Abstract Objective: Readmission is a big part of health care expenditure and recent studies suggested that hospital readmissions can be applied as an important indicator of quality of care within health care system. Furthermore elderly population usually costs the large amount health care expenses and is the main group in readmission. Moreover readmission is usually attributed to chronic diseases. Nevertheless, evaluations of hospital readmissions under universal health care coverage areas were not well-studied in Taiwan. Therefore this study aims to explore the associations between initial hospitalizations and probability of hospital readmissions in details. Research method: Patients aged 65 or older with primary clinical diagnosis of asthma or COPD based on ICD-9-CM for hospital admissions and readmissions in Taiwan.National claims of these two diseases were collected and analyzed from year 2000 to 2004. Population-based descriptive analyses of related health care utilizations were estimated. Multivariate logistic regressions were conducted to predict the probability of hospital readmissions. Controlled variables included patient factors, medical institutions¡¦ characteristics, urbanizations, and air quality indicators. Result: Among asthma and COPD elderly patients, more health care utilizations were observed in the hospital readmissions than initial admissions. Multivariate logistic regressions indicated that age, gender, disease severity, hospital characteristics, and air quality were significant predictors of the probability of hospital readmission. Meanwhile, age, disease severity, and hospital characteristics also significantly affected the time interval between initial admission and readmission. In addition, longer length of stay in the initial admission will significantly shorten the time interval between initial admission and readmission (P<0.001). Conclusion: For Asthma and COPD elderly patients, longer length of stay in the initial admission will significantly shorten the time interval between initial admission and readmission and have higher probability of hospital readmission. This study provides the evidence of reducing the health care expenditure by controlling readmission rate. With more understandings of factors affecting hospital readmissions, we can improve the health care delivery and reduce unplanned readmissions in the future. Key words: Asthma, COPD, hospital readmission, health care utilization, length of stay, admission fees

White-Black disparities in disability in the older population are consistently reported in the literature, and are usually ascribed to differences in socio-economic, health, and cognitive status. However, the role of modifiable influences on disability, such as health and lifestyle behaviors or health care utilization on these differences is less clear. This dissertation examines: (1) longitudinal White-Black differences in disability and the potential contributions of distinct health behaviors to these differences; (2) White-Black differences in the effects of health care utilization on trajectories of disability; and (3) whether cognition mediates the effects of health behaviors on disability in Whites and in Blacks, independent of established confounders for these relationships. This dissertation uses longitudinal data from the Asset and Health Dynamics among the Oldest Old study (AHEAD). Trajectories of disability in basic (ADL) and instrumental (IADL) activities of daily living are fit using mixed effects models with time-varying predictors. The mediation effect is tested using a multilevel mediation model. Results indicate that health behaviors close the residual White-Black gap in IADL trajectories but not the residual gap in ADL trajectories. Physical activity participation and maintenance of a normal weight or overweight status resulted in lower ADL and IADL disability levels over time among Whites. None of the health behaviors influenced longitudinal trajectories of disability in Blacks. Short-stay nursing home and home health care utilization was associated with lower ADL and IADL disability levels over time among Blacks. Cognition mediated the effect of physical activity participation on ADL and cognitive IADL in Whites but not in Blacks. That is, physical activity participation had positive effects on ADL and IADL disability both directly, and indirectly through beneficial effects on cognition. Modifiable influences on disability, such as health and lifestyle behaviors and health care utilization should be targeted by intervention programs and regulatory policies in order to narrow or eliminate the White-Black disability disparities. Such interventions may represent effective avenues for achieving the goals of Healthy People 2010.

Background: A significant number of laryngeal cancer patients are diagnosed with advanced-stage disease. Since stage at diagnosis is an important prognostic factor, it is necessary to understand the characteristics of individuals at risk of being diagnosed at an advanced stage. Objectives: (1) Compare usual health care utilization between laryngeal cancer patients and the general population. (2) Evaluate the association between usual health care utilization and stage at diagnosis in laryngeal cancer. Methods: The study population included 1,702 laryngeal cancer patients diagnosed from 2005–2008, and 8,510 matched-controls from the general population. Demographic, clinical, and health administrative data from Ontario were used to measure usual health care utilization in a two-year period (i.e. frequency of encounters, continuity of care, primary care model enrolment, and preventive services use), stage at diagnosis, and covariates. Results: Laryngeal cancer patients had fewer health care encounters and a greater propensity for using preventive services than the general population. Comparisons of usual health care utilization among laryngeal cancer patients showed significant trends across Stage I–IV for the frequency of encounters (p=0.002), continuity of care (p=0.02), and preventive services use (p<0.0001). Stage I patients were less likely than Stage II–IV patients to have a low frequency of encounters (10%), low continuity of care (28%), and no preventive services use (28%). In adjusted multivariable analyses, low continuity of care was marginally associated with an increased risk of advanced-stage laryngeal cancer (RR [95% CI]: 1.17 [1.01, 1.34]). Stratification by subsite showed a marginally significant association between continuity of care and stage in glottic cancer (RR [95% CI]: 1.25 [0.98, 1.58]), but no association in supraglottic cancer (RR [95% CI]: 1.01 [0.89, 1.15]). Conclusions: Laryngeal cancer patients’ patterns of usual health care utilization differ from the general population. There was little evidence of an effect of usual health care use on the risk of advanced-stage laryngeal cancer in multivariable analyses adjusting for confounders. Multinomial regression may be needed to fully elucidate the effects of health care utilization across Stage I–IV. Understanding health care utilization among laryngeal cancer patients is important for improving early detection and warrants further research. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-04-26 10:50:05.976

No description available.

This dissertation has explored the problem of a yawning gap between policy and the implementation of lay participation in health development activities in Ghana, using data from 577 households in 22 rural communities. / A Health Systems model has been applied to data, to explain relationships and four sets of variables--household need for health services, predisposing attributes, participatory patterns, enabling factors--on household use of available health facilities and services. / Overall, results indicate a complex interdependence of factors which influence modern health services use. A multiple regression procedure identifies the presence of children under 5 years, the household's perception of its influence in the community, household participation in community health-related activities, household socio-economic and educational levels, to be significantly related to services use. Results suggest that Need for services is Not a sufficient condition for the Use of available health services.

This study examines the importance of age, education, and the health system reforms in the mid 1990's on the utilization of five health services: specialists' visits, family doctor visits, non-physician health professional visits, hospital use, and home care services. The analysis focuses on the Canadians 45 and over, and uses data from the National Population Health Survey. / Results. Age per se has only a minor effect on utilization; the relative high utilization rates observed among the aged relate to the use of services by people with chronic conditions, whose prevalence is higher among the aged. Education has little impact on use of services among the aged. The reforms had only significant effect for four services. They increased utilization of non-medical health professional consults, and increased probability of consulting a specialist. They reduced length of stay, and decreased the number of visits made to family doctors.

Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references. / Also available by subscription via World Wide Web / vii, 188 leaves, bound ill. (some col.) 29 cm

Bibliography: p. 320-341. / xvii, 341 p. : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Addresses the documented variation in dental service rates and the questions of appropriateness of care arising from this variation. Examines the association of services provided with dentists, practice and patient factors. Based on a survey pf private general practice dentists who provided a data log for one typical day. / Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 2000

Researchers examining issues of recent veterans of military conflicts in Iraq and Afghanistan have found evidence of psychological distress and difficulty adjusting to civilian life post-deployment. Changes in educational benefits offered to veterans will likely facilitate greater numbers of veterans to enter academia in the coming years. This survey of 49 college student veterans at a large Midwestern university was designed to reveal the frequency and intensity of psychological distress, PTSD and alcohol misuse. Relationships between these constructs and the constructs of social support, stigma and barriers to psychological care, life satisfaction, traumatic experiences, attitudes toward help seeking, and service utilization are reported. A history of mental health service utilization since military service was reported by many respondents. PTSD and alcohol misuse symptoms were reported by many college student veterans and incidence in this sample was greater than the incidence previously reported in the literature on veterans. Stigma was found to be negatively correlated with attitudes toward help seeking. Post deployment social support was found to be negatively associated with psychological distress and positively associated with service utilization. Implications and limitations of these findings are presented and future directions for research and intervention are discussed.

Increases in the number of users of the medical delivery system, along with an ever-increasing variety of available services, makes it desirable to identify those individuals who will benefit most from its services. With the growing reliance on third party payment, economic limitations no longer effectively restrict the use of the system's resources to those individuals who are truly ill. A framework is needed whereby individuals who are medically ill can be separated from those whose needs might be more effectively addressed by other services. A variety of means, including locus of control, has been used in the attempt to make such discriminations. In conclusion, it was observed that the low magnitude of obtained relationships presents opportunities for future research, but disallows meaningful prediction at the present time.