Samuel L. Baker

An appraisal of organizational response to fiscally constraining regulation: the case of hospitals and DRGs.

Results from analysis of 227,771 discharge abstracts from 68 short-term, acute-care hospitals and from interviews with a stratified random selection of 24 of the 68 chief executives of these hospitals demonstrate that institutions perceive implementation of DRGs as fiscally constraining, especially in light of other resource-constraining conditions (an increase in unemployment resulting in fewer people with hospitalization insurance, in addition to severe cuts in Medicaid rolls and budget). Hospitals responded to DRGs by decreasing the use of affected resources or services available to the hospitalized Medicare patient. In order to survive a more economically stringent marketplace, hospitals no longer protected the traditional core within the Medicare inpatient market. They opted instead to change practices and products at the unregulated margins of the DRG system.

A program evaluation of postpartum/newborn home visitation services in Aiken County, South Carolina.

OBJECTIVE Home visiting programs for very young children seek to promote their health and development. We conducted a process and outcome evaluation of the Postpartum/Newborn Home Visit (PPNBHV) service in 1 county. DESIGN A retrospective study of Aiken County Health records of live infant births in 2004 was conducted. SAMPLE A random sample of 176 infants who were born in 2004 and enrolled in the women, infants, and childrens (WIC) program in the same year was selected. MEASURES Process measures include timeliness of the home visit, and appropriateness of revisits. Outcome measures include age at WIC enrollment and immunization status at 6/9 months. RESULTS Of the 176 infants, 76 (43%) received a home visit. Of these, 13 (17%) received the visit within the stipulated time frame. After controlling for potential confounders, infants who received a home visit were 4 times (95% CI 1.92-8.36) as likely to enroll early in the WIC program compared with those who did not. CONCLUSION The PPNBHV service may contribute to early enrollment in the WIC program. Improvement in the timeliness of the visits is needed. Program monitoring and evaluation are necessary to ensure adherence, measure outcomes, and provide feedback for continuous quality improvement.

The Reliability and Construct Validity of a Behaviorally Anchored Rating Scale Used To Measure Nursing Assistant Performance

Data are presented that demonstrate the reliability and construct validity of a 27-item Behaviorally Anchored Rating Scale (BARS) used to rate nursing assistant performance. A sample of 757 nursing assistants from 44 randomly selected long-term care facilities were rated with the BARS instrument by a team of independent observers, and later by the nursing assistantssupervisors. Interrater reliability between the independent observers and supervisors ranged from 0.34 to 0.96 and averaged 0.78. The internal consistency reliability measured by Cronbachs alpha was 0.71 for the independent observers, 0.76 for the supervisors. Construct validity was assessed by exploratory factor analysis. The underlying factor structure had 3 factors that accounted for 84.0% of the variance. Results were interpreted as supporting the reliability and indicating construct validity of this BARS for nursing assistants. Because BARSs have been shown to reduce subjectivity and personal bias, they are recommended for evaluating nursing assistant performance.

Projected Public Sector Savings in a Teen Pregnancy Prevention Project

Abstract Broad-based community education strategies have been implemented in a rural South Carolina county since fall, 1983, to prevent unintended teen pregnancy. Indices of pregnancy among teens show reductions from 1984–1987. Public sector costs were projected for Medicaid, Aid to Families with Dependent Children, and Food Stamps for families begun by first live births to 17 and under teens in the target county and three comparison counties. Assuming continuation of births/costs from preintervention time period, and as compared to actual number of births in 1984–1987, the reduced numbers in the target county realized a 20-year projected savings of

Aids-Related Knowledge and Attitudes of Social Workers in South Carolina

611,688. Two comparison counties realized a 20-year projected savings of

Incentives for physicians to treat hiv-seropositive patients: Results of a statewide survey

180,726 and

Rural physicians: a survey analysis of HIV/AIDS patient management.

13,902, while the third comparison county increased projected costs by

Increasing Home Health Service Referrals, Boon or Bane?

305,844. Considering that program implementation costs of

Medicaid prospective payment: case-mix increase.

260,000 were required from 1982 to 1987, the savings of this intervention approach are substantial for taxpayers and have meaning for public po...