Second-order analysis of inhomogeneous spatial point processes using case-control data.

Methods for the statistical analysis of stationary spatial point process data are now well established, methods for nonstationary processes less so. One of many sources of nonstationary point process data is a case-control study in environmental epidemiology. In that context, the data consist of a realization of each of two spatial point processes representing the locations, within a specified geographical region, of individual cases of a disease and of controls drawn at random from the population at risk. In this article, we extend work by Baddeley, Møller, and Waagepetersen (2000, Statistica Neerlandica54, 329-350) concerning estimation of the second-order properties of a nonstationary spatial point process. First, we show how case-control data can be used to overcome the problems encountered when using the same data to estimate both a spatially varying intensity and second-order properties. Second, we propose a semiparametric method for adjusting the estimate of intensity so as to take account of explanatory variables attached to the cases and controls. Our primary focus is estimation, but we also propose a new test for spatial clustering that we show to be competitive with existing tests. We describe an application to an ecological study in which juvenile and surviving adult trees assume the roles of controls and cases.

Opportunities and challenges in Medicaid managed care: the experience in Maryland.

OBJECTIVE: The effects of the Maryland Medicaid mandatory managed care programs on Medicaid beneficiaries are examined with the main objective of gaining insight into the initial experience and beneficiary satisfaction with Maryland's Medicaid program. The background of the Maryland Medicaid system, initial implementation, results of beneficiary satisfaction surveys, and future concerns are discussed. STUDY DESIGN: An observational study based on survey data. DATA AND METHODS: Beneficiary surveys mailed to adult and child participants in HealthChoice and the Rare and Expensive Case Management (REM) Medicaid programs in Maryland are analyzed. Descriptive univariate and bivariate data statistics are used. RESULTS: The 4 questions rating satisfaction with primary care provider (PCP), relevant specialists, all providers, and the overall health plan indicate high levels of satisfaction in both adult and child populations. CONCLUSIONS: The Maryland Medicaid programs appear to have met the goal of providing a comprehensive, coordinated healthcare system of quality care during their first year of operation. The satisfaction of these beneficiaries suggests that with an appropriate risk-adjusted capitation approach, managed care organizations (MCOs) can successfully provide for even the most complex needs of Medicaid members.

Quality, sacrifice, and value in hospital choice: a comparative study of rural and suburban consumer perspectives.

This research examines consumers' value perceptions and their role in hospital choice behavior in rural and suburban markets. While health care markets are "local," this study confirms the broad efficacy of a value-based approach to understanding consumer choice of providers.

The effect of consumer perceptions of quality and sacrifice on hospital choice: a suburban vs. urban competitive scenario.

The primary objective of this research was to determine how a suburban hospital located near an urban center fares when local consumers are selecting a hospital. A significant portion of the 161 suburban respondents to the study's mail survey perceive the quality of care available at alternative urban hospitals to be higher than that available at their local suburban hospital on the vast majority of quality-related attributes. Most respondents, however, select their local hospital for both major and minor medical treatment. Te greater value represented by suburban hospitals, due to their relative closeness to the consumer, represents a significant competitive advantage.

Health promotion in primary health care: the situation in England.

National policy, including changes to the management of the National Health Service, is intended to increase the amount of primary and secondary prevention in primary health care in England. The growth of financial power of general practitioners makes them key decision-makers in planning and delivering health promotion. The vast majority of people in contact with their family doctor could benefit from making appropriate lifestyle modifications. However, the level and quality of health promotion activity in primary care is variable, with many patients not receiving interventions. A review of research indicates that both skepticism about the relationship between behaviour and risk factor, and lack of confidence in efficacy of health promotion in changing patient behaviour act as barriers to general practitioners taking on more health promotion activity. For prevention work to increase, therefore, general practitioners require more evidence of effective replicable interventions, and appropriate training on the design and implementation of programmes. The role of the Health Education Authority, the national agency for health promotion in England, in meeting these needs is described. The paper also includes a brief discussion of evaluation methods for assessing the success of health promotion interventions.

The uninsured consumer and hospital choice: an assessment of emergency department utilization.

The term "choice" has played an important role in the ongoing debate over health care reform in the United States. One of the major assumptions underlying reform efforts is that affordability drives consumers' choice of health care providers, particularly for the uninsured. In the state of Maryland, the issue of affordability is addressed by an "all-payor" system. In such a scenario, where enhanced choice opportunities are available for the uninsured, such consumers seem to be making choices which lead to the use of hospitals other than those which would be predicted based upon convenience or closeness of location alone.

The relative importance of information sources in consumers' choice of hospitals.

The research presented focuses on an examination of the relative importance of word-of-mouth, expert opinion, external communication, and past experience in the context of hospital choice. Past research has examined the effect of each individually and various combinations of the four sources, but not all four simultaneously. Results of the present study suggest that past experience plays a greater role in hospital choice than other information sources, including expert opinion. The strength of word-of-mouth as a source of information is also verified. The implications of this research include the following: (1) health care researchers need to incorporate word-of-mouth when investigating informations sources, and (2) local hospitals need to be aware of "negative perceptions" and strive for consumer satisfaction. Health care delivery systems incorporating consumer-based choice render these findings especially valuable as researchers and practitioners address the challenges that these evolving systems will bring.