Afraid Of Marriage Or The Ravages Of Divorce?

From the 19th December 2011 Medical News Today article

With the share of married adults at an all-time low in the United States, new research by demographers at Cornell University and the University of Central Oklahoma unveils clues why couples don’t get married – they fear divorce.
Among cohabitating couples, more than two-thirds of the study’s respondents admitted to concerns about dealing with the social, legal, emotional and economic consequences of a possible divorce.

The study, “The Specter of Divorce: Views from Working and Middle-Class Cohabitors,” is published in the journalFamily Relations (December 2011) and is co-authored by Sharon Sassler, Cornell professor of policy analysis and management, and Dela Kusi-Appouh, a Cornell doctoral student in the field of development sociology. (http://bit.ly/sJqeFa).

Roughly 67 percent of the study’s respondents shared their worries about divorce. Despite the concerns, middle-class subjects spoke more favorably about tying the knot and viewed cohabitation as a natural stepping stone to marriage compared to their working-class counterparts. Lower-income women, in particular, disproportionately expressed doubts about the “trap” of marriage, fearing that it could be hard to exit if things go wrong or it would lead to additional domestic responsibilities but few benefits. …

Read the entire article

Residential Care Facilities: A Key Sector in the Spectrum of Long-term Care Providers in the United States

 

From the US National Center for Health Statistics Data Brief (Number 78, December 2011)

Key findings

Data from the 2010 National Survey of Residential Care Facilities

• In 2010, residential care facilities (RCFs) totaled 31,100, with 971,900 beds nationwide.
• About one-half of RCFs were small facilities with 4–10 beds. The remainder comprised medium facilities with 11–25 beds (16%), large facilities with 26–100 beds (28%), and extra large facilities with more than 100 beds (7%).
• One-tenth of all RCF residents lived in small RCFs and about that percentage (9%) lived in medium facilities, while the majority resided in large (52%) or extra large (29%) RCFs.
• About 4 in 10 RCFs had one or more residents who had some or all of their long-term care services paid by Medicaid.
• Larger RCFs were more likely than small RCFs to be chain-affiliated and to provide occupational therapy, physical therapy, social services counseling, and case management.

Residential care facilities (RCFs)—such as assisted living facilities and personal care homes—provide housing and supportive services to persons who cannot live independently but generally do not require the skilled level of care provided by nursing homes. RCFs are not federally regulated, and state approaches to RCF regulation vary widely (1). The ability to provide a comprehensive picture of the long-term care (LTC) industry has been hampered by the lack of data on RCFs (2,3). Previous estimates of the size of the RCF sector varied depending on how RCFs were defined (4,5). Using data from the first nationally representative survey of RCFs …

Read the entire press release

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Illicit drug related emergency department visits vary by metropolitan area

From the 15 December 2011 press release by US SAMHSA (Substance Abuse and Mental Health Services Administration)

Illicit drug related emergency department visits vary by metropolitan area

Major metropolitan areas show significant variation in the rates of emergency department (ED) visits involving illicit drugs. In terms of overall illicit drug-related emergency room visits, Boston has the highest rate (571 per 100,000 population), followed by New York City (555 per 100,000 population), Chicago (507 per 100,000 population), and Detroit (462 per 100,000 population). By comparison the national average was 317 per 100,000 population.

This new report published by the Substance Abuse and Mental Health Services Administration (SAMHSA) was drawn from the agency’s Drug Abuse Warning Network – (DAWN), a public health surveillance system that monitors drug-related emergency department visits throughout the nation. This information was collected from eleven metropolitan areas including Boston, Chicago, Denver, Detroit, Miami (Dade County and Fort Lauderdale Division), Minneapolis, New York (Five Boroughs Division), Phoenix, San Francisco, and Seattle.

“When friends, family members and health professionals miss the signs and symptoms of substance abuse the results can be devastating,” said SAMHSA Administrator Pamela S. Hyde.   “One consequence is the costly and inefficient use of emergency rooms as a first step to treatment.   Substance abuse prevention and early intervention can keep people off drugs in the first place and clear the path to healthier lifestyles.”

The emergency department findings were similar to the overall trend regarding visits related specifically to heroin use. Again Boston had the highest rate (251 per 100,000 population, followed by Chicago (216 per 100,000 population), New York City (153 per 100,000 population), Detroit (150 per 100,000 population) and Seattle (118 per 100,000 population).   The national average was 69 per 100,000.

The same differences were also evidenced between these major metropolitan areas and the national average when it came to rates of emergency department visits involving illicit drugs in combination with alcohol. New York City had the highest rate (223 per 100,000 population), followed by Boston (153 per 100,000 population), San Francisco (150 per 100,000 population), Chicago (120 per 100,000 population) and Detroit (112 per 100,000 population). The national average was 60 per 100,000 population.

This survey was developed by SAMHSA as part of its strategic initiative on data, outcomes, and quality – an effort to create integrated data systems that help inform policy makers and providers on behavioral health issues.

This survey is available on the web athttp://www.samhsa.gov/data/2k11/WEB_DAWN_023/DAWN_023_IllicitDrugEDVisits_plain.pdf . For related publications and information, visit http://www.samhsa.gov/ .

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Healthy Roads adds “A Quick Look at Medicare” and other free patient education resources

Posted on December 19, 2011 at
Health Information Literacy – for health and well being

Reflections on the importance of health information literacy awareness and how it impacts the public health of our citizens. Low health literacy affects nearly 50% of the US population.

The following was posted to several listservs by Mary Alice Gillispie, M.D.; Healthy Roads Media.   “Healthy Roads Media has several new free patient education resources.  There is now a Spanish version of Advance Directives in multiple formats.  There is also an English version of A Quick Look at Medicare in multiple formats.  The link iswww.healthyroadsmedia.org/topics/personalhealth.htm   We hope to have materials on both Medicare and Medicaid in English, Spanish and Russian in the next couple of months.
If you work for one of the hundreds of organizations who uses Healthy Roads Media materials but have not provided any support, please consider making an end of the year tax deductible donation (www.healthyroadsmedia.org/donate.htm).  Keeping these materials free and adding new resources is an increasing challenge!

– Mary Alice Gillispie, M.D.

Related Resources

• General Comprehensive Health Resources (at Health and Medical News and Resources by Janice Flahiff)
• Healthy Roads Media and other sources of quality health information in many languages and multiple formats (jflahiff.wordpress.com)

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Performance Measurement – Converting Practice Guidelines Into Quality Measure

 

Excerpts from the 19 December blog item by Ha-Vinh at Health Services Authors

Performance incentives have been recently adopted in France by the national health care insurer to remunerate French Doctors. In Health care, when one can not measure outcomes one measures process. But a good process for an individual patient doesn’t reflect necessarily a good process for the average patient studied by the evidence-based medical research. In a precedent post I presented what the heterogeneity of treatment effect means. In the present post I will try to highlight where stands the fundamental difference between professional guidelines and quality assessment tools of physician practice. Guidelines stem from the average patient. A quality assessment tool assesses the individual patient dealing with the heterogeneity or deviation around the mean value. From now on, given the use of guidelines made by health policy makers to evaluate health care professionals, it becomes a priority goal for searchers to take into account this use when writing their guidelines. For that purpose they should more insist on the heterogeneity of their results and perform sub group analysis across the different risk level of disease to which their studied subjects are exposed. They should accurately determine if their recommendations are applicable to subjects with multiple co morbidities. That is only at this condition that guideline will coincide with a sound balanced quality assessment tool for physician practice…

Read the entire article here

Comment I left at this blog item..

Thank you…it reinforces my beliefs about practice guidelines, emphasis on guidelines!
It is good to measure compliance, and have incentives for performance…
Although generalizations can be made about how to best treat diseases/conditions…at the end of the day…it is people, not diseases/conditions..that are the focus of any good health care system…and heterogeneity of treatment effect is an important facet of treating the whole person, not just the disease/condition..

 

 

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