Evaluating Area-Based Socioeconomic Status Indicators for Monitoring Disparities within Health Care Systems: Results from a Primary Care Network

ObjectiveTo determine which area-based socioeconomic status (SES) indicator is best suited to monitor health care disparities from a delivery system perspective.ConclusionsArea-based SES indicators detected health outcome differences well and may be useful for monitoring disparities within health care systems. Our preferred indicator was ZIP-level median household income or percent poverty, using cut points.     

Health Care Reform in Massachusetts: Implementation of Coverage Expansions and a Health Insurance Mandate

Context: Much can be learned from Massachusetts's experience implementing health insurance coverage expansions and an individual health insurance mandate. While achieving political consensus on reform is difficult, implementation can be equally or even more challenging.
Methods: The data in this article are based on a case study of Massachusetts, including interviews with key stakeholders, state government, and Commonwealth Health Insurance Connector Authority officials during the first three years of the program and a detailed analysis of primary and secondary documents.
Findings: Coverage expansion and an individual mandate led Massachusetts to define affordability standards, establish a minimum level of insurance coverage, adopt insurance market reforms, and institute incentives and penalties to encourage coverage. Implementation entailed trade-offs between the comprehensiveness of benefits and premium costs, the subsidy levels and affordability, and among the level of mandate penalties, public support, and coverage gains.
Conclusions: National lessons from the Massachusetts experience come not only from the specific decisions made but also from the process of decision making, the need to keep stakeholders engaged, the relationship of decisions to existing programs and regulations, and the interactions among program components.     

Differentiating Subgroups of Children with Special Health Care Needs by Health Status and Complexity of Health Care Needs

Objectives Our objective is to use the Children with Special Health Care Needs (CSHCN) Screener to identify subgroups of CSHCN differentiated by health status and complexity of need. Methods Data are from the National Survey of Children with Special Health Care Needs, 2001 and the National Survey of Children’s Health, 2003 (conducted by the Maternal and Child Health Bureau and the National Center for Health Statistics); and the 2001 and 2002 Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research and Quality. A broad array of variables measuring health status, complexity of need, and related issues are examined by subgroupings of CSHCN. Results Relative to other CSHCN, CSHCN with functional limitations or who qualify on more CSHCN Screener items have poorer health status and more complex health care needs. They more often experience a variety of health issues; their insurance is more often inadequate; the impact of their conditions on their families is higher; and their medical costs are higher. Conclusion In the absence of information on specific conditions, health status, or complexity of need, the CSHCN Screener alone can be used to create useful analytic subgroups that differ on these dimensions. The proposed subgroups, based on the type or number of CSHCN screening criteria, differentiate CSHCN by health status and complexity of health care needs, and also show differences in the impact of their conditions on their families, costs of their medical care, and prevalence of various health problems. Certification of ethical research: This material presents a secondary data analysis of a deidentified data set. Human subjects review was therefore not required for this study.     

新医改背景下杭州市社区卫生服务满意度及需求的调查分析

目的 了解新医改背景下杭州市居民对社区卫生服务的满意度水平及服务需求.方法 分层随机抽取了杭州市下城区、拱墅区、余杭区三个地区,并分别于三个区中随机抽取1个社区卫生服务中心进行拦截式满意度问卷调查,每个社区分别调查70例当天的就诊居民,共210例.结果 了解和熟悉新医改的居民为0.5％,社区卫生服务总体满意度为33.3％,最需要的社区卫生服务是常见病诊治和配药服务.结论 杭州市社区卫生服务的总体满意度和社区医师的主动服务意识有待提高,“强基层”重在“强人才”,落实基本药物制度和新医改需要舆论助推.     

Organizational Leadership For Building Effective Health Care Teams

The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.     

卫生体制改革与医院生存发展

本文论述了卫生体制改革与医院生存发展的问题，面对医疗市场从卖方向买方的转变，医院只有及时进行战略性调整，从以往的外延型、规模型转变为内涵型、质量效益型、改革人事和分配制度，才能在改革的浪潮有生存和发展。     

从医药消费量的时序变化看医疗改革效果

文章使用经价格指数调整后的医疗保健支出作为医药消费量的代理变量,以城镇居民医药消费量的时序变化为评价指标,建立计量模型,采用最小二乘法,对1997—2005年30个省的相关数据进行回归分析,得出医药消费量的时序变化。发现在保证其他因素不变后,居民人均医药消费量在大部分年度不但没有增加反而下降的事实,证明医疗体制改革没有达到预期效果。最后本文建议医疗体制改革设计要从根本入手,要考虑到具体措施的可操作性。     

Functional Status Outcome Measures in Home Health Care Patients with Heart Failure

Elderly, chronically ill patients' ability to stay at home is dependent on their capacity to perform activities of daily living (ADLs). The Outcome and Assessment Information Set (OASIS) defines ADLs and can be evaluated in various ways. The purpose of this research was to evaluate these approaches and make recommendations for use in research. Several different approaches to the evaluation of functional status were done using ADLs (ambulation, bathing, dressing lower body, dressing upper body, feeding, grooming, toileting, and transferring) scored individually and as indices. Each approach has advantages and disadvantages depending on the research question being asked. The ADL change index score provided the most comprehensive analysis of functional status change although the categorical scores are useful for simple approaches.     

中国部分贫困地区孕产妇保健服务提供质量状况分析

利用卫Ⅵ项目终末现场调查资料，重点围绕乡村级孕产妇保健服务提供的内容，数量，拥有相关的知识技能情况进行了分析。分析显示：产前检查，住院分娩，产后访视服务提供的数量及内容基本达到了项目要求，乡村妇保人员的基本知识与技能掌握良好，服务态度令被访妇女满意，但分析也反映出，乡村妇保人员对于产后血的紧急处理和护送转诊处理，妊高征（尤其是先兆子痫）的处理等相关知识还存在不足，分析结果提示，今后应加强贫困地区乡村级孕产妇保健服务质量的提高。     

Health status and health care use of Massachusetts women reporting partner abuse

BACKGROUND: Studies indicate that women abused by their intimate partners are at increased risk for a number of health problems and have increased rates of health care utilization. However, these findings are based mainly on studies using clinic or health plan populations. In this study, we examined the association between intimate partner abuse (IPA) and health concerns and health care utilization in a population-based sample of adult women. METHODS: We analyzed data on 2043 women aged 18 to 59 who participated in the 1998 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), a population-based health survey that included questions on IPA. IPA was defined as experiencing physical violence by, fear of, or control by an intimate partner. Consequences of IPA and self-rated health status and health care utilization of women experiencing IPA were examined. RESULTS: A total of 6.3% of Massachusetts women aged 18 to 59 reported IPA during the past year. Women experiencing IPA were more likely than other women to report depression, anxiety, sleep problems, suicidal ideation, disabilities, smoking, unwanted pregnancy, HIV testing, and condom use. Women experiencing IPA were less likely to have health insurance, but received routine health care at similar rates as other women. CONCLUSIONS: These results indicate that women in the general population experiencing IPA are at increased risk for several serious emotional and physical health concerns. Most of these women are in routine contact with health care providers. These findings also suggest that the BRFSS may provide a valuable mechanism for tracking state-based IPA prevalence rates over time.     

208名高知人员体检状况的分析与保健对策

目的了解我单位208名高知人员的健康状况,分析影响高知人员健康的不利因素,提出相应的保健对策。方法选取2008年度浙江省医学科学院副高级职称及以上高知人员健康体检档案进行分析。结果在参检的208人中,体检结果异常率达99．5％,患病率随着年龄的增高而增高,总检出率占前6位的疾病分别是甲状腺结节110人（52％）、前列腺增生50人（49％）、高脂血症88人（42．％）、高血压75人（36％）、子宫肌瘤29人（27％）和脂肪肝47A-（23％）。结论高知人员健康状况不容乐观,定期检查是预防保健的一方面．更重要的是要开展健康促进行动。     

Health Care Reform: Analysis of Narrative Responses from Directors of Pastoral Care Departments

SUMMARY

This paper is a narrative analysis of comments written by hospital pastoral care department directors in response to the questionnaire item that asked them to write about their experience with health care reform and to make suggestions as to what the profession could do about it. Three central themes included: (1) the importance of and need for administrative support of the department, (2) the importance of departmental visibility within the institution, and (3) the challenges of embracing change. Two secondary themes were the admonishing of peer department directors concerning inadequate performance and the ministry to hospital staff during reform efforts.     

Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2009 Patient Survey

Objective

To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts.

Data Sources/Study Setting

Nationally representative data from the 2009 Health Center Patient Survey.

Study Design

Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients'' health care experiences.

Data Collection

Computer-assisted personal interviews were conducted with health center patients.

Principal Findings

Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92).

Conclusions

There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use.     

理性评估中国医改三年成效

新一轮医改三年来进展顺利,在促进基本公共卫生服务逐步均等化、加快推进基本医疗保障制度建设、初步建立国家基本药物制度、健全基层医疗卫生服务体系、推进公立医院改革试点等方面取得明显成效,基层基本医疗卫生制度模式初现雏形。理性评价医改三年的成效,客观分析其中存在的问题,直接影响到进一步推进和完善医改。本文根据评估标准,对三年医改成效、进展和制度建设进行评估,并就下一步医改面临的挑战提出政策建议。     

甘肃省在深化医改中发挥中医药作用政策评估与建议

近几年,甘肃省致力于中医药政策体系的建立与推行,以此发挥中医药在医改中的优势作用。2014年1月,甘肃省确定6个样本县（区）对甘肃省在医改中发挥中医药作用政策进行评估。评估发现,甘肃省通过中医药政策体系的建立与推行,有效促进了中医药事业发展,充分发挥了中医药在医改中的优势作用。同时,评估发现甘肃省中医药政策建立与执行过程中的问题,并对问题解决提出建议。     

Private Care and Public Health: Do Vaccination and Prenatal Care Rates Differ between Users of Private versus Public Sector Care in India?

Objective. To determine whether patients who use private sector providers for curative services have lower vaccination rates and are less likely to receive prenatal care.
Data Sources/Study Setting. This study uses data from the 52d round of the National Sample Survey, a nationally representative socioeconomic and health survey of 120,942 rural and urban Indian households conducted in 1995–1996.
Study Design. Using logistic regression, we estimate the relationship between receipt of preventive care at any time (vaccinations for children, prenatal care for pregnant women) and use of public or private care for outpatient curative services, controlling for demographics, household socioeconomic status, and state of residence.
Data Collection/Extraction Methods. We analyzed samples of children ages 0 to 4 and pregnant women who used medical care within a 15-day window prior to the survey.
Principal Findings. With the exception of measles vaccination, predicted probabilities of the receipt of vaccinations and prenatal care do not differ based on the type of provider at which children and women sought curative care. Children and pregnant women in households who use private care are almost twice as likely to receive preventive care from private sources, but the majority still obtains preventive care from public providers.
Conclusions. We do not find support for the hypothesis that children and pregnant women who use private care are less likely to receive public health services. Results are consistent with the notion that Indian households are able to successfully navigate the coexisting public and private systems, and obtain services selectively from each. However, because the study employed an observational, cross-sectional study design, findings should be interpreted cautiously.