Computer-Assisted Screening and Intervention for Alcohol Problems in Primary Care

ABSTRACT

The effectiveness of a bilingual (English/Spanish) computer-assisted alcohol screening/intervention for hazardous and harmful alcohol use, the Health Habits Survey (HHS) was tested in primary care settings. Assessment-only patients were compared with patients exposed to the HHS. Of the 2053 recruited, 151 (7.4%) screened positive on the Alcohol Use Disorders Identification Test (AUDIT) and were re-contacted six months later for follow-up. Significant alcohol reduction was observed in both conditions. No between-group differences were observed. Computer-assisted screening and intervention are feasible in primary care settings and may be a realistic provider-extender when traditional screening is absent or inconsistently implemented.     

Examining Outpatient Health Care Utilization Among Adults with Severe or Profound Intellectual Disabilities Living in an Urban Setting

Abstract

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors andhealth statuses were similar regardless of living situation, except for ageand the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.     

Introduction

No abstract available for this article.     

Efficacy of Statistical Outlier Analysis for Monitoring Quality of Care

Researchers have proposed that hospitals with excessive statistically unexplained mortality rates are more likely to have quality-of-care problems. The U.S. Health Care Financing Administration currently uses this statistical “outlier” approach to screen for poor quality in hospitals. Little is known, however, about the validity of this technique, since direct measures of quality are difficult to obtain. We use Monte Carlo methods to evaluate the performance of the outlier technique as parameters of the true mortality process are varied. Results indicate that the screening ability of the technique may be very sensitive to how widespread quality-related mortality is among hospitals but insensitive to other factors generally thought to be important.     

Influence of Late Life Stressors on the Decisions of Older Women to Relocate into Congregate Senior Housing

Late-life stressors often require individuals to make substantial alterations in behavior and lifestyle and can affect their overall health and well-being. Relocation is a significant life stress, regardless of age. The primary aim of this study is to elucidate the push-pull factors associated with moving into congregate senior housing. The secondary aim is to investigate the decision-making processes and stresses associated with moving into a congregate living environment. Interviews were conducted with 26 women who were new residents in congregate senior housing. Relocation, as expected, was considered to be stressful, although individual differences were found among perceptions of relocation stresses. Women who had made the decision to relocate on their own showed evidence of better psychosocial well-being at the time of the move. One-quarter of the sample chose to move to provide care to another person. As the options for senior housing continue to evolve and the number of adults reaching advanced age continues to increase, it is important to understand the factors that contribute to successful adaptation. This knowledge will enable facility administrators to implement programs and procedures to assist incoming residents with acclimating to their new homes.     

A Comparison of Spanish and American Housing Policy Frameworks Addressing Housing for the Elderly

Abstract

Housing policies in Spain and die United States have important similarities and dissimilarities mat affect housing for the elderly. Spain, even more so than me United States, promotes homeownership. Bom countries face significant challenges in addressing the housing needs of the elderly, particularly those challenges associated wim aging in place. The paper reviews me broader housing policy frameworks in bom countries in order to understand me context for elderly housing policy. The paper identifies lessons from the American experience mat can expand housing policies in Spain.     

Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study

We compared data drawn from a random sample of 399 current assisted living residents and a subsample of 222 newly admitted residents for two groups: childless residents and residents with children. The percentage of childless residents (26%) in our study was slightly higher than U.S. population estimates of childless individuals aged 65 years and older (20%). In the overall sample, the two groups differed significantly by age, race, and women's years of education. The childless group was slightly younger, had a higher percentage of African American residents, and had more years of education than the group with children. In the subsample, we looked at demographic, functional, financial, and social characteristics and found that childless residents reported fewer diagnoses of dementia and fewer visits from a relative but more reported paying less money per month for assisted living and having private insurance than residents with children. As childlessness among older adults continues to increase, it will become increasingly important to understand how child status affects the need for and experience of long-term care.     

A comparison of social work education across South Africa and Japan in relation to the Global Standards for Social Work Education and Training

Sakaguchi H, Sewpaul V. A comparison of social work education across South Africa and Japan in relation to the Global Standards for Social Work Education and Training Int J Soc Welfare 2011: 20: 192–202 © 2009 The Author(s), International Journal of Social Welfare © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. This article draws on a one‐year study visit to the University of KwaZulu‐Natal, South Africa, interviews with field supervisors and students in Japan and reviews of the national frameworks of education in Japan and in South Africa. In doing so, the authors identify the similarities and differences in social work education across the two countries and they explore some of the historical and socio‐cultural factors that might account for the differences. There are some identifiable peculiarities in social work education in Japan, especially with the coalescing of care work and social work education. The lack of differentiation between care work and social work makes it difficult to narrow the scope of social work education and practice. National social work standards have been approved in South Africa and regulatory frameworks for social work education and practice have been long accepted, thus rendering ‘social work’ a protected title and a profession that is more entrenched compared with social work in Japan. The codes of ethics in Japan and South Africa are discussed with specific reference to their control functions in South Africa. The article concludes by discussing these comparisons in relation to the Global Standards for Social Work Education.     

A Dynamic Model of Demand for Houses and Neighborhoods

This paper develops a dynamic model of neighborhood choice along with a computationally light multi‐step estimator. The proposed empirical framework captures observed and unobserved preference heterogeneity across households and locations in a flexible way. We estimate the model using a newly assembled data set that matches demographic information from mortgage applications to the universe of housing transactions in the San Francisco Bay Area from 1994 to 2004. The results provide the first estimates of the marginal willingness to pay for several non‐marketed amenities—neighborhood air pollution, violent crime, and racial composition—in a dynamic framework. Comparing these estimates with those from a static version of the model highlights several important biases that arise when dynamic considerations are ignored.     

Competition and The Operational Performance of Hospitals: The Role of Hospital Objectives

We examine the effect of a hospital's objective (i.e., non‐profit vs. for‐profit) in hospital markets for elective care. Using game‐theoretic analysis and queueing models to capture the operational performance of hospitals, we compare the equilibrium behavior of three market settings in terms of such criteria as waiting times and patient costs from waiting and hospital payments. In the first setting, a monopoly, patients are served exclusively by a single non‐profit hospital; in the second, a homogeneous duopoly, patients are served by two competing non‐profit hospitals. In our third setting, a heterogeneous duopoly, the market is served by one non‐profit hospital and one for‐profit hospital. A non‐profit hospital provides free care to patients, although they may have to wait; for‐profit hospitals charge a fee to provide care with minimal waiting. A comparison between the monopolistic and each of the duopolistic settings reveals that the introduction of competition can hamper a hospital's ability to attain economies of scale and can also increase waiting times. Moreover, the presence of a for‐profit sector may be desirable only when the hospital market is sufficiently competitive. A comparison across the duopolistic settings indicates that the choice between homogeneous and heterogeneous competition depends on the patients' willingness to wait before receiving care and the reimbursement level of the non‐profit sector. When the public funder is not financially constrained, the presence of a for‐profit sector may allow the funder to lower both the financial costs of providing coverage and the total costs to patients. Finally, our analysis suggests that the public funder should exercise caution when using policy tools that support the for‐profit sector—for example, patient subsidies—because such tools may increase patient costs in the long run; it might be preferable to raise the non‐profit sector's level of reimbursement.