since the 1994 International Conference on Population and Development recognized men as legitimate targets for sexual and reproductive health promotion. This recognition was born of the experience of many health promoting agencies in the 1980s and 1990s who realized that without working with men, change would be very difficult or impossible. It was proposed that men should be involved because their active participation was crucial to the success of programs and to the empowerment of women. However, the idea that men should play an active role in health promotion has not been without its critics, who have posed serious questions about the efficacy of involving men and the effects their involvement would have on women and children. In an effort to examine the lessons learned from men's involvement, this paper reviews published evaluations of interventions that have targeted heterosexual men. Twenty-four studies that met the criteria for inclusion (reported on interventions in areas of sexual and reproductive health that targeted heterosexual men and contained evaluation data) were found. From their review of these studies, the authors suggest that there is some evidence that the use of media approaches may be a successful strategy and that there may be some problems with the application of some cognitive behavior change approaches. However, the fact that few interventions have targeted heterosexual men and have been the subject for detailed evaluation suggests that there is a need for more interventions and better evaluations, which would examine not only the process of men's involvement, but also their impact on the lives of both the men themselves and their families. The reality is that although perhaps no longer regarded as part of the problem, men have yet to be seen as part of the solution.     

Informed consent: what do patients want to know?

Informed consent is an important aspect of surgery, yet there has been little inquiry as to what patients want to know before their operation. This study has questioned 50 patients within 3 months of an ENT (ear, nose and throat) operation. We found that most were happy to allow doctors to determine their treatment but they wanted to know about their condition, the treatment, and the important side effects. Fifty per cent of patients admitted worrying about some aspect of their recent surgery. More than two-thirds thought signing a consent form primarily signified agreement to undergo treatment and that it was a legal document; 54% thought there was an important medico-legal aspect. Over half thought information sheets would be reassuring, one-third thought they would provoke anxiety and 8% thought they would frighten them from having surgery. Closer examination of the answers to our questions showed that those who were most worried about aspects of their surgery had a higher mean anxiety score, as did those who thought an information sheet would be either frightening or anxiety provoking. However, a higher anxiety score was not associated with a desire to know less about the proposed treatment.     

Governor kills plan to give hemophiliacs more time to sue

Governor Arne Carlson vetoed a bill that would extend the statute of limitations another year for hemophiliacs to sue pharmaceutical manufacturers. The bill would have extended the statute of limitations to June 1, 1997, for civil suits brought by people who contacted HIV through contaminated blood-clotting products. The current 6-year statute of limitations ran out before some individuals learned how they or their family member contracted the virus.     

Forgotten mysteries in the early history of vitamin D

In the early 1920s, workers in both England and the US had discovered that rats on a rachitic diet would remain healthy if irradiated with ultraviolet light. However, they also found, to their surprise, that "control" rats too would recover if either their jar was irradiated without the rat in it or if a cage-mate was removed for irradiation and then returned. The ideas that either air or material objects that had been irradiated continued themselves to convey healthful secondary radiations were investigated but not confirmed. There was then the commercially important finding that with irradiation, some rachitic diets would become anti-rachitic. However, this effect did not explain all the previous findings. Consumption of either small irradiated fecal particles or of feces from irradiated rats was the likely explanation for the recovery of nonirradiated rats, but this was not tested by direct experiment, and it now appears unlikely that feces from irradiated rats would show significant antirachitic activity. It is suggested that an alternative possibility--activity of grease from irradiated fur--deserves investigation.     

A regional strategy. Networking gives rural residents access to high-quality healthcare

In 1978 the Board of Trustees at St. Edward Mercy Medical Center, Fort Smith, AR, adopted a policy that the center would increase its bed size only to meet community needs or to offer needed services. The policy choice was the first step in the development of a regional network that now serves five rural communities. Although there was some resistance to the move at first, when management formalized some of its basic assumptions and values, it became clear that establishing a regional network was right for St. Edward. It would provide economic benefits to the communities in which facilities were acquired or constructed; it would give rural residents better access to primary healthcare; and it would provide the Religious Sisters of Mercy an opportunity to extend their ministry. Networking has also allowed the facilities involved to develop economies of scale and to avoid costly duplication of certain basic services. In addition, primary care physicians in rural communities served by the network have been an important source of referrals to specialists who utilize St. Edward.     

Experiences of disabled health and caring professionals

The widespread discrimination against disabled people in most types of employment is well known. It would seem likely, therefore, that disabled people would find it difficult to gain access to the health and caring professions, although many people have argued that their personal experience of disability would be an invaluable asset to the professions and patients alike. By means of semi-structured interviews this study aimed to gain insight into the experiences of people who had been accepted into the health and caring professions despite having a substantial disability. Although most respondents reported either positive or neutral attitudes from colleagues, a sizeable minority had experienced negative attitudes, especially when trying to gain access to training and during training itself. Negative attitudes from patients and clients were, in contrast, exceptionally rare. Most respondents viewed their disability as an advantage rather than a disadvantage in the work context, and although some people were restricted in the specialties they could follow, most could fulfil all of their work obligations.     

Confidentiality in General Practice

Attitudes among general practitioners to confidentiality werestudied in Denmark in 1980 and in 1984 and in France in 1980using mailed questionnaires. A number of typical situationsin general practice were described. The doctors were asked whetherthey would disclose information about the patient in the situationsdescribed. In a parallel study the same situations were describedand lay people were asked whether in their opinion the doctorshould disclose information or preserve confidentiality. The results showed some similarities but some marked differencesbetween Danish and French practitioners; the Danish doctorsattached more importance to the opinion of their patients. Duringthe period from 1980 to 1984 a pronounced change in attitudesoccurred among the Danish practitioners towards restraininginformation about the patients. In many questions the doctor'sanswers were in accordance with the expectations of lay people,especially regarding the preservation of confidentiality. But,contrary to the doctor's opinion, lay people expect that thedoctor would provide information if the patient had given consent.     

David Duke, running for governor, proposes tattooing people with HIV

Former Ku Klux Klan leader, David Duke, planning a second run for governor of Louisiana, said he would curb the AIDS epidemic by tattooing people who are infected with HIV. His suggestion is to put indelible, glow-in-the-dark tattoos on the genitals of people infected with HIV. According to Duke, it may sound very draconian but it would not demean people. He also believes that tattooing would be legal because courts have a history of supporting the quarantining and institutionalizing of people with infectious diseases, such as tuberculosis. Duke said Cuba has had some success in using quarantines to reduce HIV infection, but he does not think it would work in the United States because it would cost too much. According to Duke, many people who get HIV from irresponsible behavior do not tell their partners that they have AIDS--these people are mad at the world and engage in dangerous behaviors even more.     

Who walks through the door? The effect of the uninsured on hospital use

Hospitals are concerned about the implications of an increase in the number of uninsured people. Using data from the 1999 Medical Expenditure Panel Survey (MEPS), we calculate what percentage of hospital inpatient, emergency department, and outpatient visits are accounted for by uninsured people and predict how those shares would change under three different scenarios. We find that although the burden of the uninsured would remain a severe problem for some hospitals, it would not likely increase much for most of them. This finding reflects the relatively low utilization rates among those most likely to lose coverage: nonelderly, nonpregnant, and nondisabled workers and their families.     

The work motivations of mothers with preschool children

This article provides a qualitative and quantitative analysis of the motivations for employment among a sample of 166 Sydney mothers, each of whom had at least 1 preschool-aged child. Mothers with high and moderate work attachment indicated a multiplicity of motives, of both an extrinsic (financial) and intrinsic (personal satisfaction, sense of achievement) nature. In contrast, the majority of women with low work attachment cited extreme financial need as the only possible reason that would impel them to enter the labor force. When asked which was, or would be, their most important reason for working, women with high work attachment endorsed more nonfinancial than financial reasons, women with moderate work attachment were about equally likely to give either reason, and women with low work attachment predominantly gave financial reasons. Husbands' perceptions of the reasons their wives were working, or would work, showed some, but not complete, agreement with those of their wives.     

Advancing public reporting through a new 'aggregator' to standardize data collection on providers' cost and quality

Advocates for consumer-friendly public reporting on the performance of health care providers anticipate that, at some point, well-vetted and standardized measures will be widely available to help patients choose clinicians who provide the best care. However, achieving that goal would require assembling standardized data from many sources. Such an effort would raise concerns, including privacy considerations about having a single massive data repository; questions of how such an effort would be funded; and potential misuse of the data. This paper proposes creating a public-private data aggregator that would receive patient and provider data from payers that are deidentified in such a way as to remain useful for consumer-reporting and research purposes. The aggregator could be funded through fees charged to commercial users. Meanwhile, registered researchers putting their methods and findings in the public domain could access the data aggregator for free.     

Disputable and unsolved aspects of mass screening

A critical review of some aspects of follow-up examinations and regular check-ups is provided. A criterion of medical and economic advisability of these examinations is suggested which would permit one to substantiate their regional variations and increase their effectiveness.     

Not 2 old 2 TXT: there is potential to use email and SMS text message healthcare reminders for rheumatology patients up to 65 years old

Short message service (SMS) and email reminders have the potential to improve adherence to appointments and medication taking. Within the UK, information and communication technology (ICT) is widely used with a very high proportion of people having access to the internet and mobile phones. Little is known about ICT use by older adults and those with chronic illness. A feasibility survey was carried out with 112 rheumatology patients in Hertfordshire, UK to determine their current use of the internet, email and SMS and their willingness to receive electronic reminders in the future. A high proportion of patients up to age 65 are successfully using ICT despite older age or functional disability caused by rheumatic disease. Forty-four percent would be willing to receive an electronic appointment reminder and 25% a medication reminder. The results suggest that reminders would be welcomed by some patients and extensive patient training would not be needed before implementation.     

Any willing provider meets the formulary

Like doctors who would legislate less restrictive provider panels at HMOs, some drug makers are trying to muscle their products onto managed care formularies.     

Doctors and management--the development dilemma

Identifies managerial knowledge and skills from undergraduate to medical director level and considers the development of a core management training strategy and development programme, transferable on a national basis. Reports on a questionnaire survey plus in-depth interviews with doctors and senior managers divided between grades covering hospitals, general practices and public health services. Explains that the model evolved is a synthesis of managerial models set in the context of doctors' work. Concludes that doctors agreed that more support and training from their organizations would have been useful, and that managers were generally supportive of doctors becoming involved in management, although some harboured doubts about their willingness or the effects such moves would have on established management career structures. Contends that there appears to be a 30:70 split between doctors receptive to the concept of management and those against.     

An Agenda for Healthcare and Information Simulation

With healthcare systems around the world undergoing redesign and refocusing on patients, there is a strategic role that simulation modellers could play. The creation of strategic scenarios that work according to process philosophies—as used, for instance, in manufacturing—could help to deliver high quality care to millions of people. There may, in addition, be serendipitous synergies between some of these industrial process philosophies and known simulation techniques. This paper addresses some strategic issues around the processes of care delivery, and considers the resultant research agenda.Not only is this strategic agenda one that would help care providers, but it is possible to derive some concepts that enable technology to be valued as part of care provision. The paper explores how, in general terms, value propositions may be derived that are acceptable to commissioning agencies and accessible to technology vendors. Were it possible to formalise these, they would be of significant benefit both to healthcare service providers and to their suppliers.