Patients In Health System Research Articles

Secondhand Smoke & Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS), an inflammatory disease of the nasal cavity and sinuses, has a prevalence of 12.5% in the United States and is the second most common chronic disease, following arthritis. The role of exposure to second hand smoke (SHS) in the etiology of CRS is unclear. This study evaluates the association between SHS and CRS. This study employs a case-control design with 306 cases (diagnosed 2000 to 2004) and 343 controls, all purporting not to have actively smoked in the 5 years prior to diagnosis (cases) or study entry (controls), sampled from the Henry Ford Health System's patient population. Study cases were incident cases having a minimum duration of disease of 12 weeks and had their diagnosis confirmed by computed tomography and/or radiography. Sociodemographic, medical, and exposure data were obtained from medical records and by phone interview by trained interviewers applying a structured questionnaire. SHS exposures at home, at work, in public, and at private social functions in the 5 years prior to diagnosis (cases) or study entry (controls) were queried. Data on potential confounders were collected and included exposures to chemicals, air pollution, illicit drugs, and occurrence of allergies. Analysis was carried out by multiple logistic regression and preliminary results are presented. Of controls and cases, 8.7% and 13.4% reported SHS exposure at home (OR = 1.61, 95% CI 0.98–2.66), 6.7% and 18.3% had exposure at work (OR = 3.12, 95% CI 1.87–5.20), 84.5% and 90.2% had exposure in public places (OR = 1.68, 95% CI 1.04–2.71), and 26.8% and 51.3% had exposure in private social functions (OR = 2.87, 95% CI 2.07–3.99), respectively. Adjusted for socioeconomic status (education), the odds ratios for the SHS-CRS associations remained elevated for all four sources of SHS and remained statistically significant (alpha error = 0.05) for SHS from work, public, and private social sources. Preliminary results indicate chronic rhinosinusitis is significantly associated with exposure to secondhand smoke, an exposure that was relatively common during the study period in this population.

Dual Eligibles Gain Time To Choose Different HMO

Back to table of contents Previous article Next article Legal NewsFull AccessDual Eligibles Gain Time To Choose Different HMOMark MoranMark MoranSearch for more papers by this authorPublished Online:5 May 2006https://doi.org/10.1176/pn.41.9.0011Settlement of a suit filed by the Pennsylvania Health Law Project (PHLP) on behalf of “dual eligibles” in that state means that those individuals will have an extended grace period to disenroll from the Medicare HMO in which they were automatically placed to obtain prescription drug coverage under the new Medicare Part D drug program.That's critical because often those HMOs have a restricted provider network that does not include the psychiatrists they were seeing previous to the start of the prescription drug program on January 1.Now, the PHLP and the federal Centers for Medicare and Medicaid Services (CMS) have reached a settlement in which the grace period during which individuals can disenroll from one plan and switch to another plan—which had been until March 31—has been extended to June 30.Moreover, psychiatrists who have been treating patients in this category may continue to do so and to submit claims to the Medicare HMO even though they may not be a participant in the network.The HMO is required to pay the Medicare fee-for-service rate or billed charge, whichever is lower, for any Medicare-covered service provided during the period beginning January 1 and ending June 30, according to a notice that CMS sent out to Medicare-participating providers in Pennsylvania.The suit was filed by the PHLP on behalf of dual eligibles in the state who—because of peculiarities in the design of Pennsylvania's public health insurance programs—were subject to one of the more glaring foul-ups accompanying the new Part D program when CMS“ auto-enrolled” those individuals into Medicare HMOs.The result, in short, was that individuals landed in plans in which their treating psychiatrist was often not a participating provider.A September 2005 letter from the Pennsylvania Psychiatric Society (PPS) to CMS, which was also accompanied by a letter from APA, outlined the problem.“Most dual eligibles in Pennsylvania are required by the state to receive health care services through managed care plans contracting with the state to provide Medicare services,” the PPS letter stated.“ However, the design, structure, payment rules, and contracting details are such that most dual eligibles do not receive health care services from providers who are in the parent company's Medicare HMO.“This is especially true in psychiatry, where behavioral health services have been deliberately carved out and separately contracted to the county government to ensure a seamless mental health system for patients funded with public dollars,” the letter continued. “If CMS auto-enrolls patients into the Medicare HMO of the company responsible for the patient's Medicaid HMO, those patients will for the most part be restricted to a network of providers that does not include the providers they normally see.” ▪ ISSUES NewArchived

Accreditation Manual for Nephrology

The IRS did not develop a new theory of accreditation but drew up a methodology for assessing public policies, which internalised accreditation philosophy and was based on a theory of the decision-making process. Two questions underlie this theory: 1) whether health is a professional organisation, a company or a public policy, 2) whether accreditation in the internationally accepted meaning of the term is the most effective system of continuous improvement for this sector as it is organised in Italy. According to the IRS, health is all three of these things and accreditation responds adequately to the complexity of the sector. In fact: a) internalises professional knowledge (and is therefore ideal for a professional organisation); b) it triggers a process of continuous improvement of the product/service supplied (and that is ideal for a company that must maintain the competitiveness of its product/service as high as possible); c) it uses a methodology which highlights the mechanisms of interaction between the actors (a methodology underlying decision making theory where there are actors who decide, knowing that they have to find a consensus and who exchange resources in a virtuous circle. The principal qualitative element identified by the IRS methodology was the internalisation by the health system of patients' expectations and patients' satisfaction in the welfare process. The main feature of the accreditation methodology designed by the IRS is that the assessment focuses neither on structures (which would have been useful to measure the degree of reliability) nor on the compilation of behaviour guidelines, but is centred on the assessment of a function, on the quality of the provision of a specialist health service. The decision to assess a specialist function (e.g. nephrology) and not a structure (e.g. a nephrology department or a hospital) gives maximum importance to the figure of the professional.