Estimates Of Need Research Articles

Estimating the Need for Radiotherapy for Patients With Prostate, Breast, and Lung Cancers: Verification of Model Estimates of Need With Radiotherapy Utilization Data From British Columbia

Estimates of the need for radiotherapy (RT) using different methods (criterion based benchmarking [CBB] and the Canadian [C-EBEST] and Australian [A-EBEST] epidemiologically based estimates) exist for various cancer sites. We compared these model estimates to actual RT rates for lung, breast, and prostate cancers in British Columbia (BC). All cases of lung, breast, and prostate cancers in BC from 1997 to 2004 and all patients receiving RT within 1 year (RT(1Y)) and within 5 years (RT(5Y)) of diagnosis were identified. The RT(1Y) and RT(5Y) proportions in health regions with a cancer center for the most recent year were then calculated. RT rates were compared with CBB and EBEST estimates of RT needs. Variation was assessed by time and region. The RT(1Y) in regions with a cancer center for lung, breast, and prostate cancers were 51%, 58%, and 33% compared with 45%, 57%, and 32% for C-EBEST and 41%, 61%, and 37% for CBB models. The RT(5Y) rates in regions with a cancer center for lung, breast, and prostate cancers were 59%, 61%, and 40% compared with 61%, 66%, and 61% for C-EBEST and 75%, 83%, and 60% for A-EBEST models. The RT(1Y) rates increased for breast and prostate cancers. C-EBEST and CBB model estimates are closer to the actual RT rates than the A-EBEST estimates. Application of these model estimates by health care decision makers should be undertaken with an understanding of the methods used and the assumptions on which they were based.

Equity in access to total joint replacement of the hip and knee in England: cross sectional study

Objective To explore geographical and sociodemographic factors associated with variation in equity in access to total hip and knee replacement surgery.Design Combining small area estimates of need and provision to...

Modeling the need for hip and knee replacement surgery. Part 2. Incorporating census data to provide small‐area predictions for need with uncertainty bounds

To develop methods to produce small-area estimates of need for hip and knee replacement surgery to inform local health service planning. Multilevel Poisson regression modeling was used to estimate rates of need for hip/knee replacement by age, sex, deprivation, rurality, and ethnic mix using a nationally representative population-based survey (the English Longitudinal Study of Ageing, n = 11,392 people age > or =50 years). Estimates of need from the regression model were then combined with stratified census population counts to produce small-area predictions of need. Uncertainty in the predictions was obtained by taking a Bayesian simulation-based approach using WinBUGS software. This allows correlations in parameter estimates to be appropriately incorporated in the credible intervals for the small-area predictions. Small-area estimates of need for hip/knee replacement have been produced for wards and districts in England. Rates of need are adjusted for the sociodemographic characteristics of an area and include 95% credible intervals. Need for hip/knee replacement varies geographically, dependant on the sociodemographic characteristics of an area. For the first time, small-area estimates of need for hip/knee replacement surgery have been produced together with estimates of uncertainty to inform local health planning. The methodologic approach described here could be reproduced in other countries and for other disease indicators. Further research is required to combine small-area estimates of need with provision to determine whether there is equitable access to care.

Modeling the need for hip and knee replacement surgery. Part 1. A two‐stage cross‐cohort approach

To explore inequalities in the need for hip/knee replacement surgery using a 2-stage cross-cohort approach. In the first stage, a small-area population-based survey, the Somerset and Avon Survey of Health, was used to provide a high-quality measure of need for hip/knee replacement using the New Zealand (NZ) score. Receiver operating characteristic curve analyses were used to validate a simplified NZ score, excluding information from clinical examination. In the second stage, a nationally representative population-based survey, the English Longitudinal Study of Ageing, was used to explore inequalities in need for hip/knee replacement using the simplified NZ score. Multilevel Poisson regression modeling was used to estimate rates of need for surgery. Exposures considered were age, sex, social class, ethnicity, obesity, Index of Multiple Deprivation 2004 deprivation quintiles, rurality, and ethnic mix of area. Rates of need for hip/knee replacement increase with age and are lower in men than in women (rate ratio [RR] 0.7, 95% confidence interval [95% CI] 0.6-0.9 for hips; RR 0.8, 95% CI 0.7-1.0 for knees). Those of lowest social class have greater need. Need was greatest for people living in more deprived areas. Individual ethnic group did not predict the need for surgery. For hip replacement, there was no rurality effect; for knee replacement, those in town and fringe areas had greater need. Obesity was a strong predictor of need for surgery (RR 2.3, 95% CI 1.9-2.8 for hips; RR 2.4, 95% CI 2.0-2.8 for knees). This study provides evidence of greater variations of inequalities in need for hip/knee replacement than previous studies. Further research should explore geographic variation and produce small-area estimates of need to inform local health planning. It is important to complement data on need with willingness to undergo surgery.

County-Level Estimates of Need for Mental Health Professionals in the United States

County-Level Estimates of Need for Mental Health Professionals in the United States

County-Level Estimates of Need for Mental Health Professionals in the United States

The goal of this study was to develop the best current estimates of need for mental health professionals in the United States for workforce planning and to highlight major data gaps. Need was estimated indirectly, on the basis of several steps. The 2001 National Comorbidity Survey Replication (NCS-R) (N=9,282) was used to model the probability of having serious mental illness, given demographic predictors. Synthetic estimation was then used to construct national and county-level prevalence estimates for adults in households. Provider time needed by these adults was estimated from NCS-R respondents with serious mental illness who used mental health services (N=356); provider time needed by adults without serious mental illness was estimated from respondents to the 2000 Medical Expenditure Panel Survey (MEPS) (N=16,418). National mental health professional workforce practice patterns were used to convert need estimates to full-time equivalents (FTEs). Adult service users with serious mental illness typically spend 10.5 hours per year with nonprescriber mental health professionals and 4.4 hours per year with prescriber mental health professionals or primary care physicians in mental health visits; adults without serious mental illness spend about 7.8 minutes with nonprescriber mental health professionals and 12.6 minutes with prescriber mental health professionals or primary care physicians in mental health visits per year. With adjustment for mental health services provided by primary care practitioners, the estimated 218,244,402 members of the U.S. adult civilian household population in 2006 required 56,462 FTE prescribing and 68,581 FTE nonprescribing mental health professionals. Available data indicate that need across the United States varies by demography and geography. These estimates are limited by several issues; in particular, they are based on current provider treatment patterns and do not address how much care ideally should be provided and by whom. Improved estimates will require refined standards of care and more extensive epidemiological data.

County-Level Estimates of Mental Health Professional Shortage in the United States

This study examined shortages of mental health professionals at the county level across the United States. A goal was to motivate discussion of the data improvements and practice standards required to develop an adequate mental health professional workforce. Shortage of mental health professionals was conceptualized as the percentage of need for mental health visits that is unmet within a county. County-level need was measured by estimating the prevalence of serious mental illness, then combining separate estimates of provider time needed by individuals with and without serious mental illness derived from National Comorbidity Survey Replication, U.S. Census, and Medical Panel Expenditure Survey data. County-level supply data were compiled from professional associations, state licensure boards, and national certification boards. Shortage was measured for prescribers, nonprescribers, and a combination of both groups in the nation's 3,140 counties. Ordinary least-squares regression identified county characteristics associated with shortage. Nearly one in five counties (18%) in the nation had unmet need for nonprescribers. Nearly every county (96%) had unmet need for prescribers and therefore some level of unmet need overall. Rural counties and those with low per capita income had higher levels of unmet need. These findings identified widespread prescriber shortage and poor distribution of nonprescribers. A caveat is that these estimates of need were extrapolated from current provider treatment patterns rather than from a normative standard of how much care should be provided and by whom. Better data would improve these estimates, but future work needs to move beyond simply describing shortages to resolving them.

International perspective: basis, need, and application of recommended dietary allowances.

The RDAs emerged in World War II to thwart existing nutrient deficiencies. The RDAs are estimates of need based on the data available. There has been remarkably little change in RDA values. The ongoing revision of the RDAs will introduce new terminology and attempt to recommend values that not only ensure the prevention of nutrient deficiency but that would thwart the more prevalent chronic degenerative diseases as well and recommend upper safe limits for RDA nutrients. The overall goal is to provide estimates of dietary allowances that are intended to avoid preventable illness, including freedom from outright clinical deficiency of truly essential nutrients.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterMargarita Alegría Ph.D.Margarita Alegría Ph.D.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2009.60.2.268aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Disparities in Depression Care: Implications for Population-Based Surveys: ReplyIn Reply: We appreciate Mr. Lee's positive comments on our study. He highlights the importance of adding questions to the assessment battery of the BRFSS that are specifically related to the number of days in which respondents felt totally unable to carry out daily activities. We could not agree more. Like other BRFSS items, additional items on problems with daily living would allow for greater focus on monitoring mental health at the population level. We can no longer continue to plan resources and evaluate the quality of mental health service delivery only at the individual level. Being able to identify geographic, systemic, and sociocultural barriers to high-quality mental health care is paramount to eradicating persistentethnic and racial service disparities. Having a national data source such as the BRFSS could help identify important shortcomings in the U.S. mental health care system. Community estimates of need could be used as outcome measures to monitor the impact of services, as they reflect the overall mental health status of the population ( 1 ). Need estimates by region could help policy makers allocate available resources more efficiently and fairly. Narrow definitions of need fail to provide information that is useful from a community prevention perspective ( 2 , 3 ). Although such definitions capture individual-level cases, they may fail to capture cases that are important to measure in community-level need estimates for monitoring and prevention, rather than for acute care. We do hope that Mr. Lee's suggestion is adopted.

Disparities in Depression Care: Implications for Population-Based Surveys: Reply

Back to table of contents Previous article Next article LetterFull AccessLetterMargarita Alegría Ph.D.Margarita Alegría Ph.D.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2009.60.2.268aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Disparities in Depression Care: Implications for Population-Based Surveys: ReplyIn Reply: We appreciate Mr. Lee's positive comments on our study. He highlights the importance of adding questions to the assessment battery of the BRFSS that are specifically related to the number of days in which respondents felt totally unable to carry out daily activities. We could not agree more. Like other BRFSS items, additional items on problems with daily living would allow for greater focus on monitoring mental health at the population level. We can no longer continue to plan resources and evaluate the quality of mental health service delivery only at the individual level. Being able to identify geographic, systemic, and sociocultural barriers to high-quality mental health care is paramount to eradicating persistentethnic and racial service disparities. Having a national data source such as the BRFSS could help identify important shortcomings in the U.S. mental health care system. Community estimates of need could be used as outcome measures to monitor the impact of services, as they reflect the overall mental health status of the population ( 1 ). Need estimates by region could help policy makers allocate available resources more efficiently and fairly. Narrow definitions of need fail to provide information that is useful from a community prevention perspective ( 2 , 3 ). Although such definitions capture individual-level cases, they may fail to capture cases that are important to measure in community-level need estimates for monitoring and prevention, rather than for acute care. We do hope that Mr. Lee's suggestion is adopted.

Health human resource planning in Canada: A typology and its application

A series of group interviews were conducted with key stakeholders in Canadian health human resource (HHR) planning. Interviews revealed that innovative HHR models arose primarily in response to perceived needs at the front line. At the same time global HHR initiatives were implemented by policy makers based on population level estimates of need. A large disconnect is identified between the top down and the bottom up approaches to HHR planning. This paper makes two important contributions. First, it provides a comprehensive typology of HHR models currently being utilized in Canada. The classification of existing HHR models is a necessary first step to standardized evaluation of effectiveness of various HHR approaches in terms of improving access to care and health outcomes. Second, the creation of a new type of health care professional is proposed--the collaboration agent. The collaboration agent is to provide much needed leadership to bottom up endavours at the front line. Furthermore, the collaboration agent is to mediate between the top and the bottom, thereby improving deficient communication and funding channels.

Interview mode effects on estimates of need for alcohol and drug treatment among welfare recipients: evidence from a quasi-experiment

Employing a quasi-experimental design, this study compared responses from face-to-face and telephone surveys of welfare recipients to assess the effects of survey modality on prevalence estimates of alcohol and drug abuse and need for treatment. Samples were drawn from adult welfare recipients in Oklahoma in 2001. We generated 1-year and 30-day prevalence estimates of alcohol and drug use, employed several common measures of substance-related behavioral and physical problems to estimate treatment need, and used odds ratios to compare prevalence estimates. Results indicated that telephone surveys provided estimates that were (1) statistically no different from those of face-to-face administration in the categories used to estimate treatment need and (2) significantly higher than those of face-to-face surveys for admission of ever having a substance problem and driving after consuming alcohol or drugs. We conclude that, for welfare recipients, telephone surveys provide similar data quality about treatment need as do more costly face-to-face interviews, a finding that is important and of practical concern to both practitioners and methodologists. More broadly, we argue that further survey methodology research is required for specific populations and subgroups that are often the focus of criminal justice and public health research and response.

A sociodental approach to assessing dental needs of children: concept and models

Traditional normative methods of assessing dental needs do not correspond to current concepts of 'health' and 'need'. Although there is dental research on quality of life, evidence-based practice, and oral behaviours, those concepts are rarely applied to dental needs estimation. Dental needs are usually calculated mainly from clinical data and are likely to be inaccurate. A structured comprehensive method for assessing dental needs is required. The objectives of this study are to develop and test a new sociodental system of needs assessment for overall dental needs of primary schoolchildren. Furthermore, normative and sociodental estimates of need are compared. The study developed a theoretical framework and pathway algorithms of sociodental needs assessment and applied them to assessing overall dental needs. Normative dental needs were assessed using standard normative criteria. The child oral impacts on daily performances (Child-OIDP) was used to assess oral impacts, and a self-administered questionnaire was used to obtain information on demographic variables and oral behaviours. Data were analysed according to the developed algorithms. A cross-sectional survey in Suphanburi Province, Thailand. All 1,126 children aged 11-12 years in a town. The sociodental approach was acceptable and not costly. In all, 54.4% had normative need under the dental needs model for life-threatening and progressive conditions, but only 16.6% had high propensity-related need; the remaining 37.8% would require dental health education or oral health promotion (DHE/OHP) or both and appropriately adjusted clinical interventions. Under the basic model of dental needs, 45.1% had normative need. Two-thirds of them (30.9%) had impact-related need and the remaining 14.2% did not have oral impacts and therefore should only receive dental health education. Only one-third of those with impact-related need had high propensity and were suitable for evidence-based conventional treatments; the remaining two-thirds should receive DHE/OHP and alternative clinical interventions. A sociodental system of dental needs assessment was developed and tested on school children. It decreased the estimates of conventionally assessed dental treatment needs and introduced a broader approach to care.

Model for end-stage liver disease (MELD) exception guidelines: Results and recommendations from the MELD exception study group and conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the standard MELD formula

Richard B. Freeman Jr., Robert G. Gish, Ann Harper, Gary L. Davis, John Vierling, Leslie Lieblein, Goran Klintmalm, Jamie Blazek, Robert Hunter, and Jeffrey Punch Division of Transplantation, Department of Surgery, Tufts–New England Medical Center, Boston, MA; Departments of Medicine and Transplantation and the Division of Hepatology and Complex GI, Physicians Foundation, California Pacific Medical Center, San Francisco, CA; United Network for Organ Sharing, Richmond, VA; Baylor Regional Transplant Institute, Baylor University Medical Center, Dallas, TX; Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA; Ochsner Multi-Organ Transplant Center, New Orleans, LA; and Department of Surgery, University of Michigan, Ann Arbor, MI

Potential Demand for Substance Abuse Treatment in the Criminal Justice System

This article considers the challenges in evaluating the potential for partnership between the treatment and criminal justice systems, and suggests an agenda for further research. Deep conceptual ambiguities and limitations of survey methods make general population estimates of need for treatment highly questionable. In criminal justice populations, we must make use ofuniquely available data to improve need estimates. For the purposes of policy analysis, it is essential to move beyond binary classification of the population as in need or not in need andattempt to estimate treatment needs by level of care. It is also essential to consider actual demand for level-appropriate treatment, because even in the criminal justice system, where patients may be subject to coercion, demand may be radically less than need. Initial studies mustbuild better knowledge of criminal offenders’choices between incarceration and longer community regimes.

Access to and patterns of use of behavioral health services among children and adolescents in TennCare.

This study assessed trends in access to and use of behavioral health services for school-aged children in TennCare, Tennessee's Medicaid managed care program, between state fiscal years 1995 and 2000. Claims, encounter, and enrollment data from the Bureau of TennCare were used. The data analyzed were restricted to services and enrollment periods for children and adolescents between the ages of four and 17 years at the time of service or enrollment. Measures were calculated in four areas: overall access to behavioral health services, use of inpatient services, use of outpatient specialty treatment services, and use of supportive services like case management and medication management. The number of youths who received a behavioral service increased by nearly 50 percent between state fiscal years 1995 and 2000. At the same time, the number of youths enrolled in TennCare increased by 19 percent. The annual access rate increased from 72.7 youths per 1000 enrollees to 91.7. However, the volume of services for children fell. Access rates were low relative to estimates of need in this population. The system made less use of inpatient services and relied more on outpatient services, particularly case management and medication management services. Children's access rates for behavioral health services improved even as the TennCare program expanded to cover more children. The system served more youths in part by reducing the volume of services for children receiving treatment and substituting more supportive services. Ongoing performance monitoring for policy making will require enhancements of data monitoring activities by the state.

State variation in SCHIP allocations: how much is there, what are its sources, and can it be reduced?

Allocations for the State Children's Health Insurance Program (SCHIP) varied 22% per state between 1999 and 2002. The funding fluctuations present significant problems for states as they develop budget priorities under difficult fiscal conditions. We examine sources of the variation in state allocations during the first four years of SCHIP, focusing on the Current Population Survey's "child component" of the allocation formula. We consider the trade-offs in using alternative estimates from the American Community Survey and model-based estimation. Obtaining reliable estimates of need for SCHIP allocations is critical for states dependent on federal support for insurance programs.

Prevalence of faecal incontinence in adults aged 40 years or more living in the community.

Prevalence studies of faecal incontinence in the general population are rare and the impact of faecal incontinence on quality of life has not been previously addressed. To establish the prevalence of faecal incontinence in adults in terms of frequency of leakage, degree of soiling, and level of impact on quality of life. In a cross sectional postal survey, 15 904 adults aged 40 years or more (excluding residents of nursing and residential homes) were selected randomly by household from the Leicestershire Health Authority patient register. Participants were asked to complete a confidential health questionnaire. Major faecal incontinence was defined as soiling of underwear or worse with a frequency of several times a month or more. Respondents were also asked if bowel symptoms had an impact on their quality of life. From a total sample of 10 116 respondents, 1.4% reported major faecal incontinence and 0.7% major faecal incontinence with bowel symptoms that had an impact on quality of life. Major faecal incontinence was significantly associated with a lot of impact on quality of life (odds ratio 12.4, 95% confidence interval 7.5-20.6). Incontinence was more prevalent and more severe in older people but there was no significant difference between men and women. This study has confirmed that faecal incontinence is a fairly common symptom, particularly in older people. Faecal incontinence in men has received little attention in the past and the results from this study indicate that it is as much of a problem in men as it is in women while the level of unmet need in this group is high. Estimates of need for health care for this symptom should be multidimensional and assess both the severity of symptoms and the impact it has on quality of life.

Availability and affordability of treatment for Human African Trypanosomiasis

Human African Trypanosomiasis (HAT) is a re-emerging disease whose usual treatments are becoming less efficient because of the increasing parasite resistance. Availability of HAT drugs is poor and their production in danger because of technical, ecological and economic constraints. In view of this dramatic situation, a network involving experts from NGOs, WHO and pharmaceutical producers was commissioned with updating estimates of need for each HAT drug for the coming years; negotiations with potential producers of new drugs such as eflornithine; securing sustainable manufacturing of existing drugs; clinical research into new combinations of these drugs for first and second-line treatments; centralizing drug purchases and their distribution through a unique non-profit entity; and addressing regulatory and legal issues concerning new drugs.

Determining the need for hip and knee arthroplasty: the role of clinical severity and patients' preferences.

Area variation in the use of surgical interventions such as arthroplasty is viewed as concerning and inappropriate. To determine whether area arthroplasty rates reflect patient-related demand factors, we estimated the need for and the willingness to undergo arthroplasty in a high- and a low-use area of Ontario, Canada. Population-based mail and telephone survey. All adults aged > or =55 years in a high (n = 21,925) and low (n = 26,293) arthroplasty use area. We determined arthritis severity and comorbidity with questionnaires, established the presence of arthritis with examination and radiographs, and evaluated willingness to have arthroplasty with interviews. Potential arthroplasty need was defined as severe arthritis, no absolute contraindication for surgery, and evidence of arthritis on examination and radiographs. Estimates of need were then adjusted for patients' willingness to undergo arthroplasty. Response rates were 72.0% for questionnaires and interviews. The potential need for arthroplasty was 36.3/1,000 respondents in the high-rate area compared with 28.5/1,000 in the low-rate area (P <0.0001). Among individuals with potential need, only 14.9% in the high-rate area and 8.5% in the low-rate area were definitely willing to undergo arthroplasty (P = 0.03), yielding adjusted estimates of need of 5.4/1,000 and 2.4/1,000 in the high- and low-rate areas, respectively. Demonstrable need and willingness were greater in the high-rate area, suggesting these factors explain in part the observed geographic rate variations for this procedure. Among those with severe arthritis, no more than 15% were definitely willing to undergo arthroplasty, emphasizing the importance of considering both patients' preferences and surgical indications when evaluating need and appropriateness of rates for surgery.