Bringing baby home: a comprehensive case management program for obstetrical services

Originally presented to the Society of Home Health Care Management of the American College of Physician Executives at its November 16, 1993, meeting in Tucson, Ariz., the program described in this article was the winner of the College's 1994 Innovations Award in Medical Quality Management, sponsored by Merck Sharp & Dohme. The program shows the potential of case management for both improvement in the quality of care and containment of costs for a managed care population with a substantial Medicaid segment. This article is part of a continuing series on innovative programs in home health care.     

Society,family, and gender in Santa Fe,New Granada,until the end of the colony

The author examines family structure in Santa Fe, the capital of New Granada, a Spanish colony that included Colombia, Ecuador, Panama, and Venezuela. The focus is on the late eighteenth and early nineteenth centuries. He finds that social class structure was closely related to ethnic group and skin color, and that the sex ratio was biased toward women. Women also headed nearly 50% of all households. Data are mainly from the 1801 smallpox census.     

Origins and destinies: Immigration to the United States since World War II

Contemporary immigration to the United States and the formation of new ethnic groups are the complex and unintended social consequences of the expansion of the nation to its post-World War II position of global hegemony. Immigrant communities in the United States today are related to a history of American military, political, economic, and cultural involvement and intervention in the sending countries, especially in Asia and the Caribbean Basin, and to the linkages that are formed in the process that open a variety of legal and illegal migration pathways. The 19.8 million foreign-born persons counted in the 1990 U.S. census formed the largest immigrant population in the world, though in relative terms, only 7.9% of the U.S. population was foreign-born, a lower proportion than earlier in this century. Today's immigrants are extraordinarily diverse, a reflection of polar-opposite types of migrations embedded in very different historical and structural contexts. Also, unlike the expanding economy that absorbed earlier flows from Europe, since the 1970s new immigrants have entered an hourglass economy with reduced opportunities for social mobility, particularly among the less educated, and new waves of refugees have entered a welfare state with expanded opportunities for public assistance. This paper seeks to make sense of the new diversity. A typology of contemporary immigrants is presented, and their patterns of settlement, their distinctive social and economic characteristics compared to major native-born racial-ethnic groups, and their different modes of incorporation in—and consequences for—American society are considered.     

Non-profit institutions in a flow of funds framework

The benefits of providing a separate accounting for non-profit organisations in the financial accounts of the United States are discussed. At present, national economic accounts in the US include non-profit organisations with individuals in the household sector; separate information on the financial activity of non-profit institutions until now has not been available. In this paper, aggregate statistics from federal government tax-exempt filings for non-profit institutions are put into a US flow-of-funds framework. The data for the 1982–1988 period indicate that non-profit institutions accounted for a significant and growing proportion of assets of the household sector in the United States. Their liabilities were also a surprisingly large share of the household sector total. Moreover, funds supplied by the non-profit sector for investment were in some years comparable to funds made available by several important groups of non-depository financial intermediaries. Separate accounting for non-profit organisations within national economic accounts would be likely to reveal an important channel for investment financing in the United States and would significantly improve our ability to measure and analyse the financial activity of individuals by allowing for a purer household sector.The analysis and conclusions set forth are those of the authors and do not necessarily indicate concurrence by Salomon Brothers, the Board of Governors, Federal Reserve Banks or other members of their staffs.     

Parametric link modification of both tails in binary regression

Common binary regression models such as logistic or probit regression have been extended to include parametric link transformation families. These binary regression models with parametric link are designed to avoid possible link misspecification and improve fit in some data sets. One and two parameter link families have been proposed in the literature (for a review see Stukel (1988)). However in real data examples published so far only one parameter link families have found to improve the fit significantly. This paper introduces a two parameter link family involving the modification of both tails of the link. An analysis based on computationally tractable Bayesian inference involving Monte Carlo sampling algorithms is presented extending earlier work of Czado (1992, 1993b). Finally, the usefulness of the two tailed link modification will be demonstrated in an example where single tail modification can be significantly improved upon by using a two tailed modification.     

Application of Stein-type estimation in combining regression estimates from replicated experiments

This paper considers the application of Stein-type estimation procedure for the coefficients in a linear regression model when data are available from replicated experiment. Two families of estimators characterized by a single scalar are proposed and their large sample asymptotic properties are derived. These are utilized for comparing the performances of the two estimators along with the conventional estimator and conditions for the superiority of one estimator over the other are deduced.     

Is the American health care delivery system ready for change?

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In this final report, the implications of the German and Dutch systems for reform of the U.S. health care system are discussed.     

Ropes course training for youth in a rural setting: “At first I thought it was going to be boring ...”

Outdoor structured activities, such as Ropes Challenge Courses, are typically utilized as interventions for youth coming from urban settings. Evaluation of such programs is scanty at best. In this instance, the course experience is used as a prevention tool for high risk youth in a remote, rural setting of high unemployment, alcohol problems, and low income. The authors discuss the effectiveness of this approach, and the intended and unintended consequences for the rural community at large. The evaluation design relies on extensive qualitative methodology as well as quantitative methods to capture the unique nature of this rural project.     

DO SURVEYS OVERSTATE PUBLIC CONCERNS?

Because the item, "How concerned are you about...?" asks respondentsto indicate their level of concern about an issue, some respondentsmay sense it assumes they are concerned or should be concernedabout the issue. Using a filter question to first determineif people are concerned about the issue before asking for theirdegree of concern may help solve this problem. To test thishypothesis, a split-ballot experiment was embedded in a nationalrandom digit dialing telephone survey on food-related issues.For the four items included in the experiment, the group receivingthe filter versions of the questions gave roughly double thepercentages of "not concerned" responses as the group receivingstandard items, and the filter group also gave fewer responsesat the upper end of the response scale.     

DO RESPONDENTS REALLY "MARK ALL THAT APPLY" ON SELF-ADMINISTERED QUESTIONS?

An experiment was conducted to assess the effect of using "markall that apply" question instructions on survey reporting aspart of the field test for the Second Follow-up of the NationalEducation Longitudinal Study of 1988 Eighth Graders (NELS:88).Mark-all-that-apply instructions were compared with instructionsasking respondents to indicate "yes" or "no" to each responseoption on responses to three items dispersed throughout thequestionnaire and consisting of different topics and numbersof response options. For the three items, significantly fewerresponse options were selected with the mark-all-that-applyinstructions than with the yes/no instructions, but becauseexternal validity criteria were not available, overreportingto the yes/no instructions cannot be ruled out. Instructiondependentprimacy effects, predicted under the hypothesis that respondentswould engage in more superficial processing when given the mark-all-that-applyinstructions, were not found.