The use of the HIV test: a conflict choice approach.

The study introduces the "Conflict-Choice model" (C-C) as an analytic framework for studying consumer demand for health and healthcare. The proposed approach integrates the Theory of Consumer Behavior (TCB), the Investment Theory of Demand (ITD), and the Health Belief Model (HBM) into a single model that might be applied to a wide spectrum of health behavior and use of health services. Separating the episode of care into the two phases (patient initiated and physician dominated), the C-C model is limited to the individual's decision to seek service. This phase is dominated by two conflicting and undesirable outcomes that the patient seeks to avoid. The first is discomfort or disutility that accompanies the use of care. The second is the discomfort of illness and a reduced ability to perform social and economic roles, an outcome that may result in a potential decline in income. In this conflict-choice situation, the interrelation between two undesirable conditions and related avoidance gradients result in a behavioral equilibrium. The study applied this framework to the use or non-use of HIV tests. The analysis used the responses of 196,081 individuals in the Behavioral Risk Factor Surveillance System (BRFSS) of 2003. The analyses supported the expectations based on the newly developed conflict-choice theoretical framework and support the adoption of policies that reduce the tendency to avoid care while increasing the avoidance of undesirable health outcomes.

The current state of electronic health record (EHR) use in Oklahoma.

There is ample evidence of the positive impact of electronic health records (EHR) on operational efficiencies and quality of care. Yet, growth in the adoption of EHR and sharing of information among providers has been slow. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides financial incentives for eligible providers to adopt and implement EHR. Until now, little information was available regarding the use of EHR in Oklahoma. Sponsored by the Oklahoma Health Information Exchange Trust (OHIET), this study reveals that the frequency of use of EHR among Oklahoma providers is near the national average. Although a large number of Oklahoma physicians have received Medicaid incentive payments for planned adoption, implementation, or upgrade of EHR systems, relatively few eligible providers in Oklahoma have been certified to receive Medicare incentive payments through the Centers for Medicare and Medicaid Services (CMS) and even fewer have actually received these incentive payments.

A planning model for the short-term management of cash.

This paper develops a model that enables the health administrator to identify the balance that minimizes the projected cost of holding cash. Adopting the principles of mathematical expectation, the model estimates the expected total costs of adopting each of the several strategies concerning the cash balance that the organization might maintain. Expected total costs consist of anticipated short costs, resulting from a potential shortage of funds. Long costs are associated with a potential surplus of funds and an opportunity cost represented by foregone investment income. Of importance to the model is the potential for the health service organization to realize a surplus of funds during periods characterized by a net cash disbursement. The paper also develops an interactive spreadsheet that enables the administrator to perform sensitivity analysis and examine the response of the desired or target cash balance to changes in the parameters that define the expected long and short cost functions.

Adverse medical events: do they influence discharge decisions?

The author examined relationships between adverse medical events (AMEs) on discharge decisions. Using secondary data capturing inpatient utilization from Oklahoma hospitals, the author employed logistic regression to estimate the probability of extended hospital stay and the need for postacute care as a function of AMEs, and multiple regression analysis to assess the effect of AMEs on the number of days of care. Findings showed that an AME increased the likelihood of extended hospital stay, number of extended days of care, and needed postacute care. Findings indicated that reducing AME incidence would likely improve quality while reducing healthcare utilization and spending.

The effect of adverse medical events on spending on inpatient care.

BACKGROUND: In this study, we examined the proposition that the occurrence of adverse medical events (AMEs) increases spending on inpatient hospital care. METHODS: Employing the individual and the episode of care as the unit of analysis, the study relied on data assembled in the Public Use Data File maintained by the Oklahoma State Department of Health. Multiple regression analyses were used to examine the covariates of the revenue per case and its components, the average revenue per day, and the number of days per case. RESULTS: The results indicate that the occurrence of AMEs would increase the revenue per case, the days of care per case, and the revenue per day. CONCLUSIONS: Study findings suggest that a decline in AMEs improves quality while lowering spending on hospital care and the use of inpatient services.

Global nurse migration: its impact on developing countries and prospects for the future.

The worldwide shortage of nurses, which results from a global undersupply and high attrition rates, affects developed countries in the West the same way as it affects developing countries in Asia, Africa and Latin America. The difference lies in the fact that developing countries serve as a readily available source of trained nurses for developed countries in Europe, North America and parts of Oceania. Strong "pull" and "push" factors favour wealthier nations in the West in their efforts to deal with domestic shortages through overseas recruitment. Thus, the ongoing nursing shortage in developing countries is worsened by a loss of thousands of trained nurses every year to emigration. This paper brings into focus the magnitude of the problem in terms of the number of nurses migrating to and from various countries and its impact on developing countries. The paper also examines some of the ongoing efforts in developing countries to mitigate the problem, and sheds light on the prospects for improvement in the foreseeable future.

Global nurse migration: its impact on developing countries and prospects for the future.

The worldwide shortage of nurses which results from a global undersupply and high attrition rates affects developed countries in the West the same way as it affects developing countries in Asia, Africa and Latin America. The difference lies in the fact that developing countries serve as a readily available source of trained nurses for developed countries in Europe, North America and parts of Oceania. Strong "pull" and "push" factors favour wealthier nations in the West in their efforts to deal with domestic shortages through overseas recruitment. Thus, the ongoing nursing shortage in developing countries is worsened by a loss of thousands of trained nurses every year to emigration. This paper brings into focus the magnitude of the problem in terms of the number of nurses migrating to and from various countries and its impact on developing countries. The paper also examines some of the ongoing efforts in developing countries to mitigate the problem and sheds light on the prospects for improvement in the foreseeable future.

Co-morbidity in an elderly inpatient population: are the risks of co-existing conditions differentially distributed?

This study examines the distribution of co-morbidity among 167,738 inpatients, aged 65 or more, who experienced an episode of hospitalization during 1999 in short-term institutions that are located in Oklahoma. The analysis was conducted in two phases. In the first, logistic regression analysis was used to examine covariates that separate inpatients who presented at least one secondary diagnosis from those who were not co-morbid. Limited to those whose condition was complicated by at least one secondary diagnosis, Probit analysis was used to assess the covariates of the number of co-existing conditions. The covariates examined were the individual's racial status, demographic attributes, primary diagnosis, source of admission and discharge destination. Results indicate that the oldest of the elderly, African Americans and, to a lesser extent, Native Americans presented more complex cases than other members of the study population. The paper concludes with the policy implications that are associated with the differential distribution of co-morbidity.

Hospital admissions: who is admitted through the emergency department?

This study examines the co-variates that separate patients who presented an emergent condition without a physician referral and were admitted through the hospital emergency department (ED) from their counterparts who were referred by a physician for the treatment of an elective or urgent condition and were admitted through the admissions department. The analysis was based on 295,945 inpatient admissions in 1999 to short-term acute-care hospitals in Oklahoma. Employing hospital admission as the unit of analysis, logistic regression was used to examine the differential likelihood of admission without a physician referral and through the ED of the uninsured, Medicare beneficiaries, Medicaid recipients, African Americans and Native Americans. The results of the logistic regression analysis indicated that Medicaid recipients and the uninsured were more likely than their commercially-insured counterparts to be admitted, without a physician referral, to an acute-care hospital in Oklahoma following an evaluation in the ED. The findings also suggest that African Americans and, to a lesser extent, Native Americans were more likely than their white counterparts to be admitted through the ED without benefit of a physician referral.

Assessing administrative costs of mental health and substance abuse services.

Increasing competition in the market for mental health and substance abuse MHSA services and the potential to realize significant administrative savings have created an imperative to monitor, evaluate, and control spending on administrative functions. This paper develops a generic model that evaluates spending on administrative personnel by a group of providers. The precision of the model is demonstrated by examining a set of data assembled from five MHSA service providers. The model examines a differential cost construction derived from inter-facility comparisons of administrative expenses. After controlling for the scale of operations, the results enable MHSA programs to control the efficiency of administrative personnel and related rates of compensation. The results indicate that the efficiency of using the administrative complement and the scale of operations represent the lion's share of the total differential cost. The analysis also indicates that a modest improvement in the use of administrative personnel results in substantial cost savings, an increase in the net cash flow derived from operations, an improvement in the fiscal performance of the provider, and a decline in opportunity costs that assume the form of foregone direct patient care.

The influence of financial incentives and racial status on the use of post-hospital care.

This study examines the influence of financial incentives and the racial status of the patient on the use of extended care following an episode of hospitalization. Post-hospital care (PHC) is defined as the services provided by a skilled nursing facility (SNF) or intermediate care facility (ICF) following discharge. The focus of the analysis is on the use or nonuse of PHC, the presence or absence of a delay in transfer to an ICF or SNF and, limited to those who experienced a postponement, the length of the delayed discharge. After controlling for multiple factors, the results indicate that Medicare beneficiaries were more likely to use PHC, less likely to experience a delay in discharge, and used fewer days of prolonged care. Medicaid recipients and uninsured patients experienced reduced access to PHC. The results also indicated that the access of Native Americans and Americans to PHC was impeded.

Factors associated with the likelihood of injury resulting from collisions between four-wheel drive vehicles and passenger cars.

The specific effects of vehicular type on the likelihood of an injury occurring are relatively unexplored. This study sought to assess the relative risk of injury to occupants of four-wheel drive vehicles and their counterparts in passenger cars. Data for 1143 occupants from all of the 454 crashes in Oklahoma, in 1995 that involved a four-wheel drive vehicle were used. Multiple logistic regression analysis determined the association between potential predictive factors and vehicular injury. Odds ratios revealed occupancy in a passenger car to be a major predictor of the likelihood of injury. Other factors include the driver being female, driving too fast, travel on curved or level roadways, and being hit laterally or from the rear.

The use of hospital care: do insurance status, prospective payment, and the unit of payments make a difference?

Limited to 251,768 discharges during 1999 from short-term hospitals located in Oklahoma, the objective of this study was to examine the influence of insurance status, prospective payment, and the unit of payment on variation in the length of stay. The regression analysis indicated that elderly patients whose care was financed by the Medicare pricing system and the uninsured experienced a significantly shorter episode of hospitalization than their commercially insured counterparts. Conversely, Medicaid recipients, whose care was financed by a fixed per diem and uninsured or self-responsible patients, experienced a significantly shorter hospital stay than the commercially insured. The results also indicate that the type and source of admissions, the discharge destination of the patient, and case complexity significantly influenced the hospital stay. African-Americans and Native Americans also experienced a longer episode of hospital care than their white counterparts. The article concludes with a discussion of policy implications and the need to develop alternate methods of financing hospital care thereby reducing the risks of premature discharge and iatrogenic injury.

The temporarily and chronically uninsured: does their use of primary care differ?

The purpose of this study is to examine differences in the use of preventive or early-detection services by the temporarily and chronically uninsured. The use of preventive care was measured by an index that depicts the use of nine preventive or early-detection services and the use or nonuse of each procedure on the index. Respondents whose lapse in insurance coverage was one year or more were identified as chronically uninsured, while those whose lapse in coverage was less than one year were identified as temporarily uninsured. The analysis indicates that the chronically uninsured and, to a lesser extent, the temporarily uninsured use significantly fewer preventive or early-detection services than their insured counterparts.