Alison Snow Jones

Health-care costs associated with amputation or reconstruction of a limb-threatening injury

BACKGROUND Recent reports have suggested that functional outcomes are similar following either amputation or reconstruction of a severely injured lower extremity. The goal of this study was to compare two-year direct health-care costs and projected lifetime health-care costs associated with these two treatment pathways. METHODS Two-year health-care costs were estimated for 545 patients with a unilateral limb-threatening lower-extremity injury treated at one of eight level-I trauma centers. Included in the calculation were costs related to (1) the initial hospitalization, (2) all rehospitalizations for acute care related to the limb injury, (3) inpatient rehabilitation, (4) outpatient doctor visits, (5) outpatient physical and occupational therapy, and (6) purchase and maintenance of prosthetic devices. All dollar figures were inflated to constant 2002 dollars with use of the medical service Consumer Price Index. To estimate projected lifetime costs, the number of expected life years was multiplied by an estimate of future annual health-care costs and added to an estimate of future costs associated with the purchase and maintenance of prosthetic devices. RESULTS When costs associated with rehospitalizations and post-acute care were added to the cost of the initial hospitalization, the two-year costs for reconstruction and amputation were similar. When prosthesis-related costs were added, there was a substantial difference between the two groups (

Women's Opinions About Domestic Violence Screening and Mandatory Reporting

81,316 for patients treated with reconstruction and

Annual and lifetime prevalence of partner abuse in a sample of female HMO enrollees

91,106 for patients treated with amputation). The projected lifetime health-care cost for the patients who had undergone amputation was three times higher than that for those treated with reconstruction (

Assessing the Effect of Batterer Program Completion on Reassault Using Propensity Scores

509,275 and

Association of Race, Substance Abuse, and Health Insurance Coverage With Use of Highly Active Antiretroviral Therapy Among HIV-Infected Women, 2005

163,282, respectively). CONCLUSIONS These estimates add support to previous conclusions that efforts to improve the rate of successful reconstructions have merit. Not only is reconstruction a reasonable goal at an experienced level-I trauma center, it results in lower lifetime costs.

Intimate Partner Violence and Abuse among Active Duty Military Women

BACKGROUND The purpose of this paper is to describe womens opinions and policy preferences concerning domestic violence screening and mandatory reporting. METHODS This case-control study included 202 abused women and 240 randomly selected non-abused women recruited from a large metropolitan health maintenance organization who were interviewed by telephone. Of these women, 46.6% had a college degree, 53.4% were white, and 60% had a household income of

Child restraint laws: an analysis of gaps in coverage.

50,000 or more. RESULTS Forty-eight percent of the sample agreed that health care providers should routinely screen all women, with abused women 1.5 times more likely than non-abused women to support this policy. For mandatory reporting, 48% preferred that it be the womans decision to report abuse to the police. Women thought it would be easier for abused women to get help with routine screening (86%) and mandatory reporting (73%), although concerns were raised about increased risk of abuse with both screening (43%) and reporting (52%) policies. Two thirds of the sample thought women would be less likely to tell their health care providers about abuse under a mandatory reporting policy. Interventions offered in managed care settings that would be well received, according to the women in this study, include counseling services, shelters, and confidential hotlines. CONCLUSIONS Women expressed fears and concerns about negative consequences of routine screening and, even more so, for mandatory reporting. Domestic violence policies and protocols need to address the safety, autonomy, and confidentiality issues that concern women.

Teen childbearing and educational attainment : A comparison of methods

Abstract Self-reported data from a survey of roughly 1,100 female health maintenance organization enrollees in the Washington, DC, metropolitan area are used to investigate the lifetime and annual prevalence of emotional, physical, and sexual abuse by intimate partners. The sample consists of a racially balanced and, for the most part, well-educated group of working women. Three dimensions of abuse based on responses to questions from a modified version of the Abuse Assessment Screen are employed. In addition to simple descriptive analyses, logistic regression was performed. The estimated annual prevalence is lower than estimates reported in other studies. However, lifetime prevalence is very similar to estimates found in primary care clinical samples and somewhat higher than those derived from population-based surveys. More highly educated women report the lowest lifetime prevalence of intimate partner abuse. The finding that this sample of well-educated, middle-class working women has lifetime prevalence rates similar to those of women who are not as well off demonstrates that intimate partner abuse is not limited to disadvantaged women from vulnerable population subgroups.

Assessing the Effect of Batterer Program Completion on Reassault: An Instrumental Variables Analysis

Recent experimental evaluations have suggested little or no effect of batterer programs on reassault but are compromised by methodological and analytical issues. This study assesses program effect using propensity score analysis with a quasi-experimental sample in an attempt to address these issues. The sample consisted of 633 batterers and their partners from three geographically dispersed batterer programs and a 15-month follow-up with their female partners. Subclassification on propensity scores was used to balance program completers and program dropouts. The propensity score was estimated as the probability of completing the batterer program conditional on observable characteristics. Direct adjustment indicates that program completion reduced the probability of reassault during the 15-month follow-up by 33% for the full sample, and by nearly 50% for the court-ordered men.

Multivariate Discrete Hidden Markov Models for Domain-Based Measurements and Assessment of Risk Factors in Child Development

OBJECTIVES We examined racial/ethnic disparities in highly active antiretroviral therapy (HAART) use and whether differences are moderated by substance use or insurance status, using data from the Womens Interagency HIV Study (WIHS). METHODS Logistic regression examined HAART use in a longitudinal cohort of women for whom HAART was clinically indicated in 2005 (N = 1354). RESULTS Approximately 3 of every 10 eligible women reported not taking HAART. African American and Hispanic women were less likely than were White women to use HAART. After we adjusted for potential confounders, the higher likelihood of not using HAART persisted for African American but not for Hispanic women. Uninsured and privately insured women, regardless of race/ethnicity, were less likely than were Medicaid enrollees to use HAART. Although alcohol use was related to HAART nonuse, illicit drug use was not. CONCLUSIONS These findings suggest that expanding and improving insurance coverage should increase access to antiretroviral therapy across racial/ethnic groups, but it is not likely to eliminate the disparity in use of HAART between African American and White women with HIV/AIDS.