This study is a description and analysis of the Tufts-Delta Health Service Project in Mound Bayou, Mississippi over a six-year period from 1967 to 1972. The purpose of the study was to identify and describe the factors which contributed to the development and decline of this Project as an experimental model for delivery of health services to a rural, poverty population. Located in an all-black community, the Project established the first rural health center in the United States following legislative action to declare War on Poverty The research design followed the case study method. Data sources included historical literature, government and organizational documents, interviews, and participant observation over a two-year period. The primary focus of the study was on information obtained from former professional and administrative personnel who had been employed with the Project. Study participants supplied information in response to an open-ended, pre-tested questionnaire. The questionnaire was designed to elicit both negative and positive factors which contributed to the Projects' operation and subsequent decline. The study was presented from a historical perspective within the theoretical framework of socioeconomic factors relevant to Black Americans in American society The findings indicated that the Tufts-Delta Health Service Project had both negative and positive factors which influenced the Projects' development, organization, operation, and decline. Although many of the problems encountered by the Project had their roots in the historical socioeconomic environment, many other problems evolved as a result of the Projects' orientation and methods of operation. Most of the negative factors expressed by study respondents related to inadequate management and administration of the Project. Based on the findings of the study, recommendations were made for improvements in health service delivery. Recommended improvements included changes in administrative structure, personnel management, communication and cooperative relationships, consumer involvement, and planning and evaluation of health needs and resources. The study findings indicated that current and future administrators have a crucial responsibility in the management of health care services The Tufts-Delta Health Service Project presented an opportunity for development of new methods in health care delivery. Flexible and innovative in its approach to meeting broad health needs, the Project was perceived as an intervention for bringing about social change through delivery of comprehensive health services. The significance of this study is in its attempts to define a problem for which there is a current lack of knowledge and understanding. As the first general and complete description of a health care project which declined, in spite of adequate funding initially, this study has value and importance for its ability to provide focus and clues for future needed research in health care services administration and financing. The study also offers an opportunity to learn from past mistakes to prevent future costly errors in the development and management of health care services delivery / acase@tulane.edu

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Abstract Not Available / acase@tulane.edu

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Statement of the Problem. The Epidemiology Unit of the Louisiana Department of Health and Human Resources had determined previously, through a systematic investigation, that children with subclinical hepatitis A infections in day-care centers (DCC) were transmitting the virus to parents and to other family members The secondary spread of hepatitis from DCC children to adult family members is known to be costly in terms of morbidity and economics. A cost of illness survey was conducted by this investigator and associates on 17 households affiliated with an outbreak center in 1977. The estimated minimum cost, including lost wages, was $1,952 per household The purpose of this study was to describe factors associated with hepatitis A outbreaks in DCC of Jefferson and Orleans Parishes and to determine which factors would differentiate outbreak from non-outbreak centers. Nine (9) research questions were addressed. Is there a difference between outbreak and non-outbreak DCC in relation to: (1) handwashing practices? (2) diapering practices? (3) employee characteristics and policies? (4) child characteristics? (5) water usage? (6) sanitarian review index? (7) demographic characteristics? (8) cleaning procedures? (9) hours of day-care operation? Methods and Material. Three (3) instruments were developed to collect data for this study: an Interview Schedule, an Observation Guide, and a Sanitarian's Inspection Schedule for Day-Care Centers. The Interview Schedule was designed to record information on 43 study variables from interviews with center directors. The purpose of the Observation Guide was to record observations on some of these same variables during on-site visits to DCC. The third tool, Sanitarian's Inspection Schedule for Day-Care Centers, was constructed from a standardized form routinely used by Louisiana Department of Health sanitarians for recording conditions in DCC Between July and November 1980, letters were written to day-care center directors informing them of the study. Appointments were then scheduled to conduct interviews and to perform observations and sanitarians' inspections of the centers The study sample consisted of 8 DCC which experienced hepatitis outbreaks in 1979 and a stratified random sample of 28 non-outbreak centers Data from coded questionnaires were key punched to computer cards and cross tabulation tables with raw scores and percentages were developed on study variables by outbreak status. Chi square tests were performed on all nominal level data and the t test was used on interval level data. The SPSS computer program was used for the data analysis Findings and Conclusions. Statistical analyses revealed that 5 of the 43 study variables selected for examination were significantly different (p < .05) between outbreak and non-outbreak DCC: (1) handwashing supervision after bathroom use, (2) a specific area designated for diapering, (3) employees who served food and changed diapers, (4) the number of children in diapers, and (5) the number of operation hours per day These findings suggest that a stringent program of personal hygiene for center children and employees, adherence to specific rules regarding diapering, restriction of the number of non-toilet trained children admitted, and restriction to an average of 10 or less hours of daily operation may decrease the risk of hepatitis A outbreaks in DCC Since the results of this study cannot be generalized to all DCC, it is recommended that similar studies be conducted in other communities and in other care facilities Certain factors identified in this study appeared to contribute to the transmission of hepatitis in DCC. Based on these findings, the investigator plans to develop a handbook that will assist DCC directors in formulating policies necessary for the prevention and/or control of hepatitis A in their centers / acase@tulane.edu

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Statement of the Problem: The purpose of this study was to determine if health status as perceived by the prisoners at the time of their incarceration in a local jail could be used as a predictor of their utilization of medical services during the following twenty-eight (28) days of confinement. The ability to predict who would utilize medical services, and to what extent, could assist medical personnel in projecting and planning for these needs. This was especially important in local jails where budgets were usually low, the number of persons being confined was large, and the period of incarceration was short. Can the utilization of health services be predicted? Can perceived health status at the beginning of incarceration be the predictor? If so then an inmate population could be studied, and a medical program that was efficient, effective, and dynamic could be established. The ability to identify consumers of health services early could facilitate planning Method and Material: Data was gathered from the medical and correctional records at the Jefferson Parish Community Correctional Center. The required information was transferred from the records to data sheets without identifying the inmate. Only inmates incarcerated for a minimum of 28 days were included in the study. The utilization of medical services was determined by the number of sick call visits. The study population consisted of 382 cases Findings and Conclusions: It was found that females made significantly more sick calls than males (almost 2:1). Whites made considerably more sick call visits than non-whites. Educational level did not seem to be a factor in the utilization of health services. In general a positive response to almost any medical history question was associated with a significant increased number of sick call visits being made. There appeared to be a relationship between the number of health problems identified and the number of sick call visits made. Positive responses to the questions regarding current illness, currently under treatment, and a history of mental illness were statistically significant when compared to the mean number of sick call visits made. Those inmates found to have at least one (1) abnormality on physical examination made significantly more sick call visits than those with none. When the physician felt that an inmate had a medical problem, regardless of how the inmate perceived their health status, the inmate made significantly more sick call visits by an estimated 2:1. The same trend applied when medical assistants felt that an inmate had a health problem It is clear for the outcome of this study that these are factors which could be used as predictors of the utilization of health services for an inmate population. These factors, medical history questions, could be asked at any correctional facility, and help medical personnel identify that segment of the inmate population that would utilize medical services more. With early identification, medical programs could operate more effectively and efficiently / acase@tulane.edu

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