bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Empty Toolbox? Changes in Health Plans’ Approaches for Managing Costs and Care
Authors: Mays Glen P. , Hurley Robert E. , Grossman Joy M. 
Published: March 2003

Objective. To examine how health plans have changed their approaches for managing costs and utilization in the wake of the recent backlash against managed care.Data Sources/Study Setting. Semistructured interviews with health plan executives, employers, providers, and other health care decision makers in 12 metropolitan areas that were randomly selected to be nationally representative of communities with more than 200,000 residents. Longitudinal data were collected as part of the Community Tracking Study during three rounds of site visits in 1996–1997, 1998–1999, and 2000–2001.Study Design. Interviews probed about changes in the design and operation of health insurance products—including provider contracting and network development, benefit packages, and utilization management processes—and about the rationale and perceived impact of these changes.Data Collection/Extraction Methods. Data from more than 850 interviews were coded, extracted, and analyzed using computerized text analysis software.Principal Findings. Health plans have begun to scale back or abandon their use of selected managed care tools in most communities, with selective contracting and risk contracting practices fading most rapidly and completely. In turn, plans increasingly have sought cost savings by shifting costs to consumers. Some plans have begun to experiment with new provider networks, payment systems, and referral practices designed to lower costs and improve service delivery.Conclusions. These changes promise to lighten administrative and financial burdens for physicians and hospitals, but they also threaten to increase consumers’ financial burdens.
Whom Should We Profile? Examining Diabetes Care Practice Variation among Primary Care Providers, Provider Groups, and Health Care Facilities
Authors: Krein Sarah L , Hofer Timothy P , Kerr Eve A , Hayward Rodney A 
Published: March 2003

Objective. To evaluate the amount of variation in diabetes practice patterns at the primary care provider (PCP), provider group, and facility level, and to examine the reliability of diabetes care profiles constructed using electronic databases.Data Sources/Study Setting. Clinical and administrative data obtained from the electronic information systems at all facilities in a Department of Veterans Affairs' (VA) integrated service network for a study period of October 1997 through September 1998.Study Design. This is a cohort study. The key variables of interest are different types of diabetes quality indicators, including measures of technical process, intermediate outcomes, and resource use.Data Collection/Extraction Methods. A coordinated registry of patients with diabetes was constructed by integrating laboratory, pharmacy, utilization, and primary care provider data extracted from the local clinical information system used at all VA medical centers. The study sample consisted of 12,110 patients with diabetes, 258 PCPs, 42 provider groups, and 13 facilities.Principal Findings. There were large differences in the amount of practice variation across levels of care and for different types of diabetes care indicators. The greatest amount of variance tended to be attributable to the facility level. For process measures, such as whether a hemoglobin A1c was measured, the facility and PCP effects were generally comparable. However, for three resource use measures the facility effect was at least six times the size of the PCP effect, and for intermediate outcome indicators, such as hyperlipidemia, facility effects ranged from two to sixty times the size of the PCP level effect. A somewhat larger PCP effect was found (5 percent of the variation) when we examined a “linked” process–outcome measure (linking hyperlipidemia and treatment with statins). When the PCP effect is small (i.e., 2 percent), a panel of two hundred diabetes patients is needed to construct profiles with 80 percent reliability.Conclusions. Little of the variation in many currently measured diabetes care practices is attributable to PCPs and, unless panel sizes are large, PCP profiling will be inaccurate. If profiling is to improve quality, it may be best to focus on examining facility‐level performance variations and on developing indicators that promote specific, high‐priority clinical actions.
Estimating Paid and Unpaid Hours of Personal Assistance Services in Activities of Daily Living Provided to Adults Living at Home
Authors: LaPlante Mitchell P. , Harrington Charlene , Kang Taewoon 
Published: March 2003

Objective. To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data.Data Sources. The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS‐D) conducted from 1994 to 1997.Data Collection/Extraction Methods. Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household‐resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables.Findings. We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18–64 received help than those ages 65 and older (6.9 versus 6.2 million), but working‐age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability.Conclusions. Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching 200billion.Only16percentofthistotalispaid,representing32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working‐age and older adults, documents that older persons are more likely to receive paid personal assistance, while working‐age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.
An Observational Study of Antibiotic Prescribing Behavior and the Hawthorne Effect
Authors: Mangione‐Smith Rita , Elliott Marc N , McDonald Laurie , McGlynn Elizabeth A 
Published: March 2003

Objectives. To assess whether prospective, observational study procedures, including questionnaires and audio recording, are associated with different patterns of physician diagnostic decision making and antibiotic prescribing.Data Sources/Setting. (1) Survey data from a prospective observational study of treatment patterns for children with acute upper respiratory illnesses (10/96–3/97) and (2) retrospective medical record abstraction data of nonobserved encounters for the same problems occurring during (10/96–3/97) and one year after (10/97–3/98) the observational study period. Ten pediatricians in two community practices were studied.Study Design. Patterns of diagnoses recorded in the medical record and antibiotics ordered for visits occurring outside of the observational study (same time period and one year later) were compared with the pattern of diagnoses and antibiotics ordered during the observational study.Data Collection/Extraction Methods. For the observational study (10/96–2/97), diagnosis and treatment choices were obtained from questionnaires completed by physicians immediately following the visit. For the nonstudy encounters (10/96–3/97 and 10/97–3/98), data were abstracted from medical records one year after the observational study was completed.Principal Findings. The proportion of viral cases in which an antibiotic was prescribed was 29 percentage points lower for the observational study compared to the retrospective analysis (p<.05). In one of two study sites, the proportion of cases assigned a bacterial diagnosis was 29 percentage points lower in the observational study period compared to the retrospective study (p<.05).Conclusions. Observational study procedures including questionnaires and audio recording can affect antibiotic prescribing behavior. Future observational studies aimed at examining the frequency of inappropriate antibiotic prescribing should measure and adjust for the Hawthorne effect; without such adjustments, the results will likely underestimate the true degree of the problem. Future interventions aimed at decreasing inappropriate antibiotic prescribing should consider “harnessing” the Hawthorne effect through performance feedback to participating physicians.
Divide and conquer: multiple leasing in common pool oil fields
Authors: Yuan Lasheng 
Published: March 2003

A theoretic model is developed to analyse strategic leasing behaviours of U.S. landowners in a non‐exclusively owned common oil pool. Oil field development is modelled as a simultaneous‐move two‐stage non‐cooperative game. The landowners choose leasing strategies in the first stage; independent lease operators choose extraction strategies in the second. Ownership structure is distinguished from operation structure and their relationship analyzed. It is shown that, in a non‐exclusively owned oil field, it is individually rational for a landowner to subdivide his landholding and delegate production rights to multiple independent firms, although more dispersed production control leads to heavier common pool losses. JEL classification numbers: L23, D23, Q24 Diviser pour régner : baux multiples dans des champs pétroliers construits sur une même nappe. Ce mémoire construit un modèle théorique pour analyser les comportements stratégiques des propriétaires terriens dans le cas de baux de forage quand le fond pétrolier à exploiter est en propriété commune. On modélise le processus de développement du champs pétrolier comme un jeu sans coopération à deux étapes avec décisions simultanées. Les propriétaires terriens choisissent des stratégies de baux dans une première étape et des opérateurs locataires indépendants choisissent des stratégies d’extraction dans un second temps. Ce faisant, on est capable de distinguer la structure de propriété de la structure des opérations, et d’analyser les relations entre elles. On montre que pour une nappe pétrolière qui est en propriété commune, il est rationnel pour un propriétaire terrien individuel de subdiviser sa propriété et de louer des droits de production à plusieurs entreprises indépendantes, même si cette dispersion du contrôle de la production entraîne des pertes beaucoup plus lourdes dans l’exploitation de la nappe pétrolière en propriété commune.
Retail price cycles and response asymmetry
Authors: Eckert Andrew 
Published: March 2003

Weekly retail gasoline prices in Windsor, Ontario, from 1989 to 1994 appear to respond faster to wholesale price increases than to decreases, but exhibit a cyclic pattern inconsistent with a common explanation of response asymmetry. I reconcile these observations through a model of price cycles. Prices on the downward portion of the cycle appear insensitive to costs, compared with price increases, supporting the theory that price decreases result from battles over market share. This pattern resembles a faster response to cost increases than to decreases, and the conclusion that asymmetry indicates a role for competition policy may be inappropriate. JEL Classification: L13, L71 Cycles des prix de détail et réponse asymétrique. Les prix de détail hebdomadaires de la gazoline à Windsor (Ont.) entre 1989 et 1994 semblent réagir plus vite aux accroissements qu’aux chutes des prix de gros, mais suivent un pattern cyclique qui ne semble pas consistant avec l’explication traditionnelle en termes de réponse asymétrique. L’auteur réconcilie ces observations à l’aide d’un modèle de cycle de prix. Les prix dans la portion descendante du cycle semblent insensibles aux variations de coûts, par comparaison avec les accroissements de prix, ce qui supporte la théorie que les chutes de prix résultent de luttes pour les parts de marché. Le pattern ressemble à celui déclenché par une réponse plus rapide aux augmentations qu’aux chutes de coûts, et la conclusion qui voudrait qu’on puisse attribuer le tout à l’asymétrie des réponses (et que donc une intervention de la politique de la concurrence s’impose) peut être inappropriée.
The impact of patent rights on international trade: evidence from Canada
Authors: Rafiquzzaman Mohammed 
Published: March 2003

The extent to which Canadian manufacturing exports are sensitive to national differences in patent rights are examined. The conclusion is that, overall, Canadians tend to export more to those countries where their patent rights are highly safeguarded. Stronger patent protection induces Canadians to export relatively more to high‐income countries than to low‐income countries. In addition, the effect of stronger patent rights is to increase exports to those countries that pose a strong threat of imitation and to reduce exports to those countries that pose the weakest threat of imitation. JEL Classification: F13; O34 Impact de la propriété des brevets sur le commerce international: résultats pour le Canada. Ce mémoire examine jusqu’à quel point les exportations manufacturières canadiennes sont sensibles aux différences dans la propriété des brevets entre pays. L’étude conclut que les Canadiens tendent à exporter davantage vers les pays où la propriété des brevets est hautement protégée.Il appert que la plus forte protection de la propriété des brevets tend à faire que les Canadiens exportent relativement plus vers les pays à hauts revenus que vers ceux à plus faibles revenus. De plus, il appert que l’effet de la plus forte protection des brevets est d’accroître les exportations vers les pays qui posent une forte menace d’imitation et de réduire les exportations vers les pays qui posent la plus faible menace d’imitation.
Rank, separability, and conditional demands
Authors: Lewbel Arthur 
Published: March 2003

RankR demand systems that are either conditioned on some good (such as durables) or are separable from that good, are shown to be identical to unconditional demand systems having rank R or R+ 1. More generally, the rank of a conditional demand system or a separable subsystem is a lower bound on the rank of the corresponding demand system over all goods. This relationship is applied to reinterpret some existing empirical results regarding rank, conditioning goods, and separability. Rang, séparabilité et demandes conditionnelles. On montre que des systèmes de demande de rang R qui sont conditionnés par rapport à un bien (des biens durables par exemple) ou sont séparables de ce bien sont identiques aux systèmes de demande inconditionnels de rang R ou R+ 1. Plus généralement, le rang d’un système de demande conditionnel ou d’un sous‐système séparable est une limite inférieure au rang du système de demande correspondant pour tous les biens. Cette relation est utilisée pour ré‐interpréter quelques résultats empiriques pour ce qui est du rang, des biens conditionnants et la séparabilité.
Decomposing changes in wage distributions: a unified approach
Authors: Lemieux Thomas 
Published: March 2003

Over the last fifteen years, many researchers have attempted to explain the determinants and changes of wage inequality. I propose a simple procedure to decompose changes in the distribution of wages or in other distributions into three factors: changes in regression coefficients; the distribution of covariates, and residuals. The procedure requires only estimating standard OLS regressions augmented by a logit or probit model. It can be extended by modelling residuals as a function of unmeasured skills and skill prices. Two empirical examples showing how the procedure works in practice are considered. In the first example, sources of differences in the wage distribution in Alberta and British Columbia are considered; in the second, sources of change in overall wage inequality in the United States, 1973–99, are re–examined. Finally, the proposed procedure is compared with existing procedures. JEL classification: J3 La décomposition des changements dans les distributions de salaires : une approche unifée. Au cours des quinze dernières années, nombre d’études se sont penchées sur les déterminants et les changements de la distribution des salaires. Ce mémoire propose une procédure pour décomposer les changements de la distribution des salaires en trois éléments: les changements dans les coefficients de régression, la distribution des regresseurs et les changements résiduels. Cette procédure ne nécessite que l’estimation de regressions par moindre carrés ordinaires et d’un modèle probit ou logit. L’auteur montre aussi comment modéliser les résidus en fonction de compétences non mesurées. La procédure proposée est mise en application dans le contexte de deux exemples: la distribution des salaires en Alberta et en Colombie–Britannique et les changements dans la distribution des salaires de 1973 à 1999 aux Etats–Unis. Le mémoire examine aussi comment cette procédure se compare aux méthodes proposées par d’autres chercheurs.
Detection of BCR-ABL mutations in patients with CML treated with imatinib is virtually always accompanied by clinical resistance, and mutations in the ATP phosphate-binding loop (P-loop) are associated with a poor prognosis
Authors: Branford Susan , Rudzki Zbigniew , Walsh Sonya , Parkinson Ian , Grigg Andrew , Szer Jeff , Taylor Kerry , Herrmann Richard , Seymour John F. , Arthur Chris , Joske David , Lynch Kevin , Hughes Tim 
Published: March 2003

Abstract
Imatinib-treated chronic myeloid leukemia (CML) patients with acquired resistance commonly have detectable BCR-ABL kinase domain mutations. It is unclear whether patients who remain sensitive to imatinib also have a significant incidence of mutations. We evaluated 144 patients treated with imatinib for BCR-ABL kinase domain mutations by direct sequencing of 40 accelerated phase (AP), 64 late chronic phase (≥ 12 months from diagnosis, late-CP), and 40 early-CP patients. Mutations were detected in 27 patients at 17 different residues, 13 (33%) of 40 in AP, 14 (22%) of 64 in late-CP, and 0 of 40 in early-CP. Acquired resistance was evident in 24 (89%) of 27 patients with mutations. Twelve (92%) of 13 patients with mutations in the adenosine triphosphate (ATP) binding loop (P-loop) died (median survival of 4.5 months after the mutation was detected). In contrast, only 3 (21%) of 14 patients with mutations outside the P-loop died (median follow-up of 11 months). As the detection of mutations was strongly associated with imatinib resistance, we analyzed features that predicted for their detection. Patients who commenced imatinib more than 4 years from diagnosis had a significantly higher incidence of mutations (18 [41%] of 44) compared with those treated within 4 years (9 [9%] of 100), P &lt; .0001. Lack of a major cytogenetic response (MCR) was also associated with a higher likelihood of detecting a mutation; 19 (38%) of 50 patients without a MCR had mutations compared with 8 (8.5%) of 94 with an MCR, P &lt; .0001. In conclusion, the detection of kinase domain mutations using a direct sequencing technique was almost always associated with imatinib resistance, and patients with mutations in the P-loop had a particularly poor prognosis. (Blood. 2003; 102:276-283)
Secondary Myeloid Leukemia and Myelodysplastic Syndromes in Patients Treated for Hodgkin’s Disease: A Report From the German Hodgkin’s Lymphoma Study Group
Authors: Josting Andreas , Wiedenmann Sabine , Franklin Jeremy , May Michael , Sieber Markus , Wolf Juergen , Engert Andreas , Diehl Volker 
Published: March 2003

Purpose: To assess the incidence and outcome of secondary acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) in patients with Hodgkin’s disease (HD). Patients and Methods: Between 1981 and 1998, the GHSG conducted three trial generations for early, intermediate, and advanced HD involving a total of 5,411 patients (called HD1 through HD9). Results: A total of 46 patients with secondary AML/MDS were identified. The median age at diagnosis of leukemia was 47 years (range, 22 to 79 years). Primary therapy was as follows: radiotherapy alone (n = 4); doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD; n = 1); cyclophosphamide, vincristine, procarbazine, and prednisone (COPP)/ABVD or similar (n = 30); bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) baseline (n = 2); and BEACOPP escalated (n = 9). Twelve patients developed AML/MDS after salvage therapy, including four patients who developed AML/MDS after high-dose chemotherapy with autologous stem-cell transplantation. Thirty-six of the secondary malignancies were AML, and 10 malignancies were MDS. After a median observation time of 55 months, incidence of secondary AML/MDS was 1%. Treatment for secondary AML/MDS was as follows: cytarabine (Ara-C)–containing regimens (6-thioguanin, cytarabine, daunorubicin [TAD]/high-dose cytarabine, mitoxantrone [HAM], HAM, Ida-Ara-C (idarubicin + Ara-C), Ida-Flag (idarubicin, fludarabin, Ara-C, G-CSF), and idarubicin, cytarabine, etoposide [ICE]+HAM; n = 11), TAD-chemotherapy (n = 5), other regimens (n = 3), no treatment or supportive care (n = 24), palliative oral chemotherapy (n = 3), and allogeneic stem cell transplantation (n = 9). After 24 months of observation, no difference in freedom from treatment failure and overall survival (2% and 8%, respectively) was observed in patients who developed AML or MDS. Conclusion: The prognosis of patients with secondary AML/MDS after primary HD is poor. Thus, emphasis should be made to improve initial treatment in an attempt to prevent this complication.
Postpartum Thyroiditis Is Associated with Fluctuations in Transforming Growth Factor-β1 Serum Levels
Authors: Olivieri A. , De Angelis S. , Vaccari V. , Valensise H. , Magnani F. , Stazi M. A. , Cotichini R. , Gilardi E. , Cordeddu V. , Sorcini M. , Boirivant M. 
Published: March 2003

Postpartum thyroiditis (PPT) is characterized by a rapid evolution and recovery of euthyroidism. Therefore, it can represent a good model to study early cytokine fluctuations in autoimmune thyroid diseases. TGFβ1 is an immunosuppressive cytokine, as it inhibits T and B cell proliferation, natural killer cell cytotoxic activity, and the generation of T cell cytotoxicity.The aim of this study was to assess serum concentrations of TGFβ1 during pregnancy and to study possible serum fluctuations of this cytokine during the different phases of PPT. Thyroid biochemical pattern, antithyroid autoantibodies (ATA), and total and active TGFβ1 (aTGFβ1) serum concentrations were evaluated in 63 pregnant women. Thirty-four of them were ATA+, and 29 were ATA−. Twenty of the 34 ATA+ women were followed in the postpartum year. Nine of these 20 women developed PPT; 11 remained euthyroid. All of the PPT women became euthyroid during the follow-up. Our results showed 1) detectable serum levels of aTGFβ1 in 50% of ATA+ pregnant women, suggesting that the presence of autoantibodies may characterize a favorable condition for TGFβ1 activation; and 2) decreased total TGFβ1 and increased aTGFβ1 serum levels during the active phase of PPT in ATA+ women. This seems to suggest that inflammation may be responsible for TGFβ1 activation and autoantibody increase because of antigen release. Although further studies of women with persistent hypothyroidism after the postpartum year are needed, the possibility that the enhanced activation of TGFβ1 may contribute to resolution of thyroid inflammation postpartum cannot be excluded.