Program Data (program + data)

Distribution by Scientific Domains


Selected Abstracts


Area-Level Poverty Is Associated with Greater Risk of Ambulatory,Care,Sensitive Hospitalizations in Older Breast Cancer Survivors

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008
Mario Schootman PhD
OBJECTIVES: To estimate the frequency of ambulatory care,sensitive hospitalizations (ACSHs) and to compare the risk of ACSH in breast cancer survivors living in high-poverty with that of those in low-poverty areas. DESIGN: Prospective, multilevel study. SETTING: National, population-based 1991 to 1999 National Cancer Institute Surveillance, Epidemiology, and End Results Program data linked with Medicare claims data throughout the United States. PARTICIPANTS: Breast cancer survivors aged 66 and older. MEASUREMENTS: ACSH was classified according to diagnosis at hospitalization. The percentage of the population living below the U.S. federal poverty line was calculated at the census-tract level. Potential confounders included demographic characteristics, comorbidity, tumor and treatment factors, and availability of medical care. RESULTS: Of 47,643 women, 13.3% had at least one ACSH. Women who lived in high-poverty census tracts (,30% poverty rate) were 1.5 times (95% confidence interval (CI)=1.34,1.72) as likely to have at least one ACSH after diagnosis as women who lived in low-poverty census tracts (<10% poverty rate). After adjusting for most confounders, results remained unchanged. After adjustment for comorbidity, the hazard ratio (HR) was reduced to 1.34 (95% CI=1.18,1.52), but adjusting for all variables did not further reduce the risk of ACSH associated with poverty rate beyond adjustment for comorbidity (HR=1.37, 95% CI=1.19,1.58). CONCLUSION: Elderly breast cancer survivors who lived in high-poverty census tracts may be at increased risk of reduced posttreatment follow-up care, preventive care, or symptom management as a result of not having adequate, timely, and high-quality ambulatory primary care as suggested by ACSH. [source]


Administrative Characteristics of Comprehensive Prenatal Case Management Programs

PUBLIC HEALTH NURSING, Issue 5 2003
L. Michele Issel Ph.D., R.N.
Abstract The purpose of this study was to examine comprehensive prenatal case management programs in terms of organizational, program, and process characteristics. Data from 66 program surveys of government agencies were used. Organizational capacity was measured as extent of organizational change and extent of interagency agreements. Program data included age and size of the program, reasons for having case management, and funding diversity. Process data were eight types of interventions. The most highly rated reason for having case management was to improve client outcomes. The greatest organizational change was in the area of the organizational structure, followed by financial status and types of services provided. Contracts with other agencies were rare. Agencies with more interagency contacts reported higher levels of change in the case management department and turnover among mid-level managers. Older programs had fewer employees. Approximately 49% of client contacts were not billed to Medicaid. Larger programs had significantly less time allocated to emotional support and coaching. Data on organizational characteristics, program, and process variables provide insights into comprehensive case management. Relationships among these variables underscore the importance of studying client outcomes within the context of program and organizational idiosyncrasies. Future studies of comprehensive prenatal case management should focus on cross-level questions. [source]


Breast cancer survivors in the United States

CANCER, Issue 9 2009
2005-201, Geographic Variability, Time Trends
Abstract BACKGROUND: Breast cancer continues to place a significant burden on the healthcare system. Regional prevalence measures are instrumental in the development of cancer control policies. Very few population-based cancer registries are able to provided local, long-term incidence and follow-up information that permits the direct calculation of prevalence. Model-based prevalence estimates are an alternative when this information is lacking or incomplete. The current work represents a comprehensive collection of female breast cancer prevalence from 2005 to 2015 in the United States and the District of Columbia (DC). METHODS: Breast cancer prevalence estimates were derived from state-specific cancer mortality and survival data using a statistical package called the Mortality-Incidence Analysis Model or MIAMOD. Cancer survival models were derived from the Surveillance, Epidemiology, and End Results Program data and were adjusted to represent state-specific survival. Comparisons with reported incidence for 39 states and DC had validated estimates. RESULTS: By the year 2010, 2.9 million breast cancer survivors are predicted in the US, equaling 1.85% of the female population. Large variability in prevalent percentages was reported between states, ranging from 1.4% to 2.4% in 2010. Geographic variability was reduced when calculating age-standardized prevalence proportions or cancer survivors by disease duration, including 0 to 2 years and 2 to 5 years. The residual variability in age-adjusted prevalence was explained primarily by the state-specific, age-adjusted breast cancer incidence rates. State-specific breast cancer survivors are expected to increase from 16% to 51% in the decennium from 2005 to 2015 and by 31% at the national level. CONCLUSIONS: To the authors' knowledge, the current study is the first to provide systematic estimations of breast cancer prevalence in all US states through 2015. The estimated levels and time trends were consistent with the available population-based data on breast cancer incidence, prevalence, and population aging. Cancer 2009. © 2009 American Cancer Society. [source]


Identification and characterization of Kentucky self-employed occupational injury fatalities using multiple sources, 1995,2004

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2006
Terry Bunn PhD
Abstract Background Identification and characterization of occupational injury fatalities in self-employed workers typically relies on a single data source and thus may miss some cases. Methods Kentucky self-employed worker injury fatalities were identified using Fatality Assessment and Control Evaluation (FACE) program data (1995,2004) and compared to non self-employed worker data. Occupations and industries listed on death certificates were compared to those in which the decedent was actually engaged. Results Of 1,281 Kentucky worker injury deaths, 28% were self-employed. Death certificates failed to identify 31% of these deaths as work-related; industry and occupation were incorrectly identified in 27% and 16%, respectively. Fifty-seven percent of the deaths were in agriculture, primarily tractor-related. For Kentucky, the self-employed crude death rate was higher (27.6/100,000) than the non self-employed worker (5.4/100,000) rate or the US (11.5/100,000) self-employed rate. Conclusions Multiple information sources improve identification of self-employed status in work-related injury fatalities. Effective prevention requires accurate surveillance and examination of contributing factors. Self-employed worker injuries in high-risk industries should be more fully examined for development of effective injury prevention programs. Am. J. Ind. Med. 2006. © 2006 Wiley-Liss, Inc. [source]