Physician organizations. Part 1: A report from the trenches of a start-up PO

How has Community Health Partners, a physician organization based in Kansas City, turned the corner as it rolls into the second year of operation? The biggest indicator is that CHP hammered out the city's first professional risk contracts and the PO has grown from 23 to more than 50 physician member/owners. Looking back, there are at least 10 reasons why CHP made it this far. These are not reasons you learn about in medical school or an MBA program. There is no one-size-fits-all template for building POs. No fixed organizational chart. No neon signs pointing to the best capital partner. Part I explores five reasons for success, such as having a strong board and physician leadership, as well as educating participating physicians about capitation and affiliating with any hospital or payer that really knows how to partner with physicians. Part 2 will focus on five more lessons learned from the trenches of a start up PO.     

Measuring living standards with proxy variables

Very few demographic surveys in developing countries have gathered information on household incomes or consumption expenditures. Researchers interested in living standards therefore have had little alternative but to rely on simple proxy indicators. The properties of these proxies have not been analyzed systematically. We ask what hypotheses can be tested using proxies, and compare these indicators with consumption expenditures per adult, our preferred measure of living standards. We find that the proxies employed in much demographic research are very weak predictors of consumption per adult. Nevertheless, hypothesis tests based on proxies are likely to be powerful enough to warrant consideration.     

The school-to-work transition of people with mental handicap in Hong Kong

The purpose of this study was to examine the school-to-work experience of people with mental handicap in Hong Kong. Fourteen young adults with mild mental handicap participated in in-depth interviews. An interview guide was utilized which included topics related to the participants' vocational preferences, work motivation and post-school placements. Data were analyzed according to a constant comparative method and content analysis. Three-quarters of the participants expressed job preferences. Three-quarters of the participants had taken a vocational training program unrelated to their job preferences. Half of the participants who had taken up open employment had not obtained their preferred jobs. None of the participants who had completed vocational training obtained job placements that matched their vocational training programs. All of the participants except five were not involved in making independent decisions regarding employment. The need to improve the quality of vocational services and empower people with mental handicap to take up self-determining roles are discussed.     

Validity of work-related assessments

Insufficient evidence of the validity of work-related assessments is frequently reported as a major concern in occupational rehabilitation. Despite this concern, and the continuing development of new and old assessments, no comprehensive evaluation of the evidence has been conducted. OBJECTIVES: The purpose of this study was to first determine the extent and quality of available evidence for the validity of work-related assessments, and then where sufficient evidence was available, determine the level of validity. STUDY DESIGN: This study examined available literature and sources in order to review the extent to which validity has been established for 28 work-related assessments. RESULTS: The levels of evidence and validity are presented for each assessment. Most work-related assessments have limited evidence of validity. Of those that had adequate evidence, validity ranged from poor to good. There was no instrument that demonstrated moderate to good validity in all areas. Very few work-related assessments were able to demonstrate adequate validity in more than one area, or with more than one study, even when contributory evidence was included. CONCLUSION: With this study clinicians will be able to examine their options with regard to the validity of the assessments they choose to use.     

Marriages and fertility among Turkish and Moroccan women in Belgium: results from census data

The patterns of family formation and fertility behavior of Turkish and Moroccan women in Belgium are changing rapidly. The census data (1991) indicate a fertility decline. The reasons are changes in the nuptiality patterns, contraceptive behavior, and migratory flows. The changes are not identical in both communities. Young cohorts postpone their marriage, but this is most prominent among Moroccan women. On the other hand, young Turkish women have a clear preference for smaller families. The changes also differentiate according to migrant "generation" and level of education. The changes are not restricted to Belgium but are also observed in the countries of origin.     

普救说与世界问题的政治化

一、真理的实在真理的传统形式:真理作为概念、结构或关系只能是肯定的东西。真理与实在的区别在于:真理不仅是存在着的,还是正确无误的,真理不可能来自谬误或错误的政策。所以,真理具有肯定的特性。这一肯定的特性能够被作为绝对知识而予以强调。为了新思维起见,我们必须超越真理与实在之间的这一鸿沟。实在不仅是肯定性的真理,它也可能是谬误。因而,实在也可能是否定性质的真理。结论:可以把实在描述成以下的东西:a.作为肯定性质的真理,实在是我们必须保存的那部分实在。b.作为否定性质的真理,实在是我们必须     

介绍几本社会老年学教科书

八年前,在我刚开始讲授社会老年学时,只有一种得到公认的入门教科书(阿奇利著)。而今天,这方面的优秀教科书已经多达十几种,并拥有大批读者。每年都要出版几本新的或经过修订的社会老年学教科书。大批教科书的问世证明,在过去10年间,老年学取得了引人注目的发展。15年前,开设老年学课的大学寥寥无几,而现在,几乎所有体面的学院     

In sickness but not in health: self-ratings, identity, and mortality

Self-rated health as a predictor of mortality has been studied primarily in large, representative populations, with relatively little progress toward understanding the information processing that individuals use to arrive at these ratings. With subsamples of National Health and Nutrition Examination Survey (NHANES) Epidemiologic Follow-up Study (NHEFS) data for respondents with circulatory system disease (N = 3,709) and respondents with no diagnosable disorders (N = 1,127) at baseline, we test the idea that individuals with experience of chronic disease of the circulatory system will have more predictive self-ratings of health than healthy individuals. Poor or fair self-rated health increased the adjusted hazard of all-cause mortality for respondents with circulatory system disease, but not for respondents who were healthy. Additional analyses confirm that poor or fair self-rated health is particularly predictive for respondents with self-reported history of circulatory system diagnoses and perception of symptoms, but not for respondents without symptoms or diagnoses prior to the NHANES physical exam.     

Cost-effectiveness analysis of the New South Wales adult drug court program

In New South Wales, Australia, a cost-effectiveness evaluation was conducted of an adult drug court (ADC) program as an alternative to jail for criminal offenders addicted to illicit drugs. This article describes the program, the cost-effectiveness analysis, and the results. The results of this study reveal that, for the 23-month period of the evaluation, the ADC was as cost-effective as were conventional sanctions in delaying the time to the first offense and more cost-effective in reducing the frequency of offending for those outcome measures selected. Although the evaluation was conducted using the traditional steps of a cost-effectiveness analysis, because of the complexity of the program and data limitations it was not always possible to adhere to textbook procedures. As such, each step involved in undertaking the cost-effectiveness analysis is discussed, highlighting the key issues faced in the evaluation.