Factors affecting total hospital charges and utilization for South Carolina inpatients with HIV/AIDS in 1994-1996,.

This study's analysis addresses trends in hospital utilization and costs for patients with human immunodeficiency virus acquired immunodeficiency syndrome (HIV/AIDS) from 1994 through 1996 in South Carolina, as well as the effect of patient sociodemographics, referrals, and provider characteristics. This is a population-based study of all emergency department visits and hospitalizations occurring during that time period. The total hospital charge per patient significantly increases over time, while the total inpatient days per patient decreases significantly, and the charge per day increases significantly. The proportion of patients with public insurance or who are indigent is increasing, and the proportion of those with private insurance is decreasing. Other variables that have a significant impact on total hospital charges, total inpatient days, and charges per day are types of insurance, physicians specialty, discharge status, and number of diagnoses (severity). Persons who are Medicare eligible are sicker and have higher hospital costs and more inpatient days when compared to those with Medicaid. Intensity of services (hospital charges per day) is associated with private insurance and self-pay patients. Persons with terminal illness stay longer and have higher costs. When HIV/AIDS is the primary admitting diagnosis, there are higher hospitalization costs. Increasing severity of illness (number of diagnoses) leads to higher total hospital charges and days. With the introduction of new AIDS treatments in 1996, further study is required to determine the effects of new drugs, physician specialties, and other provider characteristics on the cost and utilization of health care services, both inpatient and outpatient.

Dual diagnosis: HIV and mental illness, a population-based study.

This is a cross-sectional, population-based (n = 378,710) study using hospital discharge abstract data to determine the relative risk associated with having a dual diagnosis of mental illness and HIV/AIDS. The analysis addresses issues of gender, race, and age, as well as types of mental illness. Persons with a mental illness are 1.44 times more likely to have HIV/AIDS. Women are at increased risk of being dually diagnosed. There are no risk differences by race. Those with a specific diagnosis of substance abuse or a depressive disorder are more likely to have a diagnosis of HIV/AIDS.

Factors affecting health status in African Americans living with HIV/AIDS.

This study surveyed face-to-face 111 African American newly diagnosed and living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) from the Washington D.C. area, to ascertain the use of, and need for, early intervention services. The survey instrument included sections on demographics, level of health functioning and health indicators, social and financial support, and needed services. This article constructs a health status proxy variable from survey items and examines its relationship to biological and social variables. Variables found to have a significant relationship with health status are gender, type of health insurance, employment, receiving Social Security Disability Income, and level of education. A log-linear model for selection of parsimony found that the type of health insurance was most highly predictive of health status, when controlling for other variables. Persons who receive Medicaid report no better levels of health status than those without health insurance. Having private health insurance is associated with a 5.3-fold greater chance of having good or excellent health status.

Population-based survey of complementary and alternative medicine usage, patient satisfaction, and physician involvement. South Carolina Complementary Medicine Program Baseline Research Team.

BACKGROUND: With an increasing proportion of Americans using complementary or alternative medicine (CAM), physicians need to know which patients are using CAM to effectively manage care. METHODS: In this cross-sectional study, telephone interviews were conducted with 1,584 South Carolina adults (ages 18 and older); 66% responded to the survey of demographics, general health, frequency of CAM use, perceived CAM effectiveness, and physician knowledge of CAM use. RESULTS: A total of 44% had used a CAM during the past year. Increasing age and higher education were significantly associated with CAM use. More than 60% perceived CAM therapy as very effective, and 89% said they would recommend CAM to others. Physicians were unaware of CAM use in 57% of their patients using CAM. CONCLUSION: Complementary or alternative medicine use in this rural Southern state is similar to national usage. Users view CAM as effective. Physicians are frequently unaware of patients' CAM use. More research is needed to establish CAM effectiveness and how CAM affects medical care, training, and public health.

The glass ceiling in academe: health administration is no exception.

This paper reviews gender issues in academe and presents findings of a limited survey of ACEHSA-accredited health administration graduate programs. The survey shows gender ratios adverse to women at the full, associate, and assistant professor levels. Men to women ratio among faculty was 1.98, among full-time faculty it was 2.24, and among tenured/tenure-track faculty it was 2.69, despite an excess of female students over male students in graduate programs, and despite equal proportions of women and men faculty holding doctoral degrees. Distribution by rank showed 48.5 percent full professors, 27.8 percent associate professors, and, 20.1 percent assistant professors among men, vs. 27.4 percent, 41.1 percent, and 31.5 percent respectively among women. In other academic fields similar gender ratios prevail, and many researchers have documented evidence of continuing gender inequities in tenure, promotion and salary, given comparable performance, despite the enactment of Title IX in 1972. Gender disparities are rooted in a complex web of gender-specific constraints interwoven with secular human capital and structural variables, and confounded by sexist discriminatory factors. In light of these issues, recommendations are made toward creating an equitable academic climate without compromising the ideal of meritocracy, through gender-sensitive initiatives and vigilance mechanisms to bring policies to fruition.

Primary care physicians and barriers to providing care to persons with HIV/AIDS.

Primary care physicians play an increasingly important role in the care of persons with HIV/AIDS due to the rising number and changing geographic distribution of persons infected with HIV/AIDS. The study explored the relationship between barriers to health services and the experience and willingness of primary care physicians to care for persons with HIV/AIDS. The study was based on a random survey of primary care physicians in South Carolina. The results indicate that although primary care physicians' willingness to treat persons with HIV/AIDS is significantly associated with many self-reported barriers (i.e., financial, structural, knowledge, and attitudinal), their HIV/AID care experience was most significantly correlated with self-reported knowledge that overrides financial and structural barriers. The results emphasize the importance of programs and policy initiatives aimed at enhancing the primary care physicians' knowledge level and improving their attitudes related to HIV/AIDS.

Developing health administration education leaders: the ACEHSA Fellowship experience.

The ACEHSA Fellowship was initially established as a professional and leadership development activity for individuals from academic and professional backgrounds. The Fellow plays an integral and critical role in the accreditation process. This key role of the Fellow is presented from former and current perspectives. Also, this discussion revisits the analysis of the Fellowship experience from the original study conducted by Fine (1984) and draws comparisons with data from a current study. The results demonstrate similarities in the role over time. The Fellowship experience appears to have a direct and positive impact on the ability of individuals to personally network with other professionals, which facilitates the opportunity to acquire future leadership roles. The authors of this study served as Fellows from 1993-1994. During that time, Dr. Sobczak was honored as Senior Fellow for his contributions to the Commission.

Observation evaluation to assess race and educational bias in state-mandated standard testing of nurse aides in nursing homes.

This article presents an assessment of whether race, education, gender, or other testing bias was present in a state-mandated nurse aide competency test. This assessment was carried out with data from two sources: (a) a statewide standardized test for all nurse aides that was given by a nationally known testing company, (b) an independent observational evaluation with a Behaviorally Anchored Rating Scale (BARS) for nurse aides' performance that was carried out by the investigators. The results show that race and education level were predictors of performance on written and manual portions of the standardized test. Gender, age, and years of experience were also shown to predict test success. Comparing data from the two sources suggests that a possible bias in the standardized nurse aid test. The independent observation of performance on the job with the BARS is shown to be less biased.

Evaluation of South Carolina's HIV/AIDS community long-term care Medicaid waiver: cost comparison and patient satisfaction.

South Carolina's HIV/AIDS community long-term care Medicaid (Section 2179) waiver is evaluated via cost comparison and patient satisfaction measures. The waiver offers personal care aids, adult day care, counseling, home meals, hospice, private-duty nursing, and foster care supervision in addition to regular Medicaid services. Services to 111 eligible individuals and 52 individuals pending eligibility are evaluated by five methods. A cost comparison is conducted by comparing the cost per patient eligible day of the waiver recipients with those of a comparable group of HIV/AIDS Medicaid patients who did not participate in the waiver. The waiver services are shown to cost less than services delivered to comparable recipients. Costs per patient eligible day were $35.68 and $68.56 for the waiver patients and non-waiver patients, respectively. Telephone surveys, focus groups, provider compliance reviews, and patient record reviews were used to assess patient satisfaction and quality of care. Waiver patients were satisfied with the program overall and with the service managers who are responsible for coordinating services. Problems are identified with personal care aid performance and TB testing for health care providers. A shortage of dentists willing to see waiver patients and delays in the eligibility process are also identified. In spite of small problems, the South Carolina's HIV/AIDS community long-term care Medicaid waiver program is considered a success.

Rural primary care program survival: an analysis of financial variables.

This study examines the effect of financial characteristics of rural primary care programs on the probability of their continuing as federally funded entities. A randomly selected national cohort of rural primary care programs (n = 162) was used to compare financial measures of programs that were continuing and those that were noncontinuing. Financial data were obtained from 1978-1987 Bureau Common Reporting Requirements (BCRR) forms submitted to the Bureau of Health Care Delivery and Assistance of the Department of Health and Human Services as part of the requirement to receive federal grant support for the programs. The results emphasize the importance of both outside funding and increased level of self-sufficiency in the continuation of rural primary care programs. Noncontinuing programs often suffer from both a lack of self-sufficiency and a lack of outside funding, mostly from federal sources. To a lesser extent, the number of patients also affects the program's chance of continuation. From a policy perspective, government intervention is both necessary and likely if rural primary care programs are to succeed and fulfill their mission of providing primary care for the medically underserved who are primarily poor, uninsured, and unable to pay.

AIDS-related knowledge and attitudes of social workers in South Carolina.

This study examines the association between knowledge of acquired immune deficiency syndrome (AIDS) and skill among social workers in South Carolina and attitudes toward people with human immunodeficiency virus (HIV) and AIDS. A stratified random sampling method was used to obtain a representative sample of social workers in South Carolina. Findings show that AIDS-related knowledge and skill were significantly associated with improving the general attitudes of social workers toward HIV/AIDS clients. In addition to knowledge and skill-related measures, other significant covariates of attitudes include levels of contact with HIV/AIDS clients and sensitivity to minorities. As with previous studies, demographic variables such as age and gender were not found to be significantly related to variations in attitudes toward HIV/AIDS clients. Furthermore, locality of practice and supervisory position did not significantly correlate with attitudes. The implications of these findings for social services agencies are discussed.

A measure of perceived burden among caregivers.

This report describes an easily administered scale for measuring perceived burden among caregivers of family members with dementia. During home interviews conducted in 1991, 82 caregivers rated their family member with dementia on several items related to functional ability, the type of care provided, and associated stress. The resulting measure of perceived burden, based on 15 internally consistent items (alpha = 0.87), is significantly correlated with depressive symptomatology (r = 0.38, p = 0.0004). This measure is useful in assessing perceived stress associated with specific caregiving responsibilities. It can be used, along with other measures of patient functional status, to assess overall caregiver burden and to target intervention strategies.

Reliability of Katz's Activities of Daily Living Scale when used in telephone interviews.

The reliability of a five-item Katz's Activities of Daily Living (ADL) scale collected by self-report telephone interview is presented. A random sample of 6,472 South Carolina residents over 55 years of age selected from a statewide population is used. Factor structure, Guttman properties, internal consistency reliability, Mokken's index of test homogeneity, and Spearman's coefficient of rank-order correlation are used to show that ADL data gathered by telephone interview are reliable. Because telephone interviewing methods are faster, cheaper, and safer they are recommended as a viable way for researchers, policymakers, and practitioners to gather ADL information.

Incentives for physicians to treat HIV-seropositive patients: results of a statewide survey.

We asked primary care physicians in South Carolina about their knowledge, attitudes, and beliefs regarding patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) and the services they provide for these patients. In support of an effort to develop more effective state policies regarding HIV/AIDS, the survey focused on conditions under which physicians would provide additional services for such patients; 597 of 900 physicians (66%) responded. Among responding physicians, 40% had not seen a patient with HIV infection/AIDS during the past year and 50% had seen only one to nine. Respondents identified lack of specialty backup support, insufficient clinical knowledge, and lack of available community services as the major barriers to providing care for these patients. Gaps in their knowledge included state and federal policies, available community resources, and clinical issues. Respondents said they would provide additional services if they had specialty backup (54%), better community and social support services (50%), additional training (46%), and limited liability (44%). We concluded that policy changes in these areas could expand access to care for HIV/AIDS patients in South Carolina.

Findings from a demonstration outreach project at a community health center.

Outreach using personal contact was a cornerstone of the federally funded Community Health Center (CHC) movement of the 1960s. Funding cuts and changes in federal policy have led to the discontinuation of this activity in most CHCs. This paper assesses aspects of a demonstration outreach project designed to encourage use of a CHC in Orangeburg, South Carolina. The evaluation shows that this type of outreach effort, which includes door-to-door canvassing, can identify specific needs for primary health care services in a poor underserved community, and can enhance community access to Medicaid, although the financial impact of bringing poor patients into CHCs by means of this type of outreach is relatively low.

The association of positive and negative events with depressive symptomatology among caregivers.

A pilot study of eighty-two caregivers was conducted in South Carolina in 1991 to identify positive and negative factors associated with caregiving. Through home visits, interviewers obtained data on a variety of physical and mental health measures, including two new scales designed to measure perceived "positive" and "negative" events that had occurred in the previous month. The Center for Epidemiologic Studies Depression scale was used as a measure of depressive symptomatology. For the new scales, only items that were significantly correlated with depressive symptomatology (p < 0.01) were retained. The new "positive" event scale (8 items) and the new "negative" event scale (16 items) had alpha coefficients of 0.79 and 0.86, respectively. These scales may be useful to researchers in sorting out mediating factors related to the burden of caregiving and in providing points for intervention.

The determinants of utilization of nonphysician providers in rural community and migrant health centers.

The use of nonphysician providers, such as nurse practitioners, physician assistants, and certified nurse midwives, in rural areas is critically important due to the continued primary care access problems. This study examines the major factors influencing the use of nonphysician providers in rural community and migrant health centers based on a 1991 national survey of the centers. This study demonstrates that the employment of nonphysician providers in rural community and migrant health centers is significantly influenced by both supply and demand factors. Among supply factors, there is a significant and positive relationship between the number of total staff and the number of nonphysician providers employed. There is a significant but inverse relationship between the number of physicians and the number of nonphysician providers employed, indicating nonphysician providers primarily serve as substitutes for physicians in rural community and migrant health centers. The supply of nonphysician providers, as measured by the number of affiliated training programs, is significantly related to the employment of nonphysician providers. The demand variable, geographic location, and the centers' staffing policies are also significant determinants of the use of nonphysician providers.

The role of the Medical Care Advisory Committee in the administration of state Medicaid programs. A twenty-year perspective.

Every state Medicaid program has a Medical Care Advisory Committee (MCAC). MCACs are required by federal regulations to have representation from state human service agencies, health care providers, and Medicaid consumers. Survey data presented in this study show the make-up of MCACs by representative group. Other data presented show meeting frequencies, subcommittee structure, and information about MCAC activities. Comparisons are made from historical MCAC data showing long-term trends of their composition and structure. It is argued that MCACs can be useful to state Medicaid agencies in policy development but have not been structured to do so. Recommendations are given to make MCACs more useful.