Medicare - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

MEDICARE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Medicare: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84594-8 1. Medicare-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Medicare. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON MEDICARE................................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Medicare...................................................................................... 16 E-Journals: PubMed Central ....................................................................................................... 74 The National Library of Medicine: PubMed ................................................................................ 76 CHAPTER 2. NUTRITION AND MEDICARE ..................................................................................... 119 Overview.................................................................................................................................... 119 Finding Nutrition Studies on Medicare .................................................................................... 119 Federal Resources on Nutrition ................................................................................................. 121 Additional Web Resources ......................................................................................................... 122 CHAPTER 3. ALTERNATIVE MEDICINE AND MEDICARE .............................................................. 123 Overview.................................................................................................................................... 123 National Center for Complementary and Alternative Medicine................................................ 123 Additional Web Resources ......................................................................................................... 130 General References ..................................................................................................................... 131 CHAPTER 4. DISSERTATIONS ON MEDICARE ................................................................................ 133 Overview.................................................................................................................................... 133 Dissertations on Medicare ......................................................................................................... 133 Keeping Current ........................................................................................................................ 146 CHAPTER 5. PATENTS ON MEDICARE ........................................................................................... 147 Overview.................................................................................................................................... 147 Patents on Medicare................................................................................................................... 147 Patent Applications on Medicare............................................................................................... 154 Keeping Current ........................................................................................................................ 159 CHAPTER 6. BOOKS ON MEDICARE ............................................................................................... 161 Overview.................................................................................................................................... 161 Book Summaries: Federal Agencies............................................................................................ 161 Book Summaries: Online Booksellers......................................................................................... 162 Chapters on Medicare ................................................................................................................ 169 Directories.................................................................................................................................. 178 CHAPTER 7. MULTIMEDIA ON MEDICARE .................................................................................... 181 Overview.................................................................................................................................... 181 Video Recordings ....................................................................................................................... 181 CHAPTER 8. PERIODICALS AND NEWS ON MEDICARE ................................................................. 183 Overview.................................................................................................................................... 183 News Services and Press Releases.............................................................................................. 183 Newsletters on Medicare............................................................................................................ 187 Newsletter Articles .................................................................................................................... 189 Academic Periodicals covering Medicare................................................................................... 190 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 193 Overview.................................................................................................................................... 193 NIH Guidelines.......................................................................................................................... 193 NIH Databases........................................................................................................................... 195 Other Commercial Databases..................................................................................................... 197 APPENDIX B. PATIENT RESOURCES ............................................................................................... 199 Overview.................................................................................................................................... 199 Patient Guideline Sources.......................................................................................................... 199 Associations and Medicare......................................................................................................... 217 Finding Associations.................................................................................................................. 218

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APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 221 Overview.................................................................................................................................... 221 Preparation................................................................................................................................. 221 Finding a Local Medical Library................................................................................................ 221 Medical Libraries in the U.S. and Canada ................................................................................. 221 ONLINE GLOSSARIES................................................................................................................ 227 Online Dictionary Directories ................................................................................................... 227 MEDICARE DICTIONARY......................................................................................................... 229 INDEX .............................................................................................................................................. 273

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Medicare is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Medicare, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Medicare, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Medicare. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Medicare, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Medicare. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON MEDICARE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Medicare.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Medicare, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “Medicare” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Medicare Diabetes Self-Management Training and Medical Nutrition Therapy Benefits: New Web Resources Offer Key Information Source: Diabetes Spectrum. 15(4): 272-273. October 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Advocacy efforts conducted within the diabetes community during the past few years have contributed to improvements in diabetes care, increased funding for diabetes research, and reduced discrimination towards people with diabetes. This article describes two significant victories in diabetes care: the passage of legislation that increases Medicare coverage for diabetes self management training (DSMT) and supplies and medical nutrition therapy (MNT) for diabetes and renal disease. The

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authors note that to implement these two benefits in compliance with their accompanying regulations, health care professionals need to be aware of many details. Thus, the authors provide a guide to web-based resources on these topics, compiled by volunteers and staff from a variety of organizations, including the American Diabetes Association (ADA), the American Association of Diabetes Educators (AADE), and many others. 2 references. •

Medicare: Health Insurance Counseling is Available Source: Diabetes Forecast. 55(10): 60-62. October 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: As the government has increased Medicare choices, Medicare has become more and more complex. However, the federal government also supplies a source of advice: the State Health Insurance Counseling and Assistance Programs (SHIP). These programs provide free insurance help and information in person or by phone to people on Medicare and to their caregivers. This article describes the SHIP services and how they vary from state to state. In addition to one-on-one help, some SHIP offices also offer brochures or other written information on understanding health care. SHIP offices can refer people to other sources of help, such as social services or legal services. SHIP programs do not sell insurance and they have no links to any insurance company. The information they provide is meant to be independent and unbiased. One chart lists the Web addresses for all 50 SHIP offices. For phone numbers, the author advices calling 1800-MEDICARE (or www.Medicare.gov/contacts/Home.asp). 1 figure.

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Medicare, Medicaid, and Medigap Source: Diabetes Self-Management. 18(6): 61,63-64,66-67. November-December 2001. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: Evaluating health insurance needs and options is a tough job, whether one is enrolling private insurance or in a government sponsored plan such as Medicare or Medicaid. This article offers an overview of the major governmental health insurance programs, starting with some basic definitions. Medicare is a federal hospital-medical plan, designed primarily for the benefit of people over age 65 who are no longer participating in an employer or union group insurance program. Medicaid is a statemanaged program that provides medical care for people of any age who are of limited financial means. Medigap is a package of private insurance policies, purchased at the option and expense of the Medicare participant, designed to cover any gaps in Medicare benefits. One sidebar offers contact information for government programs, including web sites and telephone numbers for Medicare, Medicaid, CHIP, PACE, Social Security, and Federally Qualified Health Centers (FQHC). The author concludes that the nation's entire medical care delivery system, both public and private, is a work in progress. New and innovative programs are being announced regularly as the United States heads toward comprehensive universal health care.

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Evaluation of Neuroleptic Drug Use by Nursing Home Elderly Under Proposed Medicare and Medicaid Regulations Source: JAMA. Journal of the American Medical Association. 265(4): 463-467. January 23, 1991.

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Summary: Federal regulations for use of neuroleptic drugs in Medicare- and Medicaidcertified nursing homes throughout the United States were implemented October 1, 1990. These regulations constitute the first time that prescription drugs are required, by law, to be justified by indications documented in the medical chart. The study described in this article used extant data to estimate ineligible neuroleptic use at the individual and nursing home levels had these regulations been in effect in 1976 through 1985. The subjects, randomly sampled admissions (5752) and residents (3191), were followed up for up to 24 months in 60 nursing homes. One half of neuroleptic use in each cohort could be considered ineligible under the regulations; all but one of the nursing homes had one or more individuals who were treated with the ineligible use of neuroleptics. Improvements in documentation and/or prescription of neuroleptic drugs for nursing home elderly will be needed to ensure compliance with these new regulations. 20 references. (AA-M). •

De-Mystifying Medicare: A Primer for the Medicare Beneficiary with an Ostomy Source: Ostomy Quarterly. 32(1): 28-35. Winter 1994. Contact: Available from United Ostomy Association, Inc. 36 Executive Park, Suite 120, Irvine, CA 92714-6744. (800) 826-0826 or (714) 660-8624. Summary: In this article, the author familiarizes readers with the Medicare system and how it can best provide for the beneficiary with an ostomy. Topics include the provisions of Medicare Parts A and B; durable medical equipment and regional carriers; how Medicare pays for hospital, home health services, and medical retailers; utilization guidelines; documentation of medical necessity; the HCFA Common Procedure Coding System; allowables; the explanation of medical benefits; fraud and abuse; and the importance of beneficiaries' involvement in the system. The article concludes with a glossary. 4 figures.

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Medicare Coverage for Diabetes Care Source: Diabetes Self-Management. 19(3): 14-15, 19-20. May-June 2002. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: Medicare coverage for people with diabetes has changed quite a bit in the past five years, reflecting a trend in health insurance toward improved coverage of preventive services. This article explains these new benefits and reviews the services and supplies for people with diabetes that Medicare continues to cover. The benefits describe in the article are all available under Part B of the Original Medicare Plan. The new benefits include increased coverage of blood glucose monitoring supplies, insulin pumps, therapeutic shoes, and self-management education. In addition, two new benefits (glaucoma screening coverage and medical nutrition therapy coverage) went into effect on January 1, 2002. In each of these areas, the author explains who is covered and what services or supplies are covered. One sidebar lists three resource organizations through which readers can get more information about Medicare coverage.

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Changes in Medicare Reimbursement for Ostomy Supplies: An Overview Source: Journal of WOCN. Journal of Wound, Ostomy and Continence Nursing. 23(1): 26-32. January 1996. Contact: Available from Mosby Year-Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 453-4351 or (314) 453-4351.

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Summary: Medicare reimbursement and utilization for ostomy supplies have undergone dramatic change in the last year. This article provides an introduction for health care professionals to the Medicare system, Durable Medical Equipment Regional Carriers, Medicare participating and nonparticipating suppliers, and practical examples of how reimbursement may affect the selection of ostomy products. The topics refer to Medicare Part B. The authors emphasize that enterostomal (ET) nurses must be cognizant of the ongoing changes in reimbursement and must collaborate with suppliers, manufacturers, and other health care professionals to provide patients with the highest quality care, products, and services. 2 figures. 4 tables. 3 references. (AA). •

Medicare Reimbursement for Ostomy Supplies: How it Works, and What Can Be Done to Improve It Source: Ostomy Quarterly. 28(2): 26, 28-30, 32-33. Spring 1991. Summary: Medicare, the federal health insurance program for elderly and disabled United States citizens, has undergone many changes in both the process for reimbursement for ostomy supplies and in the amounts which are reimbursed. This article looks at several aspects of the program. Topics include: Medicare coverage of ostomy supplies; the definition of a Medicare carrier; how to become eligible for Medicare reimbursement; the use of the federal procedure code; the differential between allowable amounts and retail prices for supplies; how to find suppliers who accept Medicare assignment; how to increase the amount of reimbursement received for supplies; the role of the United Ostomy Association; and how to file an appeal of a Medicare decision. (AA-M).

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What Does It Mean for Patients? Expanded Medicare Coverage of Immunosuppressive Medications Source: Transplant News and Issues. S15-S17. May 2001. Contact: Available from Nephrology News and Issues Inc. 15150 North Hayden Road, Suite 101, Scottsdale, AZ 85260. (602) 443-4635. Summary: Organ transplantation has helped improve the quality of life of patients with end stage renal disease (ESRD) and has proven to be a successful alternative to dialysis. The trade off for transplant recipients is that they must take expensive medications for the rest of their lives and are forced to deal with the high costs. Historically, Medicare has covered 80 percent of the cost of immunosuppressive medications but imposed restrictive time limits. In 2000, Congress passed the Beneficiary Improvement and Protection Act (BIPA), which extends lifetime coverage of immunosuppressive drugs to Medicare beneficiaries and returns this medication benefit to other individuals who had lost coverage as the result of a previous time limit. This article explores the details of Medicare coverage of immunosuppressive medication and examines its impact on transplant recipients. Lifetime drug coverage is offered to ESRD Medicare beneficiaries, Social Security Disability Income (SSDI) Medicare beneficiaries, Social Security Retirement (SSR) beneficiaries, and transplant patients who lost drug coverage due to prior imposed time limits. The author offers eight different patient scenarios to help readers understand the impact of the new Medicare immunosuppressive drug benefit. One sidebar considers the other medications (non immunosuppressants) that the transplant recipient may need after the transplant.

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Quarter Century of Medicare Expenditures for ESRD Source: Seminars in Nephrology. 20(6): 516-522. November 2000.

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Contact: Available from W.B. Saunders Company. Periodicals Department. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Summary: The Medicare end stage renal disease (ESRD) program is unique in that it is the only example of an entitlement program based solely on the basis of a clinical condition. ESRD Medicare payments combine ESRD-specific payment policies such as those for dialysis, physician care, erythropoietin, and immunosuppression, and general Medicare payment policies such as hospital payments, nondialysis physician services, home health, and skilled nursing care. This article reviews the 25 year history of the program, noting that much of ESRD related care has been subject to more stringent cost controls than elsewhere in Medicare. Total payments for ESRD beneficiaries continue to consume an increasing percentage of Medicare expenditures, largely because of ever expanding patient treatment criteria. However, increases in per capita expenditures for ESRD beneficiaries have been far below that of Medicare in general. Medical care inflation has caused per capita costs for most of Medicare to increase by over 11 percent per year for a quarter of a century; ESRD per capita costs have increased by less than 5 percent annually, even in the face of expenses added for recombinant erythropoietin and parenteral vitamin D analogues. In addition, as experience with dialysis and transplantation increased, sicker patients began to be treated with dialysis, as shown by the increase in older and diabetic patients. The relatively controlled financial outlay has been accomplished by restrictions on dialysis facility payments, payments to physicians for oversight of dialysis, and, in the first years of the program, rapid increases in the numbers of transplants. 1 figure. 4 tables. 10 references. •

ESRD Patients Are Eligible for the Medicare ESRD Program Source: aakpRenalife. American Association of Kidney Patients Renalife. 13(2): 16, 18. Special Edition, 1998-1999. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. Summary: The Medicare ESRD Program is the only Federal program that finances disease specific services to a segment of the American people on virtually a universal basis. The program ensures that practically every patient with end stage renal disease (ESRD) in the U.S. has access to life sustaining dialysis treatment or kidney transplantation without having to exhaust all personal and family resources. This article reviews the Medicare ESRD Program and how it can be utilized by people with this disease. The author discusses the role of managed care and the situations of people who may already be covered or partially covered by employer based health plans. The author concludes by describing a booklet available to help readers understand their coverage options. The author encourages readers to learn all they can about their choices in the insurance opportunities available to them.

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Medicare Payment Options for Recombinant Erythropoietin Therapy Source: American Journal of Kidney Diseases. 18(4 Supplement 1): 93-97. October 1991. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (212) 889-2210 or (800) 622-9010. Summary: The authors of this article analyzed alternative payment approaches that Medicare could use to pay for recombinant human erythropoietin (rHuEPO) therapy. Topics include the influence of Medicare decisions on health care provision, balancing

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desirable and undesirable implications, notably in access to care and quality of care, the variable method of payment according to the setting in which care is provided, and the role of the Health Care Financing Administration (HCFA) in monitoring and responding to changing market conditions. The authors contend that HCFA's responsiveness to continuing changes promises to influence the quality of care, Medicare and beneficiary expenditures, and the positions of manufacturers and providers. 11 references. (AA-M). •

Recombinant Erythropoietin and Medicare Payment Source: JAMA. Journal of the American Medical Association. 266(2): 247-252. July 10, 1991. Summary: The biologic agent recombinant human erythropoietin provides a recent cas e study of the great influence which federal policies, especially Medicare payment, exert over the use and cost of medical technologies. By covering most dialysis patients, Medicare has been the predominant payer for recombinant erythropoietin, which corrects anemia associated with chronic renal disease. This article examines the impact of Medicare policies on the quality of care for beneficiaries. 7 tables. 22 references. (AAM).

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Misclassification and Selection Bias When Identifying Alzheimer's Disease Solely from Medicare Claims Records Source: JAGS: The Journal of the American Geriatrics Society. 47(2): 215-219. February 1999. Summary: This article addresses the fact that classification of Alzheimer's disease (AD) based on Medicare claims produces lower prevalence estimates and higher average costs than previous healthcare cost studies. Discrepancies arise because the types of studies differ in data sources, period length, and specification of dementia. Researchers used data on participants in the Medicare Alzheimer's Disease Demonstration (MADDE) to test the adequacy of claims data. Less than 20 percent of MADDE participants were classified with Dementia of the Alzheimer's Type (DAT) from a single year of claims, although 68 percent had a DAT diagnosis from a referring physician. Annualized expenditures were 1.7 times higher among those with DAT from claims. The authors conclude that underclassification of dementia from claims records can be partially remedied by increasing the period during which claims are compiled. Additional diagnostic sources are needed to obtain more accurate prevalence counts. 3 tables, 12 references (AA-M).

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Preventing Diabetic Foot Disease: Lessons from the Medicare Therapeutic Shoe Demonstration Source: American Journal of Medicine. 86(7): 935-938. July 1996. Summary: This article describes a 3-year Medicare-administered pilot program of a therapeutic-shoe benefit for beneficiaries with diabetes. This paper describes the benefit and its implementation in the pilot program based on demonstration records, a patient survey, and discussions with clinicians and shoe suppliers before and during the demonstration. During the demonstration, far fewer beneficiaries applied for the therapeutic shoes than were eligible for them. The authors discuss reasons for the low beneficiary application rate and the associated low participation rate among physicians treating patients with diabetes. The authors conclude that the benefit is unlikely to be used any more in the national program than in the demonstration unless physicians are

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educated in the role therapeutic shoes can play in diabetic foot disease, they prescribe the shoes for their patients, and they increase their patients' awareness of the shoes' value. 2 tables. 8 references. (AA-M). •

Diabetes in the African-American Medicare Population: Morbidity, Quality of Care, and Resource Utilization Source: Diabetes Care. 21(7): 1090-1095. July 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article describes a study that determined whether African American Medicare recipients with diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization. The sample included 1,376 patients with diabetes who were 65 years old or older and in the 1993 Medicare Current Beneficiary Survey. Morbidity measures were the Katz Index of Activities of Daily Living, Instrumental Activities of Daily Living, overall health perception, Charlson Comorbidity Index score, and diabetes complications. Quality of care standards were glycosylated hemoglobin measurements, ophthalmological visits, lipid testing, mammography, influenza vaccination, readmission within 30 days of hospital discharge, and outpatient visits within 4 weeks of hospital discharge. The Medicare reimbursement was stratified by type of service and adjusted for sex, education, and age in multivariate analyses. Results reveal that, compared with white patients, African American patients had worse health perception and lower quality of care. In multivariate analysis, African Americans were less likely than whites to have measurement of glycosylated hemoglobin, lipid testing, ophthalmological visits, and influenza vaccinations. African Americans were more likely to visit the emergency department and had fewer physician visits per year. They also had higher reimbursement for home health services, but total reimbursement was similar after case-mix adjustment. The article concludes that improved access to preventive care for older African Americans with diabetes may improve health perception and use of the emergency department. Future policy interventions to improve quality of care among Medicare patients with diabetes should especially target African Americans. An appendix lists reimbursement categories. 4 tables. 27 references. (AA-M).

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Effect of Donepezil Therapy on Health Costs in a Medicare Managed Care Plan Source: Managed Care Interface. 15(3): 63-70. March 2002. Summary: This article estimates the effect of donepezil therapy on health care costs in a large Medicare managed care plan. Patients with a diagnosis of Alzheimer's disease (AD) or related dementia were identified from the claims-and-encounters records of the plan. Costs for 204 patients with AD who were receiving donepezil were compared with a matched group of 204 AD patients who were not receiving donepezil. After controlling for age, gender, pharmacy benefits, comorbid conditions, and complications of dementia, annual costs for medical services and prescription drugs were found to be $3,891 lower for the donepezil group ($8,056 versus $11,947). Patients receiving longerterm therapy (270 days or longer) had greater savings ($4,192) than those receiving shorter-term therapy ($3,579). The results suggest that donepezil may be a cost-saving therapy for AD patients in Medicare managed care. 2 figures, 5 tables, 29 references.

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Medicare Expenditures Associated With Alzheimer Disease Source: Alzheimer Disease and Associated Disorders. 14(4): 187-195. 2000.

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Summary: This article examines the effects of dementia on the costs of medical care. Four years of data from the Medicare Current Beneficiary Survey were analyzed to compare the use of Medicare covered services by patients with Alzheimer's disease or related dementia (ADRD) and those without a dementing illness, adjusting for the presence of comorbidities and functional limitations. Although overall rates of Medicare spending were higher for ADRD patients, no consistent relation was found between the presence of dementia and higher Medicare spending when other factors such as functional status were included in the predictive model. In some years, dementia was associated with higher adjusted expenditures in community-dwelling patients, whereas nursing home residents with AD had lower Medicare expenditures. 6 tables, 42 references. •

Medicare Managed Care: Why Is It Coming? Source: Gastroenterology Clinics of North America. 26(4): 755-762. December 1997. Contact: Available from W.B. Saunders. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: This article explores recent and future changes to the Medicare system that are patterned after the managed care format. The author notes that many physicians are worried about this trend, but stresses that making more options, including many types of managed care plans available to seniors, may be more attractive to physicians than continued reliance on the direct control system traditionally associated with Medicare. The author first reviews the changes happening in private sector medical care and then summarizes the present structure of Medicare. Despite all of the changes occurring in the private sector, Medicare continues to remain primarily a fee for service program, with limited availability of and participation in managed care. Problems arise in the way Medicare payments are made to health maintenance organizations (HMOs). In addition, there is some controversy over the possibility that healthier than average seniors are participating in HMOs, thus skewing risk factors and costs. The author concludes by discussing what physicians can expect in the near future in this arena, as well as the future fiscal pressures expected to affect Medicare. A scenario in which traditional Medicare would become one of the many plan offerings available to seniors is briefly described. Most important, the premium payment made by the Government would be the same regardless of the choice. Seniors choosing less expensive plans would have most (or all) of the premium paid by the Government. Those choosing more expensive plans would pay more of the premium themselves. However, this model assumes many more choices than are currently available, more information available to seniors about the choices, monitoring or control of the enrollment process, and oversight of plan performance.

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Expanded Medicare Outpatient Coverage for Alzheimer's Disease and Related Disorders Source: Hospital and Community Psychiatry. 36(9): 939-942. September 1985. Summary: This article presents a case history which shows how the removal of certain limitations on Medicare coverage will give patients with Alzheimer's disease and related disorders greater financial access to appropriate medical and psychiatric care. It discusses the implications for geriatric psychiatry of a new recommendation of the Alzheimer's Disease Task Force of the Department of Health and Human Services concerning nonpsychotherapy physician services for patients with Alzheimer's disease and related disorders.

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Diabetes Care for Medicare Beneficiaries: Attitudes and Behaviors of Primary Care Physicians Source: Diabetes Care. 21(8): 1282-1287. August 1998. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article presents the results of a primary care physician (PCP) survey that obtained information related to PCP attitudes, knowledge, and practice patterns, as well as perceptions about barriers to care and the use of materials to assist in the delivery of diabetes care for elderly patients in the office setting. The survey was mailed to a random sample of 900 PCPs practicing in the states of Alabama, Iowa, and Maryland who met selection criteria and provided diabetes care to 25 or more Medicare beneficiaries during calendar year 1993. Results indicate that 370 PCP respondents considered blood glucose control to be the most important treatment goal. Ninety-two of respondents considered acceptable glycosylated hemoglobin (GHb) values to be those less than 8 percent. Blood pressure measurement and foot inspections for the detection of ulcers and infection were the most commonly reported routine procedures performed as part of an office visit. Laboratory tests reported to be frequently ordered included GHb, serum creatinine, and proteinuria tests. Patient nonadherence to the treatment regimen was reported to be the most common barrier to care. The majority of respondents reported using two treatment aids in caring for patients with diabetes. The article concludes that results provide some evidence that PCP self-reported attitudes, knowledge, and practice patterns in delivering diabetes care for elderly patients in the office setting more closely reflect current recommended practice than reported in previous physician surveys. However, opportunities for improvement still exist. 5 tables. 18 references. (AA-M).

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Medicare End-Stage Renal Disease Program: A Report from the Institute of Medicine Source: New England Journal of Medicine. 324(16): 1143-1148. April 18, 1991. Summary: This article reports on an Institute of Medicine study of the Medicare EndStage Renal Disease (ESRD) Program. The study investigated changes in the population of patients with ESRD, problems of access to care, quality of care now provided through the program, the effect of changes in reimbursement on quality of care, and the adequacy of current data systems to monitor these matters. The authors outline the recommendations of the Institute of Medicine in each of these areas and conclude by calling for a comprehensive program of basic and applied research into the diseases that cause kidney failure, as well as clinical studies, preventive and epidemiologic research, and health services research. 14 references.

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Caregiver Supports: Outcomes From the Medicare Alzheimer's Disease Demonstration Source: Health Care Financing Review. 19(2): 97-117. Winter 1997. Summary: This article reports the caregiver support network outcomes from the Medicare Alzheimer's Disease Demonstration and Evaluation. This randomized 3-year study involved 5,254 caregivers of people with dementia who were randomly assigned to a treatment group eligible for expanded community services reimbursement and case management or to no expanded benefit (controls). There was an overall decline in primary caregiving hours for both the treatment and control groups, with no difference in the rate of decline between groups. There was a small decline in the number of

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activities of daily living and instrumental activities of daily living (ADL/IADL) tasks provided by the primary caregivers over time. The rate of this decline was significantly slower for the treatment group, but the effect was small. The level of secondary caregiver assistance was low at baseline and declined for both the treatment and control groups over time. The number of unmet needs decreased significantly faster for the treatment group than for controls (30 percent reduction versus 12 percent reduction at 36 months). Assistance with ADL/IADL tasks increased to a similar extent in the two groups over the study period. The lack of a differential impact between the two models (low resource and high resource) on three of the five outcome measures - combined with greater impact in low-resource sites on the other two outcomes - suggests that more intensive case management and larger monthly expeditures for community based services did not sufficiently change caregiver support outcomes. 6 tables, 31 references. •

How Much Do Persons With Alzheimer's Disease Cost Medicare? Source: JAGS. Journal of the American Geriatrics Society. 48(6): 639- 646. June 2000. Summary: This article reports the cost to Medicare in 1994 of providing care to people with Alzheimer's disease (AD). A 12-year period of claims history was used to identify prevalent cases of AD and to investigate the effect of time since diagnosis on cost. The study population was drawn from respondents to the National Long Term Care Survey (NLTCS) in 1994, which identified and screened Medicare beneficiaries, aged 65 or older, with at least one limitation in a basic or instrumental activity of daily living. To be included in the analysis, respondents completed either a screener interview (n=10,858), a community interview (n=5,429), or an institutional interview (n= 1,341). Those with a diagnosis of AD were then identified based on the diagnosis codes found in their Medicare claims from 1984-1995. The average total cost to Medicare was $6,021 for persons with a claims- based diagnosis of AD, compared with $2,310 for those without a diagnosis of AD. This cost ratio of 2.6 to 1 was reduced to about 1.6 to 1 after adjustment for patient characteristics. Total Medicare cost was decreased by approximately 10 to 30 percent for each year since the initial diagnosis of AD. The authors conclude that time since diagnosis is an important predictor of cost and should be explicitly included in any rate-setting formula. 4 tables, 26 references.

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Medicare, Medicaid, and Diabetes Source: Diabetes Forecast. 53(9): 53-54. September 2000. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article, from a magazine for people with diabetes, describes the government sponsored health problems known as Medicare and Medicaid. The article explains the differences between the qualifications for these programs and the medical coverage they provide. The traditional Medicare program consists of Part A and Part B. Everyone who signs up for Medicare receives Part A insurance. This covers the cost of treatment while in the hospital, skilled nursing care outside the hospital, and hospice care under certain conditions. Medicare Part B is optional insurance that covers many more services but involves paying a premium. Many expenses are not covered by either Part A or Part B, so Medigap policies may be bought to cover these expenses. Aspects of Medicare that are of special interest to people who have diabetes include coverage for some therapeutic shoes, kidney treatments, diabetes education, and diabetes supplies. Medicaid qualifications and coverage vary from state to state, so people need to contact their state office to obtain specific information about their state's program.

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Donepezil Use in Managed Medicare: Effect on Health Care Costs and Utilization Source: Clinical Therapeutics. 21(12): 2173-2185. 1999. Summary: This journal article describes a study that examined the impact of donepezil on the costs of dementia care in a multi-site managed care organization between January 1996 and March 1998. Researchers examined retrospective medical and prescription claims data for 70 patients with Alzheimer's disease and related dementias who were prescribed donepezil. The outcomes of interest were the medical, prescription, and combined costs during the pretreatment and posttreatment phases. The median per diem medical costs (adjusted for differences in length of follow-up) were $1.22 lower in the posttreatment phase than the pretreatment phase. Posttreatment costs were reduced in six of seven service settings. However, the median per diem costs for prescriptions and all claims combined were increased by $2.59 and $2.11, respectively, in the posttreatment phase. Although donepezil was associated with a decrease in medical costs, particularly for outpatient services, overall costs were increased due to the higher costs of medication. 2 tables, 43 references.

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Medicare Alzheimer's Demonstration Project in the Greater Cincinnati Area Source: Pride Institute Journal of Long Term Home Health Care. 8(4): 22-27. Fall 1989. Contact: Pride Institute Journal, St. Vincent's Hospital, 153 West 11th Street, New York, NY 10011. (212) 790-8864. PRICE: Call for price information. Summary: This journal article describes the rationale of the national Medicare Alzheimer's Disease Research and Demonstration project mandated by the U.S. Congress in its Omnibus Budget Reconciliation Act of 1986, and discusses activities and progress of this project in the Cincinnati area. The project was authorized to document the cost and effectiveness of expanding the Medicare system to defray some of the service expenses for home and adult day care for Alzheimer's disease (AD) patients. The Cincinnati site will enroll 600 families, randomly divided into treatment and control groups of 300 each. The Cincinnati model will allow Medicare reimbursement for daily money management and chore services, and provide a rental pool of durable medical equipment in addition to the home care services available at all project sites. Formal notification of the grant award was made in January 1989, with the project start date set for December 1, 1989. Initial inquiries from applicant families have shown a widespread interest in and need for assistance to pay for in-home care. Nationally, over the next 30 months, the health status of AD patients and their primary caregivers who receive case management, family education and training, and Medicare reimbursement for in-home and day care services will be compared to a control group who do not receive special assistance or Medicare waivered services. The results of the study will be reported to the Congress, which will then consider if an expansion of Medicare services to include non-medical in-home care and/or case management for all AD families is financially feasible. 7 references.

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Cost of Alzheimer's Disease and Related Dementia in Managed-Medicare Source: Journal of the American Geriatrics Society. 47: 1065-1071. 1999. Summary: This journal article examines the costs of Alzheimer's disease and related dementias in a managed care organization (MCO) serving Medicare patients in four geographic regions of the United States. Medical and prescription claims seen for 677 patients with dementia were compared with those for 677 matched controls between January 1996 and March 1998. Total costs and claims were annualized and adjusted for

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age, sex, and comorbid conditions. Dementia prevalence was 0.83 percent. Mean total costs per year were 1.5 times higher for patients with dementia compared with controls ($13,487 vs. $9,276). Nearly 75 percent of the higher costs among dementia cases were related to inpatient expenses. Those with dementia had almost twice as many inpatient and emergency room claims as controls. In addition, among hospitalized patients, those with dementia stayed an average of 12 days longer than those without dementia. The higher total and inpatient costs for patients with dementia in this MCO parallel patterns found among Medicare patients in fee for service settings. Results emphasize the importance of improving clinical practice to maximize patient quality of life, reduce caregiver burden, and manage costs and service utilization. 4 tables, 27 references. •

Case Manager-Defined Roles in the Medicare Alzheimer's Disease Demonstration: Relationship to Client and Caregiver Outcomes Source: Care Management Journals. 1(1): 29-37. Winter 1999. Summary: This journal article explores the different approaches to case management used in the Medicare Alzheimer's Disease Demonstration (MADD). Fifty-seven case managers at eight MADD sites across the country were surveyed regarding their professional backgrounds and experience, and how they prioritized certain tasks, functions, and goals of case management. Client and caregiver outcome measures were collected at each site as part of the demonstration. The case managers differed significantly by site in how they prioritized tasks, functions, and goals, viewing themselves along a continuum from a clinical approach to one that emphasizes service management. The variations in case management style were related to certain outcomes such as behavioral management, caregiver burden, and service use, but not to other outcomes such as client cognitive or functional status. For the population with dementia, a more clinical approach to case management, focused on client outcomes works well and may be explored to help reduce caregiver burden. Appropriate design of case management programs with a clinical approach can be researched as a basis for case management practice. 1 figure, 3 tables, 29 references.

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Association Between Hospital and Surgeon Procedure Volume and Outcomes of Total Hip Replacement in the United States Medicare Population Source: Journal of Bone and Joint Surgery, The. 83-A(11): 1622-1629. November 2001. Summary: This journal article provides health professionals with information on a study that determined whether the volumes of primary and revision total hip replacements performed at hospitals and by surgeons are associated with rates of mortality and complications. The study involved an analysis of claims data of Medicare recipients who underwent elective primary total hip replacement (58,521 procedures) or revision total hip replacement (12,956 procedures) between July 1995 and June 1996. The study assessed the relationship between surgeon and hospital procedure volume and mortality, dislocation, deep infection, and pulmonary embolus in the first 90 days postoperatively. Analyses were adjusted for age, gender, arthritis diagnosis, comorbid conditions, and income. Analyses of hospital volume were adjusted for surgeon volume, and analyses of surgeon volume were adjusted for hospital volume. The study found that 12 percent of all primary total hip replacements and 49 percent of all revisions were performed in centers in which 10 or fewer of these procedures were carried out in the Medicare population annually. In addition, 52 percent of the primary total hip replacements and 77 percent of the revisions were performed by surgeons who carried out 10 or fewer of these procedures annually. Patients treated with primary total hip replacement in hospitals in which more than 100 of the procedures were performed per

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year had a lower risk of death than those treated with primary replacement in hospitals in which 10 or fewer procedures were performed per year. Patients treated with primary total hip replacement by surgeons who performed more than 50 of those procedures in Medicare beneficiaries per year had a lower risk of dislocation than those who were treated by surgeons who performed 5 or fewer of the procedures per year. Patients who had revision total hip replacement done by surgeons who performed more than 10 such procedures per year had a lower rate of mortality than patients who were treated by surgeons who performed 3 or fewer of the procedures per year. The article concludes that patients treated at hospitals and by surgeons with higher annual caseloads of primary and revision total hip replacement had lower rates of mortality and of selected complications. These analyses of Medicare claims are limited by a lack of key clinical information such as operative details and preoperative functional status. 7 tables and 37 references. (AA-M). •

Physicians and Their Elderly Patients' Legal Rights, Part I: Medicare, Medicaid, Elder Abuse Source: Geriatrics. 44(9): 57-58, 61-63, 66. September 1989. Summary: This journal article, presented in the form of a panel discussion between two physicians and three attorneys, describes the ways in which physicians can get involved with their elderly patients' legal affairs. Topics include Medicaid eligibility, financial planning, Medicare and Medicaid benefits, nursing home admission, and elder abuse. 1 reference.

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Discrimination Against HIV - Infected Employee Can Result in Termination of Hospital's Medicare and Medicaid Funding Source: Health Care Law Newsletter; Vol. 8, No. 3, March 1993. Contact: Mathew Bender, Inc., 11 Penn Plaza, New York City, NY, 10001, (800) 833-9844. Summary: This newsletter article describes the legal consequences of discrimination against an HIV-infected employee. In the Westchester County Medical Center case, an employer faces the potential loss of Medicaid and Medicare funding due to discrimination against a potential employee, a pharmacist. The Americans with Disabilities Act and the Rehabilitation Act of 1973 require proof that a direct threat of communicating infections to others exists. Other arguments the employer raises include a concern for the health of the pharmacist as well as State laws prohibiting employment of actively-infected individuals. The employer ultimately loses all appeals and must hire the HIV- infected pharmacist without restrictions to avoid loss of Federal funding.

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Geographic Variation of Lower-Extremity Major Amputation in Individuals With and Without Diabetes in the Medicare Population Source: Diabetes Care. 24(5): 860-864. May 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This review article describes a cross sectional population based study that investigated geographic variation of lower extremity major amputation in people with and without diabetes in the Medicare population. The study analyzed claims data during hospitalizations for all nontraumatic lower limb major amputations in people with and without diabetes enrolled in Medicare from 1996 through 1997. The unit of analysis was 306 hospital referral regions (HRRs) representing health care markets for

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their respective tertiary medical centers. Numerators were calculated using nontraumatic major amputations and the diabetes code (205.x) for people with diabetes. Denominators for people with diabetes were created by multiplying the regional prevalence of diabetes by the regional Medicare population. Denominators for people without diabetes were the remaining Medicare beneficiaries. Rates of major amputations were adjusted for age, gender, and race. In the Medicare population during 1996 and 1997, a total of 44,599 and 39,111 major amputations were performed in people with and without diabetes, respectively. The adjusted rate of major amputations per year was 3.83 per 1,000 people with diabetes compared with 0.38 per 1,000 people without diabetes. Marked geographic variation was observed for people with and without diabetes; however, patterns were distinct between the two populations. Rates were high in southern and Atlantic states for people without diabetes. In contrast, rates for people with diabetes were widely varied. Variation across HRRs for people with diabetes was 8.6 fold compared with 6.7 fold in people without diabetes for major amputations. The article concludes that diabetes related amputation rates exhibit high regional variation, even after age, gender, and race adjustment. Future work should be directed at exploring sources of this variation. 2 figures. 1 table. 29 references. (AA-M).

Federally Funded Research on Medicare The U.S. Government supports a variety of research studies relating to Medicare. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Medicare. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore Medicare. The following is typical of the type of information found when searching the CRISP database for Medicare: •

Project Title: ACCESS TO BEHAVIORAL HEALTH SERVICES FOR WOMEN ON TANF Principal Investigator & Institution: Southerland, Dannia G.; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 04-JAN-2002; Project End 31-DEC-2003 Summary: Key features of welfare reform from an income maintenance entitlement (AFDC) to temporary cash assistance in exchange for work (TANF) are strict work requirements, sanctions, and time limits on eligibility. The expected outcome of this reform is self-sufficiency through employment. Underlying welfare reform is the assumption that TANF recipients are as able to work as women in the general

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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population. There is increasing recognition that a subset of the TANF population face barriers to work and self-sufficiency based on significant disability due to -serious mental illness (SMI). Access to behavioral health services by this at-risk population may be in jeopardy as a consequence of changes to welfare entitlements and declines in Medicaid enrollment. Employment for these women can be facilitated by access to effective behavioral health services. This pilot study examines these research concerns by identifying patterns of service use of the AFDC/TANF population with SMI and determining whether female heads of households with SMI who had received behavioral health services before leaving welfare continue to receive services after leaving TANF. Findings from this pilot study will be used to determine the feasibility of conducting a full-scale longitudinal study of the impact of welfare reform outcomes on heads-of-households currently or formerly receiving welfare that have SMI. The specific aims of the pilot are to: Identify patterns of service use of the target population of current and former female heads-of households with SMI receiving AFDC/TANF who used Medicaid reimbursed behavioral health services in Philadelphia, PA, between 1997 and 2000. Determine whether leaving welfare reduces access to treatment for women with SMI who used Medicaid behavioral health services while on AFDC/TANF. Develop a research design for a longitudinal study of the impact of welfare reform outcomes on current and former heads-of-households receiving welfare that have SMI, to submit as an R01 or a career development award proposal. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ADHERENCE AND ADJUSTMENT IN END-STAGE RENAL DISEASE Principal Investigator & Institution: Christensen, Alan J.; Professor; Psychology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-JAN-1995; Project End 31-DEC-2003 Summary: (adapted from investigator's abstract): Increased quality assurance concerns associated with the Medicare End-Stage Renal Disease (ESRD) program underscore the need for research addressing the adaptation and quality of life of ESRD patients. Patients' levels of psychological adjustment and their degree of adherence with ESRD treatment regimen reflect two important criteria that are examined in the present continuation proposal. One central objective of the research involves identifying psychological characteristics that influence medical regimen adherence and emotional adjustment among patients treated with renal dialysis. This will be accomplished using a longitudinal study design that considers the effects of patient individual differences (i.e., coping style) and contextual differences among the available dialysis treatment modalities. A key aspect of the study involves the assessment of patients at an early stage of progressive renal insufficiency, before renal dialysis is clinically necessary. We hypothesize that adherence and adjustment will vary as a joint function of the type of dialysis prescribed and patient individual differences assessed at baseline. For example, we predict that patients' possessing a more active or vigilant style of coping will exhibit more favorable adherence when undergoing a self-administered dialysis treatment modality (e.g., continuous ambulatory peritoneal dialysis) but poorer adherence when receiving staff administered dialysis (e.g., center hemodialysis). A second objective involves identifying patient characteristics that are related to adherence to adjustment among renal transplantation patients. Initial psychosocial assessment will be conducted during the pre-transplant evaluation process. A set of hypotheses regarding psychological predictors of patient adherence and changes in emotional well being after transplantation will be tested in a prospective manner. For Example, we hypothesize that patients with a more active style of coping with health-related stress will exhibit

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better regimen adherence and better emotional adjustment than other transplant patients. We believe the proposed research will extend the role of psychological theory and practice in contributing to the care of ESRD patients. The knowledge generated will add to a growing body of literature that suggests psychosocial assessment information can be useful in the selection f the most beneficial renal treatment modality for a particular patient. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ADHERENCE INTERVENTION FOR MINORITY CHILDREN WITH ASTHMA Principal Investigator & Institution: Rand, Cynthia S.; Associate Professor of Medicine; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: Low-income, minority children have disproportionately high rates of emergency department (ED) care for asthma compared to other children. Lack of access to asthma primary care and under-treatment of asthma have been implicated as contributing factors to this excess morbidity. Preliminary research by this group suggests that poor adherence with prescribed asthma therapies may also play a significant role. In a pilot study of low-income, minority children with symptomatic asthma we observed average daily adherence with anti-inflammatory therapy ranging from 1 percent to 32 percent of prescribed use. We hypothesize that improved adherence with asthma therapy can significantly reduce emergency room use for asthma care among high-risk children. To test this hypothesis, we will evaluate the effectiveness of an intensive adherence intervention that utilizes electronic medication monitors and medication measurement for monitoring and feedback, compared to a home-based asthma education intervention, and a usual care control group. The Johns Hopkins Pediatric Emergency Department (JHPED) will serve as our recruitment site. Families of asthmatic children ages 2-12 (N=270) with two or more emergency room visits or a hospitalization for asthma care in the past 12 months will be enrolled. Baseline measures will be collected after obtaining consent and prior to randomization. Participants will be randomly assigned to: 1) an Asthma Basic Care Intervention, or 2) an Adherence Monitoring and Feedback Intervention, or 3) a Usual Care Control Group. The duration of each intervention will be three months, with two booster visits at 6 months. Followup measures will be collected from families at 6, 12, and 18 months. The primary outcome measure will be medical record documented emergency care for asthma at the JHPED or other emergency or urgent care facilities over the eighteen-month follow-up period. Secondary outcomes include adherence with asthma therapy based on Medicaid pharmacy claims for asthma medications, other asthma health care (urgent and primary), self-reported medication adherence, barriers to health care, school absences, restricted activity, nighttime symptoms, asthma medications, self and family asthma management, asthma management self-efficacy, functional status, and quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ASSESSING PATIENT OUTCOMES IN PEDIATRIC ESRD Principal Investigator & Institution: Furth, Susan L.; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 15-APR-1999; Project End 31-MAR-2004 Summary: Dr. Furth, who trained in Pediatrics and Pediatric Nephrology at Johns Hopkins, is seeking this mentored award to study clinical outcomes associated with

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treatment choices for pediatric end stage renal disease (ESRD), complete a PhD in Clinical Investigation and transition to an independent career in clinical research. Under the mentorship of Dr. Neil Powe, she received the NIDDK Renal Disease Epidemiology Training Grant, was appointed as an Assistant Professor in the Division of Pediatrics, co-authored several published papers, developed the proposed research plan and presented several abstracts at important National Pediatrics and Nephrology meetings. Over 4,600 children and adolescents in the U.S. live with ESRD, at an annual Medicare cost of 40,000 dollars per patient year. Despite tremendous gains in survival, their "outcomes" in terms of mortality, hospitalizations, and the development of comorbid conditions, remain poor. No national study has previously addressed how particular treatment regimens and clinical experience with ESRD care affect pediatric patient mortality, hospitalization, growth and educational achievement. Furthermore, reliable measures of functional outcome, as an alternative measure of treatment effectiveness, have not been systematically studied in children with ESRD. The long term objectives of this proposal are to define patient, provider and treatment factors associated with optimal clinical outcomes in pediatric ESRD, and to test the use of a generic health questionnaire assessing functional health in adolescents with ESRD. We will achieve these aims through cross- sectional and longitudinal analyses of national data from the U.S. Renal Data System. We propose to identify how treatment with hemodialysis, peritoneal dialysis or transplantation and the facility's experience with children independently affect clinical outcomes. Additionally, we will assess the responsiveness of a generic adolescent health questionnaire in assessing changes in health status over time as an alternative outcome measure. This research proposal will provide an indepth analysis of health outcomes, and will provide valuable information regarding optimal treatment choices for children with kidney failure. During this project, Dr. Furth will gain new skills and knowledge in the sophisticated research techniques of multivariate risk adjustment, analysis of longitudinal data and psychometric assessment. The combination of observational and experimental research will provide the basis for further prospective studies in pediatric ESRD, and will give Dr. Furth the tools she needs to develop into an independent clinical investigator in a nurturing academic environment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BARRIERS TO ENROLLING THE ELDERLY IN CANCER TRIALS Principal Investigator & Institution: Gross, Cary P.; Assistant Professor; Internal Medicine; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 03-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant): BACKGROUND: Elderly patients are currently underrepresented in cancer clinical trials. As a result, new evidence may not be generalizable to the population group that carries the greatest burden of illness. Access to clinical trials also offers patients the opportunity to receive the newest treatments and meticulous clinical care. In order to ensure that the clinical trial system is relevant and accessible to all patients with cancer, it is important to identify specific barriers to the enrollment of elderly cancer patients. SPECIFIC AIMS: 1) To identify demographic and clinical characteristics of elderly cancer patients that are associated with clinical trial participation; 2) To identify institutional and organizational determinants of trial participation for elderly cancer patients; 3) To identify research centers that are particularly successful in enrolling elderly cancer patients into clinical trials, and determine whether the investigators' attitudes and enrollment strategies at these centers are different from those at centers that are less successful at enrolling elderly patients;

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and 4) To identify attitudes of elderly cancer patients towards participation in clinical trials. RESEARCH PLAN: First, we will perform a population-based analysis of barriers to the participation of elderly cancer patients with breast, prostate, lung, and colon cancer in clinical trials sponsored by the National Cancer Institute. The SEER-Medicare data will be used to estimate characteristics of incident cancer patients in the population. We will analyze the impact of patient and hospital characteristics, and health system factors such as managed care market penetration on the recruitment of elderly patients. Guided by these findings, we will then perform qualitative studies of elderly cancer patients as well as clinical investigators to ascertain their attitudes toward the participation of elderly patients in clinical trials. CAREER DEVELOPMENT PLAN: My career goal is to become an independent investigator, focusing on the quality of care for elderly patient with cancer-specifically on how new cancer therapies for elderly patients are evaluated and disseminated. In order to attain the necessary skills, I will work closely with my mentors on a rigorous program of research and independent study. Additionally, I will receive formal training in the Masters of Public Health program in Health Policy and Administration. SIGNIFICANCE: We hypothesize that patient reluctance, investigator attitudes, and the lack of insurance coverage for direct medical costs are crucial barriers to trial participation for elderly cancer patients. It is our hope that this work will facilitate the development of targeted and novel approaches to overcoming these barriers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BLACK HEALTH/FUNCTION

RURAL

AND

URBAN

CAREGIVERS--MENTAL

Principal Investigator & Institution: Chadiha, Letha A.; Associate Professor & Hartford Geriatric; None; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-OCT-2004 Summary: African-American women caregivers are vulnerable to poor mental health and social functioning due to their minority status and the high levels of care they provide to disabled elders. Moreover, African-American women provide such care in the context of less formal service. Research and theory suggest that rural and urban African-American women caregivers differ in their mental health, social functioning, and service use; however, virtually no systematic research has addressed these issues. This study will assess the mental health and social functioning of rural and urban African-American women who provide unpaid care to an elder (65 years and older) and will identify factors related to their service use. Using a cross-sectional research design and random sample of elders, this study will yield data on 300 rural and 300 urban African-American women caregivers living in the St. Louis metropolitan and southeastern Missouri Bootheel area. Three years of funding are requested to address four specific aims: (1) To assess and compare caregivers' mental health and functioning; (2) To identify type and quality of caregivers' formal and informal service use; (3) To determine caregiver and care recipient factors associated with caregivers' mental health and social functioning; and (4) To determine caregiver and care recipient factors associated with caregivers' service use. Data will be obtained through personal interviews. Trained African-American female interviewers will screen elders by telephone for caregiver referrals and conduct face-to-face interviews through a structured questionnaire in their home. Data analysis and interpretation will be guided by a stress and coping framework with elements of a life course perspective model.

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Study results will guide development of policy, programs and services promoting African-American women caregivers' mental health, social functioning, and service use. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CAN ADMINISTRATIVE DATA MATCH CLINICAL TRIAL RESULTS? Principal Investigator & Institution: Hebert, Paul L.; Health Policy; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2005 Summary: (provided by applicant): The Heart Outcome Prevention Evaluation (HOPE) trial demonstrated the efficacy of the angiotensin converting enzyme (ACE) inhibitor ramipril in slowing the progression of cardiovascular disease for persons with diabetes and reducing the incidence of diabetes in persons with other cardiovascular risk factors. Despite compelling findings from this randomized controlled trial, some questions remain, including the efficacy of medications with similar pharmacodynamic properties to ramipril that were not included in the HOPE study, and the efficacy of these drugs in patients who have been under-represented in clinical trials. The purpose of this study is to test the feasibility of using Medicare and Medicaid administrative data in conjunction with results from the HOPE trial to address these questions. We propose to: 1. Use causal statistical models to estimate the impact of the ACE-inhibitor ramipril on cardiovascular disease in persons with hypertension and diabetes or other coronary risk factors using Medicaid and Medicare administrative databases. 2. Compare the results of this model with the results for clinically similar patients who participated in the HOPE trial. If the results compare favorably, we will 3. Use the same statistical techniques to analyze the effectiveness of medications with similar pharmacodynamic properties to ramipril, such as other ACE-inhibitors and Angiotensin Receptor Blockers (ARBs), and to 4. Analyze the effectiveness of ramipril and other ACE-inhibitors and ARBs in African-American patients who were under-represented in the HOPE and other trials. The proposed study will make two important contributions. First, we will provide evidence on pharmacological therapy for persons with diabetes that can shape clinical care for a highly prevalent and burdensome disease. Second, we will develop and test a methodological framework that can be duplicated in numerous situations and may significantly enhance the utility of administrative and other secondary data sources for health outcomes research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COLORECTAL CANCER AND OTHER CANCERS OF THE GI TRACT Principal Investigator & Institution: Neugut, Alfred I.; Professor; Medicine; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 08-FEB-2001; Project End 31-JAN-2006 Summary: The applicant was the first to undertake a large-scale case-control study of colorectal adenomas, describing risk factors for their incidence and recurrence. This led to a strong interest in colorectal cancer screening, with Dr. Neugut one of the earliest advocates of the use of colonoscopy for screening. More recently, his interest in large bowel neoplasia has led to research in the epidemiology of small bowel adenocarcinoma; his research has confirmed a similarity between large and small bowel adenocarcinoma in a number of important ways. Dr. Neugut has also had extensive experience in the use of the SEER Registry and other large data bases for studying the epidemiology of multiple primary cancers, including a close association between small

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bowel and large bowel adenocarcinoma for co-occurrence in the same individuals, and an elevated risk for colorectal cancer with breast cancer in women. He proposes in this Award to expand his activities in health outcomes and health services research. This is an area in which Dr. Neugut has obtained research funding proposing to utilize the linked Medicare-SEER database, to explore various diagnostic and treatment-related issues in colorectal cancer, i.e., the risks of colonoscopy on a population-based scale, variations in the use of adjuvant chemotherapy for stage 111 colorectal cancer, the extent and cost of toxicity associated with the use of chemotherapy for colorectal cancer, etc. This research effort builds on his experience with the use of SEER and his clinical oncology experience. The Award will provide the opportunity to delve more deeply into use of the linked Medicare-SEER database for important epidemiologic, prevention, and cost-effectiveness questions, and will serve as a vehicle for future trainees. To translate cancer prevention and control findings to the community, he has developed expertise in the area of academic detailing, a method of increasing use of cancer prevention and screening tools by educating primary care practitioners regarding new advances in these areas. An American Cancer Society funded study is to randomize 400 primary care physicians, half to the intervention (visits and materials from the detailers), and half not. Knowledge, attitudes and beliefs regarding screening will be measured at baseline and at six months, and random records will be reviewed and audited to determine changes in behavior. This project builds upon Dr. Neugut's expertise in colon cancer epidemiology and screening as well as in academic detailing. He has been the PI of a T32 training grant which is funded for 10 pre- and post-docs yearly, and has been personally responsible for mentoring multiple trainees on every level, many of whom have gone on to academic faculty positions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COLORECTAL CANCER CARE VARIATION IN VULNERABLE ELDERLY Principal Investigator & Institution: Baldwin, Laura-Mae; Associate Professor; Family Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 04-JUN-2001; Project End 31-JAN-2004 Summary: Specific Aims: This study's long-term goal is to improve colorectal cancer care for the elderly who have a high incidence of this highly treatable and potentially curable disease. In 1990, a National Institutes of Health Consensus Panel recommended adjuvant therapies for colorectal cancer patients with stage III colon and stage II and III rectal cancer. The degree to which the elderly, especially traditionally vulnerable groups, are receiving these recommended treatments is unclear. This study will (1) compare the receipt of recommended colorectal cancer treatments between AfricanAmerican and Hispanic versus white elderly, and rural versus urban elderly; (2) compare diffusion of these treatments from 1992-1996 between our study groups; (3) identify the physician, patient, hospital, and environmental factors that predict differences found in treatment or diffusion; (4) measure treatment cost differences between our study groups, and the cost implications to the Medicare program of providing recommended treatments to all beneficiaries with colorectal cancer; and (5) evaluate several methodologies for cancer research using administrative databases, including different measures of comorbidity and costs. Research Design and Methods: This study will use the linked SEER-Medicare claims database in a retrospective cohort design to examine differences in receipt, diffusion, and cost of recommended colorectal cancer treatments between more and less vulnerable elderly populations. Using stage III colon and stage II and III rectal cancer cases identified in SEER between 1992 and 1996,

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we will identify different patterns of treatment and alternative measures of the costs for colorectal cancer care with Medicare claims data. Annual study cohorts will be tracked in a comprehensive database using 1991-1998 linked SEER-Medicare, AMA Masterfile, AHA, and Area Resource File data. Physician, hospital, and patient characteristics (including cancer stage and comorbidity) will be linked to the location, size, and socioeconomic profile of places of residence, travel distances to different treatment sites and cancer specialists, service utilization, and allowed charges. In the second phase of the study, we will use multivariate analysis to identify the degree to which physician, patient, hospital and environmental factors predict systematic differences in treatment patterns between our study populations. The cost analysis will include an estimate of the resources required to bring all patients up to the recommended standard of care. Alternate methods of defining comorbidity and costs will be used to evaluate their utility in cancer research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONSUMER ASSESSMENTS OF HEALTH PLANS STUDY (CAHPS) II Principal Investigator & Institution: Garfinkel, Steven; Managing Research Scientist; American Institutes for Research 1000 Thomas Jefferson Nw Washington, Dc 200073835 Timing: Fiscal Year 2002; Project Start 24-JUN-2002; Project End 31-MAY-2007 Summary: This project will (1) advance empirical knowledge of health care quality measurement and reporting through a carefully planned, long-term program of research, (2) study alternatives for integrating CAHPS data with other quality indicators, (3) bring new theoretical grounding to CAHPS, and (4) move CAHPS research into practice more effectively by developing methods for new sponsors and audiences. The research design includes a series of integrated projects in the areas of instrumentation and survey procedures, reporting quality information, using CAHPS measures for quality improvement, and evaluating CAHPS implementation and effects. The specific projects include: (a) Maintenance of the CAHPS Survey and Reporting Kit, (b) Updates of the CAHPS analytic strategy, with particular attention to developing the theoretical basis and practical applications for the assessment of entities with small populations, (c) Continued development of the instrument and survey procedures for G-CAHPS, NH-CAHPS, and PWMI-CAHPS, (d) Development of IP-CAHPS, PPO Questions, translations, and Web data collection procedures for CAHPS, (e) Laboratory studies of CAHPS evaluability, narratives, and framing, especially among persons with low educational attainment and literacy, (f) Electronic reporting, especially for parents of children with special health care needs and persons with low computer literacy, (g) Report templates development and a Final Report on the results of the 5-year reporting research program, (h) Use of G-CAHPS for Q1 with group practices in Oklahoma that primarily serve the Native American population and practices that serve the general Medicaid population, (i) Use of NH-CAHPS for QI in Tennessee, and (j) Evaluation of a social marketing intervention to promote effective CAHPS dissemination and use in Oklahoma, using G-CAHPS, CSHCN CAHPS, and the electronic report template. These projects will improve the measurement and reporting of CAHPS information, focus CAHPS on the units of analysis and aspects of care most salient to the public, and develop the new methods and understanding about quality needed to broaden the acceptance and use of CAHPS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CONSUMER DRIVEN MODEL FOR IMPROVING HEALTH CARE QUALITY Principal Investigator & Institution: Hopkins, David S.; Pacific Business Group on Health 221 Main St, Ste 1500 San Francisco, Ca 94105 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-DEC-2003 Summary: This proposal describes the California Physician Performance Measurement and Reporting (CPPMR) project, which will be conducted by the Pacific Business Group on Health (PBGH) in partnership with major employers, health plans, and consumer groups. The primary goal of the CPPMR project is to improve health care quality by stimulating market demand for high-quality physicians through the publication of individual physician quality and efficiency performance information. PBGH anticipates that market forces will direct health care purchasers and consumers to high quality physicians after reliable information is made available to inform their decisions. We also anticipate that physicians who do not perform well will be motivated to improve. In short, we feel that good information about physician performance plus market dynamics will lead to substantial improvements in health care quality. The CPPMR will use the AHRQ-supported RAND Health Quality of Care series, in combination with methodological advancements in physician-level performance measurement, to develop reliable and useful measures. We will use these measures and CMS claims data to develop indicators of physician quality and efficiency. The CPPMR measurement system will be based on improved methodologies such as modified episode of care methods and improved severity-of-illness adjustments. We anticipate that performance results will be generated for over 30,000 physicians in California. The CPPMR has the potential to directly improve health care for tens of millions of people. CPPMR results will be published through HealthScope.org, PBGH's consumer information website. The general public, will have access to quality and efficiency information about tens of thousands of California physicians. We anticipate that several large health plans including Blue Cross of California, Blue Shield of California and United Health Plan will make the information available to their members. The impact of the CPPMR will be expanded through the involvement of major consumer organizations such as AARP. While initially based on California data, the project can be considered a pilot that represents 10% of all Medicare claims data nationally. There are immediate and direct applications as a national model for CMS. National health plans and employers are involved as partners, so they will specifically consider how the quality and efficiency metrics and applications tested in California could be applied in other states. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--POLICY Principal Investigator & Institution: Leibowitz, Arleen; Senior Economist; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 15-APR-2002; Project End 31-DEC-2006 Summary: (provided by applicant): The Policy Core aims to promote research that informs HIV/AIDS policy making with relevant dat and will develop and disseminate unbiased information about how public and private policies affect services received and outcomes for persons with HIV. In the past, HIV/AIDS policies have not been grounded in scientific evidence. Thus, this Core will elucidate links between public policies and health outcomes and disseminate its findings to policy makers. For example, the differential impact of public policies (such as Medicaid) and of private policies (such as managed care) on different communalities (defined by ethnicity or gender or sexual

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orientation) may be a focus of this Core. We will assist our community partners in responding to policy makers' evolving needs for information about the effectiveness of their programs in terms of behavior, health outcomes, and costs. A multi-disciplinary group of economists, policy analysts, psychologists, and methodologists will work with out community partners to address emerging policy issues to assist researchers in securing funding examining the effects of existing policies on person's living with HIV/AIDS, and to analyze proposed HIV/AIDS policies. The addition of a Policy Core to our Center is a natural outgrowth of our ongoing activities promoting research to inform policy making, assisting collaborators and government entities in implementing evidence-based planning relevant to HIV identification, prevention and treatment services. The proposed policy-related activities are generally not funded by traditional research funding sources and, therefore, this core must emphasize developing new information. Because site specific interventions or revaluations collecting primary data generally do not allow for examination of different policy environments, this Core will apply new econometric methodology to secondary data to isolate the effects of public policies relevant to HIV. This Core will also promote policy-related research by tracking and disseminating HIV relevant legislative developments to investigators and by training researchers and community collaborators in methods for collecting and analyzing data that address specific public policy concerns. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COST EFFICIENT TREATMENT OF GERIATRIC DEPRESSION Principal Investigator & Institution: Mcdonald, William M.; Associate Professor; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 10-APR-1998; Project End 31-JAN-2004 Summary: (Applicant's abstract): The annual cost of depression in the United States has been estimated to be greater than 40 billion dollars, and includes the direct costs of treatment and indirect costs related to lost productivity. The elderly are particularly prone to increased disability from depression. Prospective studies demonstrate that up to two-thirds of elderly depressed patients have a poor outcome in one year, and over one-fourth are re-hospitalized in the year following the acute depressive episode. Yet the current public policy debates have focused on the cost of entitlement programs such as Medicare and have ignored the complex relationship between the cost of the initial treatment, efficacy and long term benefit in reducing overall healthcare costs. The primary aim of the present proposal is to develop practical guidelines for the acute and prophylactic therapy of treatment resistant geriatric major depression. In this proposal, severely depressed elderly patients will be evaluated, treated with either medication or electroconvulsive therapy (ECT) and followed for 18 months. The data generated will be used to develop statistical models of the most clinically effective and cost-efficient acute, continuation and maintenance treatments for severe geriatric depression,. 360 patients meeting DSM-IV criteria for Major Depression, severe (approximately half with psychotic features) and the American Psychiatric Association guidelines for ECT will be randomized to either an acute trial of ECT or a 6 week prospective medication trial. Medicare costs, neuropsychological, sociodemographic and clinical data will be analyzed to determine both the costs of an additional medication trial, and the patient characteristics which are associated with a response to medication/ECT. Patients who fail the prospective medication trial will be administered an acute course of ECT. The second and third phases of the study will evaluate alternative prophylactic therapies after an acute response to ECT. Patient who are severely depressed and respond to ECT.

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Patients who are severely depressed and respond to an acute course of ECT have extremely high healthcare costs and attendant morbidity and mortality. The risk of relapse in 6 months in these patients is unacceptably high (50-70%) using the conventional strategy of placing the patient on continuation antidepressant medication. The 180 patients who respond to an acute course of ECT or fail the prospective medication trial and then respond to an acute course of ECT and will be randomized to either 6 months of continuation strategies. In the third phase, 160 patients will be followed for an additional year in order to examine the long term benefits of alternative continuation strategies (i.e., ECT vs. medication) on measures of mood stability, neuropsychological function and total healthcare costs. The data from these studies will be used to develop a clinical checklist which can be used in general psychiatric practice to assist clinicians in making clinically effective and cost-efficient treatment decisions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COST-EFFECTIVENESS--TREATMENTS--DUCTAL CARCINOMA IN SITU Principal Investigator & Institution: Dick, Andrew W.; Assistant Professor; Community and Prev Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2005 Summary: (provided by applicant): The incidence of ductal carcinoma in situ (DCIS) of the breast, a non-invasive form of breast cancer, has increased dramatically in the last 15 years. Its burden both on patients and on society has grown correspondingly. The optimal management of DCIS remains controversial because of the heterogeneity of the disease, the lack of randomized clinical trials comparing treatment strategies for women diagnosed with DCIS, the importance of patient preferences for possible outcomes and the uncertainty surrounding its natural history. Variations in the treatment of DCIS highlight the gaps in knowledge about the optimal management of the disease, gaps that have become increasingly important as the incidence of DCIS has increased. The cost implications of treatment variations also become substantial as DCIS is diagnosed more frequently. Ultimately, the variations in treatment result in differences in outcomes, including life expectancy, quality of life, and cost-effectiveness. We will examine the effects of various treatment strategies, including mastectomy with and without tamoxifen, and breast-conserving surgery with and without radiation and tamoxifen, on the following patient outcomes: DCIS recurrence rates, survival, costs, and quality of life. Decision analytic models will be used to estimate the costeffectiveness and cost-utility of the various treatment strategies. Models will include patient preferences for DCIS and associated treatments obtained from primary data collection. Transition probabilities for the decision analytic models wilt be estimated from primary data using duration models and supplemented from the literature as necessary. Potential endogeneity in treatment selection will be corrected using instrumental variable techniques. The linked Medicare-SEER data will be used to examine the generalizability of our estimated transition probabilities. DCIS treatment costs will be estimated using Medicare data. Sensitivity analyses will be used to test the robustness of our models. The ultimate goal of our project is to identify the most costeffective approaches to manage DCIS, taking into account a variety of clinical presentations and patient preferences, thus improving patient care and reducing the burden of the illness on society. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COVERAGE, ORGANIZATION OF CARE, AND COLORECTAL SCREENING Principal Investigator & Institution: Schneider, Eric C.; Assistant Professor of Medicine; Health Policy and Management; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-MAR-2005 Summary: (provided by applicant): The Institute of Medicine recently issued a report calling for improvements in the quality of cancer prevention services. Colorectal cancer is the third leading cause of cancer-related mortality. Colorectal cancer screening could substantially reduce the morbidity and mortality of this disease, yet screening rates are surprisingly low. Insurance coverage and the management practices of health plans may be critical factors if we are to increase screening rates. We propose to analyze data from two national survey samples and to develop a new survey of health plan medical directors to examine insurance coverage and managed care as determinants of colorectal cancer screening. The specific aims of the study are: (1) Using national data from the Behavioral Risk Factor Surveillance System (BRFSS), we will assess rates of colorectal cancer screening before and after the Medicare program instituted first-dollar insurance coverage for colorectal cancer screening in 1998; (2) Using the Medicare Current Beneficiary Survey (MCBS), we will assess whether colorectal cancer screening rates are higher among Medicare beneficiaries enrolled in managed care health plans compared to those with fee-for-service insurance controlling for other confounding factors. Additionally, we will examine whether disparities in colorectal cancer screening rates for socioeconomic minorities are smaller for managed care enrollees than for others; (3) Using structured interviews of health plan medical directors, we will evaluate and compare the quality management programs of health plans that have high colorectal cancer screening rates and those with lower rates. Results of this study can guide the enactment of health policies that will increase rates of colorectal cancer screening and thereby reduce the incidence of colorectal cancer and its associated morbidity and mortality. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CV RISK FACTORS AT AGE 25-64 & LONG-TERM MEDICARE COSTS Principal Investigator & Institution: Daviglus, Martha L.; Professor; Preventive Medicine; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 20-SEP-2000; Project End 31-JUL-2004 Summary: (Adapted from the Investigator's Abstract) Background: Much recent effort has been directed toward controlling health care costs, but there has been little emphasis or research on prevention as a means of cost containment. This is due largely to lack of data relating to economic impact of prevention. Initial research: New data on two large Chicago cohorts followed for 22 years show that men and women with favorable baseline levels of all major CVD risk factors in middle age are at much lower agespecific risk of death from CVD, non-CVD, and all causes, and have much lower average annual Medicare costs (1984-1994), total and for CVD care, after becoming eligible at age 65 for Medicare. Aims: General - Assess in four large Chicago population cohorts whether young adult and middle-aged risk factor status has an impact not only on average annual Medicare costs, but also on cumulative and lifetime Medicare costs, to ages 70, 75, 80, >80, including to death, and during last one to two years of life. Specific Aims: 1) Assess relationships of CVD risk factors measured in young and

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middle-aged adult men and women to Medicare utilization and charges, from Medicare enrollment to death or attainment of age 70, 75, 80, >80, including in last one to two years of life. 2) Determine long-term relationship between earlier low-risk status vs. notlow-risk to subsequent Medicare health care charges. Baseline low risk is all six CVD risk factors favorable: systolic/diastolic pressure 120 mmHg/80 mmHg and no antihypertensive treatment, serum cholesterol <200 mg/dl, not currently smoking, no ECG abnormalities, no history of diabetes or heart attack. 3) Determine relationships between baseline habitual eating patterns and subsequent Medicare utilization and charges. 4) Further develop statistical methods for optimal analyses of health care expenditures. To accomplish these aims, the investigators propose to substantially extend their existing database by obtaining additional years of morbidity-mortality experience and of Medicare charge data to the year 2002. Significance: The investigators state that this research is unique and pioneering, with strong implications as to potential for both increasing longevity with health and saving money by shifting population risk factor status downward, to increase the percentage of low risk individuals from current low levels (<10 percent). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DECISION MAKING IN END-STAGE HEART FAILURE Principal Investigator & Institution: Hauptman, Paul J.; Internal Medicine; St. Louis University St. Louis, Mo 63110 Timing: Fiscal Year 2003; Project Start 15-JUN-2003; Project End 31-MAY-2007 Summary: (provided by investigator): The investigator, Paul J. Hauptman MD, proposes a program of research focused on congestive heart failure in its advanced stages. This is a disease of increasing prevalence, especially in the elderly, accounting for high morbidity and mortality. However, little is known about actual and self-reported practice. The research program is in two complementary parts. The first is designed to examine the use of chronic continuous outpatient intravenous infusions of inotropic drugs, a therapy associated with high costs, unproven clinical efficacy and the potential to shorten survival while achieving palliation. The investigator will use administrative and clinical data from several Medicare databases including the records of a Durable Medical Equipment carrier encompassing a 17-state region and Medicare Provider Analysis and Review (MedPAR), Carrier, Denominator and Hospice Analytical Files for the period 1997-2000. Specifically, the population of older Medicare beneficiaries receiving, and the physicians prescribing, this therapy will be described and contrasted with the demographics and outcomes of older patients hospitalized for heart failure but not receiving the drugs. The data will be used to develop predictors of inotropic agent use and mortality in this group at risk for re-admission and death. The second part is designed to assess physicians' knowledge about, attitudes toward and practices regarding the care of end-stage heart failure patients including perceptions of patient prognosis, quality of life, efficacy/toxicities of inotropic drugs and the role for hospice in a survey of 1200 cardiologists, geriatricians, internists and family/general practitioners. Approximately one-third of the physicians will be known prescribers of inotropic drugs. We plan to investigate how physicians make decisions and the degree to which the care an end-stage patient receives is influenced by physician specialty, volume, or other factors. Formal survey development methodology including performance of focus groups, cognitive interviews, and pilot testing will be applied. These studies will form the conceptual framework for an intervention study designed to address, at physician and patient levels, the process of selection of care options for older heart failure patients near the end of life.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DISTANCE REHABILITATION

LEARNING

SYSTEM

FOR

LOW

VISION

Principal Investigator & Institution: Massof, Robert W.; Professor; Emerald Events, Inc. 1409 Saybrooke Ct Pasadena, Ca 21122 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2004 Summary: (provided by applicant): The objective of the proposed STTR project is to develop an online distance learning system and online courses to teach low vision rehabilitation to occupational therapists, vision rehabilitation teachers, ophthalmic and optometric technicians, nurse educators, and nursing home and assisted living center staff. Recent changes in Medicare coverage policies have created a demand for low vision therapists that will continue to grow as the population ages. The proposed distance learning system will make it possible to educate therapists and other health care service providers who work with the visually impaired by means of self paced courses that can be scheduled at the convenience and tailored to the background of the student. The specific aims of Phase 1 are to 1) integrate the distance learning system and develop the system software, 2) develop and test content authoring tools, and 3) develop a prototype online optics and low vision refraction course and test it with ophthalmic technicians. Phase 2 will refine the distance learning system and develop and evaluate the online courses for the target health care service providers. The distance learning system will host online lectures, virtual workshops, live online case conferences with problem based learning groups, and online examinations and course evaluations. The online lectures will employ graphics, animation, video clips, and audio. The online workshops will be based on interactive 2D and 3D models combined with presentation matedal and exercises. Downloadable PDF/RTF files will provide supplemental material. Online case conferences will have a presentation window, whiteboard, 2-way audio, seating chart, "hand raising," and microphone passing. The problem-based learning groups will employ text-based chat. A prototype optics and low vision refraction course that consists of two online lectures, a virtual workshop, and a live online low vision refraction case conference will be developed and presented to volunteer ophthalmic technician CE students to evaluate the performance of the system and the acceptance of the distance learning format. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DO MEDICARE CLAIMS MEASURE CHEMOTHERAPY USE AND OUTCOMES Principal Investigator & Institution: Lamont, Elizabeth B.; Assistant Professor; Medicine; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: (provided by applicant): Although they present more than half of all Americans with cancer, the elderly are under-represented on the clinical trials that seek to determine efficacy and toxicity of chemotherapy. For this reason, results of clinical trials may not be applicable to the general population of elderly cancer patients. Nonetheless, physicians need clinical information regarding tile risks and benefits of chemotherapy in this substantial group of patients. I am a medical oncologist who seeks to develop a career at the crossroads oncology and health services research that is focused on determining the risks and benefits of chemotherapy in the general population of elderly cancer patients. In five years, I want to be able to execute a series

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of epidemiologic studies examining the possible contribution of medical comorbidity to the chemotherapy utilization and outcomes of elderly Americans with cancer. This longterm research agenda requires additional training on my part and three preliminary studies to determine the ability of a candidate data source, Heath Care Financing Administration's Medicare claims files, to provide inexpensive but reliable clinical information for these studies. Through the three related projects, I seek to determine the reliability of Medicare chemotherapy claims at capturing three critical elements of anticancer therapy 1) chemotherapy administration, 2) chemotherapy-related toxicities, and 3) disease-free survival. To meet these three aims, I will create a new and unique data set by linking Medicare claims to a gold-standard of clinical information regarding chemotherapy administration and outcomes, Cancer and Leukemia Group B (CALGB) clinical trial data. Defining the CALGB data as the gold standard against which to compare the Medicare claims, I will then calculate the sensitivity and specificity of the Medicare claims at capturing 1) chemotherapy administration, and 2) specific chemotherapy-related toxicities, and 3) disease-free survival. In the next phase of my career, I will use Medicare claims, to the extent of their validity, to execute a series of epidemiologic studies examining the chemotherapy utilization and outcomes of elderly Americans with cancer and medical comorbidity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EARLY DISCHARGE AND INFANT MORTALITY Principal Investigator & Institution: Malkin, Jesse D.; Rand Corporation 1700 Main St Santa Monica, Ca 90401 Timing: Fiscal Year 2003; Project Start 20-JAN-2003; Project End 31-DEC-2004 Summary: (provided by applicant): Of the 4 million infants born in the United States each year, about 20,000 (5 out of 1,000) die during the neonatal period and another 10,000 die after the neonatal period but before their first birthday. Some of these deaths are caused by conditions that can be treated successfully if they are diagnosed promptly. One factor that may influence whether such conditions are diagnosed quickly is the length of a well-appearing newborn's postpartum stay, because signs of congenital heart disease, infection, and other health problems may not be evident until two or more days after delivery. Although many studies have examined health effects of early postpartum discharge, few studies have considered mortality as an outcome. The investigators propose to assess the association between early discharge and neonatal mortality using an administrative database from California that captures about three million births between 1991 and 1999. The primary objective of the proposed analysis is to test the hypothesis that newborns discharged early are at increased risk of dying during the neonatal period relative to newborns with longer stays. The investigators will perform unadjusted analyses, multivariate analyses to control for observed confounders, and instrumental variable estimation to mitigate biases due to unobserved confounders. The investigators will also perform analyses of high-risk sub-populations. The secondary objective of the proposed analysis is to test the hypothesis that newborns discharged early are at increased risk of hospital readmissions during the neonatal period relative to newborns with longer stays. The investigators will also describe time trends in early discharge, neonatal mortality, and hospital readmission rates. An improved understanding of these issues will provide policymakers, health plans, hospitals, providers, and patients with information that can be used to help make more informed decisions about newborn lengths of stay. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ECONOMIC DETERMINANTS OF MORTALITY Principal Investigator & Institution: Dow, William Hatfield.; Assistant Professor; Health Policy and Administration; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2004 Summary: This study seeks to better understand the role of economic factors in explaining mortality patterns, particularly in low-income populations. Our focus is on the role of the health insurance system, and more specifically, how large changes in the health insurance coverage of a population might influence mortality. In order to synergistically begin to build a body of empirical regularities, we propose to analyze the causal effects of actual large insurance expansions in different settings. One set of analyses will examine the mortality effects of the implementation of the Medicare and Medicaid programs in the United States during the 1960's, which have received surprisingly little study. A parallel set of analyses will build on previous work examining a large expansion in insurance coverage in Costa Rica during the 1970's. The project also includes a methodological investigation of the effects of the common practice of analyzing regionally aggregated mortality data instead of individual-level micro data. This project is expected to yield important new information in understanding the effect of health insurance on mortality patterns themselves, and on explaining socioeconomic differences in health. This knowledge is important not only for these two countries, but for many other countries as well as they debate large-scale reforms of their health insurance systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ECONOMICS OF FORMULARY DESIGN AND MENTAL HEALTH POLICY Principal Investigator & Institution: Huskamp, Haiden A.; Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 31-MAY-2007 Summary: (provided by applicant): Prescription drugs have become an increasingly important component of mental health treatment and the costs of psychotropic drugs have increased rapidly in recent years. However, there are major gaps in our knowledge about the economics of psychotropic drug treatment. This Mentored Research Scientist Development Award would allow Dr. Haiden Huskamp, a health economist with expertise in mental health policy and economic institutions, to supplement her economic tools with the knowledge and skills needed to conduct clinically-relevant and policysignificant research on the economics of prescription drugs used in the treatment of mental illnesses. The specific aims of this career development proposal are to: 1) develop a greater understanding of clinical decision-making related to the use of psychotropic drugs; 2) acquire basic knowledge of psychopharmacology; and 3) expand knowledge of the important economic institutions influencing the prescription drug market. In this undertaking, Dr. Huskamp will be guided by her sponsor, Richard Frank, PhD, and cosponsors, Andrew Nierenberg, MD, and Ernst Berndt, PhD. Her career development plan includes guided study with Dr. Nierenberg on clinical issues related to treatment decision-making and Drs. Berndt and Frank on economic institutions of the pharmaceutical market, as well as coursework and participation in psychopharmacological "Grand Rounds," relevant seminar series, and professional meetings. Dr. Huskamp will use the knowledge and skills developed through these career development activities to conduct three research projects. The first project

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examines the effect of generic entry in the class of selective serotonin reuptake inhibitors (SSRls) on utilization patterns, costs, and market share among antidepressants as well as the competitive response of brand antidepressant manufacturers with respect to drug prices and promotional spending. The second project assesses the economic incentives created by three-tier drug formularies and how these arrangements affect costs, utilization patterns, and adherence to treatment guidelines in a non-elderly population. This project includes an economic welfare analysis of the tradeoffs associated with restrictive formularies. The third project examines the effect of a three-tier formulary on psychotropic drug costs and utilization patterns in a retiree population and explores the impact of formularies on the mental health costs of adding a prescription drug benefit to Medicare and on access to appropriate psychotropic drug treatment under such a benefit. The proposed plan of career development will provide Dr. Huskamp the training, mentoring, time and resources to develop the skills that will put her in a position to lead independent research on the economics of pharmaceutical treatment for mental illnesses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF INCOME-BASED DRUG CHARGES ON OLDER PATIENTS Principal Investigator & Institution: Schneeweiss, Sebastian; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-MAY-2007 Summary: (provided by investigator): Policies to contain prescription drug costs in the elderly are widely debated because they will impact heavily on the health of older Americans as well as affect the fundability of federal and statewide programs of drug coverage for the elderly. Many coverage plans include annual deductibles that require the patient to pay 100% of drug costs out-of-pocket until a predefined deductible limit is reached. Income-based deductibles set these limits to vary directly with the patient's income status. Although we have shown earlier that some drug cost containment methods can result in net health care savings without adverse outcomes in an elderly population (R01-HS10881), it remains unclear to what extent income-based deductibles may adversely affect adherence to chronic drug therapy and health outcomes in elderly and poor patients. Based on our earlier work we propose to study the clinical and economic consequences of an income-based deductible policy in a large-scale natural experiment in the province of British Columbia. Starting January 2003, all residents 65+ (about 500,000) will be subjected to such a policy. We will use longitudinal data analysis for linked individual-level health care data describing medication use, other health care use, and clinical events in all such patients. Additional analyses will implement patients' self-report in a subgroup of patients. We will focus on specific drug classes and chronic conditions that are prevalent in elderly patients in which a dose reduction or discontinuation would be most important, or likely cause measurable adverse health effects. The project will produce the first data describing the clinical and economic consequences of such a cost-containment policy in a large and stable population of older patients. It will also analyze savings for drug benefit plans and the impact of financial contributions by patients. Its findings will be of great importance for the ongoing debate over proposed programs for drug coverage in the elderly and will provide a set of refined recommendations and tools for planning, implementing, and executing future policies. A separate dissemination component will bring together researchers and policymakers from a variety of settings to review these findings and assess their relevance to emerging research and policy issues related to drug therapy for the elderly.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF DEMENTIA IN AGED NURSING HOME ADMISSIONS Principal Investigator & Institution: Magaziner, Jay S.; Professor; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 15-AUG-1991; Project End 31-MAR-2004 Summary: The long-term care of older persons with dementia is a major concern of providers and policymakers. Approximately 750,000 persons with dementia in the United States reside in nursing homes, and more than 800,000 new cases enter these facilities each year. The cost of caring for persons with dementia who reside in nursing homes has received only limited research attention, despite the fact that the aggregate cost of caring for this group is estimated to be as high as $120 billion annually. The aims of the proposed continuation study are to: 1) determine the temporal patterns (up to six years) of direct medical care costs and utilization of demented v. non-demented persons admitted to nursing homes for the first time; 2) compare the direct medical care costs and utilization of these demented v. non-demented persons at different levels of functioning and comorbid status; 3) evaluate the variability in costs and utilization for demented v. non-demented new admissions by characteristics of the nursing home; and 4) assess the sensitivity of a diagnosis of dementia using secondary records to determine whether associations observed in Aims 1-2 are robust to alternative definitions of dementia. These aims will be addressed by linking Medicare and Medicaid claims data for up to six years following admission to data from the current study, "The Epidemiology of Dementia in Aged Nursing Home Admissions," (R0l AGOS21 1) in which 2,285 new admissions to a representative sample of 59 nursing homes in Maryland, 1992-1995, were enrolled and evaluated for the presence of dementia by an expert clinical panel of neurologists, psychiatrists, and a geriatrician. These new admissions were similar in demographic, functional, and comorbid status to nursing home admissions elsewhere in the U.S. during the same period. Cost and utilization rates defined by type of service, procedures, sites of care, and payor (Medicare/Medicaid) will be expressed in per person month terms, and longitudinal Poisson regression models will be used to estimate these rates and examine their association with individual (e.g., dementia diagnosis, function, comorbidity) and environmental (e.g., structure and process of care) characteristics. With changes in reimbursement for those in nursing homes and the increasing demand to care for persons with dementia in nursing homes and other settings, policymakers need to have information on cost to optimize care for this growing segment of the long-term care population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EPIDEMIOLOGY OF LUMBAR SPINE SURGERY: RATES AND TRENDS Principal Investigator & Institution: Deyo, Richard A.; Professor; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Spine surgery rates in the United States exceed those in most developed countries by at least twofold. Furthermore, they increased 55 % during the 1980's. Wide geographic variations in surgical rates may imply professional uncertainty about optimal indications. Recent technical changes in spine surgery,

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including new spinal implants and a shift towards ambulatory surgery, may affect surgical rates and reoperation rates. The goals of this project are to examine whether surgical rates continue to rise, and if the introduction of interbody fusion cages resulted in acceleration of surgery rates: to examine surgical rates among the elderly and for spinal stenosis in particular to examine whether reoperation rates are increasing over time; and to determine if certain surgical procedures are associated with unusually high rates of reoperation. The analyses will make use of existing survey and administrative data. We will use a previously validated algorithm for identifying patients with lumbar spine surgery from automated data, as well as a previously validated comorbidity index. National rates of surgery will be examined using the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project, both available from the National Technical Information Service, Examination of rates and trends among elderly patients, and especially for spinal stenosis, will make use of these national databases and of Medicare claims data for selected years. The analysis of reoperation rates will depend largely on a Washington State hospital discharge registry which will provide data from 1987 through 2000. Reoperation rates will also be examined using Medicare claims data. Finally, we hope to examine the growth of ambulatory disc surgery, which became increasingly popular after 1994. Although previously available surveys of ambulatory surgery are no longer available, we will have an opportunity to examine the growth of the ambulatory surgery using Medicare claims data, and some state ambulatory surgery databases. This series of analyses is important because it will help to clarify factors associated with changes in surgical rates. It will also help to assess the impacts of recent technical and practice innovations. Reoperation is generally regarded as an unfavorable outcome of lumbar spine surgery, and rising reoperation rates would be alarming. Thus, rates and trends in the use of spinal surgery and repeat operations may help identify high priorities for research, suggest areas requiring a more consistent therapeutic approach, and indicate possible problems in quality of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ETHNIC /SOCIOECONOMIC DISPARITIES IN ARTHRITIS AND FUNCTIONAL LIMITATION Principal Investigator & Institution: Dunlop, Dorothy D.; Associate Professor; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Arthritis is recognized as the most common chronic condition affecting elderly persons and the leading cause of functional limitations in die United States. The number of people with arthritis in the United States is projected to increase 56.5% by the year 2020 and the number with attributable limitations is projected to increase 66.3% from their 1990 levels. Current knowledge to deal with the oncoming health care burden from this rapidly growing arthritic population is needed. This study addresses arthritis from a public health and public policy perspective by estimating differences in prevalence and incidence of arthritis and self-reported functional limitations across different ethnic/racial groups using data from the combined 19982002 Asset and Health Dynamics Among the Oldest Old (AHEAD) and Health and Retirement Survey (HRS). Our research will estimate the extent that these ethnic/racial differences in older adults are associated with disparities in socioeconomic status (SES), health behaviors, and access to medical care. In addition, this project evaluates differences due to SES in medical utilization among people with arthritis. The 1998-2000 AHEAD/HRS data will be augmented with Medicare records to provide documented health care utilization data. State of the art statistical methods for longitudinal data will

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be applied. The investigators provide a spectrum of statistical, economic, clinical, and public health expertise needed to complete this methodologically sophisticated project. The project extends their preliminary work based on the 1993 AHEAD data. This study addresses goals from Healthy People 2010 and the National Arthritis Action Plan (NAAP) related to the elimination of health disparities that occur by gender, race, education or income and the use of longitudinal databases to identify risk factors to reduce the disability from arthritis. Results from this study will serve as a benchmark against which to judge the action of the NAAP and other programs that are aimed at reducing the impact of arthritis in the population. In addition, study findings will help to identify disparities due to race/ethnicity and SES factors in the burden of arthritis and related functional limitations and medical utilization, and thereby possibly lead to improved quality of care for under-served groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVALUATING MAMMOGRAPHY CLAIMS DATA Principal Investigator & Institution: Freeman, Jean L.; Associate Professor; Internal Medicine; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2004; Project Start 01-JUN-1996; Project End 31-MAR-2007 Summary: (provided by applicant): Variations in the use of breast cancer screening, diagnostic and treatment services have long raised questions about the quality of breast cancer care and its impact on patient outcomes. Wide variations in mammographic interpretation and high rates of breast biopsies have raised particular concerns about the quality of screening mammography and how quality varies by different mammography providers and different population groups. In response to these concerns, the Institute of Medicine (IOM) has recommended that the use of screening mammography in community practice be carefully examined and that ways of monitoring performance should be developed. The IOM further recommends exploring the use of the Medicare claims database to describe trends in the use of screening mammography, examine geographic variations in screening incidence and study the outcomes of routine screening. Our research has shown that the Medicare data can be a valid source of information on screening, provided appropriate methods are used to define screening practices using information on the claims. We now propose to apply these methods in a population-based study of screening quality. The study will use SEER and Medicare claims data to examine screening performance measures among the SEER areas over the period 1998-1999. Our objectives are to: 1) investigate the relationship between screening performance (sensitivity and specificity of screening mammography) and the characteristics of radiologists and patients and 2) evaluate whether Medicare claims alone can provide valid measures of sensitivity and specificity compared to a linked SEER-Medicare database. The wide dissemination of screening mammography into community practice, particularly among older women, necessitates the ongoing assessment of its performance. Through this population-based study we will be able to compare screening performance by characteristics of patients and radiologists. Moreover, if we demonstrate that Medicare data alone provide valid measures of sensitivity and specificity, then our approach will allow for the generation of screening quality indicators (specificity) for virtually 100% of U.S. radiologists. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EVIDENCE-BASED DESIGN OF AN XML DECISION SUPPORT SYSTEM Principal Investigator & Institution: Kawamoto, Kensaku; Pathology; Duke University Durham, Nc 27706 Timing: Fiscal Year 2003; Project Start 01-JAN-2004; Project End 31-DEC-2007 Summary: (provided by applicant): A recently completed systematic review identified the specific features of clinical decision support systems (CDSSs) that are most important for bringing about a desired change in clinical practice patterns. The objective of the proposed research is to apply the insights gained from this systematic review to design an XML-based CDSS, and to use this CDSS to improve the care of approximately 13,000 Medicaid benificiaries living in central North Carolina. The CDSS will support compliance with HEDIS guidelines for preventive and chronic care, and decision support communications will be provided to a variety of stakeholders, including clinicians, social workers, care managers, and patients. Of note, this work will leverage a number of existing resources established by this group, including a core XML-based decision support engine, a clinical database designed to support the care of Medicaid patients, and a touch-screen system for collecting information directly from patients. In building the CDSS, systems analysis techniques will be used to inform the design process, and a rapid prototyping approach will be used for system development. Then, a randomized controlled trial will be conducted to evaluate the impact of the CDSS, and outcomes will be measured using the HEDIS indicators for which the decision support was provided. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EXAMINING DISPARITIES IN CHILD DENTAL MEDICAID Principal Investigator & Institution: Lee, Jessica Y.; Pediatric Dentistry; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): The candidate is currently a fellow in Pediatric Dentistry completing a Ph.D in Health Policy Analysis with additional advanced training in health services research. She has a long established history of commitment and interest in research and academic dentistry. This application proposes a comprehensive interdisciplinary program wherein the candidate would receive the necessary training and mentorship to develop into an independent investigator. Two phases are described. In the first phase (Scholarly Development) Dr. Lee will work under the mentorship of Dr. R. Gary Rozier and a research advisory committee to complete the first part of the study. In the second phase (Faculty Transition) the candidate will work more independently to complete the second part of the proposal and build upon this research to seek additional funding. This will assist in the transition towards becoming an independent investigator. The research component will examine disparities in access to oral health care for pre-school aged children enrolled in Medicaid. The current level of oral health service utilization in Medicaid has presented a major public policy challenge as evident by reports from the Office of Technology Assessment, the General Accounting Office and the Office of the Surgeon General. Medicaid is the country's largest investment in improving access and decreasing oral health problems of young low-income children. It has been established that low-income, minority, rural children have a disproportionately higher level of dental disease, but very little is known about their use of and access to oral health services. This research proposal will be the first to systematically study racial and geographic disparities and

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their interactions with each other and Medicaid enrollment on utilization, treatment outcomes and expenditures among pre-school aged children. Four large databases will be used: Composite birth records from 1992, Medicaid enrollment and claims files from 1992-97, and the Area Resource File. This longitudinal cohort study treats the child as the unit of analysis. The data set will contain multiple observations per child-that is one observation for each year until the fifth birthday. Panel data techniques, specifically random effects models, will be incorporated into the estimation equations. Complex and hierarchical modeling will be used in the analyses. While controlling for predisposing and enabling characteristics, we will examine disparities on different outcome measures; 1) any oral health utilization 2) extent of utilization 3) type of visit 4) avoidable hospitalizations and source of care 5) dental related Medicaid expenditures. We will also examine quality performance measures as established by the NCQA expert panel. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HCV TREATMENT COST-EFFECTIVENESS IN 3 IDU POPULATIONS Principal Investigator & Institution: Schackman, Bruce R.; Public Health; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): This K01 award will support the Principal Investigator's development as an independent research scientist conducting economic evaluations of the medical complications of injection drug use (IDU). A team of mentors and advisors with expertise in cost-effectiveness evaluation, epidemiology of drug abuse, hepatitis C clinical treatment, infectious disease modeling, and health behavior research will provide the PI with the necessary support and guidance. The purpose of the research proposal is to determine chronic hepatitis C (HCV) treatment preferences among HCV-infected IDUs and to assess the cost-effectiveness of HCV treatment for 3 specific IDU populations: (1) HCV-infected IDUs in methadone maintenance treatment (MMT) and other substance abuse treatment settings; (2) IDUs co-infected with HIV and HCV who have early stage liver disease; and (3) HCV-infected pregnant women with a history of IDU. An estimated 65 to 90% of injection IDUs are infected with HCV and are at risk for sequelae such as cirrhosis, decompensated liver disease, and hepato-cellular carcinoma. Decisions about HCV treatment require complex trade-offs between uncertain benefits and considerable quality-of-life and financial costs. Combination therapy with ribavirin and pegylated interferon is effective in 40-80% of patients, depending on their genotype, but is costly and potentially toxic. Treatment preferences will be assessed by computer-assisted interviews with 200 HCV-infected patients at 3 New York City hospitals before and after treatment. Cost-effectiveness analysis provides a methodology for analyses to inform HCV treatment resource allocation decisions. Computer simulation models to measure cost effectiveness will be developed using the treatment preferences identified, reports from the literature, results of a survey of MMT providers, and data from HIV/HCV co-infected cohorts in 2 urban clinics. The specific aims are: (1) To assess preferences and perceived barriers to HCV treatment among HCV patients infected by IDU, and to compare preferences before and after HCV treatment; (2) To conduct a cost-effectiveness analysis of treating IDUs with chronic HCV in MMT clinics and other substance abuse treatment settings, and to determine the budgetary costs of these alternatives for government-funded programs such as Medicaid; (3) To conduct a cost-effectiveness analysis of treating chronic HCV in HIV/HCV co-infected patients with persistently normal or moderately elevated ALT levels and/or stage 1 or 2 liver disease, using cohort data from 2 urban clinics; and (4) To conduct a cost-effectiveness analysis of elective Cesarean delivery for HCV-infected

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women identified with detectable HCV RNA during pregnancy and of HCV RNA screening of pregnant women with a history of IDU. This work will provide insight into important policy questions identified by the NIH Consensus Development Conference on the Management of Hepatitis C in June 2002 and will inform development of treatment and reimbursement guidelines. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTH AND CARE TRAJECTORIES OF OLDER DISABLED AMERICANS Principal Investigator & Institution: Freedman, Vicki A.; Polisher Research Institute 1425 Horsham Rd North Wales, Pa 19454 Timing: Fiscal Year 2002; Project Start 01-FEB-1998; Project End 31-JUL-2003 Summary: Currently over 5 million older Americans require care for chronic disability. The cost of providing long-term care to these Americans currently amounts to over one hundred billion dollars per year. In light of impending growth in the number of older disabled Americans and the current deficit-reduction climate, policy makers now face important questions about how to best restrain growth in public spending for long-term care. Because costs are driven by families decisions about the intensity, structure and balance of arrangements over time, policy makers seeking to control costs require a basic understanding of how families choose care arrangements in response to health declines and improvements of older family members. Yet surprisingly few studies have investigated basic questions about the relationship between health and care trajectories of older disabled Americans over time. The goal of this FIRST award is to understand the dynamic process driving long- term care decisions, particularly the ways in which older persons and their families respond over time to changes in the health of older family members. Using a dynamic, interdisciplinary framework, two overarching research questions will be explored: 1) How do older disabled Americans and their families shift care arrangements in response to various health trajectories and what are the critical junctures in the health progression of older disabled Americans when families shift the intensity and structure of care? And 2) How do various health trajectories affect the balance of informal and formal care over time? That is, under what circumstances do changes in health lead to the displacement of formal care over time? That is, under what circumstances do changes in health lead to the displacement of formal for informal care over time and what is the magnitude of that displacement? To address these issues, the project will use multiple waves from two relatively new nationally representative panel survey: the Study of Asset and Health Dynamics of the Oldest Old (AHEAD) and the Medicare Current Beneficiary Survey (MCBS). Answers to these questions will provide critical information on the underlying process by which older disabled persons and their families cope with disability over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HEALTH CARE PARTNERSHIPS AND SELF CARE OF OLDER ADULTS Principal Investigator & Institution: Kahana, Eva F.; Director, Elderly Care Research Center; Sociology; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-AUG-1999; Project End 31-MAY-2004 Summary: We will examine how responsiveness of Health Care Partners (Primary Care Physicians and Health Significant Others) and self- care undertaken by old-old adults

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(80+) lessens the adverse impact of chronic illness on their ability to function and help maximize the quality of their lives. Physicians, patients, and Health Significant Others are seen as partners in care, with responsiveness of Health Care Partners enhancing preventive and corrective self-care by patients. Extensive data will be obtained from elders about self-care goals and strategies, patterns of consultation with Health Care Partners, other providers, and lay health consultants, and about perceived responsiveness of Health Care Partners. A major innovative focus of the study deals with mutual influences between responsiveness of Health Care Partners on patterns of support use by elders. Complementary and compensatory models of patient interaction with physicians and Health Significant Others will be considered. We will obtain a long term longitudinal follow-up of old-old adults living in sunbelt retirement communities and a broad cross-section of urban elderly and racial minorities. We will collect four annual waves of data based on in-home interviews of an estimated 350 respondents in Florida and 350 respondents in Cleveland. These elderly constitute committed cohorts in two probability samples of community-based elders. Based on prior attrition rates, a combined sample size of 527 elderly persons is projected for the fourth year follow-up. We will also conduct annual telephone surveys with Primary Care Physicians and Health Significant Others of respondents to ascertain responsiveness in terms of patient knowledge, involvement and communication. We will use least squares regression, structural equations, latent growth curve analysis, and event history analysis to test our comprehensive causal model regarding buffers of the Disability Cascade. Specifically, we will examine the buffering effects of patient-responsive medical care, lay support, and proactive adaptation on the progression from chronic illness to disability and diminished quality of life. Data will also be obtained on satisfaction with health care, mortality and cost of care (information based on Medicare records) as salient medical outcome variables. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTH CARE USE /COSTS OF DEMENTIA IN MERDICARE ELDERLY Principal Investigator & Institution: Husaini, Baqar A.; Tennessee State University 3500 Centennial Blvd Nashville, Tn 37203 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2006 Summary: This study will examine four key issues: (1) race and gender differences in the correlates of dementia, particularly focusing on morbidity processes that are associated with dementia in its varied forms; (2) race and gender differences in health care service utilization and health care costs among those suffering from forms of dementia; (3) the influence of socioeconomic contexts and the availability of health services on morbidity processes leading to dementia, and health care costs; (4) the impact of contexts of consumption of alcohol and tobacco on morbidity processes leading to dementia and on health care costs. Data: The study will examine a 2.5% random sample of HCFA beneficiaries from 1996-2000 in the states that make up the census designation of the South (N=275,000). Our contextual level analyses on 1425 counties in the South will examine the impact of socioeconomic conditions, the availability of medical services in the area, and alcohol and tobacco consumption. We will estimate a variety of multi-level hierarchical models for logistic regression models, multinomial logistic regression models, and linear models that incorporate the influence of socioeconomic contexts and other factors into predictions of morbidity, service utilization and health care cost of individual beneficiaries. Significance: The proposed work will generate several important contributions: (1) It will help identify how race

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and gender differences in heart disease and stroke influence the onset of dementia, and how these processes may differ between vascular/multi-infarct dementia and Alzheimer's disease; (2) It will elucidate how race and gender variations in morbidity processes leading to dementia impact health care service utilization and health care costs. (3) It will allow us to discern if contextual factors such as socioeconomic inequality and health care availability influence the development of dementia and its effect on healthcare outcomes (service utilization and costs); and (4) It will allow a systematic assessment of the influence of contexts of alcohol and tobacco consumption on the development of dementia and its influence on health care service utilization and costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTH CONDITIONS OF ELDERLY PUERTO RICANS Principal Investigator & Institution: Palloni, Alberto; Professor; Sociology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 15-JUN-2000; Project End 31-MAY-2004 Summary: (Adapted from the Applicant's Abstract): The proposed project will collect and analyze information on health conditions, living arrangements, transfers, and access to and use of health care among older adults (aged 60+) in Puerto Rico. We propose an island-wide, cross-sectional sample survey of target individuals and their surviving spouses or partners. The baseline survey will be complemented by (a) a single follow-up to take place two years after the baseline survey; (b) record linkages with Medicare and other insurance providers;(c) record linkage with certificates of decedents who die between in the inter-wave period; and, (d) a sample of targets' siblings for the analysis of paired survival times. The data the investigators propose to collect can be used to addresses the following goals: (i) to describe health conditions of adults 60+ in general, and of those 80+ in particular, with regard to self-reported health conditions, physical and mental impairment, and functional disability; (ii) to assess the effects of socioeconomic conditions and migration histories on health status, physical and mental impairment, functional disability, rates of institutionalization and mortality risks; (iii) to assess relations between self-reported chronic conditions, functional disability, mortality and institutionalization, and background conditions, including migration experience. (iv) to assess relations between individuals' history of illness, behavioral risks, and shared environments, on the one hand, and chronic diseases, disability, mortality and institutionalization, on the other; (v) to identify risk profiles based on functional limitations, self-reported conditions, and risky behavior and use them as inputs for short-term forecasting of age-patterns of morbidity, disability, and mortality, (vi) to evaluate elderly's access to and use of health care services, including those supplied outside the formal medical establishment; (vii) to investigate the sources, magnitude and direction of intergenerational support, as well as the activity of kin networks, as a function of elderly' health status; (ix) to establish comparisons with information about Puerto Ricans in the US and other Hispanics and, with proper modeling techniques based on spouse and siblings data, to obtain robust estimates of effects of socioeconomic effects and migration experience. This will help to shed light on the seemingly favorable health conditions of Hispanics living in the US (NRC1997). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EMPLOYMENT

HIGHLY

ACTIVE

ANTIRETROVIRAL

THERAPY

AND

Principal Investigator & Institution: Bernell, Stephanie L.; Public Health; Oregon State University Corvallis, or 973391086

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Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JAN-2005 Summary: (PROVIDED BY APPLICANT): The objective of this research is to examine the employment consequences of HIV, focusing on the labor market behavior of HIV positive individuals who use and who do not use highly active antiretroviral therapy (HAART). Like all workers, HIV positive individuals leave the state of employment and unemployment for very different reasons. This study examines the causes of job loss and job acquisition, concentrating primarily on the contribution of HAART and secondarily on the effect of mental health and substance abuse problems. This study uses data from the HIV Cost and Services Utilization Study (HCSUS) and employs discrete choice models of analysis. The specific aims of this research are to (1) examine the effect of HAART on the probability of leaving employment, (2) assess the effect of HAART on the probability of leaving unemployment, and (3) identify whether persons dually diagnosed as HIV positive and having mental health and/or substance abuse problems have differential labor market outcomes than those without mental health or substance abuse problems. Understanding the influence of HAART on the labor market behavior of HIV positive individuals is of fundamental significance to pubic sector policymakers as well as employers in all parts of the economy. On an individual level, it is likely that many people with HIV are still denied opportunities in the workplace due to their HIV status. On a national level, if HAART results in better employment outcomes, it is likely that individuals will remain privately insured for a longer period of time and will be less reliant on federal and state programs (SSI, Medicaid, Medicare, etc,). Furthermore, by having a clearer understanding of the employment outcomes of those who are dually diagnosed with HIV and mental health and/or substance abuse problems, this project will provide new information on the effects of recent policy revisions, including employment-based mental health insurance parity mandates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HOMEBOUND CONTINENCE

ELDERLY--MAINTAINING

POSTTREATMENT

Principal Investigator & Institution: Engberg, Sandra; Health Promotion & Development; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 10-SEP-1998; Project End 31-MAY-2004 Summary: (Adapted from the Investigator's Abstract): The purposes of this study are to (1) examine the effectiveness of a relapse prevention intervention based on Self-efficacy theory and Marlatt s model of relapse prevention in sustaining post-treatment continence levels; (2) examine the impact of standard behavioral therapy and the relapse prevention intervention with respect to adherence, relapse, cost and cost-effectiveness; (3) examine the direct economic incentive for home health care agencies to provide both the standard behavioral therapy and the relapse prevention intervention for urinary incontinence (UI); and (4) examine the impact of standard and relapse prevention behavioral therapy on the quality of life and self-efficacy of homebound older adults. In addition, we will explore the development of a predictive model to identify patients who are likely to relapse following the behavioral treatment of UI. This study will collect baseline cost data relative to UI on all subjects for a two month period prior to randomization (Phase I). Subjects will then be randomized to receive a 6 week behavioral therapy intervention (relapse prevention behavioral therapy, RBT) consisting of two additional in-home visits and three telephone interventions over a period of four months (Phase II). All subjects will be followed every three months for one year after completing the initial behavioral therapy. The specific aims of this study of cognitively

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intact homebound older adults are to: (1) examine the effectiveness of RBT in sustaining or improving post-treatment continence levels during follow-up compared to SBT. (2) Compare adherence rates of subjects who receive RBT to the rate for subject who receive SBT. (3) Compare the relapse rates of subject who receive RBT to the rate for subjects who receive SBT. (4) Estimate the cost and cost-effectiveness of RBT and SBT. (5). Examine the direct economic incentive for home health care agencies to provide RBT and SBT for UI to Medicare recipients. (6) Examine the impact of RBT and SBT on UI on quality of life measures. Secondarily, we will (7) Determine whether changes in selfefficacy are associated with improvements in UI. (8) Determine whether self-efficacy at the end of treatment predict relapse. (9) Determine if self efficacy at the end of treatment predicts maintenance of post-treatment continence levels at 3, 6, 9 and 12 months post treatment. (10) Explore the development of a predictive model of patients who relapse during follow-up. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HOSPITAL-LEVEL VARIATION IN TREATMENT INTENSITY Principal Investigator & Institution: Barnato, Amber E.; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2008 Summary: (provided by applicant): The purpose of this proposal is to provide Dr. Amber Barnato with the means and structure to transition to an independent investigator. The candidate is a new Assistant Professor at the University of Pittsburgh with fellowship training in health services research. Her long-term career goal is to conduct and disseminate research that informs Medicare financing policy and the delivery of health care to older Americans, motivated by the coincident rise in technological capabilities of health care and the expected doubling of the population over age 65 by 2030. In the context of this career award application, which contains a well-defined curriculum in quantitative and qualitative methods and has the institutional support of a highly successful Division of General Internal Medicine and the commitment of practiced mentors Drs. Derek Angus and Judith Lave, the candidate will study hospital-level variation in treatment intensity at the end of life. Regional analyses demonstrate that elders in Miami spend twice as much on health care in the last 6 months of life as those in Minneapolis and are 4 times more likely to be admitted to an ICU during that period, without any measurable outcome benefit. Studying hospitals, rather than regions, may be more informative since they are where clinical decisions are actually made and most likely to be influenced. Yet there is very little hospital-level research on end-of-life care, and that which exists is limited by focusing only on patients who have been retrospectively identified as decedents, having data on too few hospitals to be more generalizable, or focusing only on patients already admitted to an ICU. Using a single state with uniform regulatory and reimbursement structures and an unusually clinically-rich hospital discharge database, this study will: 1) Measure hospital-level rates of ICU admission and intensive procedure use in Pennsylvania; 2) Identify the hospital-level correlates of intensive treatment at the end of life; and 3) Determine the effects on survival and inpatient costs of varying hospital treatment intensity. This is a secondary database analysis augmented by primary data collection at the hospital level. This research may help to identify policy-relevant organizational factors that can be influenced to improve the care of older Americans at the end of life. This award will facilitate the candidate's transition to an independent health services researcher will lead to future funded studies and quality-improvement activities in Pennsylvania hospitals.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IDENTIFYING CASES AND COSTS OF DEMENTIA IN THE U.S. Principal Investigator & Institution: Langa, Kenneth M.; Assistant Professor; Internal Medicine; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 15-AUG-2001; Project End 31-JUL-2006 Summary: (applicant s abstract): Dr. Kenneth Langa is a General Internist and faculty member in the Department of Internal Medicine and the Institute for Social Research at the UM. He gained research experience while earning a Ph.D. in Public Policy at the UC and completing the Robert Wood Johnson Clinical Scholars Program at the UM. During his fellowship training he initiated pilot studies on direct and informal caregiving costs of dementia while working as a Collaborator on the NIA-funded Health and Retirement Study (HRS).His immediate career goal is to obtain new clinical and research skills required for the longitudinal study of cognitive impairment in both clinical and population-based settings; his long-term goal is to lead multidisciplinary research efforts to better understand the social and economic impact of dementia on patients, families, and society. The UM provides a uniquely rich environment to support training in the study of aging and cognitive impairment. Dr. Langa will be mentored by senior faculty in the Institute for Social Research, Medical School, Michigan Alzheimer's Disease Research Center, and School of Public Health. He will benefit from his established collaborations with the principal investigator (Robert J. Willis, Ph.D.) and CoInvestigators of the HRS. The research plan will utilize 6 waves of HRS data (collected between 1993 and 2004) to study the direct and informal caregiving costs of cognitive impairment in a population-based nationally representative sample. The longitudinal design (with up to 11 years of follow-up) and extensive data on socioeconomic status, co-morbidities, and informal caregivers will be used to determine the relationship between severity of cognitive impairment (from mild or pre-clinical to severe disease) and direct and family caregiving costs. Longitudinal models will identify determinants of the incidence and progression of cognitive impairment, as well as nursing home admission and death. Markov models will be developed to estimate the lifetime costs associated with cognitive impairment, and determine the distribution of costs across age, gender, race, socioeconomic status, and public (Medicare and Medicaid) and private payers. This project will better define the economic impact of the growing prevalence of dementia in the United States, as well as the potential benefits of new treatments to prevent or slow the progression of this costly and increasingly common condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMPACT OF DEPRESSION & FUNCTION ON HEALTHCARE USE & COST Principal Investigator & Institution: Friedman, Bruce; Community and Prev Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: (provided by applicant): The purpose of this Mentored Research Scientist Career Development Award (KO1) is to become an independent researcher prepared to make a unique and significant contribution to our understanding of the impact of depression and functional impairment on health services use and expenditures among older adults (age 65+). Three themes characterize my background: (a) work-related

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positions with an exclusive or major focus on the aged; (b) exposure to and involvement with late life mental health; and (c) expertise in crosssectional analysis of healthcare use and expenditures. My past scientific history has focused on innovative intervention studies of elderly patients. I will receive the needed training and conduct mentored research at the University of Rochester, with additional study at the University of Michigan and training and mentored research at Cornell University. Presently little is known about the impact of depression and functional impairment on healthcare use and expenditures among most categories of elderly patients (e.g., primary care patients, home care patients, and community-dwelling high users of medical care). The Training Objectives of my Research Career Development Plan are to: (1) Improve my knowledge base in relation to affective illness, cognitive dysfunction, and chronic illness comorbidity and disability in elderly persons; (2) Increase my knowledge of mental health oriented community-based interventions and public health models; (3) Add to my knowledge and skills in longitudinal data analysis; (4) Become more familiar with the requirements for responsible conduct of research involving human subjects; and (5) Plan, organize, and carrying out a systematic research program adding knowledge of geriatric mental health and function to my expertise and skills in Health Services Research and community-based geriatric interventions. The Specific Aims of the Research Plan are: (Aim 1) To better understand the impact of major and subsyndronml depression on certain specific types of healthcare use and expenditures; (Aim 2) To better understand the effect of functional impairment (deficits in activities of daily living, instrumental activities of daily living, and ambulation/-mobility) on certain specific types of healthcare use and expenditures; and (Aim 3) To study the role of depression as a mediator between functional impairment and use/expenditures, and functional impairment as a mediator between depression and use/expenditures. The Analytic Plan consists of (a) bivariate associations, (b) regression analyses, (c) an examination of direct and indirect effects, and (d) longitudinal analyses applied to data from 3 studies: (1) the Medicare Primary and Consumer-Directed Care Demonstration (2) the Depression Outcome in Primary Care Elderly study, and (3) the Depression in Elderly Medical Homecare Patients study. Given the expected continuing rise in healthcare costs and the high prevalence of depression and functional impairment among the chronically ill aged, understanding the impact of depression and functional impairment on healthcare use and expenditures is of particular public health importance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPACT OF PUBLICLY FUNDED PROGRAMS ON CHILD SAFETY NETS Principal Investigator & Institution: Budetti, Peter P.; None; Northwestern University 633 Clark Street Evanston, Il 60208 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-MAR-2003 Summary: Expansion of Medicaid managed care (MMC), a decline in Medicaid enrollment, and an increase in the number of uninsured children appears to be threatening the stability of pediatric safety net hospitals and Federally Qualified Health Centers (FQHC). Implementation of the State Children's Health Insurance Program (SCHIP) may play a key role in their survival. The impact of these health care-related changes on community safety nets for children has not been studied. SPECIFIC AIMS The study will (1)describe relationship between characteristics of publicly funded programs and survival/financial viability of pediatric safety net providers (PSNP), (2) determine differential effects of MMC and S-CHIP for PSNPs relative to pediatric

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FQHCs, (3) investigate institutional and organizational factors among PSNPs that are precipitating change as a result of evolving Medicaid and S-CHIP programs, and (4)examine how successes and failures that PSNPs have experienced in confronting changes have affected their communities. STUDY DESIGN The unit of analysis is the individual pediatric safety net institution and the study period is 1996 through 1999. Safety net hospitals will be identified from the American Hospital Association's (AHA) Annual Survey of Hospitals and the Medicare Cost Report. FQHCs will be identified from the Uniform Data System (UDS). All hospitals with a high burden of uncompensated care (UC) and/or a large proportion of Medicaid revenues and all FQHCs will be included. Pediatric safety net hospitals and FQHCs will be selected by service mix (AHA data) and telephone survey to gather pediatric UC and Medicaid revenues for each hospital and by service mix and patient characteristics on the UDS, respectively. Key informant interviews will be conducted in MSAs with significant changes MMC and S-CHIP and in MSAs with significant negative, positive, or no changes in financial status of pediatric safety nets. Five case studies of MSAs with substantial change in MMC and S-CHIP and financial safety net success or failure will be conducted. ANALYSIS A logistic regression model will estimate the impact of hospital, market, and policy factors on closure. The model will indicate the extent to which baseline factors as well as changes in state Medicaid and S-CHIP policies affected the probability of closure over time. The hospital's cost, revenue, and profit equations will be modeled using a fixed effects regression model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LARGE DATABASE RESEARCH FOR CANCER PREVENTION & CONTROL Principal Investigator & Institution: Cooper, Gregory S.; Associate Professor; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: The Candidate, a gastroenterologist/health services researcher has developed a focused research program in cancer prevention and control, primarily through the use of large population-based databases. In addition, he has mentored several trainees and junior faculty at different levels of training. However, because of time and budgetary restraints, his ability to provide data and methodological support to junior researchers is increasingly limited. In addition, he has been unable to expand his research focus to different cancer sites and other content areas, including pharmacoepidemiology. The proposed Established Investigator Award in Cancer Prevention, Control Behavioral and Population Research will assist the Candidate in fulfilling his long-term career goals. These include to evaluate the effectiveness of commonly performed screening, treatment and surveillance procedures in routine clinical practice; determine the accuracy, completeness and appropriateness of alternative methods to measure cancer screening, surveillance, and therapy; and develop a critical mass of cancer prevention and control researchers. The proposal will enable the Candidate to use data sources with which has considerable experience to study other clinically relevant issues. He will investigate the recognition of premalignant conditions of the esophagus and its impact on patient outcome, as well as the frequency of use and clinical impact of endoscopic ultrasonography on the diagnosis and treatment of patients with gastrointestinal cancer. In addition, we will develop expertise in the use of pharmacy databases to study the protective effects of nonsteroidal anti-inflammatory drugs on colorectal cancer incidence. The resources of this award will also enable aim to develop an infrastructure that will provide the necessary

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data and research support to train junior investigators in the use of large databases to conduct cancer related health services research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LINKING MOTHER AND CHILD ACCESS TO DENTAL CARE Principal Investigator & Institution: Grembowski, David E.; Professor; Health Services; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by investigator): Background. Healthy People 2010 and the U.S. Surgeon General's report, Oral Health in America, indicate that caries is a severe oral health problem among low-income, minority preschool children that is compounded by low access to dental care. Potential solutions to this problem may exist in the linkage between mother and child access to dental care. If low-income mothers have a regular source of dental care (RSDC), oral health benefits may accrue to both mother and child through biological and dental care mechanisms, but little is known about these associations. Aims. Among children aged three-to-six years old and enrolled in Medicaid dental insurance in Washington state (N=115,853), study aims are: 1) to measure the percentage of mothers with a RSDC and identify the determinants of mothers having a RSDC; 2) among mothers, to determine whether having a RSDC is associated with greater dental knowledge, oral health behaviors, dental satisfaction, better self-reported oral health, and less reparative treatment and work loss due to dental care; 3) among children, to determine whether having a mother with a RSDC is associated with greater utilization of dental care and better oral health; and 4) among children, to determine whether children with mothers losing dental coverage have less dental utilization than other children. Methods. Aims will be achieved through a prospective cohort study design composed of a baseline survey of mothers and one-year follow-up of children's dental utilization from Medicaid dental claims. Disproportionate stratified random sampling will select Medicaid households with children aged three-tosix years in four racial/ethnic strata (White non-Hispanic (n=3,050), Hispanic (n=4,511), African-American (n=6,100), and other race/ethnic groups (n=4,518). At least 780 sampled mothers will complete a baseline telephone or mail survey. One year later, Medicaid dental claims for one-year pre/post-survey will be extracted for sampled children. Separate regression analyses will be conducted for each racial/ethnic stratum. Aim 1 analyses will identify factors associated with mothers having a RSDC. Aim 2 analyses of mothers will determine the association between having a RSDC and knowledge and attitudes about dental care, oral health behaviors, and dental utilization. Aim 3 analyses of children will determine whether having a mother with a RSDC is associated with greater dental utilization in the prospective year. Aim 4 analyses of children will determine whether mothers' loss of dental insurance results in fewer children dental utilization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LONG-TERM CARE INSURANCE: THE PURCHASE DECISION Principal Investigator & Institution: Cramer, Anne T.; None; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2003; Project Start 01-JAN-2004; Project End 31-DEC-2005 Summary: (provided by applicant): The need for long-term medical care has been increasing in recent years and is projected to continue in the years ahead. With this increase, there is much concern about how to pay for the long-term medical care.

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Because of the potential drain on public funds, there is interest in identifying what circumstances motivate private purchase of long-term care (LTC) insurance and what options individuals have if they choose not to purchase LTC insurance. The goal of the proposed study is to develop, extend, and publish findings about the LTC insurance purchase decision. Specific aims of the proposal include: 1) Expand preliminary findings which suggest that family circumstances are influential in the original purchase decision, while price and income considerations become more important in the renewal decision. 2) Explore the relationship between LTC insurance and other products, such as Medigap, Medicare HMO, and retiree health insurance. 3) Explore the relationship between LTC insurance and care alternatives such as nursing home care and care giving at home. An understanding of the LTC insurance purchase decision is critical in ensuring continued access to long-term medical care for seniors. It will allow us to assess the potential for encouraging private purchase and will allow us to evaluate the appropriateness of public funding. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MAJOR MENTAL DISORDERS AND HIV--HEALTH SERVICES USE Principal Investigator & Institution: Crystal, Stephen; Research Professor; None; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, Nj 08901 Timing: Fiscal Year 2002; Project Start 20-AUG-2000; Project End 31-JUL-2004 Summary: This study will investigate the provision of health care services to a statewide population of HIV-positive Medicaid participants whose service needs are complicated by major psychiatric comorbidities, particularly schizophrenia and schizoaffective disorder. The overall objective is to generate much-needed knowledge about care of these persons so that policies and programs, which have largely been developed on the basis of findings from inpatient samples, can better address their complex needs. The research will use a unique database created by merging multiple New Jersey Medicaid administrative and claims records with HIV/AIDS Registry data, covering the years 1988-1999 for 8,996 individuals, including (according to preliminary classifications) 577 who received at least one inpatient or two outpatient diagnoses with schizophrenia or schizoaffective disorder, with a mean of 55 encounters with schizophrenia diagnoses. We will also examine, as a secondary focus, individuals diagnosed with mood disorders including bipolar disorder and recurrent major depressive disorder, and will explore the association between combinations of psychiatric and substance abuse comorbidities and use of health care services. The study will examine the types and combinations of psychiatric diagnoses reported by health care providers during health care encounters with HIV+ persons on Medicaid; refine claims-based diagnostic classifications; explore the impact of psychiatric conditions on the types and amounts of health care services used over the course of HIV; analyze receipt of mental health services and the type and consistency over time of psychotropic use; and examine the relationship between comorbid major mental disorders, with and without comorbid substance abuse, and patterns of antiretroviral therapy including type of regimen, incidence of use, consistency of use over time, and dropout from treatment. Results of these analyses will provide an important information base for the development of policies and programs to improve the care of this under-studied group within the population living with HIV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MANAGED CARE AND ALCOHOL TREATMENT INDEP SCIENTIST AWARD Principal Investigator & Institution: Mcfarland, Bentson H.; Associate Professor; Psychiatry; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: Candidate: This proposal for an Independent Scientist Award represents a change in focus for an individual with considerable experience in mental health services research. The rise of managed behavioral health care coupled with the growing recognition of comorbid mental illness and alcohol use disorders have created a need for investigators who can address these issues as they pertain to the treatment of individuals with alcohol problems. The applicant is a board certified psychiatrist with degrees in epidemiology and biostatistics as well as a clinical background in managed behavioral health care. Environment: Conveniently, Oregon's adoption of managed care for its Medicaid chemical dependency treatment program plus the implementation in Oregon state of several large scale research studies provide an ideal environment in which to examine the impact of managed care on chemical dependency treatment programs. In addition, Oregon Health Sciences University is now the site of growing research programs pertaining to the epidemiology of alcohol use disorders among American Indians and the genetics of alcohol problems, respectively. Research: The Independent Scientist Award will be used (a) to further the applicant's development as an investigator in health services research pertinent to alcohol problems and (b) to facilitate the implementation of research projects pertaining to (1) managed care financial arrangements and alcohol treatment programs, (2) pharmacoepidemiology of antidepressant usage by people with alcohol problems, and (3) organization and financing of alcohol treatment services for American Indians. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEASURING ENDARTERECTOMY

AND

IMPROVING

QUALITY:

CAROTID

Principal Investigator & Institution: Chassin, Mark R.; Health Policy; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 01-JUN-1998; Project End 31-MAY-2004 Summary: Carotid endarterectomy is a surgical procedure commonly performed among the elderly to prevent stroke. Its annual incidence is rising rapidly, up 61 percent nationally between 1991 and 1994. Past research has suggested significant quality problems relating to this procedure, including: the selection of inappropriate surgical candidates, high rates of complications in community-based studies, an inverse relationship between provider volume and complications, and substantial racial disparities in use rates. Recent studies have produced much new data on the efficacy of this operation but few new data on quality of care. We propose to investigate quality of care in carotid endarterectomy in a retrospective, multiple cohort, 2-phase study, measuring appropriateness, risk-adjusted complications (death, stroke, and myocardial infarction), and the relationship of specific surgical processes of care to outcomes. In the phase 1, we will study patients treated in a group of 7 collaborating hospitals. In phase 2, we will conduct 2 parallel investigations. We will study a large, stratified random sample of about 8000 Medicare cases from across New York State, a sample large enough to build robust models of risk-adjusted perioperative complications. We will examine appropriateness, risk- adjusted outcomes, and surgical processes of care. Attempting to characterize best surgical practices, we will assess the extent to which

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specific surgical processes of care are associated with low rates of risk-adjusted perioperative complications. In addition, we will explore the relationship of hospital and surgeon volume to risk-adjusted perioperative complications. We will also assess the relationship between race and appropriateness. In the second part of phase 2, we will design, conduct, and evaluate a series of quality improvement interventions at the 7 collaborating hospitals. With the active participation of the surgeons who perform carotid endarterectomy at these institutions, we will examine the phase 1 data on appropriateness. We will examine differences among collaborating hospitals in the surgical processes of care shown in Phase 2 to be associated with improved riskadjusted perioperative outcomes. We will determine at each hospital where opportunities exist to improve both the appropriateness of patient selection and the effectiveness of surgical processes of care, intervene to improve, and assess the impact of those interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDICAID MCO'S AND SUBOPTIMAL PEDIATRIC CARE Principal Investigator & Institution: Cooper, William O.; Pediatrics; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2006 Summary: (provided by the applicant): The candidate is a pediatrician committed to improving equity in childhood healthcare outcomes, especially for low-income children enrolled in Medicaid. Career development activities for the award period arise from three primary goals: 1) become a state-of-the-art child health services researcher; 2) establish a child health services research center; and, 3) increase national visibility for child health services research in high-risk, vulnerable children. The career development plan uses adult learning theory as a basis for designing and implementing specific objectives for each goal. Plans for achieving each objective include formal instruction, interaction with collaborators, practical applications, and self-evaluation and feedback. An advisory group of internal and external senior faculty will meet semi-annually with the candidate to provide feedback and guidance on progress towards stated goals and objectives. The aim of the candidate's research proposal is to examine the effect of Medicaid managed care organizations (MCOs) on access to specific recommended care for children with asthma, as individual MCOs may have conflicting incentives for authorizing care or providing resources for care. The study will compare MCO's with respect to suboptimal use of preventive medications for asthma among approximately 24,000 children with moderate to severe asthma in Washington State and Tennessee. The study will be conducted using a Medicaid research database, linked with vital records and U.S. Census data in Washington State and Tennessee. Additional studies will apply new research methodologies and will be directed at augmenting study findings by addressing recognized limitations of the proposed studies. These evaluations will increase understanding of inequities in care for children and will allow for future interventions to reduce disparities for vulnerable children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEDICAID MGD CARE FOR CHILDREN WITH SPEC HLTH CARE NEEDS Principal Investigator & Institution: Mitchell, Jean M.; Professor; None; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 31-MAY-2004

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Summary: The substantial increase in Medicaid enrollment in capitated plans has raised a number of concerns regarding the delivery of child health care in the U.S. because the financial incentives to control costs inherent in such plans may elicit under-treatment and restrict access to specific treatments, services and specialty providers (Hughes and Luft, 1998). Policymakers also recognize that the shift to Medicaid managed care is likely to have the most profound impact on poor children with chronic or disabling conditions (Fox and McManus, 1998). On the other hand, capitated managed care plans offer several advantages such as care management and coordination of services. Despite the widespread growth of managed care in recent years, little research has examined the effects of managed care arrangements, in particular capitated plans, on utilization of and access to health care services by children with special health care needs (SHCN). We propose to analyze Medicaid eligibility, claims and encounter data for children with SHCN (as determined by eligibility for Supplemental Security Income (SSI)) enrolled in the DC Medicaid program. In addition, we will conduct interviews with parents of children with SHCN to evaluate access to care. Currently, some parents of children with SHCN who qualify for SSI have chosen to voluntarily enroll their child in the capitated managed care plan, while the remainder have opted to remain in the traditional fee-forservice system. As of October 2000, enrollment in capitated managed care will be mandatory for all children with SHCN. Parents will have a choice between two capitated managed care plans. The specific aims of this study are: (1) to prepare detailed case studies for the managed care plans; (2) to analyze factors determining selection of a managed care plan by the parents of children with SHCN; (3) to evaluate the effect of plan choice, child health status, and other characteristics on utilization of services based on several indicators constructed from claims data; (4) to conduct a telephone survey with a random sample of 1,200 parents of children with SHCN to elicit information on why parents have difficulties obtaining access to care for their children; and (5) to conduct a pilot study to obtain information on children's access to care from about 100 parents of children with SHCN who reside in households without telephones. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDICARE EDUCATION AND DECISION SUPPORT TOOLS Principal Investigator & Institution: Mcarthur, Lynne; Johnson, Bassin and Shaw, Inc. 8630 Fenton St, 12Th Floor Silver Spring, Md 20910 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JAN-2004 Summary: (provided by applicant): Who will care for aging baby boomers? They will likely have to do it themselves. The need to educate boomers about the extent of the problems they will face in obtaining affordable health insurance and assisted-living services is abundantly clear. To date, boomers have tended to "turn a blind eye" to these issues, partly out of ignorance and partly out of denial that they will ever need these services. Medicare, Medigap, M+C, Medicaid, and private health insurance eligibility, enrollment, dis-enrollments, coverage, and costs have become a maze of complexity. Government sources of information are inadequate and often not sought until a crisis occurs. Our firm, JBS, runs the Centers for Medicare and Medicaid Services' national resource center in support of all state health insurance and counseling programs We believe that the private sector can develop some informational products that will better enable boomers to plan for and use long-term health insurance options. The proposed products are CD-based interactive software, a "Medicare Game," a Dummies-type book that would make Medicare understandable, a toolkit for retirement planners and human resources professionals, and a Web site. Our SBIR goals are to develop prototype products, assess interest of likely distributors, and evaluate commercial viability.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENTAL HEALTH AND NURSE STAFFING IN US NURSING HOMES Principal Investigator & Institution: Myers, Sarah K.; Rand Corporation 1700 Main St Santa Monica, Ca 90401 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): Using 1998 data, we have estimated persons with mental disorders in U.S. nursing homes may now total approximately 1,000,000, or 67% of all residents. Jakubiak and Callahan (1995-96) note that, "More than two-thirds of nursing home residents exhibit some level of dementia, depression, anxiety, schizophrenia, or delirium." High quality, error free nursing home care is time and labor-intensive and vital to optimizing residents' mental and physical health, but the current nursing shortage will escalate as the Baby Boomers age and require substantially more care. In the proposed project, we will examine possible associations between nurse staffing and mental health outcomes in approximately 17,000 U.S. nursing homes. We will focus on two outcomes available in the Center for Medicare and Medicaid Services' On-line Survey Certification of Automated Records: (1) Psychoactive medication use; and (2) Deficiencies for mental health care. Mental disorders are quite prevalent in nursing homes and present a substantial illness burden. Additionally, quality issues around inappropriate use of chemical restraints, inappropriate treatment, and failure to diagnose mental disorders are errors that generate concern among nursing home residents, their families, nursing home staff, and the public. The insights possible through this research support a key component of NIMH's research plan to: "Determine the best fit and utility of treatment and prevention interventions for diverse populations," including the elderly population and to: "Determine the impact of organization and financing of services on outcomes." The specific objectives are to: (1) Describe nursing staffing levels in U.S. nursing homes; (2) describe the mix of nursing staff in U.S. nursing homes; (3) assess possible associations between nursing home staffing and mental health-related quality outcomes and deficiencies (including those persisting over time); (4) assess possible associations between nursing home staff mix and mental health-related quality outcomes and deficiencies (including those persisting overtime); and (5) inform policies related to nurse staffing that aim to enhance mental health outcomes. We will generate simple descriptive statistics related to the level and mix of nursing staff, mental health-related quality outcomes and deficiencies, and basic environmental and market characteristics for each nursing home. Then, we will examine the cross-sectional relationship between (1) mental health-related quality outcomes and deficiencies and (2) facility and market factors (especially nurse staffing levels and mix). Because studies of small area variation show that environmental factors have a strong impact upon the health care system and can affect process and outcome variables such as psychotropic medication use and code violations, we will include them in our analysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MENTAL MANAGED CARE

HEALTH

SERVICES

RESEARCH

PROGRAM

IN

Principal Investigator & Institution: Mclaughlin, Thomas J.; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, Ma 02481 Timing: Fiscal Year 2002; Project Start 10-APR-1998; Project End 31-MAR-2004

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Summary: (Applicant's Abstract): As organized systems of care move towards becoming the predominant form of health delivery system in the U.S., managed care organizations are attempting to measure and improve health outcomes per unit cost ("value"). This agenda, characteristic of today's managed care organization, is due in large part to the demands of the marketplace which expects reorganization of the health care system in order to maximize benefit at the lowest possible cost. Harvard Pilgrim Health Care (HPHC) proposes to develop a research infrastructure building program (RISP) of mental health services and clinical research in the context of managed care which complements and extends an existing and highly developed process of clinical quality management and improvement cycles. The proposed work will accelerate and facilitate a continuously emerging mental health infrastructure within this large health maintenance organization. It is likely that processes of skill-building and formation of multidisciplinary research groups "invented" or developed at HPHC will be applicable to other managed care organizations. Specific aims of the proposed RISP are to develop multidisciplinary groups of mental health researchers that will: (1) study the organization, process and outcomes of care for mental illness in primary care. This group will be represented by core individuals from within the different divisions of HPHC, researchers from academic organizations with a solid track record in mental health research and educational training, and representatives from the public sector who are increasingly important actors in defining and evaluating mental health care for their clients; (2) explore mechanisms to link primary care providers to mental health specialists in order to improve access to and outcomes of care for common and expensive mental illnesses such as depression with or without substance abuse; (3) examine experiments in the re-organization of mental health care delivery within staff and medical groups components of HPHC to improve patient and provider satisfaction and care ("hybrid models"); (4) examine patient factors associated with access and particularly patient-directed interventions aimed at facilitating entry into traditional health and mental health programs, (5) and, finally to study the special needs of publicly-insured members, especially Medicaid populations which are characterized by disproportionately high levels of serious and chronic mental illness such as schizophrenia and major affective disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENTAL HEALTH SYSTEMS AND JUVENILE JUSTICE OUTCOMES Principal Investigator & Institution: Cuellar, Alison; Biostatistics; Columbia University Health Sciences Po Box 49 New York, Ny 10032 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): The program of training and research proposed in this Mentored Research Scientist Development Award application is designed to further both the applicant's near-term and long-term career goals. In this near term it will allow her to develop skills in conducting longitudinal studies dealing with the relationship between mental health and juvenile justice systems using large, secondary datasets. In the long-term it will help her develop theoretical models and empirical tests about the behavior of mental health care and juvenile justice systems, the dynamics of their relationship, and their responses to policy change. The proposed training and research program is designed to address three career development needs: 1) develop a knowledge base of the juvenile justice system as it relates to youth with emotional disorders; 2) develop statistical skills in longitudinal data analysis; and 3) train in the responsible conduct of research and scientific communication. This training will facilitate the applicant's pursuit of innovative, comprehensive, and technologically

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efficient approaches in research on mental health and juvenile justice systems. The research plan is divided into three separate studies which will complement the proposed sequence of training activities and provide the applicant research experience with dynamic modeling using a variety of datasets. The specific aims of the proposed studies are 1) to estimate the impact of major health policy changes, including Medicaid eligibility and mental health managed care, on juvenile crime outcomes, using two separate approaches; 2) to estimate the effects of major policy changes and key organizational structures on the continuity of mental health service delivery for youth exiting the juvenile justice system; and 3) to estimate the effects of a mental health diversion program for youth in the juvenile justice system on criminal outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTIMEDIA LONG-TERM CARE RESOURCE Principal Investigator & Institution: Lantz, Penelope A.; Health Media Lab, Inc. 2734 Cortland Pl Nw Washington, Dc 20008 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 31-OCT-2003 Summary: (provided by investigator): The long-term goal of this project is to develop and evaluate through focus group discussions and questionnaire survey data, a multimedia resource designed to help individuals and caregivers of individuals navigate through the maze of intricacies associated with long-term care planning, and to help them make informed decisions about long-term care options including, type of care, source of care, and how to pay for care. This resource will include a CD-ROM with tutorials, worksheets, common applications, and legal forms; a toll-free telephone helpline staffed by experienced long-term care counselors; and Website resources from Health Media Lab's long-term care Website section, plus links to other Internet resources. We envision the information provided by each of these media as overlapping, although each has its own advantages. For instance, the telephone helpline will offer personalized, one-on-one help. The Website will have tutorials, printable worksheets, links to other resources, and will be updated frequently. The CD-ROM can have much of the same information and tools as the Website, but may be easier to use for people without high speed Internet access. This multimedia resource will be for use by individuals and couples who want to plan for their long-term care, adult children of elderly parents who are caregivers or who monitor care, and spouses, friends, relatives and others who provide care to elders. It will also be useful for professionals, including employee benefits coordinators, public health, medical and nursing personnel, elder care lawyers and others who provide legal assistance, insurance companies, social workers and other senior service providers, and elder care volunteers who assist in educating caregivers about long-term care options. It will help users understand and utilize (or help others to utilize) health insurance, health care, legal and financial issues, Medicare and medicaid, and other long-term care issues for seniors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OUTCOMES

MULTIPLE

POLLUTANTS

AND

CARDIORESPIRATORY

Principal Investigator & Institution: Tolbert, Paige E.; Associate Professor; Epidemiology & Biomathematics; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 16-SEP-2002; Project End 31-JUL-2006 Summary: (provided by applicant): The investigators seek to elucidate the roles of specific air pollutants, and inter-relationships among them, in producing acute

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exacerbations of certain cardiac and respiratory conditions, using two complementary approaches. First, the study period of an ongoing study of emergency department (ED) visits in Atlanta will be doubled and multi-pollutant questions will be addressed in the resulting unique and powerful database. This study is an investigation of cardiac and respiratory ED visits in relation to daily measures of air quality, including detailed measurements of particulate matter (PM) components being conducted at the station operated for the Aerosol Research and Inhalation Epidemiology Study (ARIES) in downtown Atlanta. The existing study period is August 1998 through August 2000. Operation of the ARIES station is being extended through August 2002, and in this application the investigators are seeking to extend ED outcome data collection for this period. With data on over a million ED visits per year, this study may be the largest single-city ED study with speciated PM data to date. As such, the expanded study will be uniquely positioned to disentangle effects of PM from the effects of other pollutants and to contribute to our understanding of the effects of exposure to PM in the presence of other pollutants. Moreover, the detailed air quality data available to the investigators will allow assessment of the role of PM components (e.g., sulfates, water-soluble metals) and size fractions in the multi-pollutant analysis. Second, a companion study of unscheduled admissions to Atlanta-area hospitals by elderly Medicare beneficiaries, is planned. Given that the investigators will have already compiled a comprehensive air quality database and will have established the time-series modeling methodology, this second substudy will provide an efficient approach to assessing coherence in the results for similar conditions across clinical care venues as well as direct comparability to the numerous other studies that have employed Medicare data. Finally, a thorough assessment of the role of measurement error in the epidemiologic analyses will be performed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATTERNS CARE FOR CANCER PATIENTS AT END OF LIFE Principal Investigator & Institution: Mccarthy, Ellen P.; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2002; Project Start 12-AUG-1998; Project End 31-JUL-2004 Summary: This proposal is submitted for a first award (R29). In recent years, the way that people die in the U.S. has attracted growing public concern. As suffering cancer patients increasingly request assistance to end their lives, some argue that too little attention is paid to the quality of life in the final months. Voters in some states have sponsored referenda on the right to end one's own life when gravely ill, although the 1997 Supreme Court ruled against the right to a physician-assisted suicide. Nonetheless, those continuing to lead public calls for more individual control over the dying process have frequently been cancer patients who describe uncontrollable pain or other intolerable symptoms. Relatively little is known about the quality of the dying experience for cancer patients, especially from the patient's perspective, or about patterns of care used during the final months of life. The overall goal of this study is to describe the dying experience of cancer patients, focusing on specific types of care, the resources consumed, and whether that care complies with a patient s preferences. The project will use two complimentary databases to achieve this goal: 1. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) database, and 2. The Surveillance, Epidemiology, and End Results (SEER) program database. Both databases have been merged with Medicare claims data for patients older than 65 years. The proposed study will be conducted in four overlapping phases, each with its own specific aims. Phase one will describe the dying experience of

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the seriously ill lung and colon cancer patients, including preferences for care. Phase two will describe patterns of care for cancer patients at the end of life. Phase three will examine the nature and intensity of care received at the end of life. Phase four will describe variations in end-of-life cancer care across place and time. This study will provide an in-depth description of the quality of the dying experience for selected cancer patients, and a better understanding of where cancer patients receive care during their last six months of life, the intensity of nature of their care, and whether patients' preferences for care are being respected. Information obtained from the study can be used to improve the quality of care for patients at the end of life and help to determine the nature and amount of resources that might be required to meet patients' needs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POPULATION MAMMOGRAPHY USE

BASED

APPROACH

TO

INCREASE

Principal Investigator & Institution: Slater, Jonathan S.; Epidemiologist/ Program Manager/ Chief; Minnesota State Dept of Health Box 64882, 85 E 7Th St St. Paul, Mn 55164 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-MAY-2004 Summary: This proposal seeks to test the effectiveness and cost-effectiveness of two mailed, population-based interventions designed to increase mammography use among medically underserved women age 40 to 84. Both interventions are designed to promote use of mammography services available through two national programs: the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and Medicare. One intervention uses personally addressed mailings to encourage women to get a mammogram, while the other intervention uses a combination of personally addressed mailings, a toll-free number, and direct appointment scheduling to encourage women to get a mammogram. Because of age-related differences in both insurance coverage for and barriers to mammography use, as well as in the availability of data to adequately measure mammography use, this proposal is divided into two studies. One study targets younger women age 40 to 64 who are eligible for mammography services through the NBCCEDP in Minnesota, while the other study targets older women age 65 to 84 who are eligible for mammography services through either Minnesota's NBCCEDP or Medicare. The study samples will be randomly drawn from the Minnesota driver's license database for the study of younger women, and from Medicare's enrollment file for the study of older women. A total of 15,201 women age 40-64 and 7,134 women age 65-84 will be randomly assigned to one of two intervention groups or a control group. A randomized post-test only control group design will be used to test for differences in the proportion of women getting a mammogram one year after receiving the mailings based on claims data from the state program and/or Medicare. If this study can demonstrate the effectiveness of a low-cost strategy for increasing mammography use among underserved populations, it can significantly contribute to reaching national public health goals for improving the health of all women. The potential for widespread incorporation of the proposed interventions are substantial because they are designed to be readily implemented by state and local health departments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POPULATION MODELS OF FACTORS AFFECTING HEALTH TRENDS Principal Investigator & Institution: Manton, Ken; Professor; Center for Demographic Studies; Duke University Durham, Nc 27706 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: This Program Project is designed to examine the recent changes in chronic disability and functioning in the U.S. elderly populations, possible sources of those changes including the introduction of the Medicare program and, more recent, biomedical research and therapeutic innovations and the future Medicare service use and cost implications of those changes and the processes underlying them. The work builds upon a significant body of research done at CDS on the analysis and forecasting of chronic disability and health changes in the U.S. elderly population. However, that model needs to be significantly expanded in scope of adding input from economists detailed analyses of Medicare expenditures, and a more in depth analysis of specific omp0onents of health changes (e.g., dementia, stroke). To perform these analysis we have assembled a multi-disciplinary team to carry out a well integrated set of analyses. To conduct those analyses one first defines three core functions. The first (A) is longitudinally linked files but also continuous linked Medicare records which will be kept current as the project is underway (i.e., we should have Medicare data from 1999 in hand with data for 2000 shortly available thereafter; later data will be available to 2001). The third core (C) will make general health forecasts. The four projects involve (1) methodological expansion of the health model to include data from multiple sources; (2) analysis of cohort different in health and Medicare service use; (3) analyses of the natural history of Medicare expenditures; (4) analyses of the recent changes in dementia and stroke and their health cost implications These projects are all designed to take advantage of the three cores and to be integrated so that their results will help resolve the basic questions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POST-BBA CHANGES IN RURAL HOSPITAL LTC STRATEGIES Principal Investigator & Institution: Fennell, Mary L.; Center for Gerontology and Health Care Research; Brown University Box 1929 Providence, Ri 02912 Timing: Fiscal Year 2002; Project Start 15-AUG-1996; Project End 31-MAY-2005 Summary: (provided by applicant): The ongoing implementation of the 1997 Balanced Budget Act (BBA) and the 1999 Balanced Budget Refinement Act (BBRA) continues to adversely affect reimbursements to hospitals and post-acute/long-term care providers. Reimbursement incentives in each setting may be having the practical effect of limiting access to care for Medicare patients requiring complex and costly services, thus further fragmenting the fee-for-service (FFS) continuum of care for the most vulnerable Medicare beneficiaries. A fragmented continuum of care is especially problematic in rural areas, where disruptions can leave large gaps in access to care if the strategic options of providers are constrained or inter-provider relationships (e.g., hospital to nursing home) are weak. Although the intended effects of the BBA and BBRA were to control costs, there are a wide range of possible unintended effects on rural hospitals, their hospital-based nursing homes and home health agencies, and the relationship between hospitals and external post-acute and long-term care providers. The unintended effects on rural hospitals may involve their adoption and/or abandonment of integration strategies, which in turn may affect the care of rural Medicare beneficiaries as well as the overall financial performance of rural hospitals. The results

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of our earlier study of rural hospitals and their post-acute and long-term care strategies offer a unique baseline from which to examine the unintended effects of the BBA and BBRA. We plan to address three specific aims: (1) To assess how the BBA and BBRA have affected the organizational strategies of rural hospitals to either diversify into longterm care or link to external providers of long-term care; (2) To assess the impact of BBA and BBRA-related strategic behavior on the timing and placement of discharges among at-risk Medicare patients treated in rural hospitals; and (3) To assess the impact of BBA and BBRA-related strategy changes on the financial performance of rural hospitals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREDICTORS AND OUTCOMES OF PNEUMONIA AFTER STROKE Principal Investigator & Institution: Katzan, Irene L.; Epidemiology and Biostatistics; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2008 Summary: (provided by applicant): The candidate's long-term goals are to become an independent clinical researcher and make significant contributions to the study of stroke management and outcomes. To fulfill these goals, the candidate proposes a 5-year plan to learn research methodologies related to assessing and analyzing stroke management in the community setting. This will involve formal training as well as comprehensive research on pneumonia as a complication of acute stroke. Pneumonia is a frequent and serious complication occurring after stroke, yet the predictors and preventability of pneumonia, and its effect on outcomes after stroke, are poorly known. The Aims of the proposed study are to use a large community-based cohort of Medicare patients hospitalized for acute stroke to: 1) Evaluate the effect of pneumonia on length of stay, rate of discharge to home, and 30-day readmissions. 2) Determine the effect of pneumonia on hospital costs. 3) Evaluate the effect of process of care measures on occurrence of pneumonia. 4) Develop a clinically useful prediction rule to identify patients most likely to benefit from preventive interventions. A retrospective cohort will be used to evaluate Primary Aims 1 and 2 and nested case-control studies will be performed to evaluate Primary Aims 3 and 4. For the first two Aims, the independent effect of pneumonia on outcomes and costs will be determined using data on 11, 286 stroke patients hospitalized in the Cleveland region from 1991-1997. Regression analyses will be performed with adjustments for both susceptibility and selection bias. To evaluate Primary Aims 3 and 4, a supplemental chart review will be performed for each case and control in the 2 nested case-control studies. Patients with pneumonia (n = 400) in a subset of 19 hospitals will serve as cases for both. For Aim 3, to isolate the effect of process of care measures, controls for Aim 3 will be selected using multivariate matching to cases on patient characteristics correlated with their propensity for pneumonia. For Aim 4, a random sample of patients will serve as controls. Products of this investigation will fill important gaps in knowledge about a serious compilation of stroke and guide further research and patient care to prevent stroke-related pneumonia. Combined with rigorous coursework in research methods, this body of work will establish a solid foundation for the candidate's long-term goals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREDICTORS OF SUCCESSFUL OPTICAL REHABILITATION IN ARM Principal Investigator & Institution: Decarlo, Dawn K.; None; Nova Southeastern University College Ave Fort Lauderdale, Fl 33314

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Medicare

Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-JAN-2007 Summary: (provided by applicant): Age-related maculopathy (ARM) is the most common cause of lost reading vision in the elderly. Difficulties with daily activities such as cooking, driving and watching television have also been documented. This condition is not curable and no treatments effective at reversing vision loss due to ARM are on the horizon. Thus, low vision rehabilitation is currently the primary mode of enhancing visual function. To date, however, there have been no large-scale, well-designed studies to examine the effects of low vision rehabilitation (primary optical rehabilitation or comprehensive low vision rehabilitation) on visual function or quality of life (QoL). Although there is much anecdotal evidence that suggests that low vision rehabilitation is useful for restoring function among persons with vision impairment, many third party payers do not cover low vision intervention services. Only recently has Medicare created a nation-wide policy for coverage for rehabilitation services. These services, however, are exclusive of optical aid prescription. The lack of published, well designed studies showing the benefits of optical rehabilitation surely contributes to policies that fail to classify low vision aids as prosthetic devices. Appropriate scientific investigations looking at low vision interventions may contribute to changing these policies. A longterm goal of this research is to develop a model of low vision rehabilitation for ARM that significantly increases the QoL for patients. The short-term goal of this proposed project is to first develop a test, or battery of tests, to determine which patients are most likely to be successful with optical low vision rehabilitation. Patients likely to be successful would then proceed directly to optical rehabilitation, whereas patients not likely to be successful would be referred for other interventions that would enhance their ability to succeed with optical magnification, such as counseling or eccentric viewing training. Development of a successful testing protocol will allow a more patient-based approach to rehabilitation, allow more accurate treatment recommendations, improve treatment efficiency, and create a greater overall success rate by initially placing patients at their correct treatment level. The outcome of this proposed research project will also provide a tool for more appropriate standardization of participants in future large scale well-designed studies examining the effects of low vision rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRESCRIPTION DRUG COST-SHARING: AFFORDABILITY/SAFETY Principal Investigator & Institution: Hsu, John; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 946123433 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: (Provided by applicant) Cost-sharing is a commonly used mechanism to control prescription drug costs; there is, however, a lack of information on how drug cost-sharing affects clinical outcomes and total medical costs, which is particularly concerning given that the most extreme version of cost-sharing (no coverage) is associated with poor health, and that poor drug adherence may lead to higher downstream medical costs. To address these issues, we propose to evaluate the effects of the level of drug cost-sharing on patient clinical outcomes and total direct medical costs between 2000-2005, using a quasi-experimental pre-post design with concurrent controls, within the Kaiser Permanente (KP) integrated health delivery system. In this natural experiment, nearly half of the 330,000 members age 65 years and older experienced a new pharmacy benefit cap on January 1, 2001; and 70% of these same members experiencing a new multi-der drug co-payment during the following year (1/1/2002). The level of cost-sharing will be the main predictor, with co-payment levels

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in effect until patients exceed their benefit cap if any, and "full costs" applicable after patients exceed their cap. The main outcome measures are emergency department (ED) visits, hospitalizations, deaths, and total annual direct medical costs, i.e. the sum of all outpatient, inpatient, and pharmacy costs (including patient out-of-pocket drug costs). We will investigate these outcomes by the level of cost-sharing within the Overall Population (age 65 years and older on 1/1/2000), and within select Vulnerable Populations, i.e. patients with low socio-economic status (SES), existing chronic diseases, existing high drug use, or those who are new to the health system. We will use a proportional hazard model to test the hypothesis that higher levels of cost-sharing are related to higher rates of adverse clinical outcomes, and a two-part model to test the hypothesis that higher levels of cost-sharing are related to lower total direct medical costs. We will have the ability to detect even small changes in our outcomes, e.g. 80% power to detect a difference of one death/1,000 person-years. We will make adjustments for relevant patient and organizational factors, such as measures of SES, case-mix, physician, and medical center. These factors may influence drug use independently or modify, the association of cost-sharing level and patients' decisions to use prescription drugs. In short, there is a tremendous need to understand the safety and economic effects of cost-sharing as its use increases, in other words primum non nocere. This study will be the first to address these issues within a broad sample of Medicare beneficiaries. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROMOTING MANAGEMENT

EVIDENCE-BASED

STATE

PHARMACY

Principal Investigator & Institution: Fox, Kimberley; None; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, Nj 08901 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2004 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROSTATE CANCER SCREENING & MORTALITY: SEATTLE VS. CT. Principal Investigator & Institution: Barry, Michael J.; Associate Professor and Director Medical; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-MAR-2005 Summary: This is a resubmission of a previous grant. The investigators propose to assess the outcomes of a "natural experiment" to determine whether aggressive early detection and treatment efforts are effective at reducing prostate cancer mortality for Medicare beneficiaries. In the United States, clinicians in the Seattle SEER area were much more aggressive in trying to detect prostate cancer early (particularly with the prostate-specific antigen or PSA test) and treat it aggressively (particularly "PSA era" (1987-1990). During the pre-PSA era, population-based prostate cancer mortality in these two are and was essentially identical. Their natural experiment focuses primarily on cohorts of about 75,000 men in Seattle and 95,000 men Connecticut who were age 65-74 (with at least a 10-year life expectancy) and who were residents of their respective regions through at least through 1990. During the period 1987-1990, they have already determined that the men in the Seattle cohort were about twice as likely to undergo prostate biopsy, twice as likely to be diagnosed with prostate cancer, and six times as likely to undergo a radical prostatectomy than men in the Connecticut cohort. In fact, the cumulative incidence of radical prostatectomy in the Seattle cohort from 1987- 1997

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Medicare

was over 3% (about the proportion of men in this cohort who would ultimately be expected to die of prostate cancer) compared to less than 1% in the Connecticut cohort. They propose to continue follow-up of these two cohorts through calendar year 2001, or 15 years from inceptions of the cohorts. Over this interval, they would expect to see a reduction in population-based prostate cancer mortality Seattle as compared to Connecticut if early detection and aggressive treatment as actually practiced in the community are indeed an effective strategy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROVIDER SPECIALTY AND OUTCOMES IN OVARIAN CANCER Principal Investigator & Institution: Silber, Jeffrey H.; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 191044399 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2006 Summary: (provided by investigator): The goal of this application is to study practice variations and outcomes across specialty type in Ovarian Cancer, and also to develop an approach for conducting chart review in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database that takes into consideration issues of patient confidentiality. In particular, the application will study how provider specialty influences surgery and chemotherapy, and how such differences influence mortality in Ovarian Cancer using multivariate counter-matching and conditional logistic regression, in order to control for chemotherapy and surgical treatment in a manner not previously accomplished. Counter-matching will allow for adjustment by factors such as age, patient co-morbidities, stage, year, chemotherapy (as determined from Medicare claims), and other provider information when appropriate, while utilizing the minimum number of pairs needed to detect important differences. Matching will be complemented with regression modeling using all available claims data in order to utilize maximum information available. The aims of the application are to: (1) determine whether outcomes after chemotherapy differ with the specialty of the provider delivering that chemotherapy; (2) determine whether chemotherapy intensity differs across the specialty of the provider delivering that chemotherapy; (3) Determine whether survival is a function of the type of surgical specialist performing the primary cancer surgery; (4) study the referral patterns associated with different surgical specialties; and (5) develop a Phase-II "minimally intrusive" approach that is sensitive to the concerns of forthcoming federal regulations regarding patient privacy, while at the same time allowing for important health services research questions to be answered using the data resources of the SEER-Medicare data base with chart review. We will propose a second phase of this research (not part of the present application), to examine those specific charts deemed interesting from this initial application or "Phase-I" analysis. Our hope is that this study could serve as a model for other matched cohort studies involving chart review utilizing the SEER-Medicare database. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RACE,TREATMENT AND ENDOMETRIAL CANCER SURVIVAL Principal Investigator & Institution: Armstrong, Katrina; Medicine; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 11-APR-2003; Project End 31-MAR-2006 Summary: (provided by investigator): Survival after the diagnosis of endometrial cancer varies significantly between African-American and Caucasian women. Between 1992 and 1998, five-year survival for African-American women after endometrial cancer

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diagnosis was 58.9%, compared to 85.8% for Caucasian women. The disparity in survival is greatest among older women, with an absolute difference in five year survival of 10% for women under 50 compared to 30% for women 50 years of age and older. Prior studies have identified several factors that contribute to the observed racial disparity in endometrial cancer survival, including stage at diagnosis and tumor grade. However, significant differences in survival between Caucasian and African-American women persist even after adjusting for these factors. There are several reasons to believe that differences in the prevalence and characteristics of treatment may contribute to this residual survival disparity. African- Americans have been shown to be less likely to undergo definitive treatment for many different medical and surgical conditions. Characteristics of treatment (including provider characteristics, hospital characteristics and intensity of therapy) are associated with outcome for other surgical conditions, including surgery for lung, pancreatic and breast cancer. Understanding the prevalence and outcomes of differences in treatment characteristics between African-American and Caucasian women offers a potentially promising new approach to improving endometrial cancer survival among African-American women. In this application we propose to use SEER-Medicare linked data to examine the outcomes of AfricanAmerican and Caucasian women diagnosed with endometrial cancer between 1991 and 1999. The primary outcome will be overall and disease-specific survival times (which may be censored) as assessed by Medicare vital statistics and SEER linkage to the National Death Index respectively. Analyses will adjust for comorbidity, socioeconomic status and tumor characteristics using information provided in the SEER-Medicare database. Provider and hospital characteristics will be determined by linkage to the AMA practitioner database and AHA annual survey respectively. Our three specific aims explore the contribution of differences in treatment to the higher mortality among African-American women diagnosed with endometrial cancer. We group differences in treatment into three categories: (1) differences in the rates of treatment; (2) differences in the extent/intensity of treatment; and (3) differences in the providers and hospitals/facilities who deliver the treatment. For each category, we will explore differences between African-American and Caucasian women, their association with outcome, and to what extent variations in treatment explain the excess mortality among African-American women. In addition, within each category, we will investigate differences related to primary surgery and adjuvant radiation therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RACIAL INTEGRATION OF MEDICINE IN THE UNITED STATES Principal Investigator & Institution: Reynolds, P P.; Individual Award--Reynolds, P. Preston 6 Concord Pl Havre De Grace, Md 21078 Timing: Fiscal Year 2000; Project Start 01-MAR-1999; Project End 31-MAY-2004 Summary: There are no comprehensive analyses of the racial integration of health care in the United States in the fields of history, political science, health policy, and health administration. Explicit discrimination against minorities, however, still existed in the 1960s in hospital patient admissions and physician and nurse staff appointments. With passage of the Civil Rights Act in 1964, and the Medicare legislation in 1965, civil rights advocates within the federal government had both a legislative mandate to guarantee equal access to programs funded by the federal government in Title VI of the 1964 Civil Rights Act, and a federal program that affected every hospital in the country in Medicare. This study will determine the extent to which the Medicare program was the major determinant in the racial integration of hospitals, and thereby assess the impact of economic incentives used by the federal government and civil rights advocates to

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achieve and then to secure the racial integration of hospital care set in the broader context of the civil rights movement and national priorities to expand health coverage to older Americans. This project will reveal the central role played by the National Association for the Advancement of Colored People beginning in the 1930s in laying the foundation for the racial integration of health care decades later under Medicare. This was accomplished through establishment of organization policies and programs, use of the courts in establishing legal precedent, building a consensus for integration among African-American health professionals, and then by engaging and pressuring executive leadership individuals to implement federal regulations consistent with legislation and court rulings. Primary sources include archival manuscripts, personal collections, government documents, newspapers and lay and medical journals as well as in-depth oral history interviews with individuals involved in the racial integration of hospitals at the local, regional and national levels. This proposal is to support the publication of a one-volume work that will serve as a comprehensive analysis of the racial integration of health care in the United States, and the preparation of the oral histories for deposit into a national archive. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RCT ON PREVENTING PRESSURE ULCERS WITH SEAT CUSHIONS Principal Investigator & Institution: Brienza, David M.; None; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 25-JUN-2003; Project End 31-MAY-2008 Summary: (provided by applicant): Pressure ulcers (PU) are a significant healthcare problem for the growing number of United States (US) elderly long-term care (LTC) residents. PU diminish quality of life, exact a devastating loss of function, increase the risk of death in geriatric populations and raise healthcare costs. Despite Federal preventive mandates for the long-term care (LTC) setting, widespread non-compliance occurs. The last three Centers for Medicare and Medicaid Services (CMS) LTC surveys showed a cumulative increase of 21% in the number of citations issued for failure to provide proper intervention to prevent or treat pressure ulcers. Costs for the management of PU in the US likely exceed $6.4 billion annually, with a prevalence of approximately 28% in the LTC population. Estimates of the prevalence of sittingacquired PU in the elderly, at-risk population range from 36-50%. Several studies, including our own pilot investigation, support these estimates and have suggested that the use of wheelchair cushions designed to reduce interface pressure will reduce the incidence of sitting-acquired PU. Despite this evidence, elderly wheelchair users are not routinely evaluated for seating and positioning needs because definitive studies have not been completed to justify funding for such seating interventions. Consequently, elderly Medicare beneficiaries are being denied access to medically necessary and clinically appropriate interventions. Instead, they are most frequently provided with convoluted or segmented-foam cushions that are not designed for pressure ulcer prevention. The primary aim of the proposed multi-center, randomized pressurereducing wheelchair cushion trial (PRWC-II) is to determine the efficacy of pressurereducing cushions in preventing sitting-acquired pressure ulcers in the elderly, LTC population. Positive results of the proposed trial will provide the level of evidence needed to change the standard of care to include the routine evaluation of at-risk residents for seating and positioning needs and the provision of a pressure-reducing cushion as a preventive measure against sitting acquired pressure ulcers. If our hypothesis is correct, such an intervention should result in a decrease in the incidence

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and prevalence of sitting-acquired pressure ulcers, reduced healthcare costs, and improved quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RELATIONSHIP OF MORBIDITY AND MORTALITY BETWEEN SPOUSES Principal Investigator & Institution: Christakis, Nicholas A.; Professor; Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 30-SEP-2001; Project End 31-DEC-2006 Summary: (provided by applicant): Employing the perspective and methods of the demography of aging, we propose to examine the relationship between the morbidity and mortality of spouses. We ask questions about how the morbidity and mortality or one spouse, and the timing and nature of that morbidity and mortality, affects the morbidity, mortality, and timing and nature of morbidity and mortality in the other spouse. For example, is the hazard of death in one spouse (the "proband") increased by illness or death in the other spouse? If so, how does the proband's hazard of illness or death change over time after the onset of illness or death in spouse? How do these affects vary according to the type of severity or duration of the spouse's morbidity? Do particular illnesses in spouses place probands at particularly high risk of development illness or dying themselves? What role do socio-demographic factors play in all these effects? To address these questions most effectively, we will create a new panel data set with demographics socioeconomic, and health information about one million elderly married couples followed up to ten years. Using a variety of even history and fixed effects methods, we will conduct four main analyses. First, we will evaluate morbidity in one spouse influences mortality in the other. We hypothesize that individuals married to unhealthy spouses will have worst mortality than those married to healthy spouses, and that the longer the spouses is ill, the greater the effect. We also hypothesize the certain types of spousal morbidity (e.g. those that most compromise activities levels) will be worse for probands. Second, we will reevaluate the widower effect (i.e. the increased tendency of the bereaved to die), but we will; adjust for the health of both spouses prior to widowhood; examine it's temporal shape in detail; and assess its dependence on socioeconomic factors. Third, we will evaluate how morbidity in one spouse influences morbidity in the other. Are healthy spouses better able then unhealthy spouses to provide health benefits in marriage? Four, we will evaluate the impact of widowhood on the morbidity, and not just mortality, of bereaved spouses. Our work advances the demographics of aging by; closely examine how an individual's morbidity and mortality are affected by the presence or absence of spousal support; focusing on cause-of-death specific aspects of demographics phenomena; examine theoretically interesting sub-populations along gender, race, socioeconomic, and health status lines; and shedding light on the mechanisms of inter-spousal health effects. Our work also has policy implications in that it; supports more accurate projections of the health burdens in the elderly; facilitates targeting of support services to the growing numbers to the widowed elderly; and addresses important populations, such as minorities the poor, the oldest old, those with dementia, and caregivers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RESPONSES TO MORTALITY REPORT CARDS FOR CARDIAS SURGERY Principal Investigator & Institution: Epstein, Andrew J.; Health Care Systems; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104

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Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2005 Summary: (provided by the applicant): This dissertation proposal examines responses to cardiac surgery mortality report cards in three states-New Jersey, New York, and Pennsylvania-over the course of the 1990s by three sets of stakeholders-cardiac surgeons, referring cardiologists, and HMOs. Report card proponents contend that publicly releasing this information provides incentives for hospitals and surgeons to improve the quality of patient care and supplies consumers with previously unavailable information to assist in selecting a provider. Critics counter that the report cards are inherently inaccurate and surgeons can act to improve their performance artificially, thereby biasing the scores. The first part of this work focuses on the incentives surgeons have to avoid riskier cases, looking across states and time for evidence of whether surgeons treat less severe cases during periods of report card data collection, and within report card states over time for evidence that lower-volume and worse-rated surgeons engaged in more patient avoidance. These difference-in-difference and surgeon fixedeffect regression analyses will be conducted using hospital discharge data from all three report card states, Maryland, and the AHRQ HCUP National Inpatient Sample. Part Two studies whether Pennsylvania cardiologists changed their referral patterns in response to the May 1998 report card release. Leveraging the fact that cardiac surgery patients undergo cardiac catheterization prior to surgery, a novel algorithm has been developed to infer the identity of the referring cardiologist from inpatient and outpatient surgery data. Nested Iogit methods will be used to explore whether the magnitude of the referral responses varied by patient and cardiologist characteristics and to attempt to uncover the extent to which the report cards presented information not already known by cardiologists. The third part considers whether HMOs in the three report card states engaged in selective contracting for cardiac surgery and whether HMOs responded to report cards by increasing their business with better or worse rated providers. Difference-in-difference, multinomial Iogit, and market-share models will compare the HMO volume response with that of Medicare FFS patients, who are not constrained in their choices of provider. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF SCAVENGER RECEPTORS IN RENAL FIBROSIS Principal Investigator & Institution: Eddy, Allison A.; Professor; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 01-APR-1992; Project End 31-MAR-2007 Summary: Description (provided by applicant) Progressive renal disease is caused by a process of fibrosis that relentlessly destroys normal renal architecture and function. The number of patients with end-stage renal disease continues to rise exponentially, at an annual cost to Medicare that now exceeds $12 billion. The goal of the proposed studies is to determine how abnormalities of lipoprotein metabolism, which are frequently present in patients with renal disease, contribute to the pathogenesis of renal fibrosis. The overall hypothesis to be tested is that macrophage scavenger receptors process low density lipoproteins that have been oxidatively modified within the kidney to initiate fibrosis-promoting events. It is further hypothesized that this pathway worsens fibrosis in the face of hypercholesterolemia. Three Specific Aims are proposed. (1) To determine the effects of hypercholesterolemia on the severity of renal fibrosis and to delineate the pattern of renal scavenger receptor expression in murine models of renal fibrosis. (2) To investigate the role of the macrophage scavenger receptor class A type I/II (SR-AI/II) and scavenger receptor CD36 in renal fibrosis. (3) To elucidate intrarenal changes in prooxidant and anti-oxidant enzymes that could promote lipoprotein oxidation in murine

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models of renal disease associated with hyperlipidemia. These in vivo studies will be based on four murine models of renal disease. The functional significance of the two best characterized macrophage scavenger receptors, which are also known to participate in atherogenesis, (SR-AI/II and CD36), will be determined by comparing renal disease severity between wild-type animals and scavenger receptor-deficient animals. Bone marrow transplantation studies will be done to distinguish between the role of renal and macrophage scavenger receptors. Our long-term objective is to provide a scientific basis for the development and use of new therapies for patients with progressive renal disease. It is anticipated that the results of the proposed studies will prove that hypercholesterolemia, intra-renal oxidation of low density lipoproteins and scavenger receptor-dependent interactions with oxLDL represent an important pathogenetic pathway of progressive renal damage. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SAFETY AND EFFICACY OF SERTRALINE FOR DEPRESSION CHF Principal Investigator & Institution: Krishnan, Ranga R.; Chairman and Professor; Psychiatry; Duke University Durham, Nc 27706 Timing: Fiscal Year 2003; Project Start 20-FEB-2003; Project End 31-JAN-2008 Summary: (provided by applicant): The significance of co-morbid depression upon the medically ill has recently been recognized in the medical literature. Higher prevalence rates of mood disorders above that of the normal population has been found in patients who suffer from chronic medical illnesses, including vascular disease (cerebrovascular and coronary artery disease). Additional work has shown increased in-patient hospitalizations, cost of care, morbidity and mortality in these patients. More than 2 million United States citizens suffer from congestive heart failure (CHF), accounting for the highest category for hospitalization in the Medicare population, with annual expenses exceeding $10 billion. One leading source of heart failure is ischemic heart disease. Despite knowledge that depressive disorders lead to increased morbidity, mortality and poorer outcomes in ischemic heart disease, little is currently known about the association of CHF and depression. There is evidence that the rate of depression may be high in the CHF population, but no studies have addressed the impact on morbidity and mortality in CHF patients when depression is adequately treated. Funding is requested for a two site, prospective placebo treatment of patients with congestive heart failure and clinically diagnosed major depression. Patients will be enrolled in this study with clinically diagnosed heart failure of NYHA functional > II. Patients will be interviewed and evaluated for major depression by use of the protocol developed by the NIMH-supported Duke Center for the Study of Depression in the Elderly. This includes sections that assess depressive symptoms, psychiatric co-morbidity, cognitive status, functional status and disability, daily and chronic stress, and social support, the longitudinal component of this study will include collecting data on all enrolled subjects. Information collected in these follow-up contacts will include deaths, rehospitalizations, cardiac events, functional status/quality of life measures, and level of depressive symptoms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SAN FRANCISCO MAMMOGRAPHY REGISTRY--A RESEARCH RESOURCE Principal Investigator & Institution: Kerlikowske, Karla M.; Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747

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Timing: Fiscal Year 2002; Project Start 01-JUN-1994; Project End 31-MAR-2005 Summary: The overall goal of this proposal is to maintain and expand the populationbased, computerized San Francisco Mammography Registry (SFMR) so that it can continue to serve as a resource for conducting high quality, clinically significant research related to breast cancer. Specifically, we will continue to collect demographic, clinical and risk factor information, mammographic interpretations and cancer outcomes obtained through linkage with the regional population-based Surveillance, Epidemiology, and End Results (SEER) program and the California Cancer Registry for the purpose of evaluating the performance of mammography. The cohort of women (N= 178,887) in the SFMR includes 49 percent non- Hispanic whites, 24 percent Asian/Pacific Islanders, 12 percent Hispanics, and 10 percent African Americans. Information on 361,884 mammography examinations has been collected. The number of women will increase over the next five years to an estimated 210,000, and the number of mammograms to an estimated 800,000. We will determine the rate of cancer, sensitivity, specificity and positive predictive value of mammography, and type of cancer detected [DCIS vs. invasive, size, grade, and stage] according to race/ethnicity, risk factors, and screening practices using the SFMR (Research Plan number 1). Additional research objectives (Research Plans number 2-number 6) include: 1) determining whether mammographic breast density and bone mineral density, both strong predictors of breast cancer risk, are correlated, 2) assessing the diagnostic accuracy among radiologists by volume of examinations interpreted per year as well as by physician characteristics using data from the SFMR and three other BCSC registries, 3) utilizing BCSC mammography registries that link with SEER programs to validate a mammography algorithm developed to distinguish screening from diagnostic mammography in the SEER-Medicare database, 4) determining patient and provider characteristics that are associated with inadequate follow-up of women with breast lumps but negative mammography, and 5) examining the prevalence and prognostic value of beta- estrogen and alpha-estrogen receptors among mammographically detected DCIS and early invasive cancers. The SFMR database and research platform will be a valuable resource for addressing issues related to mammography performance, for identifying factors that optimize the quality of mammography, for biologic studies of screen-detected compared with other cancers, for developing clinical guidelines, and for future studies of emergent screening technologies and clinical interventions to improve screening outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SELECTION BIAS BY MEDICARE BENEFICIARIES WITH DIABETES Principal Investigator & Institution: Maciejewski, Matthew L.; Health Services; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-DEC-2003 Summary: The purpose of this study is to examine the effect of Medicare HMO enrollment on the mortality and cost of care for Medicare beneficiaries with diabetes between 1994 and 1998. There are two major public policy concerns regarding individuals with chronic conditions that enroll in Medicare HMOs: Does Medicare contain costs by encouraging people with chronic diseases, such as people with diabetes, to join TEFRA-risk HMOs? and Are the quality of care and health outcomes provided to these enrollees comparable to those in the fee-for-service sector? This study will provide insight into both of these questions using Medicare administrative data from 1992 to 1998. This proposal will extend recent work by Dowd, et al., (1998) and Maciejewski, et al. (2001) looking at biased selection of the general Medicare population into TEFRA-

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risk HMOs. It will use a unique dataset (the National Medicare Diabetes Cohort), which contains 2.5 million elderly Medicare beneficiaries with diagnosed diabetes mellitus in fee-for-service plans in 1994. The following specific research questions will be addressed: 1) Do healthier beneficiaries with diabetes systematically enroll in Medicare HMOs? 2) Do HMO enrollees with diabetes have different five-year survival rates than Medicare beneficiaries with diabetes who remain in the fee-for-service (FFS) sector? 3) Do unhealthier beneficiaries with diabetes systematically disenroll from Medicare HMOs? 4) Do HMO disenrollees with diabetes have different FFS costs than Medicare beneficiaries who remain in the FFS sector? The careful analysis of enrollment and disenrollment patterns of this chronically ill population, combined with the mortality and cost analyses, will provide insight into the advantages and disadvantages of enrollment in Medicare HMOs. Analyses will be conducted on a cohort of beneficiaries with diabetes in thc fee-for-service sector in 1992-1993, so results are not generalizable to people with diabetes who enrolled in Medicare HMOs prior to 1994. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SHORTAGE OF HEALTH PROFESSIONALS IN RURAL AREAS Principal Investigator & Institution: Merwin, Elizabeth I.; Director; None; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2003; Project Start 16-JUL-2003; Project End 31-MAR-2007 Summary: (provided by applicant): An ongoing challenge to the provision of state of the science, empirically tested mental health interventions in rural areas is a shortage of mental health and general health care professionals. The lack of specialty mental health professionals in many rural areas is compounded by the current registered nurse shortage, which is predicted to worsen. More daunting is the lack of providers with adequate training in the provision of culturally relevant care as well as the small number of mental health providers of different minority race and ethnic populations. The shortages of these professionals may result in the absence of care, the provision of substandard care, poor consumer outcomes, the lack of culturally acceptable care and, ultimately, in negative health for the community. Using existing data we will evaluate the impact of having different amounts and mixes of professionals on public health and utilization types of outcomes. We will: 1) determine the influence of community characteristics including race, poverty and rurality on the availability of different types of mental health professionals; 2) evaluate the relationship between current and proposed numbers of professionals, the need for culturally relevant mental health care and the outcomes of mental health care; and 3) propose better methods for determining a shortage of mental health professionals (e.g. HPSA's). Products of the research will include a CD with information on the nation, states', and counties' mental health workforce. This data will be available for use in planning by policy-makers and for use in other research studies. The study will provide both improved data and improved methods to create and evaluate different definitions of Mental Health Shortage Areas. According to the Health Resources and Services Administration more than 34 federal programs depend on the shortage designation to determine eligibility or as a funding reference (HRSA, 2002). This study will provide improved accuracy to these important designations which influence eligibility for participation in federal programs, loan repayment for the National Health Service Corps and financial incentives to providers for caring for Medicare clients residing in these designated areas. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SURVIVAL

SOCIO-ECONOMIC

DETERMINANTS

OF

KIDNEY

GRAFT

Principal Investigator & Institution: Woodward, Robert S.; Associate Professor; Health Management and Policy; University of New Hampshire Service Building Durham, Nh 038243585 Timing: Fiscal Year 2002; Project Start 05-JUL-2002; Project End 31-MAY-2004 Summary: (provided by applicant): Objective: This study proposes to expand the understanding of how insurance coverage, recipient incomes, immunosuppression prices, Medicaid, and state-specific support programs interact to significantly affect long-term kidney transplantation graft survival. Specific Aims: Elsewhere, we have demonstrated that in the absence of Medicare's immunosuppressive medication coverage, low-income recipients had significantly greater graft loss. Here we ask: 1) whether recipient income and immunosuppression insurance affect graft survival among black recipients differently than white; 2) whether differences in state Medicaid regulations and state programs such as the Missouri Kidney Program have ameliorated the importance of insurance as a determinant of graft survival among low income recipients; and 3) whether the cost of the immunosuppressive regimen correlates with graft survival. Methods: The project merges a) patient-level USRDS-provided data about the patient, transplant, immunosuppressive medications, graft survival, and cost; b) ZIP-code-level Census data socio-economic characteristics (Income, Education, and state-level data with details about Medicaid programs relevant to kidney transplantation and state-kidney-specific support programs. The project will illustrate the importance of each of these variables on graft survival using Kaplan-Meier plots of graft survival. The project will estimate each variable's importance in multivariate Cox Proportional Hazards model. Importance: The results of this project will provide some guidance to both Medicare and state policy-makers responsible for determining the length of immunosuppression coverage. Specifically, it will identify those patient characteristics for which insurance had the greatest historical impact. The results will also guide physicians in selecting among immunosuppressive medications with widely variable prices by identifying those patient groups for whom out-of-pocket price was an important determinant of long-term graft survival. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STATE POLICIES AND HOSPITALIZATIONS FROM NURSING HOMES Principal Investigator & Institution: Mor, Vincent M.; Chairman; Ctrs/Gerontol & Hlth Care Res; Brown University Box 1929 Providence, Ri 02912 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2005 Summary: (provided by applicant): Every 6 months, nearly 25 percent of nursing home residents are hospitalized in the U.S. This figure varies considerably within and between states. In spite of the high cost and iatrogenic problems associated with hospitalizing nursing home residents, and observed inter-state variation, there has been little systematic study of the influence of state policy on these rates and whether this influence may be differential for subgroups of vulnerable residents. Preliminary evidence suggests that states with low Medicaid nursing home payment rates tend to have higher hospitalization rates. A more complete analysis of how state policies affect the strategic clinical and management investment choices nursing homes make should inform the development of more coherent and equitable state and federal policies affecting this highly vulnerable population. Using MDS data and matched Medicare

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hospital claims for all long stay nursing home residents, in all non-hospital based facilities in the 48 contiguous states merged with facility-level Online Survey Certification Automated Records (OSCAR) data, market-level information from the Area Resource File, and data on state policies, we propose examining the effect of state policies on hospitalization as mediated by nursing homes? investments in medical and managerial resources. The specific aims are: (1) To characterize inter and intra state variation in the long-stay nursing home population, particularly the dually eligible population, in terms of patients? clinical conditions and their concentration. (2) To examine the relationship between state Medicaid nursing home policies and facilities? investment in medically relevant clinical and managerial infrastructure to care for longstay Medicaid residents. (3) To model the unique association of facility and state-level factors with hospitalization events among long-stay nursing home residents. (4) Using the model developed in (3), to summarize the moderating effects of state Medicaid payment rates and policies on the relationship between facility context and hospitalization for specific sub-populations of long-stay residents: (4a) prevalence of cognitively impaired residents and/or availability of special dementia unit among cognitively impaired residents; (4b) prevalence of African Americans; and (4c) prevalence of dually eligible residents. The results of the proposed study should inform extant theories about how long term care providers respond to exogenous policy shocks, the relative competitiveness of the market and local resource constraints. These theoretical insights will help shape the policy implications emerging from the study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STUDY OF A NEW PAYMENT SYSTEM FOR MEDICAID Principal Investigator & Institution: Eklund, Stephen A.; Professor; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2003 Summary: (Provided by the applicant): This study will monitor utilization of dental care in Michigan children, in order to evaluate the effectiveness of recent and future SCHIP (State Children?s Health Insurance Program) and Medicaid initiatives in reducing disparities in access to and utilization of dental care. Evidence from many sources demonstrates a wide disparity in utilization of dental care that is associated with the socioeconomic status of children. Disparities exist as measured by both visits for care as well as untreated oral disease. Dental insurance claims data will be used to demonstrate historical patterns of utilization and the disparities between privately insured and Medicaid-eligible children. Future data from both the privately-insured child in Michigan and from the newly-implemented private-insurance based SCHIP and Medicaid programs in Michigan will then be monitored for the next several years to assess the ability of these methods of payment and administration to reduce the historical disparities in dental care utilization. Specific null hypotheses to be tested are: 1) Payment for dental care at market rates will result in no difference in the percent of children with at least one dental visit per year, between children with Medicaid, SCHIP, or private insurance coverage, 2) Payment for dental care at market rates will result in no difference in the mix of services received, between children with Medicaid, SCHIP, or private insurance coverage, and 3) Payment for dental care at market rates will result in no difference in the distance traveled to receive care, between children with Medicaid, SCHIP, or private insurance coverage. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TAMOXIFEN EFFECTIVENESS

&

BREAST

CANCER--ACCEPTANCE/COST

Principal Investigator & Institution: Melnikow, Joy; Family and Community Medicine; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: Risk reduction or prophylaxis of breast cancer with tamoxifen is a controversial intervention. The decision to take or recommend tamoxifen presents a range of potential outcomes and associated costs which must be considered in both individual and clinical policy decisions. Objectives: The primary objectives of this 3 year proposal are: (1) to evaluate women's acceptance and utilities for the outcomes of tamoxifen prophylaxis of breast cancer, (2) to evaluate the association of self-perceived breast cancer risk with preferences for tamoxifen prophylaxis compared to the association of calculated breast cancer risk using the NCI Gail breast cancer risk screening tool with preferences for tamoxifen prophylaxis and (3) to determine the marginal cost- effectiveness of tamoxifen prophylaxis for reduction of breast cancer mortality compared with annual screening by clinical breast exam and mammography. Methods: We will collect cross- sectional data from interviews with 300 women as well as perform secondary analyses on pre-existing data. Utilities and patient preferences will be collected from interviews with 300 women potentially eligible for tamoxifen prophylaxis, as identified through use of the NCI Gail breast cancer risk screening tool. Because low income minority women have been largely excluded from clinical trials examining tamoxifen prophylaxis, particular efforts will be made to recruit African American and Latina women participating in California's Breast Cancer Early Detection Program for assessment of these parameters. Costs will be derived from Medicare average allowed charges and average wholesale prices for outpatient medications. Model probabilities will be determined when possible from a systematic review of the literature, relying primarily on recent published results from randomized trials and a large meta-analysis for relative risks of tamoxifen related outcomes, and population based data or large cohort studies for estimating baseline risks. When probabilities are not available from the medical literature, expert opinion will be solicited from a panel using a modified Delphi process. Outcomes will include breast cancer, endometrial cancer, venous thromboembolism, stroke, hip fracture, cataracts, and bothersome side effects. The cost-effectiveness analysis will be based on modifications of a previously developed Markov process model. One way and two way, sensitivity analyses and Monte Carlo analysis will be conducted. Expected results: Findings from this project will enhance understanding of women's decisionmaking about tamoxifen prophylaxis, identify key parameters influencing cost effectiveness of tamoxifen prophylaxis, and provide perspective on the marginal cost effectiveness of tamoxifen compared with other preventive interventions, outside the context of randomized controlled trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTING A MODEL OF QUALITY CARE IN HOME HEALTH Principal Investigator & Institution: Lynn, Mary R.; None; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 31-JAN-2007 Summary: Since home health care is the fastest growing sector of the health care system, determining the quality of home health care is essential. However, evaluation of the quality of home health care has been largely idiosyncratic, unstandardized or, until recently, simply ignored. To address the need for a uniform, standardized data set that

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could be used to evaluate the attainment of specific outcomes, OASIS, a structured assessment tool completed by a nurse 3 or 4 times, as relevant, for each patient was developed. Subsequent to HCFA mandate, OASIS is being used in all Medicare-certified home health agencies. While the implementation of OASIS will certainly assist with the generation of a standardized data set for the evaluation of home health care, it will not contain sufficient information for that evaluation to be sufficiently broad. The proposed project will test a model of quality care that goes beyond that implicitly proposed in OASIS by including structure, process and outcome dimensions and provides for multiple sources of input into the evaluation. If the model is found to be an efficient and effective approach for measuring quality home health care, the knowledge gained about which determinants in the model are the best predictors of patient outcomes will be disseminated to home health administrators, payers, researchers, and clinicians. They may also serve as a national standard for quality assessment in home care. The aim of this study is to test the ability of the model to predict changes in patient health status between admission and discharge. Secondarily, the scales used to obtain perceptions of the quality of care exchange between provider and patient will be refined and the utility in evaluating quality of care of several well known instruments will be examined. The overall research question is: Does home health care affect patients' self-care abilities at discharge, change in health status between admission and discharge, and change in term health status one month after discharge? This study will be conducted in two sites. All nurses employed in these sites (166) plus 200 nurses employed at a 3rd site will be asked to participate in the study. Over the 3 years of data collection, 925 patients will participate. Data will be collected upon admission to home care (T1), discharge from home care (T2), and one month after discharge from home care (T3). Analyses will include structural equation modeling to identify the best determinants of the health status outcomes for home health patients and evaluating the psychometric properties of the perceptions of quality care scales. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE EPIDEMIOLOGY OF DIABETES IN THE U.S. ELDERLY Principal Investigator & Institution: Mcbean, Alexander M.; Health Services Research and Policy; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): The reported prevalence of diabetes is increasing in the United States and in many other countries. It is not known how much of this increase is due to an increased incidence or increased survival. The majority of the cases of diabetes occur in the elderly population. This study will measure the incidence and prevalence of diabetes, as well as the mortality rates for the years 1997 through 2003 among Medicare beneficiaries 67 years of age and older. In addition, cardiovascular, kidney, eye and neurological complications are a major part of the natural history and burden of diabetes in the elderly. This study will measure the frequency and time to the onset of these complications in people who have diabetes at the time the study begins (prevalent cases) as well as in the new cases (incident cases) that develop during the study. All of these analyses will provide information on different age groups of the elderly, men and women, as well as the five race groups: white, black, Asian, Hispanic and North American Native. This study will be one of the few, and the most current, to provide nationally representative information on this population, particularly among members of minority race groups. Thus, the information will be useful to the Healthy People 2010 initiative and the President's Initiative to Eliminate Racial and Ethnic

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Disparities in Health by providing information for the tracking of the Healthy People 2010 Objectives for diabetes and the President's Initiative. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE SEXUAL ABUSE OF VULNERABLE ADULTS IN INSTITUTIONS Principal Investigator & Institution: Teaster, Pamela B.; Gerontology; University of Kentucky 109 Kinkead Hall Lexington, Ky 40506 Timing: Fiscal Year 2004; Project Start 15-APR-2004; Project End 31-MAR-2007 Summary: (provided by applicant): In 2000, Adult Protective Services (APS), typically the state agency of first contact in cases of abuse, neglect, or exploitation, received 473,095 domestic (in the community) and institutional (nursing homes, assisted living, group homes) reports concerning vulnerable adults. Included in that number were 4,150 reports of sexual abuse, a number highly under-reported due to differing reporting categories and its taboo nature. Sexual abuse runs the gamut from kissing and fondling to forcible rape, and, validated by earlier studies, results in a diminished quality of life and, often, premature death. Because sexual abuse poses a significant public health and public safety problem requiring government intervention, this study is grounded in democratic governance theory, which emphasizes responsively, representative ness, and responsibility through government intervention. The specific aims are: (1.) to investigate patterns of the sexual abuse of vulnerable older and younger adults living in long-term care institutions; (2.) to test a web-based system for obtaining sensitive and confidential information on the sexual abuse of vulnerable adults; and (3.) to refine an emergent theory of the mistreatment of vulnerable adults derived from democratic governance theory. This multi-state study focused on four states (New Hampshire, Oregon, Tennessee, and Texas) will utilize survey data provided by APS staff regarding all reports, reports investigated, and reports that were substantiated. Data collection will be undertaken using a web-based protocol. To check for reliability of survey data, the Principal Investigator's and APS supervisors will conduct a clustered, randomized review of 20% of APS files. A randomized sample of 15% of APS staff will complete indepth telephone interviews regarding reports that were investigated only and reports substantiated. For nursing home residents only, data from resident's Minimum Data Set (MDS) will be collected six months prior to the report and six months after to provide a before and after picture of the resident who was sexually abused. To make comparisons about the types of facilities in which sexual abuse is occurring, the research team will use Nursing Home Compare, a Medicare website that provides public and facility specific information on all nursing homes receiving Medicare or Medicaid funds. We will analyze the data using descriptive statistics, Chi Squares, and logistic regression. This is the first systematic multi-state, theoretically grounded study to address the sexual abuse of vulnerable adults living in institutional settings. It will lay the foundation, for APS, law enforcement, health-related regulatory agencies, and the medical community for establishing investigator protocols and intervention strategies as well as a for a model of prevention to address sexual abuse at local, state, and national levels. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: USE OF CLAIMS DATA TO STUDY QUALITY OF CANCER CARE Principal Investigator & Institution: Goodwin, James S.; Professor and Director; Internal Medicine; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555

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Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2008 Summary: (provided by applicant): Sixty percent of all cancers occur in men and women aged 65 or older at diagnosis. A number of investigators have shown that older individuals with cancer are at increased risk for receiving less than definitive treatment for cancer, and that such non-definitive treatment contributes to poor survival. This proposal will examine the use of chemotherapy in older men and women with colon cancer and older women with breast cancer. Based on the results of numerous clinical trials, the NCI consensus conferences and other authorities recommend adjuvant chemotherapy for all men and women with stage III colon cancer, and for women up to age 70 with breast cancer > 1.0 cm in size. Nevertheless, others and we have found that fewer than half such patients in the community actually receive chemotherapy. In addition, there are substantial variations in use of chemotherapy by geographic region and also by patient characteristics, after controlling for tumor characteristics such as size, stage, hormone receptor status and histologic grade. Finally, others and we have found that only about half of older cancer patients see a medical oncologist. Thus we propose a two steps model governing receipt of chemotherapy: one set of factors influences whether or not the patient sees a medical oncologist and another set of factors influences whether the patient, once she or he sees an oncologist, actually receives chemotherapy. We now propose to use the SEER/Medicare linked data to address the following aims: determine the factors influencing whether older colon and breast cancer patients with tumor characteristics for which chemotherapy is generally recommended actually see a medical oncologist; and determine the factors influencing receipt of chemotherapy by the patients who see a medical oncologist. These analyses will be performed at the level of the patient and at the level of the provider. This will allow for the generation of provider-level information on an important process of quality cancer care in the elderly. We will then explore the reliability of the provider-level data in order to assess its potential utility in assessing quality of care for individual providers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: USE OF RADIATION IN STAGE IV NON-SMALL CELL LUNG CANCER Principal Investigator & Institution: Hayman, James A.; Assistant Professor; Radiation Oncology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 31-MAR-2004 Summary: (provided by applicant): The primary objective of this project is to examine factors associated with the utilization of radiation therapy in a sample of patients with Stage IV (i.e., metastatic) non-small cell lung cancer diagnosed in selected regions of the U.S. during a period ranging from 1991 to 1996. Anecdotal reports suggest that the use of radiation therapy to palliate symptoms associated with metastatic cancer is common and that there may be substantial variation in the intensity of treatment (i.e., number of treatments). This has important cost and quality implications because studies published over the last decade suggest that shorter courses of radiation treatment may be as effective as longer courses. Although this remains controversial in the U.S., as early as 1994 clinical guidelines in the U.S. began to endorse shorter courses of therapy. We propose to use the population-based linked SEER-Medicare data set to examine patterns and determinants of the utilization of palliative radiation therapy in patients age 65 or greater diagnosed with metastatic non-small cell lung cancer between 1991 and 1996. Created by researchers at the National Cancer Institute, this data set contains clinical data on almost all patients aged 65 and older diagnosed with cancer in the eleven SEER

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regions that have been linked to their respective Medicare claims data. Specifically, we plan to use SEER data to identify incident cases of metastatic non-small cell lung cancer and then use the Medicare claims data to identify those patients who received radiation therapy and quantify the intensity with which they were treated. We then propose to use this information to identify factors associated with the use and intensity of treatment with radiation including patient predisposing/enabling factors, clinical factors, organizational factors and physician factors. Lastly, we plan to examine whether the frequency and intensity of the administration of treatment with palliative radiation in this patient population has changed over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “Medicare” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for Medicare in the PubMed Central database: •

"Completely ridiculous" demands ruining Medicare. by Rich P.; 2002 Jun 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116176

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Birthplace of Medicare braces for more health care reform. by Ehman AJ.; 2002 Jan 22; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=99293

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Can we afford Medicare? Romanow to find out. by Sibbald B.; 2001 May 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81129

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Canadian "Medicare refugee myth" debunked in major US study. by Gray C.; 2002 Sep 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=121985

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Chretien's prescription for Medicare: a green poultice in lieu of accountability. by Sullivan T, Flood CM.; 2004 Feb 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=331388

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CMA proposes health charter, Medicare "auditor general". by Wharry S.; 2002 Jul 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117107

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Debating Medicare from the left and right. by Sullivan P.; 2000 Nov 14; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80355

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. by Ham C, York N, Sutch S, Shaw R.; 2003 Nov 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=286244

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Last proposed charter helped launch Medicare. by [No authors listed]; 2002 Jul 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117108

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Measuring access to effective care among elderly Medicare enrollees in managed and fee-for-service care: a retrospective cohort study. by Barton MB, Dayhoff DA, Soumerai SB, Rosenbach ML, Fletcher RH.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=59902

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Medicare charges and the operational-year coding concept. by Lehv MS.; 1994 Mar 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=116191

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Medicare reform series: left-wing bias? by Wiedrick J.; 2002 Nov 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=134129

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Medicare reform series: left-wing bias? by Hoey J, Todkill AM.; 2002 Nov 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=134130

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Medicare, 1949. by [No authors listed]; 2000 Dec 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80591

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Ontario, Quebec compare views on Medicare. by Pinker S.; 2001 Nov 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81647

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Quebec may tighten Medicare eligibility. by Pinker S.; 2001 Jan 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80698

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Renewing Medicare. by Begin M.; 2002 Jul 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116642

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Some thoughts on Medicare. by Rae B.; 2002 Aug 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117473

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The Medicare Participating Heart Bypass Demonstration Project in Houston, Texas. The experience of St. Luke's Episcopal Hospital, Texas Heart Institute, and CardioVascular Care Providers, Inc. by Nangle M, Duncan JM.; 1995; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=325214

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US MDs respond to pay cuts by turning backs on Medicare. by Korcok M.; 2002 May 14; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=111097

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US Medicare reform: why drug companies and private insurers are smiling. by Hurley J, Morgan S.; 2004 Feb 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=332707

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Utilization of the propensity score method: an exploratory comparison of proxycompleted to self-completed responses in the Medicare Health Outcomes Survey. by Ellis BH, Bannister WM, Cox JK, Fowler BM, Shannon ED, Drachman D, Adams RW, Giordano LA.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=222919

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Medicare, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Medicare” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Medicare (hyperlinks lead to article summaries): •

A bitter pill. Why a Medicare prescription-drug benefit isn't good for our health. Author(s): Birnbaum JH. Source: Fortune. 2003 July 7; 148(1): 36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12858794

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A cautionary tale: rethinking Medicare. Author(s): Hodge M, Battista RN. Source: Healthc Pap. 2000 Summer; 1(3): 55-9; Discussion 88-91. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811192

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A line in the sand: the politics of Medicare reform. Author(s): Scott JS. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2003 June; 57(6): 24-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12866422

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A Medicare Rx benefit: so close and yet so far. Author(s): Coons SJ, Vogel RJ. Source: Clinical Therapeutics. 2003 October; 25(10): 2610-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14667961

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A practical method of linking data from Medicare claims and a comprehensive electronic medical records system. Author(s): Weiner M, Stump TE, Callahan CM, Lewis JN, McDonald CJ. Source: International Journal of Medical Informatics. 2003 August; 71(1): 57-69. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12909159

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A primary concern. Medicare provision ensures program is second payer; $9 billion savings seen. Author(s): Taylor M. Source: Modern Healthcare. 2004 January 5; 34(1): 12-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14735706

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A redefinition of the issues for rethinking Medicare. Author(s): McMurtry R. Source: Healthc Pap. 2000 Summer; 1(3): 48-54; Discussion 88-91. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811191

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Accuracy of Medicare claims data for rheumatologic diagnoses in total hip replacement recipients. Author(s): Losina E, Barrett J, Baron JA, Katz JN. Source: Journal of Clinical Epidemiology. 2003 June; 56(6): 515-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12873645

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Acute ischemic stroke in hospitalized Medicare patients: evaluation and treatment. Author(s): Roychoudhury C, Jacobs BS, Baker PL, Schultz D, Mehta RH, Levine SR. Source: Stroke; a Journal of Cerebral Circulation. 2004 January; 35(1): E22-3. Epub 2003 December 04. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14657452

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Adding choice to Medicare. Author(s): Olsen GG. Source: Rehab Manag. 2004 March; 17(2): 50-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15022501

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Advocating for a Medicare prescription drug benefit. Author(s): Rother J. Source: Yale J Health Policy Law Ethics. 2003 Summer; 3(2): 279-90. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14577144

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After the storm. Medicare bill foes vow to overturn provisions. Author(s): Fong T. Source: Modern Healthcare. 2003 December 1; 33(48): 8-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14666837

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Against the current. Uncertainty of consensus still roils debate of embattled Medicare reform. Author(s): Tieman J. Source: Modern Healthcare. 2003 August 11; 33(32): 12-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12931530

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An affordable transformation. Medicare reforms may be basis for streamlining the larger healthcare system. Author(s): Gingrich N. Source: Modern Healthcare. 2003 August 18; 33(33): 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12964484

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An 'inexact science'. Cost discrepancy turns Medicare into mayhem. Author(s): Tieman J. Source: Modern Healthcare. 2004 March 22; 34(12): 8-9, 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15069894

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An introduction to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Author(s): Siegel S. Source: Health Care Law Mon. 2004 January; : 3-14. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14750394

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Apart from Medicare, what other work do GPs do? Author(s): Field D, Ward AM, Lopez DG. Source: Aust Fam Physician. 2003 June; 32(6): 476-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12833780

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Associations among processes and outcomes of care for Medicare nursing home residents with acute heart failure. Author(s): Hutt E, Frederickson E, Ecord M, Kramer AM. Source: Journal of the American Medical Directors Association. 2003 July-August; 4(4): 195-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12837140

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Average out-of-pocket health care costs for Medicare+Choice enrollees increase 10 percent in 2003. Author(s): Gold M, Achman L. Source: Issue Brief (Commonw Fund). 2003 August; (667): 1-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12911025

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Averting a Medicare disaster. Author(s): Wroten D. Source: J Ark Med Soc. 2003 April; 99(10): 313. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12868132

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Baby boomers and Medicare. Author(s): Ganim LJ. Source: Health Aff (Millwood). 2004 March-April; 23(2): 282-3; Author Reply 283. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15046153

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Back to basics: the Medicare Plan of Care. Author(s): Zuber RF. Source: Home Healthcare Nurse. 2003 June; 21(6): 371-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12802106

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Barriers to Medicare reimbursement for nurse practitioners. Author(s): Brandon P. Source: Oreg Nurse. 1998 October; 63(3): 16. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12025565

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Battle over Medicare. Providers ready to defend their pet provisions. Author(s): Tieman J. Source: Modern Healthcare. 2003 July 14; 33(28): 10-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12884706

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Beneficiaries get green light to appeal Medicare policies. Author(s): Maher L. Source: Contemporary Longterm Care. 2002 October; 25(10): 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12397814

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Beneficiaries' perceptions of new Medicare health plan choice print materials. Author(s): Harris-Kojetin LD, McCormack LA, Jael EM, Lissy KS. Source: Health Care Financing Review. 2001 Fall; 23(1): 21-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500360

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Beneficiary reported experience and voluntary disenrollment in Medicare managed care. Author(s): Lied TR, Sheingold SH, Landon BE, Shaul JA, Cleary PD. Source: Health Care Financing Review. 2003 Fall; 25(1): 55-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14997693

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Beneficiary survey-based feedback on new Medicare informational materials. Author(s): McCormack LA, Garfinkel SA, Hibbard JH, Kilpatrick KE, Kalsbeek WD. Source: Health Care Financing Review. 2001 Fall; 23(1): 37-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500361

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Benefits update: program offers extra $43.80 in Social Security check plus medical bill help to PWAs on Medicare. Author(s): McCormack TP. Source: World. 1998 June; (No 86): 6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11365612

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Beyond prospective payment. Where is reimbursement for Medicare home health services headed? Author(s): Callan M, Zadoorian J. Source: Care Manag J. 2000 Spring; 2(1): 38-43. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11000722

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Biased enrollment of Medicare beneficiaries in HMO plans--implications for Medicare costs. Author(s): Khan MM, Tsai WC, Kung PT. Source: Journal of Health Care Finance. 2002 Summer; 28(4): 43-57. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12148663

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Big changes ahead for Medicaid and Medicare. Author(s): McHenry KF. Source: Iowa Med. 2003 July-August; 93(4): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12971235

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Bile duct injury during cholecystectomy and survival in Medicare beneficiaries. Author(s): Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Source: Jama : the Journal of the American Medical Association. 2003 October 22; 290(16): 2168-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14570952

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Billing Medicare. Are you ready? Author(s): Benedict M. Source: Health Care Food & Nutrition Focus. 2002 March; 18(7): 8-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11915212

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Body MR imaging and CT volume: variations and trends based on an analysis of Medicare and fee-for-service health insurance databases. Author(s): Mitchell DG, Parker L, Sunshine JH, Levin DC. Source: Ajr. American Journal of Roentgenology. 2002 July; 179(1): 27-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12076898

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Breast cancer pathology practices among Medicare patients undergoing unilateral extended simple mastectomy. Author(s): Imperato PJ, Waisman J, Wallen M, Llewellyn CC, Pryor V. Source: Journal of Women's Health & Gender-Based Medicine. 2002 July-August; 11(6): 537-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12225627

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Bridging the gap: state and private industry response to the lack of a Medicare outpatient prescription drug benefit. Author(s): Goldstein WC, Peterson KA. Source: Manag Care Interface. 2002 June; 15(6): 55-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12087608

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Bringing competitive pricing to Medicare. Author(s): Cooper BS, Vladeck BC. Source: Health Aff (Millwood). 2000 September-October; 19(5): 49-54. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10992651

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Bringing FAIR-ness to Medicare reimbursement rates. Author(s): Harkin T. Source: Iowa Med. 2001 November-December; 91(6): 9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11771489

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Bush proposes Medicare reform. Author(s): Charatan F. Source: Bmj (Clinical Research Ed.). 2003 March 15; 326(7389): 570. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12637399

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Can managed care and competition control Medicare costs? Author(s): Gold M. Source: Health Aff (Millwood). 2003 January-June; Suppl: W3-176-88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14527251

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Can Medicare be saved? Reflections from Alberta. Author(s): Bear R. Source: Healthc Pap. 2000 Summer; 1(3): 60-7; Discussion 88-91. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811193

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Can we be connected while remaining separate? Forging partnerships between allvolunteer & Medicare-certified hospices. Author(s): Walsh ME. Source: Caring. 2003 November; 22(11): 26-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14658201

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Caught in between: prescription drug coverage of Medicare beneficiaries near poverty. Author(s): Shea DG, Stuart BC, Briesacher B. Source: Issue Brief (Commonw Fund). 2003 August; (669): 1-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12926411

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Chretien's prescription for Medicare: a green poultice in lieu of accountability. Author(s): Sullivan T, Flood CM. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2004 February 3; 170(3): 359-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14757674

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CMS issues updated rules for the Medicare claims appeal process. Author(s): Davidson NJ. Source: Nephrol News Issues. 2003 January; 17(2): 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12629822

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Colonoscopy practice patterns since introduction of Medicare coverage for averagerisk screening. Author(s): Harewood GC, Lieberman DA. Source: Clin Gastroenterol Hepatol. 2004 January; 2(1): 72-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15017635

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Coming to a billing office near you: a new Medicare. Author(s): Scott JS. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2003 August; 57(8): 30-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12938616

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83

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Community-acquired pneumonia: compliance with centers for Medicare and Medicaid services, national guidelines, and factors associated with outcome. Author(s): Ziss DR, Stowers A, Feild C. Source: Southern Medical Journal. 2003 October; 96(10): 949-59. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14570338

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Comparing beneficiaries of the Medicare savings programs with eligible nonparticipants. Author(s): Sears J. Source: Social Security Bulletin. 2001-2002; 64(3): 76-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12655742

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Comparing Medicare and private insurers: growth rates in spending over three decades. Author(s): Boccuti C, Moon M. Source: Health Aff (Millwood). 2003 March-April; 22(2): 230-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12674426

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Comparison of performance of traditional Medicare vs Medicare managed care. Author(s): Landon BE, Zaslavsky AM, Bernard SL, Cioffi MJ, Cleary PD. Source: Jama : the Journal of the American Medical Association. 2004 April 14; 291(14): 1744-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15082702

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Confronting the barriers to chronic care management in Medicare. Author(s): Berenson RA, Horvath J. Source: Health Aff (Millwood). 2003 January-June; Suppl: W3-37-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14527234

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Congress glumly moves towards Medicare drug benefit: but the cost is expected to be very high, and coverage limited. Author(s): Greenberg D. Source: Lancet. 2003 June 28; 361(9376): 2216. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12846248

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Considerations in Medicare reform: the impact of Medicare preemption on state laws. Author(s): Jackonis MJ Jr. Source: Ann Health Law. 2004 Winter; 13(1): 179-231, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15002184

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Coordination of health coverage for Medicare enrollees: a case study of HIV/AIDS. Author(s): Eichner J. Source: Medicare Brief. 2001 June; (7): 1-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11795323

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Coordination of health coverage for Medicare enrollees: living with HIV/AIDS in California. Author(s): Eichner J, Kahn JG. Source: Medicare Brief. 2001 August; (8): 1-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11797740

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Cost-effectiveness analysis of pharmaceutical care in a Medicare drug benefit program. Author(s): Etemad LR, Hay JW. Source: Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research. 2003 July-August; 6(4): 425-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859583

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Court rules PROs must inform Medicare beneficiaries of health care review results. Author(s): McGinty C, Herron S. Source: Gha Today. 2003 July; 47(7): 3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12953377

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Covering the uninsured. Expanding Medicare to achieve universal coverage. Author(s): Hacker JS. Source: Healthplan. 2003 July-August; 44(4): 25-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12920866

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Decoding the myths. Physician supervision in Medicare. Author(s): Gosfield AG. Source: Mgma Connexion / Medical Group Management Association. 2003 August; 3(7): 50-3, 1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12959058

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Demand for a Medicare prescription drug benefit: exploring consumer preferences under a managed competition framework. Author(s): Cline RR, Mott DA. Source: Inquiry. 2003 Summer; 40(2): 169-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13677564

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Dementia in community-dwelling elderly patients: A comparison of survey data, Medicare claims, cognitive screening, reported symptoms, and activity limitations. Author(s): Pressley JC, Trott C, Tang M, Durkin M, Stern Y. Source: Journal of Clinical Epidemiology. 2003 September; 56(9): 896-905. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14505776

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Developing a Medicare prospective payment system for inpatient psychiatric care. Author(s): Lave JR. Source: Health Aff (Millwood). 2003 September-October; 22(5): 97-109. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14515885

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Diagnosis and treatment of depression in the elderly Medicare population: predictors, disparities, and trends. Author(s): Crystal S, Sambamoorthi U, Walkup JT, Akincigil A. Source: Journal of the American Geriatrics Society. 2003 December; 51(12): 1718-28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687349

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Diagnostic testing and Medicare: how to get paid without getting in trouble. Author(s): Gosfield AG. Source: Family Practice Management. 2003 June; 10(6): 14, 17-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12852224

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Disability and the future of Medicare. Author(s): Cutler DM. Source: The New England Journal of Medicine. 2003 September 11; 349(11): 1084-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968093

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Disability outcomes of older Medicare HMO enrollees and fee-for-service Medicare beneficiaries. Author(s): Porell FW, Miltiades HB. Source: Journal of the American Geriatrics Society. 2001 May; 49(5): 615-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11380756

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Discounted Medicare? It's already here. Author(s): Terry K. Source: Med Econ. 2000 May 22; 77(10): 53-6, 63-4, 67. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11010250

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Do seniors get the medicines prescribed for them? Evidence from the 1996-1999 Medicare Current Beneficiary Survey. Author(s): Craig BM, Kreling DH, Mott DA. Source: Health Aff (Millwood). 2003 May-June; 22(3): 175-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12757282

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Do the Medicare math, then make quick decision. Author(s): Carroll J. Source: Manag Care. 2004 January; 13(1): 18-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14763269

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Does Medicare managed care provide equal treatment for mental illness across races? Author(s): Virnig B, Huang Z, Lurie N, Musgrave D, McBean AM, Dowd B. Source: Archives of General Psychiatry. 2004 February; 61(2): 201-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14757597

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Does the ownership of the admitting hospital make a difference? Outcomes and process of care of Medicare beneficiaries admitted with acute myocardial infarction. Author(s): Sloan FA, Trogdon JG, Curtis LH, Schulman KA. Source: Medical Care. 2003 October; 41(10): 1193-205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14515115

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Don't cut Medicare fees. Author(s): Dockray KT. Source: Tex Med. 2003 December; 99(12): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14983773

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Double the money. Lawmakers exceed Bush budget request for Medicare reform, drug benefit. Author(s): Gardner J. Source: Modern Healthcare. 2001 May 7; 31(19): 8-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11357276

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Dramatic improvement or death spiral--two members of congress assess the Medicare bill. Author(s): Kennedy EM, Thomas B. Source: The New England Journal of Medicine. 2004 February 19; 350(8): 747-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14973220

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Droughts in Medicare leadership. Author(s): Gamache E. Source: Mich Health Hosp. 2003 January-February; 39(1): 21. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12664914

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Drug coverage, utilization, and spending by Medicare beneficiaries with heart disease. Author(s): Sharma R, Liu H, Wang Y. Source: Health Care Financing Review. 2003 Spring; 24(3): 139-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12894640

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Drugmakers shift on Medicare coverage. Author(s): Gardner J. Source: Modern Healthcare. 2000 January 24; 30(4): 3, 11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11009988

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Dually eligible for Medicare and Medicaid: two for one or double jeopardy? Author(s): Ryan J, Super N. Source: Issue Brief Natl Health Policy Forum. 2003 September 30; (794): 1-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14524355

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Economic cost of expanded criteria donors in cadaveric renal transplantation: analysis of Medicare payments. Author(s): Whiting JF, Woodward RS, Zavala EY, Cohen DS, Martin JE, Singer GG, Lowell JA, First MR, Brennan DC, Schnitzler MA. Source: Transplantation. 2000 September 15; 70(5): 755-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11003352

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Effect of an innovative Medicare managed care program on the quality of care for nursing home residents. Author(s): Kane RL, Flood S, Bershadsky B, Keckhafer G. Source: The Gerontologist. 2004 February; 44(1): 95-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978325

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Effect of extended coverage of immunosuppressive medications by Medicare on the survival of cadaveric renal transplants. Author(s): Woodward RS, Schnitzler MA, Lowell JA, Spitznagel EL, Brennan DC. Source: American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2001 May; 1(1): 6973. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12095042

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Effect of Medicare coverage on use of invasive colorectal cancer screening tests. Author(s): Ko CW, Kreuter W, Baldwin LM. Source: Archives of Internal Medicine. 2002 December 9-23; 162(22): 2581-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12456230

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Effect of postoperative epidural analgesia on morbidity and mortality after total hip replacement surgery in Medicare patients. Author(s): Wu CL, Anderson GF, Herbert R, Lietman SA, Fleisher LA. Source: Regional Anesthesia and Pain Medicine. 2003 July-August; 28(4): 271-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12945019

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Effect of private health insurance on health care access and health status of diabetic patients covered by Medicare. Author(s): Harris MI. Source: Diabetes Care. 2002 February; 25(2): 405-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11815524

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Effect of the new Medicare guideline on patient qualification for positive airway pressure therapy. Author(s): Raj R, Hirshkowitz M. Source: Sleep Medicine. 2003 January; 4(1): 29-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14592357

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Effects of state Medicaid home care Medicare maximization programs on Medicare expenditures. Author(s): Anderson WL, Norton EC, Kenney GS. Source: Home Health Care Services Quarterly. 2003; 22(3): 19-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14629082

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Either way. you pay. Medicare HMOs seek more out-of-pocket payments. Author(s): Benko LB. Source: Modern Healthcare. 2003 September 15; 33(37): 8-9, 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520919

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Employer options. The new Medicare Prescription Drug Act will have a big impact on employers and their health insurance plans. Author(s): Olsen GG, Reisinger RA. Source: Rehab Manag. 2004 January-February; 17(1): 54-5, 62. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14974144

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End stage renal disease and Medicare. Author(s): Greer JW. Source: Health Care Financing Review. 2003 Summer; 24(4): 1-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14628396

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Enrollees choose priorities for Medicare. Author(s): Danis M, Biddle AK, Goold SD. Source: The Gerontologist. 2004 February; 44(1): 58-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14978321

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Enrollment in FEHBP plans in rural America: what are the implications for Medicare reform? Author(s): McBride T, Mueller K, Andrews C, Xu L, Fraser R. Source: Rural Policy Brief. 2003 June; 8(8(Pb2003-8)): 1-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14577385

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Errors of underuse and overuse among Tennessee hospitals for selected clinical conditions in Medicare patients. Author(s): Jain M, Weddle J, Wildman L. Source: Tenn Med. 2003 September; 96(9): 425-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14513531

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Estimating health care costs related to cancer treatment from SEER-Medicare data. Author(s): Brown ML, Riley GF, Schussler N, Etzioni R. Source: Medical Care. 2002 August; 40(8 Suppl): Iv-104-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12187175

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Estimating the cost of the Medicare Pharmacist Services Coverage Act of 2001. Author(s): Poole VH, Moran DW, Webb CE. Source: Pharmacotherapy. 2003 August; 23(8): 955-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12921241

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Evaluating VA patient-level expenditures: decision support system estimates and Medicare rates. Author(s): Hendricks AM, Lotchin TR, Hutterer J, Swanson J, Kenneally K; Decision Support System Cost Evaluation Work Group. Source: Medical Care. 2003 June; 41(6 Suppl): Ii111-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12773833

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Explaining Medicare to caregivers. Author(s): Petty D. Source: Issue Brief Cent Medicare Educ. 2002; 3(7): 1-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12322725

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Exploring the demand for a voluntary Medicare prescription drug benefit. Author(s): Cline RR, Mott DA. Source: Aaps Pharmsci [electronic Resource]. 2003; 5(2): E19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12866945

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Eye of the storm. Medicare tempest hits over hospitals' priorities. Author(s): Tieman J. Source: Modern Healthcare. 2003 September 22; 33(38): 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571523

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Fact and fiction: The Medicare “crisis” seen from the United States. Author(s): Marmor TR. Source: Healthc Pap. 2000 Summer; 1(3): 82-6; Discussion 88-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811196

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Factors associated with Medicare beneficiary complaints about quality of care. Author(s): Harrington C, Merrill S, Newman J. Source: J Healthc Qual. 2001 May-June; 23(3): 4-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11378977

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Factors influencing mammography use among women in Medicare managed care. Author(s): Barr JK, Reisine S, Wang Y, Holmboe EF, Cohen KL, Van Hoof TJ, Meehan TP. Source: Health Care Financing Review. 2001 Summer; 22(4): 49-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12378781

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Failure to vaccinate Medicare inpatients: a missed opportunity. Author(s): Bratzler DW, Houck PM, Jiang H, Nsa W, Shook C, Moore L, Red L. Source: Archives of Internal Medicine. 2002 November 11; 162(20): 2349-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12418949

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Familiar message. AHA's new causes rely on old plea for higher Medicare, Medicaid reimbursements. Author(s): Gardner J. Source: Modern Healthcare. 2001 May 7; 31(19): 12-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11357266

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Family physicians are the main source of primary health care for the Medicare population. Author(s): Mold JW, Fryer GE, Phillips RL Jr, Dovey SM, Green LA. Source: American Family Physician. 2002 December 1; 66(11): 2032. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12484684

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Favorable selection in the Medicare+Choice program: new evidence. Author(s): Greenwald LM, Levy JM, Ingber MJ. Source: Health Care Financing Review. 2000 Spring; 21(3): 127-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11481751

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Fecal occult blood test use by Kansas Medicare beneficiaries. Author(s): Engelman KK, Ellerbeck EF, Ahluwalia JS, Nazir N, Velasco A. Source: Preventive Medicine. 2001 December; 33(6): 622-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11716659

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Federal fraud busters eye Medicare contractors. Author(s): Childs N. Source: Provider. 1999 November; 25(11): 13. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10787913

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Fee-for-service joins the Medicare+Choice product line. Author(s): Ahl D, Wergin K. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2000 October; 54(10): 41-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11183543

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Few details, big debate. President Bush still needs to fill in the blanks on how he wants to reform Medicare, but advocates are already feuding. Author(s): Tieman J. Source: Modern Healthcare. 2003 February 3; 33(5): 6-7, 16, 1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12602295

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Final Medicare provider-based status rule. Author(s): Ferman J. Source: Healthcare Executive. 2000 July-August; 15(4): 54-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11182910

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Financial impact if payers use Medicare rates: anesthesiology versus other specialties. Author(s): Johnstone RE, Hosaflook C. Source: Anesthesiology. 2000 September; 93(3): 852-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10969321

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Financial impact of a home intravenous antibiotic program on a Medicare managed care program. Author(s): Dalovisio JR, Juneau J, Baumgarten K, Kateiva J. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2000 April; 30(4): 639-42. Epub 2000 April 04. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10770722

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Financing of care for fatal chronic disease: opportunities for Medicare reform. Author(s): Lynn J, Wilkinson A, Etheredge L. Source: The Western Journal of Medicine. 2001 November; 175(5): 299-302. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11694467

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First things first. Medicare must be fixed before adding a hugely expensive drug benefit. Author(s): Wool M. Source: Modern Healthcare. 2002 August 19; 32(33): 27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12219572

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Foot care practices, services and perceptions of risk among Medicare beneficiaries with diabetes at high and low risk for future foot complications. Author(s): Harwell TS, Helgerson SD, Gohdes D, McInerney MJ, Roumagoux LP, Smilie JG. Source: Foot & Ankle International / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 2001 September; 22(9): 734-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11587391

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Fraud & abuse: DOJ and Medicare and Medicaid model compliance programs. Author(s): Bradshaw KM. Source: The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics. 1997 Summer-Fall; 25(2-3): 218-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11066496

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Freedom to pay or freedom to choose? Private contracting and Medicare beneficiaries. Author(s): Moon M. Source: Health Matrix (Cleveland, Ohio : 1991). 2000 Winter; 10(1): 21-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11184041

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Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Author(s): Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, Ren J, Peel J. Source: American Journal of Public Health. 2002 August; 92(8): 1278-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12144984

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GAO suggests Medicare make separate payments for clotting factors, delivery. Author(s): Young D. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 April 15; 60(8): 741. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12749159

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Gender differences in functional status and pain in a Medicare population undergoing elective total hip arthroplasty. Author(s): Holtzman J, Saleh K, Kane R. Source: Medical Care. 2002 June; 40(6): 461-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12021672

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Geographic variation in breast-conserving surgery in Kentucky's Medicare population. Author(s): Beaulieu J, Galland J, Fleming S, Chen K, Peng X. Source: J Ky Med Assoc. 2002 March; 100(3): 99-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11911013

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Geographic variation in determinants of Medicare managed care enrollment. Author(s): Penrod JD, McBride TD, Mueller KJ. Source: Health Services Research. 2001 August; 36(4): 733-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11508637

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Geographic variation in Medicare spending and the real focus of Medicare reform. Author(s): Baucus M, Fowler EJ. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W115-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12703564

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Geographic variation of lower-extremity major amputation in individuals with and without diabetes in the Medicare population. Author(s): Wrobel JS, Mayfield JA, Reiber GE. Source: Diabetes Care. 2001 May; 24(5): 860-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11347744

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Geographical variations in Medicare spending. Author(s): Shine KI. Source: Annals of Internal Medicine. 2003 February 18; 138(4): 347-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12585834

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Geography and the debate over Medicare reform. Author(s): Wennberg JE, Fisher ES, Skinner JS. Source: Health Aff (Millwood). 2002; Supp Web Exclusives: W96-114. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12703563

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Get ready for your Medicare survey: understanding the new interpretive guidelines. Author(s): Ayer TS. Source: Home Care Provider. 2001 December; 6(6): 185-93. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11744894

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Good news on fraud, dumping sparks concern. GAO reports find most providers don't set out to defraud Medicare, Medicaid. Author(s): Lovern E, Gardner J. Source: Modern Healthcare. 2001 July 2; 31(27): 4-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11460443

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Growing differences between Medicare beneficiaries with and without drug coverage. Author(s): Poisal JA, Murray L. Source: Health Aff (Millwood). 2001 March-April; 20(2): 74-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11260961

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Growing physician access problems complicate Medicare payment debate. Author(s): Trude S, Ginsburg PB. Source: Issue Brief Cent Stud Health Syst Change. 2002 September; (55): 1-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12229929

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Health insurance and mammography: would a Medicare buy-in take us to universal screening? Author(s): Taylor DH Jr, Van Scoyoc L, Hawley ST. Source: Health Services Research. 2002 December; 37(6): 1469-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12546282

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Health-related quality of life of cancer and noncancer patients in Medicare managed care. Author(s): Baker F, Haffer SC, Denniston M. Source: Cancer. 2003 February 1; 97(3): 674-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12548610

Studies

95

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Heart failure mortality among older Medicare beneficiaries: association with left ventricular function evaluation and angiotensin-converting enzyme inhibitor use. Author(s): Ahmed A, Maisiak R, Allman RM, DeLong JF, Farmer R. Source: Southern Medical Journal. 2003 February; 96(2): 124-9. Erratum In: South Med J. 2003 April; 96(4): 418. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12630634

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HEDIS performance trends in Medicare managed care. Author(s): Lied TR, Sheingold S. Source: Health Care Financing Review. 2001 Fall; 23(1): 149-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500369

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HHS announces Medicare premium and deductible rates for 2003. Author(s): United States Department of Human Services. Source: Health Care Law Mon. 2002 November; : 13-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12498022

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HMO provider networks in Medicare+Choice: comparing Medicare and commercial lines of business. Author(s): Lake T, Gold M, Hurley R. Source: Managed Care Quarterly. 2001 Fall; 9(4): 16-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11813453

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HMOs dump more Medicare patients. Author(s): Bloice C. Source: Revolution. 2003 October-November; 4(5): 9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14631718

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Home care and prescription drugs to be funded under Medicare. Author(s): Garmaise D. Source: Can Hiv Aids Policy Law Rev. 2003 April; 8(1): 25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12924293

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Home care, continuing care and Medicare: a Canadian model or innovative models for Canadians? Author(s): Beland F, Bergman H. Source: Healthc Pap. 2000 Fall; 1(4): 38-45, Discussion 109-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811171

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Hospice use among Medicare managed care and fee-for-service patients dying with cancer. Author(s): McCarthy EP, Burns RB, Ngo-Metzger Q, Davis RB, Phillips RS. Source: Jama : the Journal of the American Medical Association. 2003 May 7; 289(17): 2238-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12734135

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Hospice use in Medicare beneficiaries with cancer. Author(s): Gagnon B. Source: Jama : the Journal of the American Medical Association. 2003 September 24; 290(12): 1578; Author Reply 1578-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14506113

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Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. Author(s): Ham C, York N, Sutch S, Shaw R. Source: Bmj (Clinical Research Ed.). 2003 November 29; 327(7426): 1257. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14644968

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Hospital-based and freestanding skilled nursing facilities: any cause for differential Medicare payments? Author(s): Liu K, Black KJ. Source: Inquiry. 2003 Spring; 40(1): 94-104. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12836911

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Hospitalization is covered--why not drugs? The need to add prescription drug benefits to Medicare. Author(s): Tellez MS. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2003 August; 29(4): 380-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12874567

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Hospitals win. They'll get biggest chunk of Medicare payment hikes but still lobby for more. Author(s): Gardner J. Source: Modern Healthcare. 2001 April 30; 31(18): 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11374181

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House vs. Senate. Medicare deadline passes without reform compromise. Author(s): Tieman J. Source: Modern Healthcare. 2003 October 20; 33(42): 8-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618752

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How does beneficiary knowledge of the Medicare program vary by type of insurance? Author(s): McCormack LA, Uhrig JD. Source: Medical Care. 2003 August; 41(8): 972-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12886176

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How state-funded home care programs respond to changes in Medicare home health care: resource allocation decisions on the front line. Author(s): Corazzini K. Source: Health Services Research. 2003 October; 38(5): 1263-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14596390

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How to opt out of Medicare. Author(s): Moore KJ. Source: Family Practice Management. 2003 November-December; 10(10): 15-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14674342

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Hyperbaric oxygen therapy 2003 Medicare coverage decision. Author(s): Schaum KD. Source: Advances in Skin & Wound Care. 2003 September-October; 16(5): 244. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14581816

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If the pillars are shaky, does faith in Medicare crumble? Author(s): Lepnurm R, Dobson R, Backman A. Source: Healthc Manage Forum. 2003 Spring; 16(1): 11-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12908161

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If we keep Medicare, who pays the bills? Author(s): Vladeck BC. Source: Manag Care. 2003 September; 12(9 Suppl Future of Medicine): 7-9; Discussion 13-21. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14560527

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Impact of an annual dollar limit or “cap” on prescription drug benefits for Medicare patients. Author(s): Tseng CW, Brook RH, Keeler E, Mangione CM. Source: Jama : the Journal of the American Medical Association. 2003 July 9; 290(2): 2227. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12851277

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Impact of managed care on the treatment, costs, and outcomes of fee-for-service Medicare patients with acute myocardial infarction. Author(s): Bundorf MK, Schulman KA, Stafford JA, Gaskin D, Jollis JG, Escarce JJ. Source: Health Services Research. 2004 February; 39(1): 131-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14965081

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Impact of Medicare coverage on basic clinical services for previously uninsured adults. Author(s): McWilliams JM, Zaslavsky AM, Meara E, Ayanian JZ. Source: Jama : the Journal of the American Medical Association. 2003 August 13; 290(6): 757-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915428

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Impact of the Balanced Budget Act of 1997 on Medicare risk plan payment rates for rural areas. Author(s): Schoenman JA. Source: Policy Anal Brief W Ser. 1998 February; 1(1): 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11808611

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Imperfect Medicare law has positive implications for pharmacists. Author(s): Young D. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2004 January 15; 61(2): 126, 128. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14750395

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Implications for rural hospitals of the Medicare outpatient prospective payment proposed rule. Author(s): Franco SJ, Mohr PE. Source: Policy Anal Brief W Ser. 1999 April; 2(2): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11811194

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Improved comorbidity adjustment for predicting mortality in Medicare populations. Author(s): Schneeweiss S, Wang PS, Avorn J, Glynn RJ. Source: Health Services Research. 2003 August; 38(4): 1103-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968819

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Improved diabetes care by primary care physicians: results of a group-randomized evaluation of the Medicare Health Care Quality Improvement Program (HCQIP). Author(s): McClellan WM, Millman L, Presley R, Couzins J, Flanders WD. Source: Journal of Clinical Epidemiology. 2003 December; 56(12): 1210-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14680672

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Improvements in breast cancer pathology practices among Medicare patients undergoing unilateral extended simple mastectomy. Author(s): Imperato PJ, Waisman J, Wallen MD, Llewellyn CC, Pryor V. Source: American Journal of Medical Quality : the Official Journal of the American College of Medical Quality. 2003 July-August; 18(4): 164-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12934953

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Improving risk adjustment for Medicare capitated reimbursement using nonlinear models. Author(s): Veazie PJ, Manning WG, Kane RL. Source: Medical Care. 2003 June; 41(6): 741-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12773840

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In with the new. Landmark Medicare legislation provides relief for rehab providers. Author(s): Olsen GG, Reisinger RA. Source: Rehab Manag. 2003 December; 16(10): 40-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14743681

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Increasing longevity and Medicare expenditures. Author(s): Miller T. Source: Demography. 2001 May; 38(2): 215-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11392909

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Inequitable Medicare coverage policy can impact your practice. Author(s): Turnbull GB. Source: Ostomy Wound Manage. 2003 August; 49(8): 30-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14631661

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Influenza immunization and mortality among diabetic Medicare beneficiaries in West Virginia. Author(s): Schade CP, McCombs MA. Source: W V Med J. 2000 May-June; 96(3): 444-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14619136

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Interview with Bruce Vladeck, Institute for Medicare Practice. Author(s): Vladeck B. Source: Managed Care Quarterly. 2000 Winter; 8(1): 58-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11009735

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Involuntary disenrollment from a Medicare managed care plan at an academic medical center: effect on patients. Author(s): Morgenstern NE, Gonzales R, Anderson RJ. Source: Journal of the American Geriatrics Society. 2000 September; 48(9): 1151-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10983918

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Is premium support the right medicine for Medicare? Author(s): Oberlander J. Source: Health Aff (Millwood). 2000 September-October; 19(5): 84-99. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10992656

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Is this the best model for Medicare reform? Author(s): Guglielmo WJ. Source: Med Econ. 2003 August 22; 80(16): 36, 40. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12964542

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Just another hand out. Effort to ease cuts in Medicare doc fee schedule faces tough competition. Author(s): Lovern E. Source: Modern Healthcare. 2001 December 3; 31(49): 8-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11765371

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Keep your Medicare in force as you go back to work (what to do and when to do it). Author(s): McCormack TP. Source: Aids Treat News. 1999 February 19; (No 313): 6-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11366240

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Kickbacks, courtesies or cost-effectiveness?: Application of the Medicare antikickback Law to the marketing and promotional practices of drug and medical device manufacturers. Author(s): Bulleit TN, Krause JH. Source: Food Drug Law J. 1999; 54(3): 279-323. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11797701

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Knowledge, attitudes, and behavior of women ages 65 and older on mammography screening and Medicare: results of a national survey. Author(s): Eisner EJ, Zook EG, Goodman N, Macario E. Source: Women & Health. 2002; 36(4): 1-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12555798

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Lab groups continue to push hard for Medicare inflation update; controversy brews over rapid HIV test. Author(s): Szabo J. Source: Mlo: Medical Laboratory Observer. 2002 December; 34(12): 52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12506851

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Laboratories clear first hurdle with House-passed Medicare bill. Author(s): Szabo J. Source: Mlo: Medical Laboratory Observer. 2002 August; 34(8): 44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12228931

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Lack of an association between Medicare supplemental insurance and delay in seeking emergency care for patients with myocardial infarction. Author(s): Ho PM, Rumsfeld JS, Lyons E, Every NR, Magid DJ. Source: Annals of Emergency Medicine. 2002 October; 40(4): 381-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12239492

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Lasting Impact. The Politics of Medicare. Essay Review. Author(s): Peterson MA. Source: Journal of Health Politics, Policy and Law. 2001 February; 26(1): 146-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11253450

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Law and the public's health. Medicare reform. Author(s): Rosenbaum S. Source: Public Health Reports (Washington, D.C. : 1974). 2003 March-April; 118(2): 1624. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12690070

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Left ventricular ejection fraction test rates for Medicare beneficiaries with heart failure. Author(s): Wu B, Pope GC. Source: American Journal of Medical Quality : the Official Journal of the American College of Medical Quality. 2002 March-April; 17(2): 61-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11941996

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Legislation calls for Medicare coverage of outpatient drugs, pharmacists' services. Author(s): Traynor K. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2002 March 15; 59(6): 494. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11908240

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Less is not more. Though newcomers are venturing into Medicare and other HMOs are expanding their territories, they plan to survive by limiting benefits, choices and raising premiums. Author(s): Benko LB. Source: Modern Healthcare. 2000 September 11; 30(38): 40-4, 48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11186533

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Lessons from Medicare+Choice for Medicare reform. Author(s): Dallek G, Biles B, Hersch Nicholas L. Source: Policy Brief Commonw Fund. 2003 June; (658): 1-17. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12833910

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Lessons learned from the Medicare Alzheimer Disease Demonstration. Author(s): Fox P, Newcomer R, Yordi C, Arnsberger P. Source: Alzheimer Disease and Associated Disorders. 2000 April-June; 14(2): 87-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10850747

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Lessons learned from the National Medicare & You Education Program. Author(s): Goldstein E, Teichman L, Crawley B, Gaumer G, Joseph C, Reardon L. Source: Health Care Financing Review. 2001 Fall; 23(1): 5-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500359

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Let the games begin. Bush proposal opens Medicare debate in the 108th Congress. Author(s): Olsen GG. Source: Rehab Manag. 2003 April; 16(3): 38-9, 46. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12741258

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Letting patients know why you've quit Medicare. Author(s): Pennachio D. Source: Med Econ. 2003 June 20; 80(12): 74-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12858788

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Linking physician characteristics and Medicare claims data: issues in data availability, quality, and measurement. Author(s): Baldwin LM, Adamache W, Klabunde CN, Kenward K, Dahlman C, L Warren J. Source: Medical Care. 2002 August; 40(8 Suppl): Iv-82-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12187173

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Lobbying. Medicare reform resuscitated? Author(s): Pretzer M. Source: Med Econ. 1999 November 22; 76(22): 41. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10787715

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Long-term blues. Nursing homes to Congress: we really need Medicare. Author(s): Sherrid P. Source: U.S. News & World Report. 2002 May 27; 132(18): 36-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12051033

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Long-term care hospitals under Medicare: facility-level characteristics. Author(s): Liu K, Baseggio C, Wissoker D, Maxwell S, Haley J, Long S. Source: Health Care Financing Review. 2001 Winter; 23(2): 1-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500335

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Measuring beneficiary knowledge of the Medicare program: a psychometric analysis. Author(s): Bann CM, Terrell SA, McCormack LA, Berkman ND. Source: Health Care Financing Review. 2003 Summer; 24(4): 111-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14628404

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Mediation will be option for resolving Medicare beneficiary complaints. Author(s): Gold JA, Streicher E, Pepple S. Source: Wmj. 2003; 102(5): 53, 55. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14621934

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Mediation: a new option for resolving Medicare beneficiary complaints. Author(s): Mihalakos G. Source: Medicine and Health, Rhode Island. 2003 October; 86(10): 325-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626865

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Medicare and Medicaid programs; religious nonmedical health care institutions and advance directives. Final rule. Author(s): Centers for Medicare and Medicaid Services (CMS), HHS. Source: Federal Register. 2003 November 28; 68(229): 66710-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649654

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Medicare beneficiaries don't receive available preventive services. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2003 November 14; 14(22): 1-2, 7-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649232

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Medicare modernization and distributional implications. Author(s): Swartz K. Source: Inquiry. 2003 Winter; 40(4): 315-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15055831

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Medicare overhaul wins Congressional support. Author(s): Greenberg DS. Source: Lancet. 2003 November 29; 362(9398): 1816. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14661626

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Medicare PPOs and managed care. Author(s): Curtiss FR. Source: J Manag Care Pharm. 2003 January-February; 9(1): 91. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14613371

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Medicare Prescription Act means money to EMS. Author(s): Ludwig GG. Source: Emerg Med Serv. 2004 March; 33(3): 32. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15055066

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Medicare program: review of national coverage determinations and local coverage determinations. Final rule. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 November 7; 68(216): 63691-731. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14610762

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Medicare program; coverage and payment of ambulance services; inflation update for CY 2004. Final rule with comment period. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 December 5; 68(234): 67960-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14661637

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Medicare program; photocopying reimbursement methodology. Final rule. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 December 5; 68(234): 67955-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14661636

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Medicare program; reduction in Medicare Part B premiums as additional benefits under Medicare+Choice plans. Final rule. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 November 28; 68(229): 66721-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649655

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Medicare: the end of an era? Author(s): Scott JS. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2003 November; 57(11): 30-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626701

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Medicare-gate, behind closed doors. Scully makes appealing scapegoat, but other key players deserve a few jeers. Author(s): McLaughlin N. Source: Modern Healthcare. 2004 March 22; 34(12): 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15069897

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National and state trends in quality of care for acute myocardial infarction between 1994-1995 and 1998-1999: the Medicare health care quality improvement program. Author(s): Burwen DR, Galusha DH, Lewis JM, Bedinger MR, Radford MJ, Krumholz HM, Foody JM. Source: Archives of Internal Medicine. 2003 June 23; 163(12): 1430-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12824092

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National trends in gastrointestinal access procedures: an analysis of Medicare services provided by radiologists and other specialists. Author(s): Duszak R Jr, Mabry MR. Source: Journal of Vascular and Interventional Radiology : Jvir. 2003 August; 14(8): 10316. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12902561

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Nationwide trends in rates of utilization of noninvasive diagnostic imaging among the Medicare population between 1993 and 1999. Author(s): Maitino AJ, Levin DC, Parker L, Rao VM, Sunshine JH. Source: Radiology. 2003 April; 227(1): 113-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12668743

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Never underguesstimate the financial future of Medicare. Author(s): Scott JS. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2000 June; 54(6): 28-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11010178

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New Medicare bill targets discrepancies in fees for cancer drugs, outpatient services. Author(s): Twombly R. Source: Journal of the National Cancer Institute. 2004 February 4; 96(3): 166-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14759976

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New Medicare changes to expand MNT access in 2002. Author(s): Ochs M. Source: Journal of the American Dietetic Association. 2002 January; 102(1): 30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11794497

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New Medicare risk adjustments bad news for unprepared HMOs. Author(s): Carroll J. Source: Manag Care. 2004 February; 13(2): 10-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15004923

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Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. Author(s): Braunstein JB, Anderson GF, Gerstenblith G, Weller W, Niefeld M, Herbert R, Wu AW. Source: Journal of the American College of Cardiology. 2003 October 1; 42(7): 1226-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14522486

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Now for the push-back. Provisions of Medicare drug plan have Democrats on warpath. Author(s): Sloane T. Source: Modern Healthcare. 2003 October 27; 33(43): 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626611

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Nurse staffing and mortality for Medicare patients with acute myocardial infarction. Author(s): Person SD, Allison JJ, Kiefe CI, Weaver MT, Williams OD, Centor RM, Weissman NW. Source: Medical Care. 2004 January; 42(1): 4-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14713734

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Obtaining advance beneficiary notices for Medicare physician providers. Author(s): Carter D. Source: J Med Pract Manage. 2003 July-August; 19(1): 10-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12971000

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ONS calls for corrections to the Medicare prescription drug bill. Author(s): Halpern IM, Waters B. Source: Ons News / Oncology Nursing Society. 2003 September; 18(9): 7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520997

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Onychauxic dystrophic toenails requiring debridement in Medicare patients. Author(s): Visintainer P. Source: Journal of the American Podiatric Medical Association. 2004 January-February; 94(1): 77-8; Author Reply 76-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14730001

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Onychauxic dystrophic toenails requiring debridement in Medicare patients. Author(s): Grapel D. Source: Journal of the American Podiatric Medical Association. 2004 January-February; 94(1): 75-6; Author Reply 76-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14729999

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Onychauxic dystrophic toenails requiring debridement in Medicare patients. Author(s): Turlik MA. Source: Journal of the American Podiatric Medical Association. 2004 January-February; 94(1): 74-5; Author Reply 76-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14729998

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Onychauxic dystrophic toenails requiring debridement in Medicare patients. Author(s): Board of Trustees, American Podiatric Medical Association. Source: Journal of the American Podiatric Medical Association. 2004 January-February; 94(1): 73-4; Author Reply 76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14729997

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Onychauxic dystrophic toenails requiring debridement in Medicare patients. Prevalence and anatomical distribution. Author(s): Frank SC, Freer HL. Source: Journal of the American Podiatric Medical Association. 2003 September-October; 93(5): 388-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13130086

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Open wide--I meant your pocketbook: repercussions of the dental exclusion to the Medicare act. Author(s): Schwob AM. Source: Spec Law Dig Health Care Law. 2003 October; (294): 9-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14671820

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Organizational and market factors associated with Medicare dependence in inpatient rehabilitation hospitals. Author(s): Thompson JM, McCue MJ. Source: Health Services Management Research : an Official Journal of the Association of University Programs in Health Administration / Hsmc, Aupha. 2004 February; 17(1): 13-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15006083

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Out-of-hand spending. Medicare+Choice out-of-pocket costs on the rise. Author(s): Tieman J. Source: Modern Healthcare. 2003 August 18; 33(33): 7, 14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12964475

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Paying for performance: Medicare should lead. Author(s): Berwick DM, DeParle NA, Eddy DM, Ellwood PM, Enthoven AC, Halvorson GC, Kizer KW, McGlynn EA, Reinhardt UE, Reischauer RD, Roper WL, Rowe JW, Schaeffer LD, Wennberg JE, Wilensky GR. Source: Health Aff (Millwood). 2003 November-December; 22(6): 8-10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649428

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Payment policy and inefficient benefits in the Medicare+Choice program. Author(s): Pizer SD, Frakt AB, Feldman R. Source: International Journal of Health Care Finance and Economics. 2003 June; 3(2): 7993. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14640068

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Predicting length of stay for Medicare patients at a teaching hospital. Author(s): Omachonu VK, Suthummanon S, Akcin M, Asfour S. Source: Health Services Management Research : an Official Journal of the Association of University Programs in Health Administration / Hsmc, Aupha. 2004 February; 17(1): 112. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15006082

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Prescription drug access: the ANA adopts principles to evaluate congressional Medicare proposals. Author(s): McKeon E. Source: The American Journal of Nursing. 2003 September; 103(9): 106. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501485

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Prescription drug benefits and health status among Medicare patients. Author(s): Moldawsky R. Source: Jama : the Journal of the American Medical Association. 2003 October 15; 290(15): 1994; Author Reply 1994-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14559949

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Prescription drug expenditures, financial burden and health plan satisfaction among Medicare beneficiaries. Author(s): Curtiss FR. Source: J Manag Care Pharm. 2003 September-October; 9(5): 453-4, 455-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14613446

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Prescription-drug coverage for Medicare beneficiaries. Author(s): Iglehart JK. Source: The New England Journal of Medicine. 2003 September 4; 349(10): 923-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12954738

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Private, individual drug coverage in the current Medicare market. Author(s): Boccuti C, Moon M. Source: Policy Brief Commonw Fund. 2003 October; (679): 1-10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14562796

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Promoting pneumococcal immunizations among rural Medicare beneficiaries using multiple strategies. Author(s): Johnson EA, Harwell TS, Donahue PM, Weisner MA, McInerney MJ, Holzman GS, Helgerson SD. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2003 Fall; 19(4): 506-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14526510

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Provider profiling and quality improvement efforts in coronary artery bypass graft surgery: the effect on short-term mortality among Medicare beneficiaries. Author(s): Hannan EL, Sarrazin MS, Doran DR, Rosenthal GE. Source: Medical Care. 2003 October; 41(10): 1164-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14515112

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Quality endorsement. MedPAC backs tying Medicare payments to quality. Author(s): Tieman J. Source: Modern Healthcare. 2003 June 23; 33(25): 7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12858717

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Quality incentives for Medicare+Choice plans. Author(s): Etheredge L, Berenson R, Ebeler J. Source: Res Agenda Brief. 2002 August; (11): 1-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12956128

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Quality of ambulatory care after myocardial infarction among Medicare patients by type of insurance and region. Author(s): Seddon ME, Ayanian JZ, Landrum MB, Cleary PD, Peterson EA, Gahart MT, McNeil BJ. Source: The American Journal of Medicine. 2001 July; 111(1): 24-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11448657

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Quality of care for hospitalized Medicare patients at risk for pressure ulcers. Author(s): Lyder CH, Preston J, Grady JN, Scinto J, Allman R, Bergstrom N, Rodeheaver G. Source: Archives of Internal Medicine. 2001 June 25; 161(12): 1549-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11427104

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Quality of care of Medicare beneficiaries with acute myocardial infarction: who is included in quality improvement measurement? Author(s): Rathore SS, Wang Y, Radford MJ, Ordin DL, Krumholz HM. Source: Journal of the American Geriatrics Society. 2003 April; 51(4): 466-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12657065

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Quality of heart failure care in managed Medicare and Medicaid patients in North Carolina. Author(s): Bertoni AG, Duren-Winfield V, Ambrosius WT, McArdle J, Sueta CA, Massing MW, Peacock S, Davis J, Croft JB, Goff DC Jr. Source: The American Journal of Cardiology. 2004 March 15; 93(6): 714-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15019875

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Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels. Author(s): Jencks SF, Cuerdon T, Burwen DR, Fleming B, Houck PM, Kussmaul AE, Nilasena DS, Ordin DL, Arday DR. Source: Jama : the Journal of the American Medical Association. 2000 October 4; 284(13): 1670-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11015797

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Quebec may tighten Medicare eligibility. Author(s): Pinker S. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2001 January 23; 164(2): 246. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11332323

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Racial and ethnic differences in public and private medical care expenditures among aged Medicare beneficiaries. Author(s): Escarce JJ, Kapur K. Source: The Milbank Quarterly. 2003; 81(2): 249-75, 172. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12841050

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Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer. Author(s): Godley PA, Schenck AP, Amamoo MA, Schoenbach VJ, Peacock S, Manning M, Symons M, Talcott JA. Source: Journal of the National Cancer Institute. 2003 November 19; 95(22): 1702-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14625261

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Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. Author(s): Skinner J, Weinstein JN, Sporer SM, Wennberg JE. Source: The New England Journal of Medicine. 2003 October 2; 349(14): 1350-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14523144

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Raising the Medicare eligibility age: effects on the young elderly. Author(s): Davidoff AJ, Johnson RW. Source: Health Aff (Millwood). 2003 July-August; 22(4): 198-209. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12889769

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Realigning incentives in fee-for-service Medicare. Author(s): Wallack SS, Tompkins CP. Source: Health Aff (Millwood). 2003 July-August; 22(4): 59-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12889751

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Reengineering Medicare: from bill-paying insurer to accountable purchaser. Author(s): Etheredge L. Source: Res Agenda Brief. 1995 June; (2): 1-13. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12940230

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Reforming Medicare payment: early effects of the 1997 Balanced Budget Act on postacute care. Author(s): McCall N, Korb J, Petersons A, Moore S. Source: The Milbank Quarterly. 2003; 81(2): 277-303, 172-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12841051

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Review of efforts to decrease costly leg wound complications in the Medicare population following coronary revascularization. Author(s): Brandt CP, Greene GC, Pollard TR, Hall WC, Bufkin BL, Briggs RM, Harville LE, Maggart ML, Ware RE. Source: Heart Surg Forum. 2003; 6(4): 258-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928211

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Risk classification of Medicare HMO enrollee cost levels using a decision-tree approach. Author(s): Anderson RT, Balkrishnan R, Camacho F. Source: Am J Manag Care. 2004 February; 10(2 Pt 1): 89-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011809

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Risk selection and benefits in the Medicare+Choice program. Author(s): Feldman R, Dowd B, Wrobel M. Source: Health Care Financing Review. 2003 Fall; 25(1): 23-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14997691

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Service-level selection by HMOs in Medicare. Author(s): Cao Z, McGuire TG. Source: Journal of Health Economics. 2003 November; 22(6): 915-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14604553

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Shortcomings in Medicare bonus payments for physicians in underserved areas. Author(s): Shugarman LR, Farley DO. Source: Health Aff (Millwood). 2003 July-August; 22(4): 173-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12889765

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Six questions about the new Medicare bill. Author(s): Waller D. Source: Time. 2003 December 8; 162(23): 50-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712555

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Skin cancer is among the most costly of all cancers to treat for the Medicare population. Author(s): Housman TS, Feldman SR, Williford PM, Fleischer AB Jr, Goldman ND, Acostamadiedo JM, Chen GJ. Source: Journal of the American Academy of Dermatology. 2003 March; 48(3): 425-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12637924

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Smoking and functional status among Medicare managed care enrollees. Author(s): Arday DR, Milton MH, Husten CG, Haffer SC, Wheeless SC, Jones SM, Johnson RE. Source: American Journal of Preventive Medicine. 2003 April; 24(3): 234-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12657341

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Spillover effects of Medicare fee reductions: evidence from ophthalmology. Author(s): Mitchell JM, Hadley J, Gaskin DJ. Source: International Journal of Health Care Finance and Economics. 2002 September; 2(3): 171-88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14625939

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Spring enrollment announced for Medicare prescription drug discount program. Author(s): Rustgi A. Source: Gastroenterology. 2004 March; 126(3): 638. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14988810

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State governors agree to support expansion of Medicare. Author(s): Charatan F. Source: Bmj (Clinical Research Ed.). 2003 August 23; 327(7412): 414. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12933726

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Surgical treatment of nonmelanoma skin cancer in the Medicare population. Author(s): Manternach T, Housman TS, Williford PM, Teuschler H, Fleischer AB Jr, Feldman SR, Chen GJ. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 December; 29(12): 1167-9; Discussion 1169. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14725656

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Systematic screening of secondary diagnoses in Medicare administrative data to identify candidate risk factors for the principal diagnosis. Author(s): Baine WB. Source: Annals of Epidemiology. 2003 July; 13(6): 443-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12875803

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The 1997 Balanced Budget Act and home services among Medicare patients. Author(s): Han B, Remsburg RE. Source: Jama : the Journal of the American Medical Association. 2003 November 26; 290(20): 2661; Author Reply 2661. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14645304

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The effect of managed care penetration on the treatment of AMI in the fee-for-service Medicare population. Author(s): Bradford WD, Krumholz HM. Source: International Journal of Health Care Finance and Economics. 2002 November; 2(4): 265-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14625994

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The effect of Medicare supplemental insurance on Medicare expenditures. Author(s): Atherly A. Source: International Journal of Health Care Finance and Economics. 2002 June; 2(2): 137-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626003

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The Medicare prescription drug benefit poses opportunities for disease management. Author(s): Kozma CM. Source: Manag Care Interface. 2004 February; 17(2): 47-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15038693

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The Medicare world from both sides: a conversation with Tom Scully. Interview by Uwe E. Reinhardt. Author(s): Scully T. Source: Health Aff (Millwood). 2003 November-December; 22(6): 167-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649443

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The new Medicare drug benefit: much ado about little? Author(s): Pauly MV. Source: Ldi Issue Brief. 2004 January-February; 9(4): 1-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15035261

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The new Medicare drug law. Analysts provide a “view from Washington” on this farreaching initiative. Author(s): Ferman JH. Source: Healthcare Executive. 2004 March-April; 19(2): 54-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15017840

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The sensitivity of Medicare billing claims data for monitoring mammography use by elderly women. Author(s): Mouchawar J, Byers T, Warren M, Schluter WW. Source: Medical Care Research and Review : Mcrr. 2004 March; 61(1): 116-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15035859

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Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Author(s): Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Source: Archives of Internal Medicine. 2004 March 22; 164(6): 637-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15037492

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Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life. Author(s): Barnato AE, McClellan MB, Kagay CR, Garber AM. Source: Health Services Research. 2004 April; 39(2): 363-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15032959

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Understanding biased selection in Medicare HMOs. Author(s): Mello MM, Stearns SC, Norton EC, Ricketts TC 3rd. Source: Health Services Research. 2003 June; 38(3): 961-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12822921

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Understanding disparities in the use of Medicare services. Author(s): Gornick ME, Eggers PW, Riley GF. Source: Yale J Health Policy Law Ethics. 2001 Spring; 1: 133-58. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12669323

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Unequal access: African-American Medicare beneficiaries and the prescription drug gap. Author(s): Reed MC, Hargraves JL, Cassil A. Source: Issue Brief Cent Stud Health Syst Change. 2003 July; (64): 1-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12884875

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US Medicare reform: why drug companies and private insurers are smiling. Author(s): Hurley J, Morgan S. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2004 February 17; 170(4): 461-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14970088

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Use of angiography in the Veterans Affairs health care system and Medicare. Author(s): Loeb HS. Source: The New England Journal of Medicine. 2003 September 11; 349(11): 1093; Author Reply 1093. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968101

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Use of high-cost operative procedures by Medicare beneficiaries enrolled in for-profit and not-for-profit health plans. Author(s): Schneider EC, Zaslavsky AM, Epstein AM. Source: The New England Journal of Medicine. 2004 January 8; 350(2): 143-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14711913

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Use of Medicare services by elderly residents of Puerto Rico. Author(s): McBean AM, Bubolz TA, Conde JG, Barosso GM. Source: P R Health Sci J. 2003 June; 22(2): 111-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12866133

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Using claims data to examine mortality trends following hospitalization for heart attack in Medicare. Author(s): Ash AS, Posner MA, Speckman J, Franco S, Yacht AC, Bramwell L. Source: Health Services Research. 2003 October; 38(5): 1253-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14596389

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Using Medicare claims to identify second primary cancers and recurrences in order to supplement a cancer registry. Author(s): McClish D, Penberthy L, Pugh A. Source: Journal of Clinical Epidemiology. 2003 August; 56(8): 760-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12954468

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Using the nursing process to accurately plan the Medicare 60-day episode of care: you really do know how to do this! Author(s): Hollers K. Source: Home Healthcare Nurse. 2004 January; 22(1): 28-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14734993

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Variations in breast carcinoma treatment in older Medicare beneficiaries: is it black or white. Author(s): Mandelblatt JS, Kerner JF, Hadley J, Hwang YT, Eggert L, Johnson LE, Gold K; OPTIONS (Outcomes and Preferences for Treatment in Older Women Nationwide Study). Source: Cancer. 2002 October 1; 95(7): 1401-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12237908

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Variations in patterns of care and outcomes after acute myocardial infarction for Medicare beneficiaries in fee-for-service and HMO settings. Author(s): Luft HS. Source: Health Services Research. 2003 August; 38(4): 1065-79. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968817

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Volume and yield of screening colonoscopy at a tertiary medical center after change in Medicare reimbursement. Author(s): Prajapati DN, Saeian K, Binion DG, Staff DM, Kim JP, Massey BT, Hogan WJ. Source: The American Journal of Gastroenterology. 2003 January; 98(1): 194-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12526957

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Vulnerability of rural hospitals to Medicare outpatient payment reform. Author(s): Mohr PE, Franco SJ, Blanchfield BB, Cheng CM, Evans WN. Source: Health Care Financing Review. 1999 Fall; 21(1): 1-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11481724

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Weighted health status in the Medicare population: development of the Weighted Health Index for the Medicare Current Beneficiary Survey (WHIMCBS). Author(s): Doctor JN, Chan L, MacLehose RF, Patrick DL. Source: J Outcome Meas. 2000-2001; 4(4): 721-39. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11394583

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What does it mean for patients? The expanded Medicare coverage of immunosuppressive medications. Author(s): Thomas C. Source: Nephrol News Issues. 2001 May; Suppl: S15-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12108991

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What does voluntary disenrollment from Medicare+Choice plans mean to beneficiaries? Author(s): Harris-Kojetin LD, Jael EM, Smith F, Kosiak B, Brown J. Source: Health Care Financing Review. 2002 Fall; 24(1): 117-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12553297

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What is known about the economics of end-of-life care for Medicare beneficiaries? Author(s): Buntin MB, Huskamp H. Source: The Gerontologist. 2002 October; 42 Spec No 3: 40-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12415132

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Who really wants price competition in Medicare managed care? Author(s): Nichols LM, Reischauer RD. Source: Health Aff (Millwood). 2000 September-October; 19(5): 30-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10992649

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Who switches from Medigap to Medicare HMOs? Author(s): Rice T, Snyder RE, Kominski G, Pourat N. Source: Health Services Research. 2002 April; 37(2): 273-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12035994

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Why Medicare cannot promulgate a national coverage rule: a case of regula mortis. Author(s): Foote SB. Source: Journal of Health Politics, Policy and Law. 2002 October; 27(5): 707-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12465777

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Winners and losers under the new and improved Medicare. Author(s): Scott JS. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2004 January; 58(1): 28-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14748295

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Winning big in reform bill. After a year of lobbying and much debate, Congress reaches a compromise Medicare agreement that pleases providers. Author(s): Tieman J. Source: Modern Healthcare. 2003 November 24; 33(47): 6-7, 10, 1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14666560

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With bated breath. Though Medicare will begin reimbursing for surgery to aid some emphysema patients, questions remain over benefit, cost. Author(s): Becker C. Source: Modern Healthcare. 2003 October 13; 33(41): 40-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14584199

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CHAPTER 2. NUTRITION AND MEDICARE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and Medicare.

Finding Nutrition Studies on Medicare The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Medicare” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “Medicare” (or a synonym): •

Ambulatory care sensitive hospitalization rates in the aged Medicare population in Utah, 1990 to 1994: a rural-urban comparison. Source: Silver, M.P. Babitz, M.E. Magill, M.K. J-rural-health. Kansas City, Mo. : National Rural Health Association. Fall 1997. volume 13 (4) page 285-294. 0890-765X

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Antithrombotic therapy for stroke prevention among Medicare beneficiaries hospitalized in Alaska with atrial fibrillation. Author(s): PRO-West/Alaska, Anchorage 99508, USA. Source: Gordian, M E Mustin, H D Alaska-Med. 1998 Oct-December; 40(4): 79-84 00024538

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Calcium supplement and bone medication use in a US Medicare health maintenance organization. Author(s): Calcium and Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center, Boston, MA 02111, USA. [email protected] Source: Dawson Hughes, B Harris, S S Dallal, G E Lancaster, D R Zhou, Q OsteoporosInt. 2002 August; 13(8): 657-62 0937-941X

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Complementary and alternative medicine use among elderly persons: one-year analysis of a Blue Shield Medicare supplement. Author(s): Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, California 94304-1583, USA. [email protected] Source: Astin, J A Pelletier, K R Marie, A Haskell, W L J-Gerontol-A-Biol-Sci-Med-Sci. 2000 January; 55(1): M4-9 1079-5006

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Cost and outcomes of Medicare reimbursement for HMO preventive services. Author(s): Department of Health Services, H689, Box 357660, University of Washington, Seattle, WA 98195-7660, USA. [email protected] Source: Patrick, D L Grembowski, D Durham, M Beresford, S A Diehr, P Ehreth, J Hecht, J Picciano, J Beery, W Health-Care-Financ-Revolume 1999 Summer; 20(4): 25-43 01958631

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Designing a strategy for quality review and assurance in Medicare. Source: Anonymous QRC-Advis. 1989 May; 5(7): 1, 6-8 0747-7384

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Diversity in delivery: the Medicare home health benefit. Author(s): National Association for Home Care, Washington, DC, USA. Source: St Pierre, M Caring. 1996 December; 15(12): 10-4 0738-467X

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How to select Medicare insurance supplements. Source: Lieurance, E. Home-Econ-Guide-GH-Univ-MO-Columbia-Coop-Ext-Serv. Columbia, Mo. : The Service. April 1989. (3426,revolume) 4 page

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Improving lipid evaluation and management in Medicare patients hospitalized for acute myocardial infarction. Author(s): IPRO, 1979 Marcus Ave, Lake Success, NY 11042, USA. [email protected] Source: Malach, M Quinley, J Imperato, P J Wallen, M Arch-Intern-Med. 2001 March 26; 161(6): 839-44 0003-9926

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Medicare medical nutrition therapy: legislative process and product. Author(s): Harvard Medical School, Cambridge, MA, USA. Source: Williams, Mark E Chianchiano, Dolph J-Ren-Nutr. 2002 January; 12(1): 1-7 10512276

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New Medicare payment opportunities. Source: Moore, Kent J Fam-Pract-Manag. 2002 June; 9(6): 18 1069-5648

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Nutrition identified as a risk factor for elderly Medicare patients' hospital readmission. Source: Ryan, V C J-Nutr-Elder. 1990; 9(4): 81-7 0163-9366

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Patient shifting as a response to Medicare Prospective Payment. Author(s): Department of Pharmacy Care Administration, College of Pharmacy, University of Georgia, Athens 30602. Source: Carroll, N V Erwin, W G Med-Care. 1987 December; 25(12): 1161-7 0025-7079

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Quality of care for Medicare patients hospitalized with heart failure in rural Georgia. Author(s): Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. Source: Baker, D W Fitzgerald, D Moore, C L South-Med-J. 1999 August; 92(8): 782-9 0038-4348

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The estimated costs and savings of medical nutrition therapy: the Medicare population. Author(s): The Lewin Group, Inc, Falls Church, VA 22042, USA. Source: Sheils, J F Rubin, R Stapleton, D C J-Am-Diet-Assoc. 1999 April; 99(4): 428-35 0002-8223

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Vitamin D update. Medicare carrier abandons plan to “ration” i.v. vitamin D in North Carolina, but not South Carolina. Source: Anonymous Nephrol-News-Issues. 2002 April; 16(5): 55, 58 0896-1263

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Warfarin use following ischemic stroke among Medicare patients with atrial fibrillation. Author(s): Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Yale University School of Medicine, Conn 06520-8018, USA. [email protected] Source: Brass, L M Krumholz, H M Scinto, J D Mathur, D Radford, M Arch-Intern-Med. 1998 October 26; 158(19): 2093-100 0003-9926

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND MEDICARE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to Medicare. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to Medicare and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “Medicare” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to Medicare: •

“Tale of a toenail” evokes response. Author(s): Kramer N. Source: Pa Med. 1994 October; 97(10): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7816464

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1984 Presidential election: issues of relevance to child and adolescent health. Author(s): Mondale WF, Reagan RW. Source: The Journal of School Health. 1984 October; 54(9): 366-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6568361

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2002: something old, something new. Author(s): Puckett RP.

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Source: Health Care Food & Nutrition Focus. 2002 January; 18(5): 1-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11794905 •

A holistic approach to specialization. Author(s): Slaymaker JH. Source: Am J Occup Ther. 1986 February; 40(2): 117-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3082211

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A primer on graduate medical education financing. Author(s): Carl JM, Knaus RJ. Source: J Am Osteopath Assoc. 1993 October; 93(10): 1055-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8258536

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A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers. Author(s): Berliner E, Ozbilgin B, Zarin DA. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 March; 37(3): 539-44. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12618689

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A vision for ambulatory care in the 21st century. Author(s): Zuckerman AM. Source: Ambul Outreach. 1998 Winter; : 5-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10346023

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Access to health care and the undocumented alien. Author(s): Loue S. Source: The Journal of Legal Medicine. 1992 September; 13(3): 271-332. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1402383

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Accuracy in the Outcomes and Assessment Information Set (OASIS): results of a video simulation. Author(s): Madigan EA, Tullai-McGuinness S, Fortinsky RH. Source: Research in Nursing & Health. 2003 August; 26(4): 273-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12884416

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ACE units take a wholistic, team approach to meet the needs of an aging America. A fresh model for gerontology. Author(s): Haugh R.

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Source: Hospitals & Health Networks / Aha. 2004 March; 78(3): 52-6, 2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15061071 •

Acupuncture in Australian general practice: patient characteristics. Author(s): Easthope G, Gill GF, Beilby JJ, Tranter BK. Source: The Medical Journal of Australia. 1999 March 15; 170(6): 259-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10212647

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Acupuncture in Australian general practice: practitioner characteristics. Author(s): Easthope G, Beilby JJ, Gill GF, Tranter BK. Source: The Medical Journal of Australia. 1998 August 17; 169(4): 197-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9734577

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Addressing Medicare coverage for biofeedback in the treatment of urinary incontinence. Author(s): Jewell KE. Source: Ostomy Wound Manage. 1998 December; 44(12): 54-60, 62-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10026549

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Advances in antimicrobial therapy for respiratory tract infections. Author(s): Mushatt DM. Source: Current Opinion in Pulmonary Medicine. 2000 May; 6(3): 250-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10782712

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Analysis of a large cohort of health maintenance organization patients with congestive heart failure. Author(s): Gladowski P, Fetterolf D, Beals S, Holleran MK, Reich S. Source: American Journal of Medical Quality : the Official Journal of the American College of Medical Quality. 2003 March-April; 18(2): 73-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12710556

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Anesthesia manpower in the United States. Author(s): Carron H. Source: Clin Anesth. 1974; 10(3): 245-64. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4613517

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Assessing resource use in oncology patients: a comparison of analyses based on claims data and medical chart review. Author(s): Semroc GN, Tierce JC, Fridman M. Source: J Manag Care Pharm. 2003 March-April; 9(2 Suppl): 6-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14613338

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Calcium supplement and bone medication use in a US Medicare health maintenance organization. Author(s): Dawson-Hughes B, Harris SS, Dallal GE, Lancaster DR, Zhou Q. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2002 August; 13(8): 657-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12181625

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Care planning and case conferencing. Building effective multidisciplinary teams. Author(s): Davis R, Thurecht R. Source: Aust Fam Physician. 2001 January; 30(1): 78-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11211720

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Chiropractic and Public Law 92-603. Author(s): Ballantine HT. Source: J Iowa Med Soc. 1974 January; 64(1): 7-11. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4590831

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Chiropractic care for patients aged 55 years and older: report from a practice-based research program. Author(s): Hawk C, Long CR, Boulanger KT, Morschhauser E, Fuhr AW. Source: Journal of the American Geriatrics Society. 2000 May; 48(5): 534-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10811547

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Chronomodulated chemotherapy: clinical value and possibilities for dissemination in the United States. Author(s): Block KI. Source: Chronobiology International. 2002 January; 19(1): 275-87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11962681

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Clinical consultations in an aboriginal community-controlled health service: a comparison with general practice. Author(s): Thomas DP, Heller RF, Hunt JM. Source: Aust N Z J Public Health. 1998 February; 22(1): 86-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9599858

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Clinical research: assessing the future in a changing environment; summary report of conference sponsored by the American Medical Association Council on Scientific Affairs, Washington, DC, March 1996. Author(s): Meyer M, Genel M, Altman RD, Williams MA, Allen JR. Source: The American Journal of Medicine. 1998 March; 104(3): 264-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9552090

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Comparison of costs for infusion versus bolus chemotherapy administration--Part two. Use of charges versus reimbursement for cost basis. Author(s): Lokich JJ, Moore CL, Anderson NR. Source: Cancer. 1996 July 15; 78(2): 300-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8674007

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Comparison of work and time estimates by chiropractic physicians with those of medical and osteopathic providers. Author(s): Hess JA, Mootz RD. Source: Journal of Manipulative and Physiological Therapeutics. 1999 June; 22(5): 280-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10395430

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Complementary and alternative medicine use among elderly persons: one-year analysis of a Blue Shield Medicare supplement. Author(s): Astin JA, Pelletier KR, Marie A, Haskell WL. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2000 January; 55(1): M4-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10719766

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Complementary and alternative medicine: the road less traveled? Author(s): Caplan C, Griffin K. Source: Issue Brief (Public Policy Inst (Am Assoc Retired Pers)). 2000 November; (Ib46): 1-14. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11885592

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Concentration, co-opetition, consumerism. and seven more “C's”. Trends that will shape healthcare strategy in 1998. Author(s): Coile RC Jr. Source: Healthc Strateg. 1998 January; 2(1): 1-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10345993

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Coordinating care in an integrated delivery system. Author(s): Darby M. Source: The Quality Letter for Healthcare Leaders. 1999 July; 11(7): 2-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10539440

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Curbing population growth in Republic of Korea. Author(s): Woo-hyun S. Source: Yojana. 1983 January 26; 27(1-2): 54, 56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12312002

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Current status of education and treatment resources for lymphedema. Author(s): Thiadens SR.

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Source: Cancer. 1998 December 15; 83(12 Suppl American): 2864-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9874412 •

Current threats to osteopathic graduate medical education. Author(s): Magen JG. Source: J Am Osteopath Assoc. 2002 March; 102(3): 156-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11926694

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DMEs discuss proposed freeze in Medicare payment. Author(s): Newald J. Source: Osteopath Hosp Leadersh. 1985 April; 29(3): 10-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10300205

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Dossey's odyssey: a conversation with Larry Dossey. Interview by Joe Flower. Author(s): Dossey L. Source: The Healthcare Forum Journal. 1998 November-December; 41(6): 20-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10346613

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Editorial: federal recognition of chiropractic: a double standard. Author(s): Ballantine HT Jr. Source: Annals of Internal Medicine. 1975 May; 82(5): 712-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1094878

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Editorial: Onward with chiropractic. Author(s): Radovsky SS. Source: The New England Journal of Medicine. 1975 September 25; 293(13): 662-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1097918

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Effective coordination of medical and supportive services. Author(s): Capitman J. Source: Journal of Aging and Health. 2003 February; 15(1): 124-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12611412

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Effectiveness of behavioral therapy to treat incontinence in homebound older adults. Author(s): McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, Engberg R. Source: Journal of the American Geriatrics Society. 1999 March; 47(3): 309-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10078893

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Evaluation of Siddha Medicare in HIV disease. Author(s): Deivanayagam CN, Krishnarajasekhar OR, Ravichandran N.

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Source: J Assoc Physicians India. 2001 March; 49: 390-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11291993 •

Hospice and Medicare benefits: overview, issues, and implications. Author(s): Wilson SA. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 1993 December; 11(4): 356-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8228139

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Hospital and physician partnership succeeds with Medicare managed care. Author(s): Kress D. Source: Med Manag Netw. 1998 November; 6(11): 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10187429

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Hyperbaric oxygen therapy 2003 Medicare coverage decision. Author(s): Schaum KD. Source: Advances in Skin & Wound Care. 2003 September-October; 16(5): 244. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14581816

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Medical morals, medical ethics, and Medicare. Author(s): Mueller CB. Source: Surg Gynecol Obstet. 1971 April; 132(4): 700-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4930020

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Medicare fraud: up close and personal. Author(s): Emord JW. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 1998 June; 3(3): 171-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9630734

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Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Author(s): Riley GF, Potosky AL, Lubitz JD, Kessler LG. Source: Medical Care. 1995 August; 33(8): 828-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7637404

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Medicare procedure code 90880 (medical hypnotherapy): use the Code (not the word) Author(s): Frischholz EJ. Source: Am J Clin Hypn. 1997 October; 40(2): 85-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9385719

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Seniors' need for and use of Medicare home health services. Author(s): Hubbert AO, Hays BJ. Source: Home Health Care Services Quarterly. 2002; 21(2): 19-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12362999

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Time for Medicare reform is now. Author(s): Linz AJ. Source: J Am Osteopath Assoc. 2000 December; 100(12): 762-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11213661

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to Medicare; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Alternative Therapy Chiropractic Source: Integrative Medicine Communications; www.drkoop.com

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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON MEDICARE Overview In this chapter, we will give you a bibliography on recent dissertations relating to Medicare. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “Medicare” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on Medicare, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Medicare ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to Medicare. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A COMPARATIVE ANALYSIS OF FACTORS THAT AFFECT PATIENT CARE IN HOME CARE: A SURVEY APPROACH (MEDICARE, REIMBURSEMENT) by SEBBEN, JAMES MICHAEL, PHD from Saint Louis University, 1991, 147 pages http://wwwlib.umi.com/dissertations/fullcit/9131024

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A general equilibrium analysis of Medicaid and Medicare by Gecan, Ronald William, PhD from University of Minnesota, 1997, 107 pages http://wwwlib.umi.com/dissertations/fullcit/9804719

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A POLICY ANALYSIS OF THE MEDICARE PROSPECTIVE PAYMENT SYSTEM (HEALTH CARE) by STONE, MICHAEL RICHARD, PHD from University of Pittsburgh, 1995, 174 pages http://wwwlib.umi.com/dissertations/fullcit/9538048

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A PRELIMINARY ANALYSIS OF BENEFICIARY DISCHARGE STATUS AND POST-HOSPITAL PLACEMENT BEFORE AND AFTER THE IMPLEMENTATION

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OF MEDICARE'S PROSPECTIVE PAYMENT SYSTEM by WILKINSON, ANNE MARGUERITE, PHD from Portland State University, 1989, 344 pages http://wwwlib.umi.com/dissertations/fullcit/9016133 •

A SOCIAL INTERPRETATION OF INSTITUTIONAL CHANGE: PUBLIC OPINION AND POLICY-MAKING IN THE ENACTMENT OF THE BRITISH NATIONAL HEALTH SERVICE ACT OF 1946 AND THE AMERICAN MEDICARE ACT OF 1965 by JACOBS, LAWRENCE RUBIN, PHD from Columbia University, 1990, 558 pages http://wwwlib.umi.com/dissertations/fullcit/9102426

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A STUDY OF DIFFERENCES BETWEEN SOCIAL/HMO AND OTHER MEDICARE BENEFICIARIES ENROLLED IN KAISER PERMANENTE UNDER CAPITATION CONTRACTS REGARDING INTERMEDIATE CARE FACILITY USE RATES AND EXPENDITURES (CARE FACILITIES) by BOOSE, LYNN ALLEN, PHD from Portland State University, 1993, 486 pages http://wwwlib.umi.com/dissertations/fullcit/9324943

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A study of hospitals' changes in length of stay and number of discharges as a result of changes in financial incentives related to Medicare exempt status for hospital-based skilled nursing care by Joseph, Jerry Allan, PhD from University of Pittsburgh, 1998, 130 pages http://wwwlib.umi.com/dissertations/fullcit/9919295

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A STUDY OF THE IMPACT OF MEDICARE AND MEDICAID ON FINANCIAL PERFORMANCES OF ST. LOUIS AREA HOSPITALS (MISSOURI) by SCHMITZ, HOMER HAROLD, PHD from Saint Louis University, 1983, 171 pages http://wwwlib.umi.com/dissertations/fullcit/8325428

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A STUDY OF THE IMPACT OF MEDICARE PROSPECTIVE PAYMENT SYSTEM ON HOSPITAL COST CONTAINMENT ACTIVITIES by CASSIDY, JUDITH HELEN, PHD from Texas Tech University, 1986, 169 pages http://wwwlib.umi.com/dissertations/fullcit/8707902

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Access to care among elderly Medicare beneficiaries: The influence of medicaid coverage by Lyons, Barbara Suzanne, PhD from The Johns Hopkins University, 1997, 406 pages http://wwwlib.umi.com/dissertations/fullcit/9730749

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Access to Medicare home health care in the wake of the Balanced Budget Act by Davitt, Joan K.; PhD from Bryn Mawr College, the Grad. Sch. of Social Work and Social Research, 2003, 272 pages http://wwwlib.umi.com/dissertations/fullcit/3088600

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ADMINISTRATIVE PROCEDURES AND THE POLITICS OF MEDICARE REFORM by BALLA, STEVEN JOHN, PHD from Duke University, 1995, 217 pages http://wwwlib.umi.com/dissertations/fullcit/9613867

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ALTERNATIVE HEALTH STATUS MEASURES AMONG THE ELDERLY: ADJUSTING CAPITATION PAYMENT RATES UNDER MEDICARE (HMO) by TOMPKINS, CHRISTOPHER P., PHD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1991, 204 pages http://wwwlib.umi.com/dissertations/fullcit/9123705

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An analysis of health risk selection and quality of care under Medicare fee-for-service and Medicare managed care health care systems by Salisbury, John Arnold; DPA from University of Southern California, 2003, 177 pages http://wwwlib.umi.com/dissertations/fullcit/3103964

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An analysis of postacute treatment and outcome differences between Medicare feefor-service and managed care by Angelelli, Joseph James, PhD from University of Southern California, 1998, 149 pages http://wwwlib.umi.com/dissertations/fullcit/9919008

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AN ANALYSIS OF THE DETERMINANTS OF MEDICARE BENEFICIARIES' HEALTH CARE UTILIZATION WITH SPECIAL EMPHASIS ON PHYSICIAN PRACTICE CHARACTERISTICS by VAN REENEN, CHRISTINE ANN, PHD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1995, 204 pages http://wwwlib.umi.com/dissertations/fullcit/9537823

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AN ANALYSIS OF THE ECONOMIC INCENTIVES OF CASE-MIX HOSPITAL REIMBURSEMENT (DIAGNOSIS-RELATED GROUPS, MEDICARE, PROSPECTIVE PAYMENT) by KOMINSKI, GERALD FRANCIS, PHD from University of Pennsylvania, 1985, 162 pages http://wwwlib.umi.com/dissertations/fullcit/8523435

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AN ANALYSIS OF THE EFFECTS OF THE MEDICARE AND MEDICAID PROGRAMS ON THE COST OF HOSPITAL SERVICES: A CASE STUDY. by GULLEY, CHARLES DOUGLAS, PHD from The Louisiana State University and Agricultural and Mechanical Col., 1976, 204 pages http://wwwlib.umi.com/dissertations/fullcit/7710371

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AN ANALYSIS OF THE IMPACT OF MEDICARE ON HOSPITAL FINANCIAL REPORTING PRACTICES by GROOMS, FERRIS LINEAU, DBA from Texas Tech University, 1971, 239 pages http://wwwlib.umi.com/dissertations/fullcit/7210351

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AN ANALYSIS OF WINNING AND LOSING HOSPITALS UNDER MEDICARE'S PROSPECTIVE PAYMENT SYSTEM by SEENPRACHAWONG, UDOMSAK, PHD from The University of Memphis, 1994, 124 pages http://wwwlib.umi.com/dissertations/fullcit/9506772

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AN ECONOMIC ANALYSIS OF THE UTILIZATION OF MEDICAL SERVICES BY MEDICARE PATIENTS by PASCAL, NINA, PHD from City University of New York, 1979, 194 pages http://wwwlib.umi.com/dissertations/fullcit/8006460

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AN EMPIRICAL INVESTIGATION INTO THE IMPACT OF ADVERSE SELECTION, SCREENING, AND MORAL HAZARD ON THE DEMAND FOR MEDICARE SUPPLEMENTAL INSURANCE AND PRESCRIPTION DRUGS BY THE ELDERLY (PENNSYLVANIA) by NESLUSAN, CHERYL ANN, PHD from The Pennsylvania State University, 1994, 104 pages http://wwwlib.umi.com/dissertations/fullcit/9428169

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An examination of firms charged with Medicare and Medicaid fraud: Does corporate governance matter? by Cammack, Susan Estelle; PhD from University of Missouri Columbia, 2002, 79 pages http://wwwlib.umi.com/dissertations/fullcit/3060090

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Analyzing urban-rural differences in the Medicare HMO market by Liu, Su; PhD from University of California, Irvine, 2003, 146 pages http://wwwlib.umi.com/dissertations/fullcit/3095155

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ASSESSING MEDICAL SERVICE DELIVERY IN THE PUBLIC SECTOR: AN EVALUATION MODEL FOR THE END-STAGE RENAL DISEASE PROGRAM (MEDICARE) by CLARK, NATHANIAL, PHD from The University of Wisconsin Milwaukee, 1984, 109 pages http://wwwlib.umi.com/dissertations/fullcit/8418233

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CASE-MIX ADJUSTMENT AND PHYSICIAN PRACTICE PROFILING: DEVELOPMENT OF A METHODOLOGY TO SOLVE ECONOMIC AND POLITICAL PROBLEMS IN MEDICARE PART B by PERKINS, NANCY ANNE KELLY, PHD from The University of Rochester, 1991, 174 pages http://wwwlib.umi.com/dissertations/fullcit/9128775

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Changes in Medicare reimbursement policies: The impact on access to care, utilization of services, and cost of care in home health and across the healthcare delivery system by Dorsey, Lisa L.; DPA from University of La Verne, 2002, 267 pages http://wwwlib.umi.com/dissertations/fullcit/3060004

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CHOICE OF HEALTH INSURANCE AND MODELS OF DECISION-MAKING UNDER UNCERTAINTY (MEDICARE) by BANTHIN, JESSICA SHERMAN, PHD from University of Maryland College Park, 1992, 175 pages http://wwwlib.umi.com/dissertations/fullcit/9234518

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CITIZEN INTEREST REPRESENTATION AND HEALTH CARE REFORM: SOCIOLOGICAL PERSPECTIVES ON THE CATASTROPHIC COVERAGE ACT (MEDICARE) by DUNHAM, NANCY CROSS, PHD from The University of Wisconsin Madison, 1993, 267 pages http://wwwlib.umi.com/dissertations/fullcit/9404721

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Clamping down on upcoding: Government efforts to curb a Medicare billing fraud and abuse by Harrington, Kirsten Beck; PhD from The University of Nebraska - Lincoln, 2003, 93 pages http://wwwlib.umi.com/dissertations/fullcit/3085736

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COMMON AGENCY THEORY AND THE INDUSTRIAL ORGANIZATION OF HEALTH CARE (MEDICARE) by ENCINOSA, WILLIAM EDWARD, III, PHD from University of Florida, 1995, 84 pages http://wwwlib.umi.com/dissertations/fullcit/9607509

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Competition among Medicare managed care plans by Brown, Jason Derrick; PhD from Stanford University, 2002, 92 pages http://wwwlib.umi.com/dissertations/fullcit/3067839

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Complement and substitute effects of prescription drug insurance on Medicare covered services by Powell, Melanie Paige; PhD from The Pennsylvania State University, 2003, 174 pages http://wwwlib.umi.com/dissertations/fullcit/3097028

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Consumer behavior and health insurance among two populations: Elderly Medicare beneficiaries and low-income parents by Taylor, Erin Fries; PhD from University of Michigan, 2003, 161 pages http://wwwlib.umi.com/dissertations/fullcit/3096216

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CRITICAL SUCCESS FACTORS IN THE MEDICAL GROUP MANAGEMENT OF MEDICARE SENIOR RISK PATIENTS (HMOS, HEALTH POLICY) by FAHEY, DANIEL FRANCIS, DPA from Arizona State University, 1993, 327 pages http://wwwlib.umi.com/dissertations/fullcit/9320593

Dissertations 137

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DEMAND AND SUBSTITUTION EFFECTS OF EXPANDING MEDICARE COVERAGE TO OPTOMETRISTS by BARRESI, BARRY JOSEPH, PHD from New York University, 1992, 163 pages http://wwwlib.umi.com/dissertations/fullcit/9306838

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DESIGN FACTORS IN MEDICARE PROSPECTIVE REIMBURSEMENT OF COMPUTERIZED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING IN HOSPITAL OUTPATIENT DEPARTMENTS (REIMBURSEMENT) by JACKSON, TERRI JURGENS, PHD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1993, 350 pages http://wwwlib.umi.com/dissertations/fullcit/9316016

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Determinants of the new entry of HMOs into a Medicare risk contract: A resource dependence-diversification model by Pai, Chih-Wen, PhD from Virginia Commonwealth University, 1996, 231 pages http://wwwlib.umi.com/dissertations/fullcit/9722584

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Dimensions of health care access and patient satisfaction for Medicare beneficiaries by Long, Carol Olson, PhD from Arizona State University, 1997, 106 pages http://wwwlib.umi.com/dissertations/fullcit/9725312

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Economic analysis of Medicare HMOs by Batata, Amber Sophia, PhD from Harvard University, 1999, 150 pages http://wwwlib.umi.com/dissertations/fullcit/9935733

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ECONOMIC INCENTIVE AND PHYSICIAN PRACTICE: AN EXAMINATION OF MEDICARE PARTICIPATION DECISIONS AND PHYSICIAN-INDUCED DEMAND by RICE, THOMAS HOWARD, PHD from University of California, Berkeley, 1982, 198 pages http://wwwlib.umi.com/dissertations/fullcit/8312946

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EFFECTS OF A MEDICARE, MEDICAID AND PRIVATE HEALTH INSURANCE PROGRAM ON KNOWLEDGE, ATTITUDES, AND PRACTICES OF ELDERLY CITIZENS by WILLIAMS, DELORIS GREEN, PHD from University of Illinois at Urbana-champaign, 1986, 325 pages http://wwwlib.umi.com/dissertations/fullcit/8623440

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Effects of Medicare payment changes on quality of care and access to care in skilled nursing facilities by Hodlewsky, Rita Tamara; PhD from The University of North Carolina at Chapel Hill, 2003, 87 pages http://wwwlib.umi.com/dissertations/fullcit/3100301

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Effects of the 1997 Balanced Budget Act on Medicare managed care providers by Hauge, Janice Alane; PhD from University of Florida, 2001, 141 pages http://wwwlib.umi.com/dissertations/fullcit/3039770

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EFFICIENCY MEASUREMENT AND MEDICARE REIMBURSEMENT IN NONPROFIT HOSPITALS: AN INVESTIGATION OF THE USEFULNESS OF DATA ENVELOPMENT ANALYSIS by NUNAMAKER, THOMAS RAY, PHD from The University of Wisconsin - Madison, 1983, 197 pages http://wwwlib.umi.com/dissertations/fullcit/8317042

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Estimating Medicare reimbursement for older South Carolina Medicare beneficiaries who would enroll in the Social HMO II demonstration by Brown, Thomas Edward, Jr., PhD from University of South Carolina, 1996, 150 pages http://wwwlib.umi.com/dissertations/fullcit/9637099

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Estimating the effect of income on health in the U.S. elderly Medicare population by Zhang, Xuejie James; PhD from Northern Illinois University, 1999 http://wwwlib.umi.com/dissertations/fullcit/f1896745

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Evaluation of the cost effectiveness of Medicare's End Stage Renal Disease program by Shih, Ya-Chen Tina, PhD from Stanford University, 1996, 87 pages http://wwwlib.umi.com/dissertations/fullcit/9723418

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EXPLORATION OF A MODEL TO UTILIZE INFORMATION AS AN ECONOMIC RESOURCE, FOR THE MEDICARE PROGRAM (MANAGEMENT, COMPUTER, DATA, CONTRACTING, MORAL HAZARD) by MARTINEZ, MAUREEN JANE, PHD from Syracuse University, 1985, 257 pages http://wwwlib.umi.com/dissertations/fullcit/8603767

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Factors contributing to variations in Medicare Home Health Agency services utilization among aged Medicare beneficiaries: Testing alternative models by Hijjazi, Kamal Hamed; PhD from University of Massachusetts Boston, 1998, 215 pages http://wwwlib.umi.com/dissertations/fullcit/9951103

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Geographic and patient variation among Medicare beneficiaries in the use of followup testing and skin examinations after local excision of cutaneous melanoma by Barzilai, David A.; PhD from Case Western Reserve University (Health Sciences), 2003, 114 pages http://wwwlib.umi.com/dissertations/fullcit/3100001

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Health care cost and quality Medicare: Capitation versus fee-for-service by Raffoul, John George; DPA from University of La Verne, 2002, 180 pages http://wwwlib.umi.com/dissertations/fullcit/3056187

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HEALTH CARE FINANCING SYSTEMS AND THE BEHAVIOR OF HEALTH CARE PROVIDERS (MANAGED CARE, MEDICARE) by CHERNEW, MICHAEL, PHD from Stanford University, 1993, 121 pages http://wwwlib.umi.com/dissertations/fullcit/9317757

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HEALTH POLITICS: PARTISANSHIP AND INFLUENTIAL FACTORS (CONGRESSIONAL VOTING, MEDICARE, IMMUNE DEFICIENCY) by NEUBY, BARBARA L., PHD from Southern Illinois University at Carbondale, 1993, 154 pages http://wwwlib.umi.com/dissertations/fullcit/9403161

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Health service use among elderly Medicare beneficiaries: Does membership in different health plan types and functional impairments impact health service use? by Lee, Ji Seon, PhD from Columbia University, 1998, 159 pages http://wwwlib.umi.com/dissertations/fullcit/9838969

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HMOS AND THE ELDERLY: ADJUSTING MEDICARE'S CAPITATION RATE by HYER, KATHRYN, DPA from Arizona State University, 1992, 230 pages http://wwwlib.umi.com/dissertations/fullcit/9307098

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HOSPITAL ADMINISTRATOR LEADERSHIP PRACTICE BEFORE AND AFTER THE IMPLEMENTATION OF FEDERAL COST CONTAINMENT POLICY (MEDICARE, COST CONTAINMENT) by ROUNDY, JAY T., DPA from Arizona State University, 1991, 198 pages http://wwwlib.umi.com/dissertations/fullcit/9124836

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HOSPITAL QUALITY AND COST: RESPONSES TO FEDERAL LEGISLATION (PROSPECTIVE PAYMENT SYSTEM, MEDICARE, COST CONTAINMENT) by MARTIN, PAMELA SMITH, PHD from The University of Texas at Dallas, 1993, 253 pages http://wwwlib.umi.com/dissertations/fullcit/9331297

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HOSPITALIZATION OUTCOMES AND EXPERIENCES: A COMPARISON OF THREE INSURANCE GROUPS UNDER MEDICARE'S PROSPECTIVE PAYMENT (MEDICARE'S PROSPECTIVE PAYMENT SYSTEM) by DENNIS, SARAH HELEN BANKHEAD, PHD from Virginia Commonwealth University, 1989, 158 pages http://wwwlib.umi.com/dissertations/fullcit/8926609

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IMPACT OF COST FINDING REQUIREMENTS OF MEDICARE LEGISLATION ON HOSPITAL ACCOUNTING AND COST CONTROL by CRAVEN, ALBERT L., JR., PHD from The University of Alabama, 1968, 223 pages http://wwwlib.umi.com/dissertations/fullcit/6815482

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INSTITUTION BEHAVIORAL CHANGE IN RESPONSE TO ALTERED FINANCIAL INCENTIVES IN FEDERAL POLICY: THE CASE OF THE PROSPECTIVE PAYMENT SYSTEM (MEDICARE) by JUNG, YOON SOO, PHD from University of Pennsylvania, 1992, 104 pages http://wwwlib.umi.com/dissertations/fullcit/9227690

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IS NURSING HOME CARE AN INSURABLE RISK? A COMPARATIVE ANALYSIS OF NURSING HOME USE AMONG ELDERLY IN THE MEDICARE POPULATION AND AMONG RESIDENTS OF SIX CONTINUING CARE RETIREMENT COMMUNITIES by COHEN, MARC AARON, PHD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1987, 228 pages http://wwwlib.umi.com/dissertations/fullcit/8722510

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IS THERE A DOCTOR IN THE HOUSE? A CRITICAL EXAMINATION OF ALTERNATIVE DELIVERY SYSTEMS OF HEALTH CARE IN AREAS WITH MANDATORY MEDICARE ASSIGNMENT (MEDICARE) by WAITON, MARILYN, PHD from Golden Gate University, 1991, 203 pages http://wwwlib.umi.com/dissertations/fullcit/9207649

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MEASUREMENT OF CONSUMER SATISFACTION/DISSATISFACTION IN A FOR-PROFIT HEALTH MAINTENANCE ORGANIZATION SETTING (HMO, MEDICARE) by WUNDER, GENE CARROLL, PHD from University of Arkansas, 1987, 269 pages http://wwwlib.umi.com/dissertations/fullcit/8718888

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MEDICAL TREATMENT BEFORE AND AFTER THE MEDICARE PROSPECTIVE PAYMENT SYSTEM: A RACIAL PERSPECTIVE (BLACKS) by HOWARD, DANIEL LESLIE, PHD from Vanderbilt University, 1992, 209 pages http://wwwlib.umi.com/dissertations/fullcit/9230977

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MEDICARE AND THE AMERICAN STATE: THE POLITICS OF FEDERAL HEALTH INSURANCE, 1965-1995 (HEALTH POLICY, ELDERLY) by OBERLANDER, JONATHAN BRUCE, PHD from Yale University, 1995, 284 pages http://wwwlib.umi.com/dissertations/fullcit/9615462

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MEDICARE REIMBURSEMENT AND AN EVALUATION OF ALTERNATIVE REIMBURSEMENT PROPOSALS. by PERRY, JAMES EDWARD, PHD from The University of Oklahoma, 1977, 223 pages http://wwwlib.umi.com/dissertations/fullcit/7721396

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Mortality patterns in the United States since 1960: Essays on migrant mortality, the impact of Medicare, and demographic consequences of cause-specific mortality change by Drevenstedt, Greg Lee; PhD from University of Pennsylvania, 2001, 220 pages http://wwwlib.umi.com/dissertations/fullcit/3003622

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MORTALITY, MORBIDITY, MEDICARE, AND SOCIAL SECURITY: ESSAYS IN HEALTH AND AGING by HARIHARAN, GOVIND, PHD from State University of New York at Buffalo, 1991, 120 pages http://wwwlib.umi.com/dissertations/fullcit/9121025

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OPTOMETRIC AND OPHTHALMOLOGICAL CARE FOR THE ELDERLY UNDER MEDICARE: IMPLICATIONS FOR NATIONAL HEALTH POLICY by SOROKA, MORDACHAI BARUCH, PHD from New York University, 1979, 307 pages http://wwwlib.umi.com/dissertations/fullcit/8010395

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OREGON HOSPICES: MEDICARE CERTIFICATION, PROGRAM CHARACTERISTICS, AND STAFF PERCEPTIONS by SONTAG, MARY-ANN ELIZABETH, PHD from University of California, Berkeley, 1993, 245 pages http://wwwlib.umi.com/dissertations/fullcit/9430697

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ORGANIZING HEALTH SERVICES FOR OLD PEOPLE: PREPAID GROUP PRACTICE VERSUS FEE FOR SERVICE IN THE MEDICARE PROGRAM. by WEIL, PETER ALAN, PHD from The University of Chicago, 1975 http://wwwlib.umi.com/dissertations/fullcit/T-25674

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Outcomes and reimbursement of inpatient rehabilitation services for Medicare beneficiaries with stroke and hip fracture by Deutsch, Anne Frances; PhD from State University of New York at Buffalo, 2003, 513 pages http://wwwlib.umi.com/dissertations/fullcit/3089198

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OUTSIDE LOOKING INTO THE HEALTH CARE FINANCING ADMINISTRATION (HCFA): HOW REGULATORS FORMULATED RULES OF SCREENING MAMMOGRAPHY FOR MEDICARE BENEFICIARIES (RULEMAKING) by BUFFINGTON, NANCY CATHERINE, PHD from The Union Institute, 1992, 129 pages http://wwwlib.umi.com/dissertations/fullcit/9238449

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OWNERSHIP PROFILES OF SUPPLEMENTAL HEALTH INSURANCE AND MEDICAL UTILIZATION BY MEDICARE ELDERLY (HEALTH INSURANCE) by HU, YU-WHUEI DEBBIE, PHD from The University of Wisconsin - Madison, 1996, 160 pages http://wwwlib.umi.com/dissertations/fullcit/9622506

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Patterns of physician participation in a changing health care market: Implications for Medicare and Medicaid by Worzala, Chantal Louise; PhD from The Johns Hopkins University, 2000, 222 pages http://wwwlib.umi.com/dissertations/fullcit/9950615

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PAYING PHYSICIANS UNDER MEDICARE: AN EMPIRICAL APPLICATION OF THE INTEREST GROUP THEORY OF GOVERNMENT by MULVEY, JANEMARIE J., PHD from George Mason University, 1994, 185 pages http://wwwlib.umi.com/dissertations/fullcit/9426906

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PERFORMANCE AND SURVIVAL IN THE HOSPITAL INDUSTRY: ORGANIZATIONAL RESPONSE TO PPS (MEDICARE) by EGGLESTON, KATHRYN ANN KIEFER, PHD from The University of Texas at Dallas, 1993, 166 pages http://wwwlib.umi.com/dissertations/fullcit/9319407

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Persistent Medicare utilization of the newly retired elderly by Wen, Yu-Ping, PhD from The University of Wisconsin - Madison, 1997, 203 pages http://wwwlib.umi.com/dissertations/fullcit/9726179

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PHYSICIAN AUTONOMY: SOCIOLOGICAL THEORY OF THE PROFESSIONS EXAMINED THROUGH PHYSICIAN PARTICIPATION AND ASSIGNMENT DECISIONS UNDER MEDICARE by CULBERTSON, RICHARD ALLEN, PHD from University of California, San Francisco, 1993, 421 pages http://wwwlib.umi.com/dissertations/fullcit/9332245

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PHYSICIAN RESPONSE TO MEDICARE FEE REGULATIONS by YIP, WINNIE CHI-MAN, PHD from Massachusetts Institute of Technology, 1994 http://wwwlib.umi.com/dissertations/fullcit/f1498883

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PHYSICIANS' PARTICIPATION AND PRICE DECISIONS WHEN FACING PUBLIC HEALTH INSURANCE PROGRAMS (MEDICARE, DISCOUNT PROGRAMS) by ZHANG, MINGLIANG, PHD from Vanderbilt University, 1991, 213 pages http://wwwlib.umi.com/dissertations/fullcit/9203351

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POLITICS OF MEDICAL PEER REVIEW (HEALTH POLICY, MEDICARE, PEER REVIEW) by GUO, BAOGANG, PHD from Brandeis University, 1994, 249 pages http://wwwlib.umi.com/dissertations/fullcit/9417688

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POSTHOSPITAL CARE FOR VULNERABLE ELDERLY: IS MEDICARE TREATMENT EQUITABLE? by STEINER, ANDREA, PHD from The Rand Graduate Institute, 1993, 229 pages http://wwwlib.umi.com/dissertations/fullcit/9322676

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Pricing and product differentiation in the managed Medicare market by Rankin, Peter James; PhD from Duke University, 1999, 254 pages http://wwwlib.umi.com/dissertations/fullcit/9942288

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PROFESSIONAL POWER AND PROLETARIANIZATION? A CLASS ANALYSIS OF CANADIAN PHYSICIANS (MEDICARE) by ALVI, SHAHID, PHD from Carleton University (Canada), 1995, 294 pages http://wwwlib.umi.com/dissertations/fullcit/NN98471

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PSYCHIATRIC FACILITIES' RESPONSE TO MEDICARE'S TEFRA REIMBURSEMENT SYSTEM by HARROW, BROOKE STACY, PHD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1992, 102 pages http://wwwlib.umi.com/dissertations/fullcit/9220236

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Quality competition and mergers: Evidence from the Medicare HMO market by Healy, Deborah A.; PhD from The University of Chicago, 2002, 84 pages http://wwwlib.umi.com/dissertations/fullcit/3060220

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Relationship between home health service utilization and functional status of Medicare patients with heart failure by Piyabanditkul, Lukawee; PhD from University of Kentucky, 2003, 156 pages http://wwwlib.umi.com/dissertations/fullcit/3092323

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Risk selection in the Medicare program by Beeuwkes Buntin, Melinda Jean; PhD from Harvard University, 2000, 112 pages http://wwwlib.umi.com/dissertations/fullcit/9972256

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Service-level risk selection by Medicare HMOs by Cao, Zhun; , PhD from Boston University, 2003, 113 pages http://wwwlib.umi.com/dissertations/fullcit/3067185

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Simulation analysis on distributional effects of reforming Medicare financing system with fundamental tax reform by Lu, Chunling; PhD from Syracuse University, 2000, 124 pages http://wwwlib.umi.com/dissertations/fullcit/9989376

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STABILITY AND CHANGE IN HEALTH CARE POLITICS (POLICY CHANGE, REFORM, MEDICARE, MEDICAID) by GUSMANO, MICHAEL KELLEY, PHD from University of Maryland College Park, 1995, 355 pages http://wwwlib.umi.com/dissertations/fullcit/9607767

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STATE RATE-SETTING IN CONJUNCTION WITH MEDICARE PROSPECTIVE PAYMENT: THE EFFECTS OF THE MAINE PROGRAM (RATE SETTING, PROSPECTIVE PAYMENT SYSTEM) by REAMY, JACKIE G., PHD from The Univ. of Texas H.s.c. at Houston Sch. of Public Health, 1992, 96 pages http://wwwlib.umi.com/dissertations/fullcit/9302797

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TECHNOLOGY-BASED SERVICES PROVIDED BY MEDICARE-CERTIFIED HOME HEALTH AGENCIES: PREDICTORS AND PROBLEMS (HEALTH CARE, CAREGIVERS) by HUMPHERS-GINTHER, SUSAN ELIZABETH, PHD from University of California, San Francisco, 1994, 296 pages http://wwwlib.umi.com/dissertations/fullcit/9523548

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THE 1983 MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR MEDICARE by DAVIS, ANNE ROBINSON, PHD from University of Maryland College Park, 1986, 352 pages http://wwwlib.umi.com/dissertations/fullcit/8712250

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THE CATASTROPHIC POLITICS OF THE MEDICARE CATASTROPHIC COVERAGE ACT OF 1988 by HIMELFARB, RICHARD, PHD from The University of Rochester, 1993, 223 pages http://wwwlib.umi.com/dissertations/fullcit/9322082

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THE COSTS, FINANCING, AND DISTRIBUTIONAL EFFECTS OF A CATASTROPHIC SUPPLEMENT TO MEDICARE. by MARQUIS, MADGE SUSAN CASE, PHD from The University of Michigan, 1978, 201 pages http://wwwlib.umi.com/dissertations/fullcit/7907131

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The cultural production of successful aging and Medicare reform: A critical analysis by Mason, Barbara L.; PhD from Fielding Graduate Institute, 2003, 494 pages http://wwwlib.umi.com/dissertations/fullcit/3072262

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THE DEMAND FOR HEALTH INSURANCE BEYOND MEDICARE by LIU, TSAICHING, PHD from The University of North Carolina at Chapel Hill, 1993, 143 pages http://wwwlib.umi.com/dissertations/fullcit/9402165

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THE ECONOMIC BENEFITS OF MEDICARE TO THE AGED: A MICROSIMULATION STUDY. by HOFER, RONALD KEITH, PHD from Indiana University, 1973, 351 pages http://wwwlib.umi.com/dissertations/fullcit/7404679

Dissertations 143

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The economics of Medicare equilibrium within the medical community by Coyte, Peter Christopher; PhD from The University of Western Ontario (Canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/NK52957

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THE ECONOMICS OF MEDICARE: EQUILIBRIUM WITHIN THE MEDICAL COMMUNITY by COYTE, PETER CHRISTOPHER, PHD from The University of Western Ontario (Canada), 1982 http://wwwlib.umi.com/dissertations/fullcit/f3144197

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The effect of having prescription drug coverage on health care expenditures by the noninstitutionalized, not disabled, Medicare population by Cifaldi, Mary Ann; PhD from University of Missouri - Kansas City, 2003, 337 pages http://wwwlib.umi.com/dissertations/fullcit/3085586

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The effect of Medicare reimbursement regulation on hospital balance sheet composition by Lynch, Luann Johnson, PhD from The University of North Carolina at Chapel Hill, 1998, 45 pages http://wwwlib.umi.com/dissertations/fullcit/9840952

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THE EFFECT OF THE IMPLEMENTATION OF PROSPECTIVE PAYMENT ON THE HEALTH CARE INDUSTRY; AN EMPIRICAL ANALYSIS (DRG, MEDICARE, MEDICAID) by LOVE, DIANNE BURGESS, PHD from University of Arkansas, 1984, 109 pages http://wwwlib.umi.com/dissertations/fullcit/8528928

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THE EFFECT OF THE INTRODUCTION OF MEDICAL ASSISTANCE AND MEDICARE ON THE STRUCTURE OF THE MICHIGAN NURSING HOME INDUSTRY by BAIR, LEE ALLEN, PHD from Michigan State University, 1973, 230 pages http://wwwlib.umi.com/dissertations/fullcit/7329662

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THE EFFECT OF THE MEDICARE PRINCIPLES OF REIMBURSEMENT ON THE ALLOCATION OF HOSPITAL COSTS BETWEEN THE MEDICARE PROGRAM AND NON-MEDICARE PATIENTS by SEAGO, WILMER EUGENE, PHD from University of Georgia, 1970, 170 pages http://wwwlib.umi.com/dissertations/fullcit/7113124

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THE EFFECT OF UNOBSERVED PLAN ATTRIBUTES ON THE HEALTH PLAN CHOICES OF TWIN CITIES MEDICARE BENEFICIARIES (MINNESOTA) by HARRIS, KATHERINE MARIE, PHD from University of Minnesota, 1996, 211 pages http://wwwlib.umi.com/dissertations/fullcit/9635857

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THE EFFECTS OF INSTRUCTIONAL PROGRAMS ON KNOWLEDGE ABOUT MEDICARE AND ATTITUDES TOWARDS PROPOSED SOCIAL PROGRAMS by BOWLING, GEORGE ST. CLAIR, EDD from Boston University School of Education, 1970, 182 pages http://wwwlib.umi.com/dissertations/fullcit/7022447

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The effects of Medicare penetration into HMOs and competition in the Medicare HMO market on stage of breast cancer diagnosis by Udie, Matthias Akomaye; PhD from University of Kentucky, 1999, 96 pages http://wwwlib.umi.com/dissertations/fullcit/9957058

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THE EFFECTS OF MEDICARE REIMBURSEMENT AND MARKET STRUCTURE ON HOSPITAL CAPITAL INVESTMENT by ZUMAS, SUSAN GEIGER, PHD from Lehigh University, 1994, 151 pages http://wwwlib.umi.com/dissertations/fullcit/9415011

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THE EFFECTS OF PUBLIC POLICY REFORM ON MEDICARE-COVERED HOME HEALTH CARE SERVICES (HEALTH CARE) by HALL, JUDITH CAROL PENGRA, PHD from The University of Texas at Dallas, 1989, 204 pages http://wwwlib.umi.com/dissertations/fullcit/9011415

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THE ELUSIVE REFORM: THE POLITICS OF NATIONAL HEALTH INSURANCE, 1915-1991 (MEDICARE) by LAHAM, NICHOLAS GEORGE, PHD from The Claremont Graduate University, 1992, 509 pages http://wwwlib.umi.com/dissertations/fullcit/9209519

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THE EMERGENCE OF COMMUNITY-BASED OPTIONS IN UNITED STATES LONG-TERM CARE POLICY (MEDICARE) by COX, DONNA MARIE, PHD from University of Maryland Baltimore County, 1993, 242 pages http://wwwlib.umi.com/dissertations/fullcit/9400520

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THE EQUITY AND IMPACT OF MEDICARE AND MEDICAID WITH RESPECT TO MEXICAN AMERICANS IN TEXAS. by HUNT, THOMAS LYNN, PHD from The University of Texas at Austin, 1978, 209 pages http://wwwlib.umi.com/dissertations/fullcit/7817654

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The geography of urban health care delivery in the United States: Locational changes incurred by nonprofit hospitals since the implementation of Medicare by Guo, Qian, PhD from The University of Tennessee, 1996, 156 pages http://wwwlib.umi.com/dissertations/fullcit/9735319

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The hospital choice of aged rural Medicare beneficiaries: The influence of patient attributes, hospital attributes, and spatial access by Tai, Wan-Tzu; PhD from University of Massachusetts Boston, 2000, 182 pages http://wwwlib.umi.com/dissertations/fullcit/3032194

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THE IMPACT OF MEDICARE AND MEDICAID ON THE SUPPLY AND DEMAND CONDITIONS OF NURSING HOMES by HENRY, LOUIS HAYES, PHD from University of Notre Dame, 1970, 220 pages http://wwwlib.umi.com/dissertations/fullcit/7105538

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THE IMPACT OF MEDICARE ON THE MANAGEMENT OF VOLUNTARY HOSPITALS IN NEW YORK STATE by RENODIN, LYLE FRANKLIN, PHD from New York University, Graduate School of Business Administration, 1970, 286 pages http://wwwlib.umi.com/dissertations/fullcit/7111432

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THE IMPACT OF MEDICARE PROSPECTIVE PAYMENT SYSTEM ON HOSPITAL PRODUCT COSTING STRATEGIES: AN EMPIRICAL ANALYSIS by KOPROWSKI, WILLIAM R., PHD from Temple University, 1987, 196 pages http://wwwlib.umi.com/dissertations/fullcit/8716409

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THE IMPACT OF MEDICARE'S PROSPECTIVE PAYMENT SYSTEM ON HOME HEALTH AGENCIES: A 'THIRD GENERATION' STUDY IN POLICY IMPLEMENTATION (HEALTH POLICY) by WILLIAMS, ARMENIA MARTIN, DPA from University of Georgia, 1991, 308 pages http://wwwlib.umi.com/dissertations/fullcit/9133548

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The impact of technology on the cost function of hospitals: An examination of the effects of the Medicare prospective payment system on capital investment by Lousteau, Carolyn Lutz, PhD from The University of Texas at Arlington, 1997, 227 pages http://wwwlib.umi.com/dissertations/fullcit/9804674

Dissertations 145

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THE IMPACT OF THE MEDICARE PROSPECTIVE PAYMENT SYSTEM POLICY ANALYSIS IN A POST-POSITIVIST VEIN by LEEDHAM, CYNTHIA ANN, PHD from University of Kentucky, 1995, 370 pages http://wwwlib.umi.com/dissertations/fullcit/9613668

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The influence of Medicare reimbursement policy on health care: How the Balanced Budget Act of 1997 impacted medical services in Delaware by Kulesher, Robert Roy; PhD from University of Delaware, 2003, 189 pages http://wwwlib.umi.com/dissertations/fullcit/3100101

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The influences of the military's TRICARE program on Medicare-eligible retirees and their family members by Sumter, Robert L.; PhD from Walden University, 2003, 183 pages http://wwwlib.umi.com/dissertations/fullcit/3098044

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THE MEDICARE CERTIFICATION PROGRAM: SUCCESS OR FAILURE IN PUBLIC ADMINISTRATION? by SZUCS, GERALD FRANCIS, PHD from University of Maryland College Park, 1977, 514 pages http://wwwlib.umi.com/dissertations/fullcit/7728757

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THE MEDICARE HOSPICE BENEFIT: ISSUES INFLUENCING UTILIZATION by WEDDLE, DIAN O., PHD from University of Illinois at Chicago, 1987, 178 pages http://wwwlib.umi.com/dissertations/fullcit/8712049

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THE MEDICARE HOSPICE BENEFIT: THE EFFECTIVENESS OF PRICE INCENTIVES IN HEALTH CARE POLICY by HAMILTON, VIVIAN HO, PHD from Stanford University, 1992, 120 pages http://wwwlib.umi.com/dissertations/fullcit/9217831

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THE MEDICARE PROSPECTIVE PAYMENT SYSTEM: THE IMPACT ON PATIENT CARE by GOLDBAUM, CAROL SEINSHEIMER, PHD from University of Illinois at Chicago, 1988, 137 pages http://wwwlib.umi.com/dissertations/fullcit/8825114

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THE MEDICARE PROSPECTIVE PAYMENT THEORY AS APPLIED TO THE MANAGEMENT OF PATIENT CARE OUTCOMES by ALDRIDGE, SUSAN COCKINGS, PHD from University of Colorado at Denver Graduate School of Public Affairs, 1991, 178 pages http://wwwlib.umi.com/dissertations/fullcit/9321104

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THE NATIONAL COUNCIL OF SENIOR CITIZENS: THE ROLE OF THE ELDERLY IN THE ENACTMENT OF MEDICARE by MONIZ, CYNTHIA DIANE, PHD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1990, 299 pages http://wwwlib.umi.com/dissertations/fullcit/9100461

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THE POLITICAL DEVELOPMENT OF OUTPATIENT PRESCRIPTION DRUG COVERAGE UNDER THE MEDICARE PROGRAM (CATASTROPHIC COVERAGE) by COSTER, JOHN MICHAEL, PHD from University of Maryland Baltimore County, 1989, 429 pages http://wwwlib.umi.com/dissertations/fullcit/9007575

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THE POLITICAL EVOLUTION OF THE MEDICARE CATASTROPHIC HEALTH CARE ACT OF 1988 by THOMPSON, CAROLYN RINKUS, PHD from The Johns Hopkins University, 1990, 304 pages http://wwwlib.umi.com/dissertations/fullcit/9030258

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THE RELATIONSHIP OF SELECTED CHARACTERISTICS OF SKILLED NURSING FACILITIES TO COMPLIANCE WITH THE MEDICARE AND MEDICAID

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CONDITIONS OF PARTICIPATION: A CASE STUDY OF FOUR SOUTHEASTERN STATES (POLICY COMPLIANCE) by HAIRE, JOHN HAGERMAN, DPA from University of Georgia, 1985, 179 pages http://wwwlib.umi.com/dissertations/fullcit/8514008 •

THE RESPONSE OF HOSPITALS TO INCENTIVES: THE CASE OF THE MEDICARE PROSPECTIVE PAYMENT SYSTEM (HEALTH CARE ECONOMICS) by SODERSTROM, NAOMI SIEGEL, PHD from Northwestern University, 1990, 137 pages http://wwwlib.umi.com/dissertations/fullcit/9031992

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THEORETICAL ASPECTS OF HOSPITAL REIMBURSEMENT: A PRICE DISCRIMINATION MODEL (PRIVATE PATIENT CHARGES, MEDICARE) by OH, CHEE JU, PHD from City University of New York, 1990, 64 pages http://wwwlib.umi.com/dissertations/fullcit/9108156

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TO LIFT A HEAVY BURDEN: THE STORY OF THE MEDICARE AND MEDICAID LAW by DAVID, SHERI IRIS, PHD from City University of New York, 1982, 320 pages http://wwwlib.umi.com/dissertations/fullcit/8222938

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UNFORESEEN FEDERAL POLICY IMPACTS AT THE URBAN LEVEL: A CASE STUDY OF MEDICARE POLICY by LOWER, CYNTHIA CONRAD, PHD from The University of Texas at Arlington, 1989, 133 pages http://wwwlib.umi.com/dissertations/fullcit/9000960

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UNIVERSALISM VS. TARGETING AS THE BASIS OF SOCIAL DISTRIBUTION: GENDER, RACE AND LONG-TERM CARE IN THE UNITED STATES (MEDICARE) by MEYER, MADONNA HARRINGTON, PHD from The Florida State University, 1991, 303 pages http://wwwlib.umi.com/dissertations/fullcit/9202308

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Utilization of ambulatory specialty mental health services by elderly Medicare beneficiaries living in the community by Schlosser, Lori Robin; PhD from Rutgers the State University of New Jersey - New Brunswick, 2003, 162 pages http://wwwlib.umi.com/dissertations/fullcit/3092986

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UTILIZATION OF HOME HEALTH SERVICES BY MEDICARE BENEFICIARIES IN CALIFORNIA, 1982 TO 1987 by FAHERTY, BONNIE, PHD from University of Southern California, 1990 http://wwwlib.umi.com/dissertations/fullcit/f2708644

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WHY WON'T MEDICARE COVER GRANDMA'S STAY? ORGANIZATIONAL DECISION-MAKING AND AUTHORITY RELATIONS IN CONNECTICUT SKILLED NURSING FACILITIES (NURSING FACILITIES) by UILI, ROBIN MOREMEN, PHD from Yale University, 1991, 371 pages http://wwwlib.umi.com/dissertations/fullcit/9218809

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON MEDICARE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “Medicare” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on Medicare, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Medicare By performing a patent search focusing on Medicare, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We

8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on Medicare: •

Apparatus and method for improved estimation of health resource consumption through use of diagnostic and/or procedure grouping and severity of illness indicators Inventor(s): Bostrom; Alan G. (San Francisco, CA), Farley; Peter J. (Orinda, CA), Frye; Lawrence J. (Atherton, CA), Mohlenbrock; William C. (Del Mar, CA), Trummell, Jr.; Donald E. (Daly City, CA) Assignee(s): Iameter Incorporated (san Mateo, Ca) Patent Number: 5,018,067 Date filed: July 29, 1987 Abstract: The likely consumption of health provider resources that are necessary to treat a particular medical patient are estimated within the framework of the existing Federal mandated system that uses Diagnostic Related Groups (DRG's) for setting the amount of payment that a hospital or other health provider will receive from the United States Government for that patient under the Medicare reimbursement system. The amount of payment is made from a calculation using the DRG system, regardless of the actual cost to the health provider. The Federal system results in a wide variation of health care costs occurring within each DRG, resulting from varying degrees of overall sickness among patients that are similarly classified. The present invention works within the DRG system and all of the sub-groups of DRG's including groups of diagnosis codes and individual diagnosis codes. Hidden information is extracted from the same input data that is used by the DRG system, in order to classify each patient into sub-categories of resource consumption, or other outcome variable, within a designated DRG or DRG sub-group. The invention is implemented by a general purpose computer system. Excerpt(s): This invention relates generally to the identification of quality and cost efficient medical providers, and specifically to computer software techniques and systems for estimating what the cost to treat a patient should be, based upon the condition of the patient and to the extent that any treatments or procedures impact the patient's health status. Due to the geometric escalation of medical care costs, there is increased pressure on public policy makers to establish cost containment programs. For this reason state and Federal governments are beginning to adopt various case specific or case-mix reimbursement systems. The Social Security Amendments of 1983, (Public Law 98-21), introduced a diagnosis specific prospective payment system that has been incorporated into the Medicare reimbursement policies. Under this system, the amount of payment for a patient hospital stay is determined by a one of hundreds of government defined Diagnostic Related Groups ("DRGs") into which the patient stay is categorized based upon diagnoses and procedures performed. Hospitals are reimbursed according to a fixed schedule without regard to actual costs to the hospital in rendering medical services to the patient. It is expected that this same reimbursement policy will in time be extended to establish the level of reimbursement to other health care providers and/or from other government entities and insurers. The DRGs represent a statistical, clinical classification effort to group together those diagnoses and procedures which are clinically related and have similar resource consumption. A DRG that is appropriate for a given hospital stay is selected, under the reimbursement system, by a particular set of patient attributes which include a principal illness diagnosis, specific secondary diagnoses, procedures performed, age, sex and discharge status (i.e., how the patient left the hospital, whether the patient was transferred, died, etc.). The principal diagnosis is

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that which caused the patient to be hospitalized, even though the patient may have even more serious problems, as would be indicated by secondary diagnoses. If a surgical procedure is performed, the DRG is determined primarily by that procedure. If no procedure is performed, the DRG is determined primarily by the principal diagnosis. The treatment of a patient during a single hospital stay is classified in only one DRG. Web site: http://www.delphion.com/details?pn=US05018067__ •

Computer software for processing medical billing record information Inventor(s): Denovich; Mark (Pittsburgh, PA), Hunt; William A. (Pittsburgh, PA), Yauch; Elizabeth F. (Pittsburgh, PA) Assignee(s): Medcom Solutions, Inc. (pittsburgh, Pa) Patent Number: 5,933,809 Date filed: February 29, 1996 Abstract: A computer-coded software instructions capable of being executed by a conventional computer microprocessor to perform information processing on preexisting medical billing record information, preferably consisting of hospital or individual doctor Medicare billing records. The software contains at least one set of instructions for receiving, converting, sorting and storing input information from the pre-existing medical billing records into a form suitable for processing. The software contains at least one set of instructions for processing the input medical billing record information, preferably to identify potential Medicare "72 hour billing rule" violations. This processing is preferably performed by comparing each input medical billing record containing dates of medical inpatient admission and discharge to each input medical billing record containing a date of medical outpatient service. The inpatient and outpatient billing records are first compared to determine if they contain matching patient identification codes to identify all the records originating from the same patient. If matching patient identification codes are found the inpatient and outpatient billing records are further compared to determine if the date of outpatient service fell within a preselected time period, preferably 72 hours, prior to the date of inpatient admission. If so, the matching inpatient and outpatient billing records are distinguished and stored separately for further processing. If not, the matching inpatient and outpatient billing records are compared to determine if the date of outpatient service fell between the inpatient admission and discharge dates. If this is the case, the matching inpatient and outpatient billing records are again distinguished and stored separately for further processing. If not, the program proceeds to the next set of billing records to repeat the sequence. Excerpt(s): The present invention relates to computer software designed for processing medical billing record information received from a pre-existing database, and in particular to processing medical billing record information to ensure compliance with the "72 hour billing rule" for submitting Medicare outpatient claims. The "72 hour billing rule" for submission of Medicare outpatient claims mandates that medical outpatient service performed within a 72 hour period prior to or during a "medically related" medical inpatient admission shall not be billed for outpatient reimbursement to Medicare. If an outpatient claim has been submitted and Medicare reimbursement has been received in either situation, the outpatient claim must be refunded to the payor of the claim. In some cases, the refund will be owed to the Medicare fund. In other cases, the refund will be owed to the provider of a coinsurance policy that supplements the Medicare coverage or to the patient as the payor of a deductible premium that covered

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the outpatient service. Finally, in some cases the refund will be owed to a combination of these payor sources if they all contributed to reimbursement of an erroneously billed outpatient claim. Recently, several hospitals have been the subject of a U.S. Department of Justice investigation into fraudulent Medicare billing practices. It was found that some hospitals have been disregarding the "72 hour billing rule" by improperly submitting claims for Medicare reimbursement of outpatient service that are prohibited under the rule. As a result the Justice Department has entered into a settlement with some of the offending hospitals to ensure that the erroneously billed outpatient claims are properly accounted for and refunded, and to ensure that a compliance mechanism is in place to prevent future erroneous outpatient billings. Web site: http://www.delphion.com/details?pn=US05933809__ •

Medical reimbursement computer system Inventor(s): Farley; Peter J. (Orinda, CA), Kahn; Theodore E. (Oakland, CA), Mohlenbrock; William C. (Rancho Santa Fe, CA), Trummell, Jr.; Donald E. (Union City, CA) Assignee(s): Iameter Incorporated (san Mateo, Ca) Patent Number: 4,667,292 Date filed: February 16, 1984 Abstract: A computer system for identifying the most appropriate of the billing categories (Diagnosis Related Groups) prescribed by the a governmental entity as a basis for determining the amount that health care providers, such as hospitals, are to be reimbursed under Medicare and similar programs for services provided to patients. The computer system responds to an initial determination of a category, upon admission of a patient, to list for medical personnel involved in giving care to the patient, such as the attending physician, a few other medically related categories for consideration as diagnosis and treatment proceeds. Only those related categories that can apply to a particular patient are listed for that patient, thereby reducing the time necessary for the physician to review and designate any new category that may be more accurate than the first. When a new category is designated by the attending physician, a new listing is provided the physician with those categories medically related to the newly designated category being listed. A brief review by the physician each day, with a new listing provided by the computer system for the following day's review if the physician designates any change, gives an accurate determination of the most appropriate billing category by the time services to the patient have been completed, such as when a patient leaves a hospital. A billing category determined in a conventional manner by medical records clerical personnel after medical services are ended can then be compared and reconciled with the physician determined category in order to improve the accuracy of the conventional determination. Excerpt(s): This invention relates generally to a technique and system for providing payments to health care providers. Due to the geometric escalation of medical care costs, there is increased pressure on public policy makers to establish cost containment programs. For this reason state and Federal governments are beginning to adopt various case specific or case-mix reimbursement systems. The Social Security Amendments of 1983, (Public Law 98-21), specifically require a diagnosis specific prospective payment system to be incorporated into Medicare reimbursement policies. The Federal government has therefore adopted a new payment plan for reimbursing hospitals for Medicare patient costs. Hospitals will be reimbursed according to a fixed schedule for

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each patient without regard to actual costs to the hospital in rendering medical services to the patient. The law provides for a 3-year transition period during which a decreasing portion of the total prospective payment will be based on hospitals' historical costs in a set base year and a gradually increasing portion will be based on a regional and/or national Federal rate per patient discharge. Beginning with the fourth year and continuing thereafter (i.e. cost reporting periods beginning on or after Oct. 1, 1986), Medicare payment for hospital inpatient services will be determined completely under a national DRG (Diagnosis Related Group) payment methodology. It is expected that this same reimbursement policy will in time be extended to establish the level of reimbursement to other health care providers and/or from other government entities and insurers. Web site: http://www.delphion.com/details?pn=US04667292__ •

Minimum income probability distribution predictor for health care facilities Inventor(s): Jones; Annie M. W. (1081 Mindingall Rd., Tuskegee, AL 36083) Assignee(s): None Reported Patent Number: 6,044,351 Date filed: December 18, 1997 Abstract: A computer program, PREdictor of Minimum INcome (PREMIN), has been developed for predicting health care facility future minimum income (FMI). PREMIN was developed using "MICROSOFT" "EXCEL" for "WINDOWS" 4.0. PREMIN allows estimation of anticipated number of office visits with three values, L (least possible), M (most probable), and H (most possible), and speculation of proportion of payments sources, i.e. HMO's Medicare, Medicaid, etc. The mathematical and statistical foundation of PREMIN is based on a method that determines the minimum number of independently distributed random variables required in a linear combination in order that its distribution can be approximated by the normal density function.Number of office visits are treated as a random variable and are approximated by the triangular distribution. Proportion of payment data is used to compute coefficients in linear combinations. If normal approximation is not adequate, PREMIN simulates the FMI distribution based on the input data. Therefore, PREMIN output is, in some cases, a plot of the normal probability density function for a FMI distribution and associated cumulative probabilities. PREMIN output may also be a histogram of simulated FMI values and associated summary statistics such as a frequency distribution by count and percentages.PREMIN provides a useful tool to estimate the distribution of FMI. After several demonstrations of the program to health care professionals, it is concluded that current methods of predicting income are quite immature in comparison with probabilistic calculations utilized by PREMIN. Further, the computer system can provide vital and beneficial financial data to health care facilities. Excerpt(s): This invention relates to predicting future minimum income, specifically income of health care facilities. Computerized systems that predict health care facility future minimum income (FMI) are either nonexistent or have not been published or patented. Computerized systems do exist that provide financial estimations relative to health care facilities. However, the estimation provided are of little or no use to physicians who want to predict future minimum income. Knowledge of FMI can be valuable in a medical practice, particularly office and health care delivery planning. FMI can be viewed as the "worst case" scenario for physician income. U.S. Pat. No. 5,018,067 to Mohlenbrock et al. (1991) relates to the identification of quality and cost efficient

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medical providers. It also relates to computer software techniques and systems for estimating cost to treat a patient. However, knowledge of cost without knowledge of income is of little use to a physician faced with decisions such as size of staff that can be afforded, purchase or lease options, and contractual agreements with insurance companies. U.S. Pat. No. 5,065,315 to Garcia (1991) relates to a computerized system located throughout the hospital facility for hospital medical record maintenance and scheduling system. However, this invention does not provide useful data to individual physicians about future minimum income. U.S. Pat. No. 5,070,452 to Doyle, Jr. et al. (1991) relates to a computerized system that included a comprehensive roster of all persons having insurance benefits available. The system included the particular medical treatment reimbursable by insurance and the dollar value of the reimbursement for each treatment. However, while the invention does generate a reimbursement amount, the invention does not generate predictions of future income for a physician. U.S. Pat. No. 5,307,262 to Ertel (1994) relates to a computerized system for reviewing the quality of patient data required on hospital payment claims. However, the invention does not relate to physician income. U.S. Pat. No. 5,325,077 to Kessler et al. (1994) relates to a system for gathering and evaluating data on delivery of medical care for ambulatory patient visits. However, primary focus of the invention is ensuring accurate and quality data on care being delivered to patients. Income received by physicians is related to individual patients after medical care is rendered. The invention does not address future income. U.S. Pat. No. 5,325,293 to Dorne (1994) relates to a system and a method for correlating medical procedures and medical billing codes. The computerized system translates medical procedures into accurate billing codes. It allows a physician to plan medical procedures in advance and modify planned procedures after performing the examination then automatically translates the performed procedures into billing codes. The billing codes do lead to specifying physician income, however, the invention does not address future income. U.S. Pat. No. 5,365,425 to Torma et al. (1994) relates to quality, cost and access in medical treatment. Medical care facilities can then be compared to each other and deficiencies identified. The invention does not address physician income. U.S. Pat. No. 5,557,514 To Seare et al. (1996) relates to a computerized system and method for analyzing healthcare providers billing patterns, enabling an assessment of medical services utilization patterns and determining whether a provider or multiple providers are over utilizing or under utilizing services when compared to a particular historical profile. The invention does not address physician income. Web site: http://www.delphion.com/details?pn=US06044351__ •

Pulse diagnosis meter Inventor(s): Nakamura; Kiyoharu (3295, Oaza-Nishidani, Koshiji-machi Santo-gun, Niigata-ken, JP), Nakamura; Yoshinobu (18-3, Yoneyama 4-chome, Niigata-shi, Niigataken, JP) Assignee(s): None Reported Patent Number: 5,724,980 Date filed: October 1, 1996 Abstract: A pulse diagnosis meter is provided to suitably carry out diagnosis and Medicare in the case where the blood pressure and pulse pressure are imbalanced. Two blood pressure sensors having the same structure are provided for measuring simultaneously the blood pressure and the pulse pressure on the right and left side arms of a person to be examined. A processor is provided for affecting predetermined

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calculations. A display indicates the calculation result. It is possible to immediately know the state of the pulse pressure and the balance of the blood pressure values on the right and left, which would be likely to overlook only by the measurement of the blood pressure of one arm of the person to be examined. Excerpt(s): The present invention relates to a pulse diagnosis meter for measuring right and left blood pressures of the human body and for displaying a difference between the right and left blood pressures for various diagnoses. In a conventional pulse diagnosis meter, it is known that a pressure value of a cuff band, a maximum blood pressure (contraction blood pressure) on the basis of an input signal from a sound sensor and a minimum blood pressure (relaxation blood pressure) are calculated or displayed in combination of the cuff band and Korotkoff sound sensor, and a predetermined blood pressure value is detected, calculated and displayed the basis of a pressure of the cuff band and a volume change (pressure change) of the cuff band pressure gas during the measurement. However, in the case where the blood pressures are measured on the right and left arms of the human body, there are some cases that the blood pressures are different between right arid left. This results from an imbalance of the autonomic nervous system on the right and left of the human body. In this connection, Japanese Utility Model Publication No. Hei 6-3529 proposes an automomic nervous system balance meter for simultaneously measuring the blood pressures on the right arid left arms and for indicating the result. Web site: http://www.delphion.com/details?pn=US05724980__ •

System and method for the rationalization of physician data Inventor(s): McCallum; William J. (Hurst, TX) Assignee(s): Integration Concepts, Inc. (bedford, Tx) Patent Number: 5,784,635 Date filed: December 31, 1996 Abstract: A system and method for rationalizing physician data in which source data is collected from source computers located at, for example, physicians' offices, hospitals, testing laboratories and pharmacies. Source data is expected to be in diverse formats and syntax, according to the particular hardware/software/operating system configuration of the source computer. Source data is converted to a common format, advantageously ASCII text, and is parsed and binned into a standard data element "layout." Source data is then cross-referenced and cleaned against standard data resources such as Medicare UPIN tables and AMA ICD9 tables. In this way, analogous data elements acquire a common alphanumeric syntax. Keying errors may also be corrected and missing information may be supplied. Source data is then ready to be accumulated into a standard database of universal format. The database may be processed in various ways to provide reports to physician groups and Independent Practice Associations ("IPAs") to support critical information systems. Excerpt(s): This invention relates generally to data processing systems, and more specifically to a system and method for assimilating diversely-formatted physician practice data into a universal single-format database to support critical information systems within said practice and among Independent Practice Associations of which said practice may be a member. Physicians today more than ever need accurate and timely information regarding their practices. Not only can improved information systems enhance the quality of the clinical care that the physician can offer, such

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improved systems can also help the physician to manage and evaluate costs. The ability to manage and evaluate costs is particularly important in an era when physicians and physicians' organizations are under increasing pressure to reduce the cost of health care. Legislation and consumer demand are recognized to be constraining health insurance premium revenue, causing health insurance companies, government agencies and selffunded employers (or "payors" as they will also be referred to herein) to limit what they will reimburse physicians for care. Meanwhile, the costs of providing health care continue to spiral. As a result, the traditional physician practice is finding it increasingly difficult to be profitable and stay in business. Web site: http://www.delphion.com/details?pn=US05784635__

Patent Applications on Medicare As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to Medicare: •

Medicare enrollment processing Inventor(s): Mistretta, Anthony; (Alpharetta, GA), Keohane, Peter; (Alpharetta, GA) Correspondence: Littman Law Offices, LTD.; P.O. Box 15035 Crystal City Station; Arlington; VA; 22215; US Patent Application Number: 20030233259 Date filed: June 14, 2002 Abstract: A Medicare enrollment processing computer system automates the completion of voluminous, new, Medicare enrollment forms, to be introduced in 2002. Required by the United States Centers for Medicare and Medicaid Services, the forms are designated 855A, 855B, 855I, 855R, and 855S. The present invention leads the use through a series of questions that are presented in a graphical user interface. As the user answers the questions, the program validates the data entered by the user to make sure that the information is appropriate for a given field. The invention prevents users from omitting required data. In addition, the instant invention automatically inserts redundant data in appropriate fields, eliminating manual reentry of data. Excerpt(s): The present invention relates to automated data processing and in particular to automated Medicare enrollment forms. The present invention is a computer program having a simplified user interface and central data storage. The program takes data from the user and outputs completed Medicare enrollment forms. The software validates data to make sure it is appropriate for a given field and automatically inserts redundant data in appropriate fields, eliminating manual reentry of data. The instant invention is required because new Medicare enrollment requirements to be introduced this year are extremely burdensome and because there is no other software that adequately automates filling out the forms. No prior art duplicates the instant invention. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

9

This has been a common practice outside the United States prior to December 2000.

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Method and system of providing medical goods and services to consumers through retail outlets Inventor(s): Rudy, Alan T.; (Columbus, OH) Correspondence: Porter, Wright, Morris & Arthur Llp; Attn: Intellectual Property Department; 28th Floor; 41 South High Street; Columbus; OH; 43215-6194; US Patent Application Number: 20030055687 Date filed: September 17, 2001 Abstract: A method of providing medical goods and services to consumers includes the steps of a retail outlet receiving a request for medical goods and services from a consumer who is present at the retail outlet. The retail outlet verifying, through a benefit manager, the consumer's current eligibility for health benefits from Medicare or other health insurance provider for the medical goods. The verification is preferably performed over a PBM computer system. An assignment of benefits is obtained from the consumer and transferred to the benefit manager by the retail outlet wherein the consumer assigns his or her rights to Medicare or other health insurance benefits to the benefit manager, including the right to submit a claim for reimbursement and the right to receive payment directly from Medicare or such other health insurance payer for the medical goods and services. If eligible and authorized by a physician's order, the retail outlet provides the needed medical goods and services to the consumer. The medical goods dispensed to the consumer by the retail outlet are either owned by the benefit manager, owned by the retail outlet and transferred to the benefit manager just prior to the release of the medical goods to the consumer, or owned by the retail outlet. The benefit manager completes a complicated Medicare claim form and/or other health insurance claim form based on the medical goods and services provided to the consumer, then submits such claim to Medicare and/or the other health insurance payer for reimbursement. If the claim is clean and proper, the benefit manager receives reimbursement from Medicare and/or the other health insurance payer after a period of time. The benefit manager makes a fixed, periodic payment to the retail outlet for services rendered by the retail outlet on behalf of the benefit manager. Excerpt(s): The present invention generally relates to an improved method and system of providing medical goods and services to consumers through retail outlets, typically retail pharmacies, and, more particularly, to such a method and system wherein consumers can receive their necessary medical goods and services at the retail outlet immediately, without delay, with no up-front payment required and little to no out-ofpocket expenses and, without having to subsequently (i) complete a complicated Medicare claim form and/or other health insurance claim form; (ii) file a claim with Medicare or other health insurance payer; (iii) wait weeks or months for reimbursement of money already paid or (iv) risk denial or rejection of such claim having already paid the money up-front for the medical goods and services. Currently when a consumer needs medical goods and services such as, for example, durable medical equipment and supplies and related items, like diabetes testing supplies, the consumer can go to a retail outlet, such as a pharmacy, and receive the medical goods and services immediately, without delay. However, the retail outlet requires full payment up-front from the consumer at the time of the consumer's request for the medical goods and services before the retail outlet will provide the medical goods and services to the consumer. If the consumer is eligible for benefits from Medicare or other health insurance, the retail outlet may or may not provide instructions to the consumer that a claim may be submitted by the consumer for reimbursement of the money already paid by the consumer for the medical goods and services. Some retail outlets will provide a copy of

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a Medicare claim form to the consumer for the consumer to complete and some retail outlets will complete and mail (or electronically submit) a claim to Medicare for the consumer. Retail outlets are less likely to provide non-Medicare claim forms or to submit claims to non-Medicare health insurance for the consumer. In any event, the consumer must wait for any reimbursement which would be received through the mail from Medicare and/or the other health insurance payer. If such claim is denied or rejected, the consumer, if still desiring to obtain reimbursement, would need to modify and correct such claim and then re-file such claim, waiting even longer for any reimbursement. While the consumer immediately receives the desired medical goods and services from the retail outlet, the consumer must be able to put forth full payment up-front for the medical goods and services even if the medical goods and services are covered by Medicare and/or other health insurance plans. This can particularly be a problem when the medical goods and services must be obtained on a regular basis, such as is often required to treat chronic health conditions like diabetes, asthma, incontinence, etc. An alternative currently available to the consumer, is to obtain medical goods and services via "mail order". The consumer orders the medical goods and services from a supplier via mail, phone or the Internet. If the consumer assigns his or her right to Medicare or other health insurance benefits to the supplier, the consumer can receive the goods and services with no up-front payment. The consumer usually has a financial responsibility for a small portion (typically 20%) of the remaining allowable amount not paid by Medicare or other health insurance, and this small portion would be due at a later time than at the time the supplier mails the medical goods to the consumer. If the consumer has qualifying secondary or supplemental health insurance coverage for the medical goods and services, the consumer may receive the medical goods and services with no up-front payment required and no out-of-pocket expense (subject to any applicable annual deductible not covered by such secondary or supplemental health insurance). The supplier mails the medical goods to the consumer and files a claim for reimbursement with Medicare and/or any other health insurance payer. This system is particularly good when the medical goods and services are needed on a regular basis. However, there can be a problem if the consumer is in short supply of needed medical goods for some reason because it takes some time for the medical goods to be received by the consumer once an order for such medical goods is placed with the supplier due to order processing and shipping time. Further, many consumers prefer to obtain their medical goods at a local retail outlet, typically retail pharmacies, due to the emotional and educational feedback the consumer can easily receive from a retail outlet representative, typically a pharmacist. Such emotional and/or educational feedback is not as easily obtained in the standard mail order context. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Software based method for tracking rejected Medicare and other insurance claims Inventor(s): Kole, Mark Hamilton; (Port Charlotte, FL) Correspondence: Frank A. Lukasik; 1250 West Marion AVE.; #142; Punta Gorda; FL; 33950; US Patent Application Number: 20030167184 Date filed: February 26, 2001 Abstract: The present invention is a method for using a computer to facilitate the tracking of Medicare and other medical insurance claims by care providers. The present invention relates to a dedicated software program which maintains a database of claim

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resubmission/review protocols for Medicare and insurance companies and interactively guides the user through all stages of the claims resubmission process to the end of either having a claim paid or disallowed for payment. Excerpt(s): The present invention relates to dedicated software for tracking rejected Medicare and other Medical Insurance claims by care providers and more particularly to a software program which maintains a database of claim resubmission/review protocols for Medicare and Insurance companies and interactively guides the user through all stages of the claims resubmission process to the end of either having a claim paid or disallowed for payment. In a preferred embodiment the present invention provides a software method for health care providers to successfully interface with Medicare and other Medical Insurance carriers in the processing of insurance claims which have previously been rejected. It is a further object of the invention to guide the health care provider sequentially through all procedures necessary for resubmission of priorly rejected claims. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System and user interface for use in billing for services and goods Inventor(s): Cole, Douglas J.; (Valley Forge, PA), Conti, Nicholas; (Spring City, PA), Hambright, Lynn; (Chester Springs, PA), Miklowcic, Geraldine; (Chester Springs, PA), Stanley, Starr; (Norristown, PA) Correspondence: Elsa Keller, Legal Assistant; Intellectual Property Department; Siemens Corporation; 186 Wood Avenue South; Iselin; NJ; 08830; US Patent Application Number: 20030018496 Date filed: December 5, 2001 Abstract: A system consolidates records of services from multiple customer accounts, encounters, cases or visits into one account to facilitate comprehensive billing and reimbursement compatible with selected contract (e.g., Medicare health plan) rules for disparate services provided to a customer. A method determines payment for provision of multiple different services based on predetermined reimbursement rules. The method involves receiving a record identifying a service provided to a specific entity and automatically creating a reimbursement record. The reimbursement record groups an item identifying the provided service together with an item identifying an other service provided to the specific entity based on predetermined service record allocation rules. A reimbursement amount for the identified provided service and the other service provided to the specific entity is calculated based on a reimbursement contract. Predetermined allocation rules are automatically applied for identifying a reimbursement record indicating a group of services provided to the specific entity on separate occasions to be billed together on a single bill. Excerpt(s): This is a non-provisional application of provisional application serial No. 60/302,065 by G. Miklowcic et al. filed Jun. 29, 2001. This invention concerns a system and user interface for determining payment and billing for provision of multiple different services and goods based on predetermined reimbursement rules for use in healthcare, insurance or other financial systems. In hospital patient registration, administration and billing systems a front-office administrative person manually makes a patient accounting decision determining how services provided to a patient are to be billed. This decision is typically taken before a thorough clinical assessment has been made of the medical condition of the patient and before an expert clinical opinion of the

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condition of the patient is taken. Given the complexity of healthcare insurance plan reimbursement and billing rules, the administrative person charged with making the billing decision is unlikely to have the knowledge and tools required to accurately establish an appropriate payment reimbursement and billing mechanism tailored to the services required by the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

SYSTEM FOR PROVIDING MEDICAL INFORMATION Inventor(s): JAVITT, JONATHAN C.; (CHEVY CHASE, MD) Correspondence: Merchant & Gould PC; P.O. Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20010041990 Date filed: June 29, 1999 Abstract: A managed care expert system provides a graphical, interactive computer system which accepts user input relating to contract variables for a plurality of alternative contract scenarios, consults a database of national and locality-specific utilization data, performs a utilization and revenue analysis for both commercial and Medicare-age beneficiaries, and provides a synthetic fee schedule for comparing the likely revenue under capitation for a plurality of services to revenue for those services under a current reimbursement scenario. The system of the invention in its preferred embodiment enables a physician or other health care professional to use a broad array of assumptions to forecast utilization of medical procedures and estimated revenue per procedure under multiple capitation scenarios. Excerpt(s): The invention relates in general to computer-based tools for aiding in business and financial decision-making, and in particular to a novel system for aiding a physician or other interested party in making decisions relating to contracts between health care payers and physician contractors or other health care providers. Capitated health care is rapidly gaining market acceptance in many geographical areas. This environment raises many decisional challenges for the physician and administrators in the medical care field. In particular, physicians and medical practice administrators entering into capitated contracts have had difficulty in balancing the often-conflicting goals of maintaining standards of quality in health care delivery and maintaining adequate practice revenue. One of the principal difficulties encountered in this regard has been the lack of an accurate means for comparing revenues generated under an atrisk contract with those generated under a traditional fee-for-service arrangement. Specifically, difficulty has arisen in understanding the interactions between an amount paid under a capitated contract, the utilization of services under the contract, and the resulting revenue earned in delivering those services. It is therefore an object of the invention to provide a computer-based system for comparing revenues and costs generated under an at-risk contract with those generated under a traditional fee-forservice arrangement. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with Medicare, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “Medicare” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on Medicare. You can also use this procedure to view pending patent applications concerning Medicare. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON MEDICARE Overview This chapter provides bibliographic book references relating to Medicare. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Medicare include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “Medicare” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on Medicare: •

Medicare Coverage of Kidney Dialysis and Kidney Transplant Services Source: Baltimore, MD: Health Care Financing Administration (HCFA), U.S. Department of Health and Human Services. August 2000. 60 p. Contact: Available from Health Care Financing Administration (HCFA). 7500 Security Boulevard, Baltimore, MD 21244-1850. (800) MEDICARE or (800) 633-4227. TTY/TDD (877) 486-2048. Website: www.Medicare.gov. PRICE: Free. Publication Number HCFA10128. Summary: This booklet explains how Medicare helps pay for kidney dialysis and kidney transplant services in the Original Medicare Plan, also known as fee-for-service. This booklet does not have detailed information about kidney failure, dialysis treatments, and kidney transplants; rather, it focuses on cost considerations of each of these treatment options and how patients can use the Medicare system. The booklet includes ten sections: Medicare basics, kidney dialysis, kidney transplants, how

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Medicare pays for blood, appeals and grievances (complaints), other kinds of health insurance, where to get more information, Medicare coverage charts, definitions of important words (a glossary), and a subject index. Patients can get Medicare no matter how old they are if their kidneys no longer work and they need regular dialysis or have had a kidney transplant; eligibility includes participation in the Social Security system. The booklet briefly outlines eligibility requirements and offers readers the toll free telephone number of the Social Security Administration (800-772-1213). Patients are encouraged to learn about Medicare and other insurance coverage and to take an active part in their own health care decisions. The booklet includes space for important telephone numbers and a few blank pages for patient notes. •

Talking With Your Parents About Medicare and Health Coverage Source: Menlo Park, CA: Henry J. Kaiser Family Foundation. 2000. 39 p. Contact: Available through the Henry J. Kaiser Family Foundation. 2400 Sand Hill Road, Menlo Park, CA 94025. (800) 656-4533, (877) 42-HEALTH. Internet: http://www.kff.org. PRICE: Free. Item number: 1522. Summary: This guide is designed to help adult children and their parents understand basic facts about Medicare, managed care options, and long- term care coverage. It explains what Medicare does and does not cover, how to plan for Medicare enrollment, and the differences between traditional Medicare, Medicare health maintenance organizations, and other Medicare options. It also discusses issues to consider before choosing a Medicare plan including private supplemental coverage, programs for people with low incomes, long-term care coverage under Medicare and Medicaid, private long-term care insurance, and the use of advance directives. The booklet concludes with information about additional national and state resources.

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Medicare Contact: US Department of Health and Human Services, Social Security Administration, Office of Public Inquiries, 6401 Security Blvd, Baltimore, MD, 21235, (410) 965-7700, http://www.ssa.gov. Summary: This monograph describes Medicare in detail. It explains what Medicare is, who is eligible, and how to register for benefits. A summary of health care costs that are and are not covered is given. Also offered are suggestions for those who may need more insurance and information for those who have other health insurance. (Persons with Human immunodeficiency virus (HIV) or with Acquired immunodeficiency syndrome (AIDS) may be eligible for Medicare benefits.).

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “Medicare” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “Medicare” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “Medicare” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com):

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1995 Mercer Guide to Social Security and Medicare by Dale R. Detlefs, Robert J. Myers (Contributor); ISBN: 1880754940; http://www.amazon.com/exec/obidos/ASIN/1880754940/icongroupinterna

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1996 Mercer Guide to Social Security and Medicare (Serial) by Dale Detlefs, et al; ISBN: 1800754965; http://www.amazon.com/exec/obidos/ASIN/1800754965/icongroupinterna

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1997 Mercer Guide to Social Security and Medicare (Serial) by Dale R. Detlefs, et al; ISBN: 1880754975; http://www.amazon.com/exec/obidos/ASIN/1880754975/icongroupinterna

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1998 Social Security Benefits: Including Medicare by CCH; ISBN: 0808002171; http://www.amazon.com/exec/obidos/ASIN/0808002171/icongroupinterna

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1999 Medicare Billing Guide; ISBN: 1563372827; http://www.amazon.com/exec/obidos/ASIN/1563372827/icongroupinterna

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21st Century Complete Guide to Medicare, Medicaid, and Nursing Homes Publications, Notices, Claims, and Appeals, Program Memos and Transmittals, Technical Information for Providers, Congressional and Agency Documents (Two CD-ROM Set) by U.S. Government; ISBN: 1592481426; http://www.amazon.com/exec/obidos/ASIN/1592481426/icongroupinterna

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Access to Medicare, 1990 by Dolores L. Dawson; ISBN: 0962658707; http://www.amazon.com/exec/obidos/ASIN/0962658707/icongroupinterna

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Advanced Ipa Management: Opportunities Under the New Medicare by Jennifer Marx, William J. de Marco; ISBN: 0071343210; http://www.amazon.com/exec/obidos/ASIN/0071343210/icongroupinterna

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Aging Sourcebook: Basic Information on Issues Affecting Older Americans, Including Demographic Trends, Social Security, Medicare, Estate Planning, Legal Rights, Health (Personal Concerns Series, Vol 3) by Dan R. Harris (Editor), Laurie L Harris (Editor); ISBN: 078080175X; http://www.amazon.com/exec/obidos/ASIN/078080175X/icongroupinterna

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All About Medicare 1994 by National Underwriters; ISBN: 0872181073; http://www.amazon.com/exec/obidos/ASIN/0872181073/icongroupinterna

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All About Medicare, 1989 by William W. Thomas (Editor), National Underwriters; ISBN: 0872184668; http://www.amazon.com/exec/obidos/ASIN/0872184668/icongroupinterna

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All about Medicare, 1992 by William W. Thomas; ISBN: 0872184935; http://www.amazon.com/exec/obidos/ASIN/0872184935/icongroupinterna

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Children Politics & Medicare: Experiences in a Canadian Province by Geoffrey C. Robinson, et al; ISBN: 189517631X; http://www.amazon.com/exec/obidos/ASIN/189517631X/icongroupinterna

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Competitive Pricing for Medicare by Bryan E. Dowd, et al; ISBN: 0844770345; http://www.amazon.com/exec/obidos/ASIN/0844770345/icongroupinterna

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Doctor's Office Guide to Medicare: 1989-1990 by Gary M. Knaus, Philip L. Beard; ISBN: 0925968099; http://www.amazon.com/exec/obidos/ASIN/0925968099/icongroupinterna

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Evaluation of the Medicare-DoD Subvention Demonstration: Final Report by Donna Farley (Editor), Stan Berenstain; ISBN: 0833033174; http://www.amazon.com/exec/obidos/ASIN/0833033174/icongroupinterna

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Extending Medicare Coverage for Preventive and Other Services by Marilyn J. Field (Editor), et al; ISBN: 0309068894; http://www.amazon.com/exec/obidos/ASIN/0309068894/icongroupinterna

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Future of Medicare Plan Performance Measurement: Conference Proceedings by Linda F. Wolf (Editor); ISBN: 0756717094; http://www.amazon.com/exec/obidos/ASIN/0756717094/icongroupinterna

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Guide to Health Insurance for People With Medicare, 2000 (017-060-00622-6); ISBN: 0160591902; http://www.amazon.com/exec/obidos/ASIN/0160591902/icongroupinterna

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Guide to Medicare Coverage Decision-Making and Appeals by Eleanor D. Kinney (Editor), A. M. Babkina; ISBN: 1590310969; http://www.amazon.com/exec/obidos/ASIN/1590310969/icongroupinterna

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H.R. 15, the "Medicare Preventive Benefit Improvement Act of 1997" : hearing before the Subcommittee on Health of the Committee on Ways and Means, House of Representatives, One Hundred Fifth Congress, first session, March 13, 1997 (SuDoc Y 4.W 36:105-13); ISBN: 0160571251; http://www.amazon.com/exec/obidos/ASIN/0160571251/icongroupinterna

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HCPCS 2002 Coders Choice, Millenium Edition, Health Care Procdure Coding System, National Level II, Medicare Codes, Color Coded by Medicode, PMIC; ISBN: 1570662304; http://www.amazon.com/exec/obidos/ASIN/1570662304/icongroupinterna

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HCPCS 2002: Medicare's National Level II Codes by American Medical Association; ISBN: 1579472095; http://www.amazon.com/exec/obidos/ASIN/1579472095/icongroupinterna

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Hcpcs 2003 Coder's Choice, Millennium Edition, Health Care Procedure Coding System, National Level Ii, Medicare Codes, Color Coded by Practice Management Information Corporation, Practice Management Information Corporat; ISBN: 1570662657; http://www.amazon.com/exec/obidos/ASIN/1570662657/icongroupinterna

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Hcpcs 2003, Millennium Edition: Health Care Procedure Coding System, National Level II Medicare Codes by Practice Management Information Corporation, Practice Management Information Corporat; ISBN: 1570662665; http://www.amazon.com/exec/obidos/ASIN/1570662665/icongroupinterna

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HCPCS 2004 Coder's Choice, Health Care Procedure Coding System, National Level II & Medicare Codes by Practice Management Information Corporat; ISBN: 1570662967; http://www.amazon.com/exec/obidos/ASIN/1570662967/icongroupinterna

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HCPCS: Health Care Financing Administration Common Precedure Coding System: National Level II Medicare Codes by J a Majors, et al; ISBN: 157066062X; http://www.amazon.com/exec/obidos/ASIN/157066062X/icongroupinterna

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HCPCS: Medicare's National Level II Codes by American Medical Association; ISBN: 0899708056; http://www.amazon.com/exec/obidos/ASIN/0899708056/icongroupinterna

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Health Care Without Medicare by Joseph A. Jackson; ISBN: 0970220804; http://www.amazon.com/exec/obidos/ASIN/0970220804/icongroupinterna

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How to Access Medicare 1992 by Dolores Dawson; ISBN: 0962658715; http://www.amazon.com/exec/obidos/ASIN/0962658715/icongroupinterna

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How to File Your Medicare Medigap Claims by Norma L. Border, Kathryn Dokas; ISBN: 1878675001; http://www.amazon.com/exec/obidos/ASIN/1878675001/icongroupinterna

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How to Recover Your Medical Expenses: A Comprehensive Guide to Understanding and Unscrambling Medicare by Kal Waller; ISBN: 0020989407; http://www.amazon.com/exec/obidos/ASIN/0020989407/icongroupinterna

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Lessons from the First Twenty Years of Medicare: Research Implications for Public and Private Sector Policy (Series in Health Economics, Health Mana) by Mark V. Pauly, et al; ISBN: 0812281187; http://www.amazon.com/exec/obidos/ASIN/0812281187/icongroupinterna

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Market Profiles for Medicare Risk Contracting; ISBN: 1573721697; http://www.amazon.com/exec/obidos/ASIN/1573721697/icongroupinterna

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Medical Visits to Medicare Patients: Physician Coding Practices/R-4055-Hcfa by Sally Trude; ISBN: 083301224X; http://www.amazon.com/exec/obidos/ASIN/083301224X/icongroupinterna

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Medicare : Issues in Political Economy by Ronald J. Vogel (Author); ISBN: 0472110608; http://www.amazon.com/exec/obidos/ASIN/0472110608/icongroupinterna

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Medicare and Extended Care: Issues, Problems, and Prospects/With Addendum by Bruce C. Vladeck, Genrose J. Alfano; ISBN: 0932500706; http://www.amazon.com/exec/obidos/ASIN/0932500706/icongroupinterna

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Medicare and the Hospitals: Issues and Prospects by Herman Miles, Somers; ISBN: 0815780400; http://www.amazon.com/exec/obidos/ASIN/0815780400/icongroupinterna

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Medicare Billing Guide 2000 by Med-Index Division Staff Medicode; ISBN: 1563373289; http://www.amazon.com/exec/obidos/ASIN/1563373289/icongroupinterna

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Medicare Billing Guide 2001; ISBN: 156337319X; http://www.amazon.com/exec/obidos/ASIN/156337319X/icongroupinterna

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Medicare Billing Guide, 2002 by Medicode; ISBN: 1563373947; http://www.amazon.com/exec/obidos/ASIN/1563373947/icongroupinterna

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Medicare Claims Management: for Home Health Agencies by Andrea L. Dumat; ISBN: 083421220X; http://www.amazon.com/exec/obidos/ASIN/083421220X/icongroupinterna

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Medicare Handbook 2002 by Judith Chiplin, et al; ISBN: 0735531846; http://www.amazon.com/exec/obidos/ASIN/0735531846/icongroupinterna

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Medicare Handbook, 1993; ISBN: 0160027802; http://www.amazon.com/exec/obidos/ASIN/0160027802/icongroupinterna

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Medicare Handbook, 2001 by Judith Stein, et al; ISBN: 0735523657; http://www.amazon.com/exec/obidos/ASIN/0735523657/icongroupinterna

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Medicare HMO risk-contractor program : hearing before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of

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Representatives, One Hundred Second Congress, first session, November 15, 1991 (SuDoc Y 4.En 2/3:102-89); ISBN: 0160377536; http://www.amazon.com/exec/obidos/ASIN/0160377536/icongroupinterna •

Medicare HMO's: Potential Effects of a Limited Enrollment Period Policy by BPI Information Services; ISBN: 1579792251; http://www.amazon.com/exec/obidos/ASIN/1579792251/icongroupinterna

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Medicare in the 21st Century: Seeking Fair and Efficient Reform by Robert B. Helms (Editor); ISBN: 0844741175; http://www.amazon.com/exec/obidos/ASIN/0844741175/icongroupinterna

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Medicare issues under health care reform : hearing before the Committee on Finance, United States Senate, One Hundred Third Congress, second session, April 12, 1994 (SuDoc Y 4.F 49:S.HRG.103-964); ISBN: 0160467551; http://www.amazon.com/exec/obidos/ASIN/0160467551/icongroupinterna

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Medicare Laboratory Payment Policy: Now and in the Future by Dianne Miller, et al; ISBN: 0309072662; http://www.amazon.com/exec/obidos/ASIN/0309072662/icongroupinterna

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Medicare Made Easy by Louise White; ISBN: 0961393904; http://www.amazon.com/exec/obidos/ASIN/0961393904/icongroupinterna

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Medicare Money: A Consumer Guide to the New Medicare & Catastrophic Coverage Act of 1988 by Edita Kaye (Editor); ISBN: 0685265986; http://www.amazon.com/exec/obidos/ASIN/0685265986/icongroupinterna

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Medicare Now and in the Future by Marilyn Moon; ISBN: 0877666539; http://www.amazon.com/exec/obidos/ASIN/0877666539/icongroupinterna

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Medicare Policy: New Directions for Health and Long-Term Care by Karen Davis, E. Diane Rowland; ISBN: 0801828740; http://www.amazon.com/exec/obidos/ASIN/0801828740/icongroupinterna

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Medicare Private Contracting:: Paternalism or Autonomy by John S. Hoff; ISBN: 0844771236; http://www.amazon.com/exec/obidos/ASIN/0844771236/icongroupinterna

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Medicare Provider-Sponsored Organizations : A Practical Guide to Development and Certification by Peter N. Grant (Author), W. Reece Hirsch (Author); ISBN: 1556482434; http://www.amazon.com/exec/obidos/ASIN/1556482434/icongroupinterna

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Medicare Rbrvs 2003: The Physician's Guide (Medicare Rbrvs, 2003) by American Medical Association, Todd Klemp; ISBN: 157947344X; http://www.amazon.com/exec/obidos/ASIN/157947344X/icongroupinterna

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Medicare Rbrvs: The Physicians' Guide 1998 (Serial) by American Medical Association; ISBN: 0899709273; http://www.amazon.com/exec/obidos/ASIN/0899709273/icongroupinterna

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Medicare Rbrvs: The Physician's Guide, 1999 (Medicare Rbrvs, 1999) by Sherry L. Smith (Editor), Patrick E. Gallagher (Editor); ISBN: 0899709672; http://www.amazon.com/exec/obidos/ASIN/0899709672/icongroupinterna

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Medicare RBRVS: The Physician's Guide, 2002 by American Medical Association, et al; ISBN: 1579472052; http://www.amazon.com/exec/obidos/ASIN/1579472052/icongroupinterna

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167

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Medicare Recover Your Medical Expenses: Recover Your Medical Expenses: A Comprehensive Guide to Understanding and Unscrambling Medicare by Kal Waller; ISBN: 0939738929; http://www.amazon.com/exec/obidos/ASIN/0939738929/icongroupinterna

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Medicare Reimbursement & the Quality of Hospital Care by Michael J. McGinty; ISBN: 0788110535; http://www.amazon.com/exec/obidos/ASIN/0788110535/icongroupinterna

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Medicare Rules & Regulations: A Survival Guide to Policies, Procedures and Payment Reform 1997 by Denise L. Knaus, Kathryn Swanson (Editor); ISBN: 1570660662; http://www.amazon.com/exec/obidos/ASIN/1570660662/icongroupinterna

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Medicare Rules and Regulations, 2002: A Survival Guide to Policies, Procedures and Payment Reform by Maxine Lewis; ISBN: 1570662347; http://www.amazon.com/exec/obidos/ASIN/1570662347/icongroupinterna

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Medicare Select and Medicare managed care issues : hearing before the Subcommittee on Health and Environment of the Committee on Commerce, House of Representatives, One Hundred Fourth Congress, first session, February 15, 1995 (SuDoc Y 4.C 73/8:104-6); ISBN: 0160473411; http://www.amazon.com/exec/obidos/ASIN/0160473411/icongroupinterna

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Medicare Unique Physician Identification Number Supplement, 1999; ISBN: 0160501857; http://www.amazon.com/exec/obidos/ASIN/0160501857/icongroupinterna

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Medicare: A Handbook on the History and Issues of Health Care Services for the Elderly (Garland Reference Library of Social Science, Vol 406) by P. Starr, William A. Pearman; ISBN: 0824083911; http://www.amazon.com/exec/obidos/ASIN/0824083911/icongroupinterna

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Medicare: A Strategy for Quality Assurance (Publication Iom; 90-02) by Kathleen N Lohr (Editor); ISBN: 0309042305; http://www.amazon.com/exec/obidos/ASIN/0309042305/icongroupinterna

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Medicare: Current Issues and Background by S. N. Colamery (Editor); ISBN: 1590336763; http://www.amazon.com/exec/obidos/ASIN/1590336763/icongroupinterna

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Medicare: Issues and Options by S. N. Colamery (Editor), S.N. Colamery; ISBN: 1560726946; http://www.amazon.com/exec/obidos/ASIN/1560726946/icongroupinterna

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Medicare's Midlife Crisis by Sue A. Blevins; ISBN: 1930865090; http://www.amazon.com/exec/obidos/ASIN/1930865090/icongroupinterna

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Mercer Guide to Social Security and Medicare by Dale R. Detlefs, Robert J. Myers (Contributor); ISBN: 1880754932; http://www.amazon.com/exec/obidos/ASIN/1880754932/icongroupinterna

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One-Tier Medicine: A Family Doctor's Cure for the Ills of Medicare by William Andre Falk; ISBN: 1553955153; http://www.amazon.com/exec/obidos/ASIN/1553955153/icongroupinterna

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Paying for Medicare: The Politics of Reform (Social Institutions and Social Change) by David G. Smith; ISBN: 0202303934; http://www.amazon.com/exec/obidos/ASIN/0202303934/icongroupinterna

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Posthospital Care Before and After the Medicare Prospective Payment System by C.R. Neu, Scott C. Harrison (Editor); ISBN: 9998149738; http://www.amazon.com/exec/obidos/ASIN/9998149738/icongroupinterna

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Redesigning the Medicare Contract: Politics, Markets, and Agency by Edward F. Lawlor; ISBN: 0226470342; http://www.amazon.com/exec/obidos/ASIN/0226470342/icongroupinterna

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Renewing the Promise: Medicare and Its Reform by Mark Schlesinger (Editor), et al; ISBN: 0195043049; http://www.amazon.com/exec/obidos/ASIN/0195043049/icongroupinterna

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Risk Contracting and Medicare + Choice by Winfield Towles, Charlotte Collins; ISBN: 0071342176; http://www.amazon.com/exec/obidos/ASIN/0071342176/icongroupinterna

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S.O.S Medicare by Cynthia Carver; ISBN: 096986180X; http://www.amazon.com/exec/obidos/ASIN/096986180X/icongroupinterna

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Saving Medicare : lessons from the private sector : hearings before the Committee on the Budget, House of Representatives, One Hundred Fourth Congress, first session, hearings held in Washington, DC, March 21 and 22, 1995 (SuDoc Y 4.B 85/3:104-9); ISBN: 0160473195; http://www.amazon.com/exec/obidos/ASIN/0160473195/icongroupinterna

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Social Security and Medicare for the New Millenium : by Maurice Y. Youakim (Author); ISBN: 0595141897; http://www.amazon.com/exec/obidos/ASIN/0595141897/icongroupinterna

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Social Security and Medicare: A Policy Primer by Eric R. Kingson (Author), Edward D. Berkowitz (Author); ISBN: 0865692009; http://www.amazon.com/exec/obidos/ASIN/0865692009/icongroupinterna

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Social Security, Medicare & Government Pensions: By Joseph L. Matthews With Dorothy Matthews Berman (Social Security, Medicare and Pensions, 8th Ed) by Dorothy Matthews Berman, J. L. Social Security, Medicare, and Pensions Matthews; ISBN: 0873377206; http://www.amazon.com/exec/obidos/ASIN/0873377206/icongroupinterna

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St. Anthony's Medicare Outpatient Reference Manual (Hcr) by Linda Buckle (Editor), Kathleen Culbertson (Editor); ISBN: 1563296020; http://www.amazon.com/exec/obidos/ASIN/1563296020/icongroupinterna

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St. Anthony's Medicare Unbundling Guidebook (Mung) by Sheila Parvis (Editor), Anita Hart (Editor); ISBN: 1563294966; http://www.amazon.com/exec/obidos/ASIN/1563294966/icongroupinterna

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Steps on the Road to Medicare: Why Saskatchewan Led the Way by C. Stuart Houston, Sylvia O. Fedoruk; ISBN: 0773523669; http://www.amazon.com/exec/obidos/ASIN/0773523669/icongroupinterna

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The ABA Complete and Easy Guide to Health Care Law : Your Guide to Protecting Your Rights as a Patient, Dealing with Hospitals,Health Insurance, Medicare, and More by American Bar Association (Author); ISBN: 0812927354; http://www.amazon.com/exec/obidos/ASIN/0812927354/icongroupinterna

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The Connecticut Nursing Home Directory: Medicare Ratings & Reviews, 2004; ISBN: 0890598541; http://www.amazon.com/exec/obidos/ASIN/0890598541/icongroupinterna

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169

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The Economics of Medicare Reform by Andrew J. Rettenmaier, Thomas R. Saving; ISBN: 0880992123; http://www.amazon.com/exec/obidos/ASIN/0880992123/icongroupinterna

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The Interaction Between Payment Adjustors and the Size of the Outlier Pool Under Medicare's Prospective Payment System by Grace M. Carter, J. David Rumpel; ISBN: 0833013491; http://www.amazon.com/exec/obidos/ASIN/0833013491/icongroupinterna

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The Magic of Medicare 7, 8 or 9 and All That Jazz by Nancy Gilmore; ISBN: 0915611759; http://www.amazon.com/exec/obidos/ASIN/0915611759/icongroupinterna

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The Medicare As A Second Payer Guide: Practical Solutions to Administration and Management by Virginia Peabody, et al; ISBN: 0786305339; http://www.amazon.com/exec/obidos/ASIN/0786305339/icongroupinterna

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The Medicare Case Mix Index Increase: Medical Practice Changes, Aging, and Drg Creep (Rand Report, R-3292-Hcfa) by Grace M. Carter, Paul B. Ginsburg; ISBN: 999533657X; http://www.amazon.com/exec/obidos/ASIN/999533657X/icongroupinterna

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The Medicare Guide by Donald J. Korn; ISBN: 1880024071; http://www.amazon.com/exec/obidos/ASIN/1880024071/icongroupinterna

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The Medicare System of Prospective Payment: Implications for Medical Education and Practice by Mohan Garg (Author), Barbara M. Barzansky (Author); ISBN: 0275920097; http://www.amazon.com/exec/obidos/ASIN/0275920097/icongroupinterna

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The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population by Committee of Nutrition Services of Medicar (Editor), Institute of Medicine; ISBN: 0309068460; http://www.amazon.com/exec/obidos/ASIN/0309068460/icongroupinterna

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Understanding Payment for Advanced Practice Nursing Services, Volume 1: Medicare Reimbursement by Sheila Abood, David Keepnews; ISBN: 1558101489; http://www.amazon.com/exec/obidos/ASIN/1558101489/icongroupinterna

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Vulnerable Populations and Medicare Services : Why Do Disparities Exist by Marian E. Gornick; ISBN: 0870784471; http://www.amazon.com/exec/obidos/ASIN/0870784471/icongroupinterna

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What You Must Know About Social Security and Medicare by Eric R. Kingson; ISBN: 0345343972; http://www.amazon.com/exec/obidos/ASIN/0345343972/icongroupinterna

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With Dignity : The Search for Medicare and Medicaid by Sheri I. David (Author); ISBN: 031324720X; http://www.amazon.com/exec/obidos/ASIN/031324720X/icongroupinterna

Chapters on Medicare In order to find chapters that specifically relate to Medicare, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Medicare using the “Detailed Search” option. Go to the following hyperlink:

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http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “Medicare” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on Medicare: •

Taking Care of Yourself Financially: An Overview Source: in Everson, G.T.; Weinberg, H. Living with Hepatitis B: A Survivor's Guide. Long Island, NY: Hatherleigh Press. 2002. p.118-138. Contact: Available from Hatherleigh Press. 5-22 46th Avenue Suite 200, Long Island City, NY 11101. (800) 528-2550. E-mail: [email protected]. Website: http://store.yahoo.com/hatherleighpress/index.html. PRICE: $15.95 plus shipping and handling. ISBN: 1578260841. Summary: Chronic hepatitis B can lead to cirrhosis (liver scarring), liver cancer, and the need for liver transplantation. This chapter on the financial challenges of chronic illness is from a book that helps readers diagnosed with hepatitis B virus (HBV) infection educate themselves about the disease and its treatment. The authors present a general overview of financial issues and include resources to help patients find their own solutions. Topics include costs of treatment, such as ongoing medical care, antiviral treatment, and liver transplantation; private health insurance, including selecting health insurance and the different types of private insurance; government health insurance, including Medicare, Medicaid, and Veterans Administration programs; applying for disability; and disability insurance, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Throughout the chapter the authors include quotes from real people who are living with hepatitis. The authors also include resource organizations that may offer additional support and information for readers.

•

Payment for Diabetes Education Source: in Franz, M.J., et al., eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 3) Diabetes Education and Program Management. Chicago, IL: American Association of Diabetes Educators (AADE). 2003. p. 223-252. Contact: Available from American Association of Diabetes Educators (AADE). AADE Member Service Center, 100 W. Monroe Street, Suite 400, Chicago, IL 60603. (800) 3383633 or (312) 424-2426. Fax (312) 424-2427. Email: [email protected]. Website: www.aadenet.org. PRICE: Individual volume $55.00 for members and $75.00 for nonmembers: complete 4-volume set $159.95 for members and $229.95 for nonmembers; plus shipping and handling. ISBN: 881876136 (Volume 3); 881876152 (4-volume set). Summary: Diabetes educators who understand reimbursement policies of the major plans provide a valuable resource to their patients for accessing health care services. This chapter on payment for diabetes education programs is from a handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. In this chapter, the author covers the public and private payor mix of health care coverage, including who they are, their target population, and how their plans are administered; the elements that determine coverage such as eligibility, exclusions, medical necessity, and coding; different coding methods, when and how they are used, and how they determine payment; current Medicare regulations for reimbursement for diabetes education; the state laws that

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171

apply to coverage of diabetes education and supplies; the role of the regulation process in defining coverage policy; and the steps in the claims process for reimbursement, identifying the key role of the diabetes educator in each step and the appropriate documentation needed to obtain payment. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 2 figures. 8 tables. 8 references. •

Coverage Source: in Warsaw, H.; Bourgeois, P.; Postigo, C., eds. Guide to Reimbursement. Chicago, IL: American Association of Diabetes Educators. 2003. p. 41-70. Contact: Available from American Association of Diabetes Educators (AADE). AADE Member Service Center, 100 W. Monroe Street, Suite 400, Chicago, IL 60603. (800) 3383633 or (312) 424-2426. Fax (312) 424-2427. Email: [email protected]. Website: www.aadenet.org. PRICE: $49.95 for members and $64.95 for nonmembers; plus shipping and handling. ISBN: 881876101. Summary: For patients and health care providers, a diagnosis of diabetes entails a lifetime of medical management. For payors underwriting the cost of health care, the diagnosis signals a possibly substantial financial liability. This chapter on payor coverage related to diabetes is from a guide that was written for the diabetes educator and health care professional who are providing care and education services to people with diabetes. The guide explains how the reimbursement industry works and should help providers submit successful claims for their diabetes self-management training (DSMT) and medical nutrition therapy (MNT) services. In this chapter, the author charts the development of payor coverage related to diabetes, including Medicare benefits mandated by the Balanced Budget Act of 1997 and the Benefits Improvement and Protection Act of 2000. Specific guidelines for Medicare coverage of blood glucose monitors and supplies, diabetes self-management training, and MNT are discussed, followed by issues relevant to Medicaid and private payor coverage. 1 figure. 4 tables.

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Perspectives of ESRD Patients Source: in Rettig, R.A. and Levinsky, N.G., eds. Kidney Failure and the Federal Government. Washington, DC: National Academy Press. 1991. p. 39-50. Contact: Available from National Academy Press. 2101 Constitution Avenue, NW, Washington, DC 20055. (800) 624-6242. PRICE: $39.96 plus shipping and handling. ISBN: 0309044324. Summary: In the Social Security Amendments of 1972, Congress created an entitlement to Medicare for all persons with a diagnosis of permanent kidney failure who were fully or currently insured or eligible for benefits under Social Security, and for spouses or dependent children of such persons. The ESRD (end-stage renal disease) program is unique within Medicare in that it is the only case in which the diagnosis of a categorical disease provides the basis for an entitlement for persons of all ages. This chapter on the perspectives of ESRD patients is from the report of the Institute of Medicine (IOM), which was asked by Congress in 1987 to study the ESRD program with respect to the following issues: epidemiological and demographic factors that may affect access to treatment, quality of care, or the resource requirements of the program; access to treatment; quality of care; effect of reimbursement on quality of care; and the adequacy of existing data systems to monitor these factors. The IOM committee believed that people with renal failure should be the primary concern of Medicare ESRD policy, and

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wished to obtain information directly from ESRD patients on their experiences. The committee held three focus groups, each of which reflected diversity in age, sex, modality (hemodialysis versus peritoneal dialysis), time on treatment, type of facility, and home setting. Each focus group addressed two major topics: experiences with renal failure and the economic effects of kidney failure. The experiences with renal failure occupied more than 50 percent of each discussion and encompassed relations between patients, physicians, and staff; patient education; available services; and the effects of erythropoietin (EPO). The quotes from the patient groups demonstrate that patients value their relationships with their physicians very highly and place great emphasis on continuing education about their disease and its management, as a mechanism for participating in clinical decision making and a means for alleviating fear and enhancing interactions with their families and with health professionals. 1 reference. •

Payor Overview Source: in Warsaw, H.; Bourgeois, P.; Postigo, C., eds. Guide to Reimbursement. Chicago, IL: American Association of Diabetes Educators. 2003. p. 1-20. Contact: Available from American Association of Diabetes Educators (AADE). AADE Member Service Center, 100 W. Monroe Street, Suite 400, Chicago, IL 60603. (800) 3383633 or (312) 424-2426. Fax (312) 424-2427. Email: [email protected]. Website: www.aadenet.org. PRICE: $49.95 for members and $64.95 for nonmembers; plus shipping and handling. ISBN: 881876101. Summary: Payors take center stage in the health care reimbursement process. They assume much of the financial risk for health care expenses and, not surprisingly, get to make many of the rules. This chapter on payors is from a guide that was written for the diabetes educator and health care professional who are providing care and education services to people with diabetes. The guide explains how the reimbursement industry works and should help providers submit successful claims for their diabetes selfmanagement training (DSMT) and medical nutrition therapy (MNT) services. In this chapter, the author helps readers understand the payor context of reimbursement: who the major payors are, what they do, and why they do it. Topics include a history of the development of health insurance and the reimbursement system, the distinction between public (government) payors and private payors, individual versus group policies, indemnity (fee-for-service) versus managed care plans, private payors, Medicare, medi-gap insurance, Medicaid, and miscellaneous payors. 8 figures. 1 table.

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Peritoneal Dialysis and Home Dialysis Therapies Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 230-253. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Peritoneal dialysis (PD) is an alternative dialytic modality for the patient with end stage renal disease (ESRD). PD is primarily a home dialysis therapy for chronic kidney (renal) failure, but it can also be a treatment option for the patient with acute renal failure (ARF) in the hospital setting. This chapter on peritoneal dialysis and home dialysis therapies is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors

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of the chapter describe PD as a process during which the peritoneal cavity acts as the reservoir for the dialysate and the peritoneum serves as the semipermeable membrane across which excess body fluid and solutes, including uremic toxins, are removed. The peritoneal membrane is in contact with the rich blood supply to the abdominal organs. Dialysate is infused into the peritoneal cavity via a catheter, allowed to dwell for a predetermined amount of time and then drained; this process is called an exchange. The authors describe the solutions used for PD, the different ways to perform PD, automated PD, the kinds of catheters used for PD, how adequacy of PD is determined, complications that may be encountered in PD, the use of PD in people with diabetes, patient selection for home dialysis, patient education for home PD, monitoring quality of care in PD, the history of home hemodialysis in the United States, the role of the Medicare ESRD program on home dialysis, and the advantages of home hemodialysis. The authors conclude that home dialysis is once again becoming more popular and, with the advent of safe, effective, and easily used equipment, patients will have the opportunity for better and more frequent dialysis and improved quality of life. 3 figures. 5 tables. •

Financing Health Care Source: in Weinstein, B.E. Geriatric Audiology. New York, NY: Thieme. 2000. p. 313-323. Contact: Available from Thieme. 333 Seventh Avenue, New York, NY 10001. (800) 7823488. Fax (212) 947-0108. E-mail: [email protected]. PRICE: $59.00 plus shipping and handling. ISBN: 0865777012. Summary: The purpose of this chapter is to provide audiologists with a brief perspective on the financing of health care, which is a very complicated, changing phenomenon. The chapter is from a textbook that is designed to incorporate issues of aging and geriatrics into the delivery of health care by audiologists and other hearing care professionals. In this chapter, the author discusses Medicare and Medicaid, particularly their long term care benefits; managed care and Medicare managed care structures; and the funding of audiologic services. The author stresses that audiologists must have an appreciation for the amount of money spent on health care, for what the money buys, and how the money is paid out. The typical payment for audiologic services in managed care plans is limited, usually to diagnostic services or to illness or accident related hearing disorders. Some benefit packages include hearing aids and more and more Medicare plans are including a small hearing aid benefit. 2 figures. 7 tables. 42 references.

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Specific Factor: Alzheimer's Source: in O'Brien, R.C.; Flannery, M.T. Long Term Care: Federal, State, and Private Options for the Future. New York, NY: The Haworth Press. 1997. p. 29-38. Contact: Haworth Press. 10 Alice Street, Binghamton, NY 13904-1580. (800) HAWORTH, (607) 722-5857; FAX: (800) 895-0582, (607) 722-6362. Internet: http://www.haworthpressinc.com. PRICE: $54.95 (hardcover), $24.95 (softcover). ISBN: 0789002612. Summary: This book section examines issues in financing long-term care for people with Alzheimer's disease (AD). Although the largest population of people requiring longterm care are those with some form of dementia, two of the largest provisional health care programs, Medicare and Medicaid, are not readily available for the care of these patients. Medicare generally does not cover custodial care except for hospitalization, and Medicaid is not available until the family has exhausted its own financial resources. No government program will pay for long-term care at home. Thus, families caring for

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dementia patients at home must rely on private insurance. Presently, however, more than 30 million Americans have no health insurance. Some studies show that proper treatment may be not unaffordable and inaccessible to those who are uninsured. Even those with health insurance are at risk for inadequate care because most insurance plans will not cover AD. In recent years, employer sponsored group long-term care programs have grown in popularity. Although these plans are not available to everyone, most include coverage for custodial nursing home care and home health care, and specifically cover impairments caused by AD. •

Solving Discrimination and Insurance Problems Source: in Touchette, N. Diabetes Problem Solver. Alexandria, VA: American Diabetes Association. 1999. p. 441-459. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $19.95 for members; plus shipping and handling. ISBN: 1570400091. Summary: This chapter deals with solving discrimination and insurance problems in people who have diabetes. Prior to the passage of the American with Disabilities Act of 1990, people who had diabetes commonly faced outright discrimination in the workplace. This law protects all civilian employees who work for companies that employ more than 15 people from discrimination. Two federal laws guarantee all students with disabilities a free and appropriate public education without discrimination. Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against individuals with disabilities in any federally funded program. The Individuals with Disability Education Act guarantees free appropriate public education for all children with disabilities. Although people who have diabetes are not allowed to enlist in the military, they may or may not be allowed to continue to serve if they are diagnosed while serving. The chapter presents guidelines for determining whether a person is being discriminated against in the workplace, in schools and day care facilities, and in the military and offers suggestions for resolving a situation involving discrimination in these settings. In addition, the chapter offers guidelines for choosing either fee-for-service and managed care health care and discusses the coverage provided by Medicare and Medicaid.

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Ambulatory Medical Care for Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 541-552. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. PRICE: Full-text available online at no charge. Also available at http://www.niddk.nih.gov/. Summary: This chapter on ambulatory medical care for diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Based on the 1989 National Health Interview Survey (NHIS), persons with diabetes in the United States had 96.1 million outpatient medical care contacts in 1990, including 53.4 million visits to physician's offices, 13.9 million visits to outpatient clinics, 1.6 million visits to emergency rooms, 10.7 million telephone contacts, and 16.4 million visits to other ambulatory care settings, including company, industry, and public health clinics and

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home visits. There was an average of 15.5 contacts with physicians for ambulatory care per person with diabetes, compared with 5.5 contacts per person in the general U.S. population. Based on the 1990 National Ambulatory Medical Care Survey (NAMCS), the estimated rate of office-based physician visits with a primary or secondary diagnosis of diabetes per person with diabetes was two to three fold higher than the rate of visits for all other diagnoses for persons without diabetes. Diabetes was the second most frequently cited chronic disease accounting for office-based physician visits in the 1990 NAMCS, after hypertension. In 1989, greater than 90 percent of persons with diabetes had one physician whom they saw for treatment of their diabetes and, of these, 65 percent had seen this physician four or more times in the past year. The mean duration of a visit for diabetes in 1990 was 17.4 minutes. Blood pressure was measured in 77 percent and cholesterol in 10 percent of the visits, and urinalysis was performed in 25 percent. Medicare was the source of payment for 46 percent of office visits, Medicaid for 10 percent, commercial insurance for 25 percent, and in 30 percent the patient had outof-pocket expenses. 2 appendices. 6 figures. 13 tables. 12 references. (AA-M). •

Money Problems Source: in Rezen, S.V. and Hausman, C. Coping with Hearing Loss: Plain Talk for Adults About Losing Your Hearing. New York, NY: Barricade Books. 2000. p. 257-263. Contact: Available from Barricade Books, Inc. 185 Bridge Plaza North, Suite 308 A, Ft. Lee, NJ 07024. (800) 592-6657. Website: www.barricadebooks.com. PRICE: $19.95 plus shipping and handling. ISBN: 1569801657. Summary: This chapter on financial considerations is from a book designed to help adults and their families cope with hearing loss. Written in nontechnical language, the chapters are filled with examples and specific strategies that real people have used in settings from the workplace to home to social and recreational situations. In this chapter, the authors remind readers that the seemingly high cost of hearing aids includes costs for research and development, an average of five hours of service and counseling by the dispenser within the first year, and the warranty as well as the hearing instrument itself. Medicare will pay for a hearing test if it is used in the diagnosis of a medical problem, but not for any testing done that is connected with a hearing aid, nor for the aid itself. Medicaid may be available for some costs associated with hearing aids; coverage varies by state. The authors provide other suggestions for obtaining financial assistance in paying for hearing aids, including state vocational rehabilitation programs, private health insurance, local service groups, and groups that provide reconditioned hearing aids at minimal costs. The authors then explore strategies for saving money on services related to hearing aids, such as using a university sponsored clinic. The chapter concludes with a brief section of answers to commonly asked questions about financial aid and hearing aids.

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Health Insurance and Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 591-600. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book).

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Summary: This chapter on health insurance and diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Among all adults with diabetes, 92 percent have some form of health insurance. However, about 640,000 people with diabetes do not have any form of health care coverage. Among individuals with diabetes, age 18 to 64 years, 10.3 percent are covered by Medicare, 69.3 percent by private health insurance, 5.5 percent through military benefits, and 14.1 percent through Medicaid or other public assistance programs. Among those 65 years of age and older, 94.7 percent are covered by Medicare, 69.2 percent by private health insurance, 4.9 percent through military benefits, and 15.4 percent through Medicaid or other public assistance programs. Government-funded programs are responsible for health care coverage for 57.4 percent of adults with diabetes, including 26.4 percent of those age 18 to 64 years and 96 percent of those age 65 or older. There is little difference by type of diabetes (IDDM or NIDDM) in the proportion of individuals covered by each health insurance mechanism. At age 18 to 64 years, males compared with females have higher rates of coverage for each insurance type except Medicaid and other public programs; a higher proportion of blacks and Hispanics compared with all whites are covered by Medicare and Medicaid; and whites are more frequently covered by private health insurance. Virtually all persons with diabetes covered by Medicare or private health insurance have coverage for hospital care and physician or surgeon bills. Coverage for prescription medicines occurs for 62.9 percent of adults with diabetes. There are only small differences between people with diabetes and those without diabetes in the proportion covered and the types of health care coverage. 10 figures. 5 tables. 14 references. (AA-M). •

Insurance and Disability Advocacy Issues in Inflammatory Bowel Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 555-559. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on insurance and disability advocacy issues is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). The author stresses that physicians can be good advocates for their patients with IBD. The key to being a good advocate is to be knowledgeable about the issues and to be able to offer facts and guidance to patients with their many insurance and disability related issues. The author discusses the vulnerable age peak for obtaining insurance; changing employment; benefits programs including Medicare, Medicaid, high risk insurance pools, and Family and Medical Leave; and disability programs, including Social Security disability benefits, the Americans with Disabilities Act (ADA), and education issues for children with IBD. The chapter offers a list of tips for patients. Do not let current health insurance coverage lapse. If the patient does not have health insurance, look into the options available to obtain it. Have regular visits with the doctor, as insurers look favorably on patients who have regular visits, and this will also help the patient to stay well. Take medication as prescribed, because the condition likely will not improve on its own, even if the use of medication temporarily disallows eligibility to an insurance plan. If possible, choose a job with group insurance and portable benefits. For parents of children with IBD, anticipate their need for modified coverage prior to their eighteenth birthday.

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Determine with the insurance agent or benefits representative what the best options are for the teenager prior to turning 18 so that no lapse in coverage occurs. •

Lower Extremity Foot Ulcers and Amputations in Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 409-428. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on lower extremity foot ulcers and amputations in diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. The authors note that lower extremity ulcers and amputations are an increasing problem among individuals with diabetes. More than half of lower extremity amputations (LEAs) in the United States occur in people with diagnosed diabetes, who represent only 3 percent of the U.S. population. Amputation rates are greater with increasing age, in males compared with females, and among members of racial and ethnic minorities compared with whites. Data from several States indicated that 9 to 20 percent of individuals with diabetes experienced a new (ipsilateral) or second leg (contralateral) amputation during a separate hospitalization within 12 months after an amputation. Five years following an initial amputation, 28 to 51 percent of people with diabetes had undergone a second leg amputation. Perioperative mortality among people with diabetes who underwent an amputation averaged 5.8 percent. Five-year mortality following amputation was 39 to 68 percent in various studies. Several studies have demonstrated the beneficial effect of patient education on reducing LEAs. Several amputation prevention programs have reported striking preintervention and postintervention differences in amputation frequency after instituting comprehensive, multidisciplinary foot care programs. The authors discuss the important differences between private insurers and Medicare in hospital reimbursement for foot ulcers and amputations by Diagnosis Related Group (DRG). Hospital reimbursement by Medicare is frequently less than 50 percent of the amount reimbursed by private insurers. Data from Colorado indicate that only 13 percent of individuals undergoing amputation at age greater than 75 years were discharged to home or self-care, while the remainder of the survivors required skills and intermediate care facilities or other institutions for inpatient care. 1 appendix. 11 figures. 17 tables. 91 references. (AA-M).

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Rehabilitation Funding Source: in Wallace, G.L., ed. Adult Aphasia Rehabilitation. Woburn, MA: ButterworthHeinemann. 1996. p. 21-38. Contact: Available from Butterworth-Heinemann. 255 Wildwood Avenue, P.O. Box 4500, Woburn, MA 01801-2041. (617) 928-2500; Fax (617) 933-6333. PRICE: $47.50 plus shipping and handling. ISBN: 0750695358. Summary: This chapter on rehabilitation funding is from a text on adult aphasia rehabilitation. After an introductory section on six criteria for a reformed health care system, the authors consider funding sources, including traditional private insurance plans, managed care organizations, legal decisions, private payment, Medicare, and other public insurance systems (Medicaid, worker's compensation); ways to maximize

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the likelihood of reimbursement for speech-language pathology services, including adequate documentation and working with case managers; and the future of reimbursement for speech-language pathology services. The authors conclude that speech-language pathologists must keep abreast of the continual changes in health care funding and financing and should continually develop strategies that provide for the most efficacious rehabilitation at the lowest cost. 2 tables. 10 references.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to Medicare have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:10 •

National Transplant Resource Directory Source: Pittsburgh, PA: Stadtlanders Pharmacy. 1998. 12 p. Contact: Available from Stadtlanders Pharmacy. Social Services Department, 600 Penn Center Boulevard, Pittsburgh, PA 15235-9931. (800) 238-7828. PRICE: Single copy free. Summary: This directory was created to assist transplant recipients, their families, and health care professionals with locating national transplant resources. The first section of the directory lists resources for coverage for health care and medications, including COBRA; high risk insurance pools; Medicaid coverages, including SSI, Medicaid, and QMB; Medicare; Medicare HMOs; Medicare Supplemental Insurance (Medigap policy); state kidney programs; state pharmaceutical assistance programs; and the Veterans Administration. The second section lists resources for educational information, financial grants, fundraising, and medication grants. Each entry notes the organization name, address, and telephone number, along with a brief description of the types of activities and resources offered.

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Reimbursement Primer Source: Chicago, IL: American Association of Diabetes Educators. 2000. 139 p. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, Suite 400, Chicago, IL 60603. (312) 424-2426. Fax (312) 424-2427. E-mail: [email protected]. Website: www.aadenet.org. PRICE: $40.00 for nonmembers; $20.00 for members. Summary: This primer, written for diabetes educators, helps them understand how the reimbursement industry works and how they can make the system work for them. The primer begins by introducing the payors who reimburse claims for health care expenses, including Medicare and Medicaid, private insurance companies, and self funded employers. Topics include the factors that payors consider in determining who is eligible, what will be covered, and how much they will reimburse. In addition, the primer describes major payors' coverage policies for diabetes education, equipment, and

10

You will need to limit your search to “Directory” and “Medicare” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “Medicare” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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supplies. This is followed by a review of the ways that diabetes educators come to be recognized by payors as suitable providers of diabetes self management education (DSME) services. The next section details the process of reimbursement, focusing on filing claims, verifying patient eligibility and coverage, obtaining precertification if necessary, determining payors' claims processes, filling out claim forms, assigning appropriate codes, being aware of legal issues, processing a claim, appealing a denied claim, and helping patients access equipment and supplies. 15 appendices. 7 figures. 18 tables. •

Georgia Senior Resource Guide Source: Atlanta, GA: Care Solutions, Inc. 1995. 258 p. Contact: Available from Care Solutions, Inc. 8302 Dunwoody Place, Suite 352, Atlanta, GA 30350. (404) 642-6722; (800) 227-3410; FAX (404) 640-6073. PRICE: $24.95 plus $3.00 shipping and handling. ISBN: 0963193996. Summary: This resource guide is designed to help older adults, caregivers, and professionals make informed decisions about finding and using elder care services in Georgia. The first chapter discusses options available to older adults who want to remain at home and describes organizations that serve as gateways to the service delivery system. Subsequent chapters discuss housing options, legal and financial issues, health insurance, and health care and caregiving. Included are discussions about retirement communities, nursing homes, retirement benefits, financial assistance, employment opportunities, wills and other legal documentation, Medicare and Medicaid coverage, major health problems, and coping issues. A resource section lists by county, service, and provider over 2,100 resource centers and the services they offer.

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CHAPTER 7. MULTIMEDIA ON MEDICARE Overview In this chapter, we show you how to keep current on multimedia sources of information on Medicare. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on Medicare is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “Medicare” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “Medicare” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on Medicare: •

Medicare Regulatory Reform: Documentation Principles, Denials, and Appeals Source: Tucson, AZ: National Center for Neurogenic Communication Disorders, University of Arizona. 1998. (videocassette). Contact: Available from National Center for Neurogenic Communication Disorders, University of Arizona. P.O. Box 210071, Tucson, AZ 85721-0071. (520) 621-1472. Fax (520) 621-2226. PRICE: $25.00 plus shipping and handling. Order Number TR-43. Summary: This videotape program, which is part of the Telerounds videoconference series from the National Center for Neurogenic Communication Disorders at the University of Arizona (funded partly by NIDCD), discusses patient selection criteria and the current Medicare rules and regulations as they relate to reimbursement for speech pathology services. The speaker explains that the Balanced Budget Act of 1997 changed the Medicare payment structure from a fee for service system to a prospective payment system. This is followed by a discussion of focused medical review. The speaker then outlines the factors considered by Medicare for determining the need for skilled care,

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including change in condition, prior level of function, reasonableness of treatment, positive expectations, medical necessity of therapy, and the need for skilled services. The speaker provides examples of skilled services and identifies the key components of the narrative notes that support the need for skilled services, including the therapist's assessment of the patient's condition, the type of instruction and training provided, patient responses, and functional improvement. In addition, the speaker provides general documentation guidelines, presents common reasons for Medicare claim denials, gives an overview of the appeals process, and offers guidelines for writing appeal letters. The program concludes by answering questions asked by the host and phoned in by the teleconference audience and by providing information about joining Centernet, the online forum operated by the Center.

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CHAPTER 8. PERIODICALS AND NEWS ON MEDICARE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover Medicare.

News Services and Press Releases One of the simplest ways of tracking press releases on Medicare is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “Medicare” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to Medicare. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “Medicare” (or synonyms). The following was recently listed in this archive for Medicare: •

Medicare will police new drug cards Source: Reuters Health eLine Date: April 22, 2004

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Health fraud recoveries up; Medicare will police new drug cards Source: Reuters Industry Breifing Date: April 22, 2004

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Novartis sees opportunity in free Medicare drugs Source: Reuters Health eLine Date: April 13, 2004

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US warns Medicare card companies about payments Source: Reuters Health eLine Date: April 12, 2004

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Former Medicare administrators warn new law tricky to implement Source: Reuters Industry Breifing Date: April 08, 2004

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Republicans reject subpoenas in Medicare probe Source: Reuters Industry Breifing Date: April 02, 2004

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Medicare drug discount cards questioned Source: Reuters Health eLine Date: April 02, 2004

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Bush Administration defends conduct on controversial Medicare law Source: Reuters Industry Breifing Date: March 31, 2004

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U.S. picks firms for Medicare drug discount cards Source: Reuters Health eLine Date: March 26, 2004

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US Senate Dems protest Medicare TV releases to FCC Source: Reuters Industry Breifing Date: March 25, 2004

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Medicare official recounts firing threats Source: Reuters Health eLine Date: March 25, 2004

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Tenet to pay $22.5 mln to settle Medicare charges Source: Reuters Industry Breifing Date: March 24, 2004

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Action needed on Social Security, Medicare Source: Reuters Health eLine Date: March 24, 2004

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U.S. Medicare seen in the red by 2004-trustees Source: Reuters Industry Breifing Date: March 23, 2004

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Medicare will be in the red for 2004: trustees Source: Reuters Health eLine Date: March 23, 2004

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U.S. Senate Democrats seek Medicare probe Source: Reuters Health eLine Date: March 19, 2004

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White House backs probe into Medicare drug cost Source: Reuters Industry Breifing Date: March 17, 2004

Periodicals and News

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Congress continues combat over Medicare law Source: Reuters Health eLine Date: March 16, 2004

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Democrats urge Congress to reconsider Medicare bill Source: Reuters Health eLine Date: March 15, 2004

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US Senate approves McClellan for Medicare job Source: Reuters Health eLine Date: March 12, 2004

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GM retiree health-care costs rise despite Medicare change Source: Reuters Industry Breifing Date: March 11, 2004

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White House: Medicare confirmation delay hurts seniors Source: Reuters Health eLine Date: March 10, 2004

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U.S. Medicare pick McClellan meets resistance Source: Reuters Industry Breifing Date: March 10, 2004

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Medicare's wish list includes more ICDs Source: Reuters Industry Breifing Date: March 10, 2004

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Medicare confirmation delay hurts seniors - White House Source: Reuters Industry Breifing Date: March 10, 2004

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Sen. Dorgan delays Medicare chief confirmation Source: Reuters Industry Breifing Date: March 09, 2004

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Nominee to head Medicare says he will look at safe drug imports Source: Reuters Industry Breifing Date: March 09, 2004

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Medicare pick will look at safe drug imports Source: Reuters Health eLine Date: March 09, 2004

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Medicare drug discount cards on schedule Source: Reuters Industry Breifing Date: March 09, 2004

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Key study may expand Medicare ICD coverage-CMS Source: Reuters Industry Breifing Date: March 09, 2004

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Key study may expand Medicare ICD coverage Source: Reuters Medical News Date: March 09, 2004

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Publicity battle over Medicare drug bill heats up Source: Reuters Industry Breifing Date: March 08, 2004

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GAO chief sees high cost for US Medicare drug plan Source: Reuters Industry Breifing Date: March 04, 2004

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FBI examines possible congressional bribes in Medicare bill - paper Source: Reuters Industry Breifing Date: February 27, 2004

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Poll shows Americans confused by Medicare changes Source: Reuters Health eLine Date: February 26, 2004

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U.S. Senate Democrats launch new assault on Medicare law Source: Reuters Industry Breifing Date: February 25, 2004

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Medicare law foes get newsman Cronkite for pitch Source: Reuters Health eLine Date: February 25, 2004

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FDA chief's move to Medicare seen good for pharma Source: Reuters Industry Breifing Date: February 20, 2004

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Bush picks Mark McClellan to head Medicare Source: Reuters Health eLine Date: February 20, 2004

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Bush close to filling key post overseeing Medicare Source: Reuters Industry Breifing Date: February 19, 2004

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Hospice care can increase Medicare expenditures Source: Reuters Health eLine Date: February 18, 2004

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Hospice care can increase Medicare expenditures in the last year of life Source: Reuters Industry Breifing Date: February 18, 2004 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

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Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “Medicare” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “Medicare” (or synonyms). If you know the name of a company that is relevant to Medicare, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Medicare” (or synonyms).

Newsletters on Medicare Find newsletters on Medicare using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “Medicare.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “Medicare” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

AHCPR Issues BPH Treatment Guidelines: More Observation, Fewer Tests Called for Source: Urology Times. 22(4): 1, 22. April 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This article, from a professional newsletter, discusses the recently-released Agency for Health Care Policy and Research (AHCPR) guidelines for the diagnosis and treatment of benign prostatic hyperplasia (BPH) and the process through which said guidelines were developed. The author stresses that the ongoing involvement of urologists in the development of these guidelines resulted in an accurate reflection of current practice. Other topics include how the guidelines can model a positive way to

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institute health care reform; the role of third-party payers, including Medicare reimbursements; and the key points of the guidelines for both diagnosis and treatment. Specific tests and procedures discussed include cystoscopy, filling cystometry, watchful waiting, and surgery, including transurethral resection of the prostate (TURP) and transurethral incision of the prostate (TUIP). •

Senior Care Professional: The Newsletter of Senior Care Management Source: Silver Spring, MD: CD Publications. 1987-. [8 p. average]. Contact: Available from CD Publications. 8204 Fenton Street, Silver Spring, MD 20910. (800) 666-6380 or (301) 588-6380. PRICE: $132.00 per year. Summary: This monthly newsletter is intended for management personnel involved in care of the elderly, including Alzheimer's disease patients. It provides brief, timely articles on topics such as public relations strategies for long term care facilities, recent medical research findings, client relations, and funding sources for facilities. Also included are schedules for upcoming conferences and other continuing education forms; a consultant's corner that provides advice on a range of care topics; and a news section that provides brief summaries of recent changes in relevant legislation or regulations, such as laws involving Medicare coverage.

•

Government Affairs Update Source: Metropolitan Washington By-Pass. p. 4-5. March 1992. Contact: Available from United Ostomy Association. Metropolitan Washington Chapter, Washington Hospital Center, East Building, Room 3102, 110 Irving Street, N.W., Washington, DC 20010. (202) 877-6019. Summary: This newsletter article presents an update on federal legislation of interest to people with ostomies. The article begins with a discussion of the new Medicare regulations that eliminate the need for ongoing prescriptions to purchase ostomy supplies. The remainder of the article provides information on three bills under consideration by the U.S. Congress that may have an impact on Medicare reimbursement of ostomy supplies.

•

Transplant Times Source: Nutley, NJ: Roche Laboratories, Inc. Winter 2002. 6 p. Contact: Available from Roche Laboratories, Inc. 340 Kingsland Street, Nutley, NJ 071101199. (800) 893-1995. Website: www.tppp.com. PRICE: Full-text available online at no charge. Summary: This newsletter is the publication of the Transplant Patient Partnering Program (www.tppp.net), an organization sponsored by Roche Pharmaceuticals that brings together the expertise of transplant doctors and coordinators with the insights of transplant recipients. This issue of the newsletter includes three articles: information on herbal supplements, how recent legislation affects Medicare reimbursement of immunosuppressive (anti-rejection) medications, and a guide to immunizations (vaccinations) for transplant recipients. The newsletter is illustrated with brightly colored graphics. Readers are encouraged to visit the web site for additional information.

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•

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In Our Age Newsletter Source: Englewood, CO: Center for Research in Ambulatory Health Care Administration (CRAHCA). 1988-. [8 p. average]. Contact: Available from Medical Group Management Association Order Department. 104 Inverness Terrace East, Englewood, CO 80112-5306. (303) 397-7888. PRICE: $42.00 per year; $11.00 per single issue. Summary: This quarterly newsletter is intended for administrative staff and support personnel within medical groups and other health care organizations who are involved in care of the elderly, including Alzheimer's disease patients. It provides brief, timely articles on topics such as recent medical research findings, client relations, and interviews with professionals representing aging organizations. Also included are schedules for upcoming conferences and other continuing education forms; a pull-out section for patients that provides advice on a range of care topics; and a news section that provides brief summaries of recent changes in relevant legislation or regulations, such as laws involving Medicare coverage. Articles related to Alzheimer's disease are included periodically.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “Medicare” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on Medicare: •

What Happens Now That Medicare Catastrophic Coverage Has Been Repealed? Source: Caregiver: Newsletter of the Duke Family Support Program. 10(1): 17-18. March 1990. Contact: Available from Duke Family Support Program. Box 3600, Duke University Medical Center, Durham, NC 27710. (919) 660-7510 or (800) 672-4213 (in North Carolina). PRICE: Free to North Carolina residents. $10.00 per year for nonresidents. Summary: This article provides answers to 14 commonly asked questions concerning the repeal of Medicare catastrophic coverage and its possible consequences. Topics include: the new Medicare Medical Insurance premium; how one can get a refund; how to respond to and correct an incorrect Medicare bill; how to fill out tax forms; and continued coverage under Medicare. It is noted that the repeal of Medicare catastrophic coverage will not change SSI checks for concurrent recipients, and that this repeal will not alter the amount of medical coverage under Medicare.

•

How Can Medicare Work For You? Source: Quality Care. 15(1): 2. Winter 1997.

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Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800)-BLADDER or (864) 579-7900. Fax (864) 579-7902. Web site: http://www.nafc.org. Summary: This brief newsletter article describes how Medicare works and how it can help pay for home medical supplies, including bladder control products. Medicare is the health insurance program administered by the Federal Government. It provides insurance benefits for people 65 years or older, and for persons of all ages who are disabled or for those who have kidney failure. Medicare Part B coverage can help patients save money on supplies. Readers are advised to ask if Medicare assignment is accepted on any product before they purchase it. If a dealer 'accepts assignment' he or she agrees to accept Medicare's 'allowable' amount for the item being purchased. The allowable amount is the price that Medicare has determined is reasonable to pay for an item. This means the dealer will bill Medicare for 80 percent of the bill and the patient needs to pay the other 20 percent. It is important to know which products are covered and which are not, and to talk with one's health care provider about all of the product options. For example, absorbent products are usually not covered, but external devices like condom catheters usually are covered. The article concludes with the toll free telephone number of the Social Security Administration (800-772-1213). (AA-M).

Academic Periodicals covering Medicare Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to Medicare. In addition to these sources, you can search for articles covering Medicare that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Medicare” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 29470 2578 214 1267 828 34357

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “Medicare” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

15

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

19 Adapted 20

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on Medicare can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to Medicare. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to Medicare. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “Medicare”:

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Guides on Medicare Medicare http://www.nlm.nih.gov/medlineplus/Medicare.html

•

Other guides Financial Assistance http://www.nlm.nih.gov/medlineplus/financialassistance.html Health Insurance http://www.nlm.nih.gov/medlineplus/healthinsurance.html Medicaid http://www.nlm.nih.gov/medlineplus/medicaid.html Medicines http://www.nlm.nih.gov/medlineplus/medicines.html

Within the health topic page dedicated to Medicare, the following was listed: •

General/Overviews Medicare Eligibility Tool Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/MedicareEligibility/home.asp?dest=NAV%257CHome %257CGeneralEnrollment&version=default&browser=IE%257C6%257CWinXP&lan guage=English

•

Specific Conditions/Aspects Does Your Doctor or Supplier Accept Assignment? http://www.Medicare.gov/publications/pubs/pdf/10134.pdf Don't Miss Out on Your Turn for Medicare Savings! http://www.Medicare.gov/publications/pubs/pdf/10126_aa.pdf Guide to Choosing a Medicare-Approved Drug Discount Card http://www.Medicare.gov/Publications/Pubs/pdf/11062.pdf How to File a Claim (for Medicare) Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/basics/fac.asp It's Your Choice - Are Medicare HMOs Right for You? Source: Consumer Action http://www.consumeraction.org/English/library/health/2001_ItsYourChoice/index.php Medicare and Clinical Trials http://www.Medicare.gov/publications/pubs/pdf/ct.pdf Medicare and Home Health Care http://www.Medicare.gov/publications/pubs/pdf/10969.pdf Medicare and Your Mental Health Benefits http://www.Medicare.gov/publications/pubs/pdf/10184.pdf

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Medicare Basics: A Guide for Caregivers http://www.Medicare.gov/publications/pubs/pdf/11034.pdf Medicare Coverage of Diabetes Related Supplies and Services Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/health/diabetes.asp Medicare Hospice Benefits http://www.Medicare.gov/publications/pubs/pdf/02154.pdf Medicare Plan Choices Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/choices/overview.asp Medicare Preventive Services. To Help Keep You Healthy http://www.Medicare.gov/publications/pubs/pdf/prevent.pdf Medicare Savings Program: State-Specific Information Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/contacts/related/msps.asp Medicare Summary Notice (MSN) Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/basics/summarynotice.asp Medicare-Approved Drug Discount Card Tip Sheet http://www.Medicare.gov/Publications/Pubs/pdf/11071.pdf Medicare-Approved Drug Discount Cards Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/maddc/home.asp Medigap Policy Basics Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/medigap/default.asp Nursing Homes Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/nursing/overview.asp What Are the Medicare Premiums and Coinsurance Rates for 2004? Source: Centers for Medicare & Medicaid Services http://Medicare.custhelp.com/cgibin/Medicare.cfg/php/enduser/std_adp.php?p_faqid=1444&p_created=106632496 8 What Is the New Electronic Medicare Summary Notice (E-MSN)? Source: Centers for Medicare & Medicaid Services http://Medicare.custhelp.com/cgibin/Medicare.cfg/php/enduser/std_adp.php?p_sid=pSEUVABg&p_lva=&p_faqid =1247&p_created=1031143266 Who Are the Sponsors That Will Be Offering the Medicare-Approved Drug Discount Cards? Source: Centers for Medicare & Medicaid Services http://Medicare.custhelp.com/cgibin/Medicare.cfg/php/enduser/std_adp.php?p_sid=deRvSd7h&p_lva=&p_faqid= 1512&p_created=1080215523&p_sp=cF9zcmNoPSZwX2dyaWRzb3J0PSZwX3Jvd19j bnQ9MzM0JnBfcGFnZT0x&p_li=

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Latest News Medicare Adds to List of Outpatient Services Eligible for Additional Payments Source: 04/16/2004, Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/media/press/release.asp?counter=999 Medicare Makes Drug Card Enrollment Easier with Autoenrollment and Standard Form Source: 04/17/2004, Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/media/press/release.asp?counter=1012 Surprising Number of U.S. Elders Do Not Have Health Insurance Coverage - Not Even Medicare Source: 04/01/2004, American Academy of Family Physicians http://www.aafp.org/x26875.xml

•

Law and Policy Beneficiary Savings Under the Medicare Prescription Drug Benefit Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/Medicarereform/issuepapers/files/beneficiary_savings _under_the_Medicare_prescription_drug_benefit.pdf Introducing Medicare-Approved Drug Discount Cards: Theres a New Way to Save on Prescription Drugs Right Now http://www.Medicare.gov/Publications/Pubs/pdf/11060.pdf Medicare Appeals Information Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/basics/appealsoverview.asp Medicare: Fraud and Abuse Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/fraudabuse/overview.asp New Medicare Limits on Therapy Services: Starting on September 1, 2003, Medicare Limits How Much It Covers for Outpatient http://www.Medicare.gov/publications/pubs/pdf/10988.pdf Regulations.gov: Public Health Search Source: U.S. Government Printing Office http://www.regulations.gov/TOPIC_42.cfm Upcoming New Benefits in Medicare: Medicare Prescription Drug Improvement and Modernization Act of 2003 http://www.Medicare.gov/Publications/Pubs/pdf/11054.pdf

•

Organizations Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/ Families USA http://fusa.convio.net/site/PageServer Medicare Source: Centers for Medicare & Medicaid Services http://www.Medicare.gov/

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You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on Medicare. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

If the Shoe Fits: A Review of the Medicare Coverage for Therapeutic Shoes for Patients with Diabetes and Basic Facts About Shoe Selection Source: Harrisburg, PA: Pennsylvania Diabetes Academy. 2001. 21 p. Contact: Available from Pennsylvania Diabetes Academy. 777 East Park Drive, P.O. Box 8820, Harrisburg, PA 17105-8820. (717) 558-7750 ext. 1271. FAX (717) 558-7818. E-mail: [email protected]. PRICE: $1.75 each, $1.25 each for 25-99 copies, $1.00 each for 100 or more copies. Summary: For people with diabetes, wearing the right shoes helps to maintain foot health and prevent abnormal pressure areas that can cause complications. The Medicare law was changed to provide coverage for therapeutic shoes for certain patients with diabetes. This booklet provides information about this new coverage, as well as general information about how to choose appropriate footwear. The author stresses that informed consumers can better avoid serious foot health problems. The booklet first explains the requirements for footwear that is covered by Medicare, including coverage limits. Line drawings illustrate some of the shoe modifications that may be covered by Medicare, including rigid rocker and roller bottoms, metatarsal bars, wedging, offset heels, or posting, flared heels, or Velcro closures. The booklet includes a detailed glossary of Medicare definitions. The remainder of the booklet provides readers with basic facts about shoe selection. Each concept is illustrated with a simple line drawing. The booklet concludes with a sample statement form of certifying physician for therapeutic shoes.

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Medicare Q and A: 60 Commonly Asked Questions About Medicare Source: Baltimore, MD: U.S. Department of Health and Human Services, Health Care Financing Administration. 1991. 18 p. Contact: Available from U.S. Department of Health and Human Services, Health Care Financing Administration. 6325 Security Boulevard, Room 555, East High Rise, Baltimore, MD 21207. (410) 966-7843. PRICE: Single copy free. HCFA Pub. No. 02172. Summary: This brochure describes Medicare, the federal health insurance program established in 1965 for people aged 65 or older. Medicare also covers people of any age with permanent kidney failure, and certain disabled people. Written in a question-and-

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answer format, the booklet details what Medicare covers, who is eligible for Medicare, Medicare enrollment, getting more information, enrolling late for Medicare Part B, the differences between Part A and Part B coverage, buying Medicare, getting Medicarecovered care, enrolling in a coordinated care plan, fee-for-service Medicare, deductible and coinsurance amounts, skilled nursing facility care, processing and filing Medicare claims, choosing and finding physicians, services covered by Medicare, home health care, hospice care, Medicare and foreign travel, Medigap insurance, Medicare SELECT insurance, and getting information about supplemental insurance. Two charts illustrate the services, benefit, Medicare payment, and patient payment for both Parts A and B of the Medicare plan. •

Medicare: What It Covers, What It Doesn't Source: Washington, DC: American Association of Retired Persons. 1991. 10 p. Contact: Available from AARP Fulfillment. 601 E Street, N.W., Washington, DC 20049. PRICE: Free. Publication Number D13133. Summary: This brochure for the general public presents an introduction to the coverage provided by Medicare. Information is provided on the following topics: Medicare benefits; supplemental Medicare insurance; Medicaid; the Medicare appeals process; community resources for more information and assistance; and materials available from the American Association of Retired Persons (AARP). Medicare benefits include coverage of part of the costs for physician services, outpatient hospital services, outpatient therapies (speech and physical therapies), laboratory tests, medical equipment, ambulance service, outpatient mental health services, alternate year mammography screenings; and limited services from a dental surgeon, chiropractor, podiatrist, and optometrist. Tabular information on specific limits of coverages is included. Long-term nursing home stays are not covered by Medicare Parts A or B. Most Medicare beneficiaries do not qualify for Medicaid until they enter a nursing home and deplete their assets to pay their medical bills.

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Frequently Asked Questions About Fee-for-Service Medicare for People With Alzheimer's Disease Source: Washington, DC: Alzheimer's Disease and Related Disorders Association, Inc. 1999. 7 p. Contact: Alzheimer's Disease and Related Disorders Association, Inc. 1319 F Street NW, Suite 710, Washington, DC 20004. (202) 393-7737; FAX: (202) 393-2109. PRICE: Free. Summary: This fact sheet answers frequently asked questions about traditional Medicare for people with Alzheimer's disease (AD). It discusses Medicare coverage for the doctor's evaluation and diagnosis of AD, diagnostic tests, visits to a mental health provider, home health and personal aid services, adult day and respite care, nursing home care, experimental treatments, clinical trials, outpatient prescription drugs, vitamins and nutritional supplements, incontinence supplies, hospice care, and physical therapy. It also answers questions about additional coverage from Medigap and retiree health insurance policies, appealing denied or incorrect claims, and determining whether out-of-pocket expenses are tax deductible.

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Original Medicare: An Outline of Benefits Source: Washington, DC: Alzheimer's Disease and Related Disorders Association, Inc. March 1999. 4 p.

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Contact: Alzheimer's Disease and Related Disorders Association, Inc. 1319 F Street, NW, Suite 710, Washington, DC 20004. (202) 393-7737; FAX: (202) 393-2109. PRICE: Free. Summary: This fact sheet provides an outline of Medicare Part A and Part B benefits, and identifies potential problem areas that may affect patients with Alzheimer's disease (AD). The first section outlines the benefits for inpatient hospital care, nursing home care, home health care, and hospice care under Part A. The second section outlines the covered services and deductible and coinsurance amounts under Part B benefits. The third section lists some of the services not covered by Medicare. It also explains when and how to appeal Medicare decisions. •

Medicare Matter for People Living With HIV/AIDS Contact: AIDS Action, 1906 Sunderland Pl NW, Washington, DC, 20036, (202) 530-8030, http://www.aidsaction.org. Summary: This fact sheet provides health professionals and organizations with information on the provision of Medicare for people living with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The fact sheet explains Medicare, its three main components, and what it covers. It examines plans that act as complementary coverage for Medicare to help cover costs for prescription drugs and details exactly how much they cover. The fact sheet provides information about how Medicare and complementary coverage work for people with HIV/AIDS and about how they often are used by individuals with this infectious disease. The fact sheet briefly makes recommendations on Medicare reform.

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Medicaids financial protections for Medicares poor and near poor Source: Menlo Park, CA: Henry J. Kaiser Family Foundation. 1997. 2 pp. Contact: Available from Henry J. Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025. Telephone: (650) 854-9400 or (800) 656- 4533 / fax: (650) 854-4800 / Web site: http://www.kff.org. Available at no charge. Summary: This fact sheet reviews Medicaids role in providing financial assistance to Medicares low income beneficiaries. It includes a legislative history of Medicaid buy-in programs.

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The facts about obesity, Medicaid and Medicare Source: American Obesity Association. Contact: American Obesity Association, 1250 24th Street, N.W., Suite 300, Washington, DC 20037. 1-800-98-OBESE. Summary: This fact sheet states that Medicaid does not cover obesity, and under Medicare, hospital and physician services for obesity are clearly excluded. Recipients of Medicaid are primary women and children who are poor and members of minority groups. Given the high prevalence of obesity among those populations, it is presumed that many Medicaid recipients are likely to have obesity.

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Medicare Advocacy Project Source: Chicago, IL: Alzheimer's Association. April 2002. 20 p. Contact: Available from Alzheimer's Association. P.O. Box 5675. Chicago, IL 60680. (800) 272-3900 or (312) 335-8700. FAX: (312) 335-1110. Website: www.alz.org. PRICE: free.

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Summary: This information kit contains several materials about Medicare benefits for people with Alzheimer's disease (AD). It includes the following papers: (1) a brief description of the Medicare Advocacy Project (a collaborative project of the Alzheimer's Association and the American Bar Association Commission on Legal Problems of the Elderly designed to respond to Medicare-related inquiries from local Alzheimer's Association chapters); (2) an outline of benefits under the original (fee for service) Medicare program; (3) recommended prescription drug benefit principles; (4) frequently asked questions about Medicare for people with AD; (5) frequently asked questions about Medicare's hospice benefit for people with AD; (6) what to do if Medicare refuses to pay for a medical service; and (7) a fact sheet about recent change affecting Medicare coverage. •

Medicare and HIV/AIDS Contact: AIDS Action, 1906 Sunderland Pl NW, Washington, DC, 20036-1608, (202) 5308030, http://www.aidsaction.org. Summary: This information sheet describes Medicare and its role as a source of health insurance for disabled and elderly people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Since people with HIV/AIDS are living longer, the number of them on Medicare has grown and Medicare spending for HIV/AIDS has increased.The information sheet discusses Medicare eligibility, how Medicare works, problems with Medicare, Medicare supplement insurance programs, Medicare managed care plans, how AIDS drug assistance programs work along with Medicare, and dual eligibility for Medicare and Medicaid.

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Medicare Enrollees: Now You Can Afford to be Serious About Diabetes Source: Alexandria, VA: American Diabetes Association. 1999. [2 p.]. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (888) 342-2383. Website: www.diabetes.org. PRICE: Single copy free. Summary: This pamphlet provides people who have diabetes with information about benefits in the Medicare program that will make monitoring blood glucose more affordable. On July 1, 1998, Medicare began covering blood glucose test strips, lancets, and meters whether or not a person uses insulin to control diabetes. The pamphlet lists some details people need to keep in mind when using these benefits.

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Medicare Coverage of Kidney Dialysis and Kidney Transplant Services: A Supplement to Your Medicare Handbook. Revised ed Source: Baltimore, MD: Health Care Financing Administration, U.S. Department of Health and Human Services. May 1996. 13 p. Contact: Available from Health Care Financing Administration Medicare hotline. (800) 638-6833. TTY (800) 820-1202. Also available on the World Wide Web at http://www.hcfa.gov/. PRICE: Single copy free. Summary: This supplement to 'Your Medicare Handbook' explains the special rules that apply to Medicare coverage and payment for maintenance kidney dialysis and transplant services. People who have end-stage renal disease (ESRD) can get these services. The supplement describes the two parts of Medicare (hospital insurance and medical insurance), enrollment in Medicare for people with permanent kidney failure, when Medicare protection begins and ends, and Medicare payment for beneficiaries

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covered by employer group health plans. Topics related to dialysis include providers of maintenance dialysis and transplant surgery; coverage and payment for outpatient and inpatient dialysis; doctor's services and maintenance dialysis; self-dialysis training; and home dialysis, including payment options, equipment, supplies, and support services. The booklet also discusses how both types of Medicare help to pay for kidney transplant surgery and how Medicare pays for blood. Topics briefly covered include what Medicare does not pay for, other payment sources, the grievance and complaint process, and sources of additional help and information. Contact information is given for the 18 ESRD Network Organizations. Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Alternative to Nursing Home Care Summary: Access to Medicare alternatives to nursing home care for persons who need such care but prefer to remain in their own home with the help of their family and friends, community services, and Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3195

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CMS Employment Opportunities Summary: A list of current employment opportunities at the Centers for Medicare and Medicaid Services. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2763

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CMS Professionals Page Summary: Links to plan and provider information online provided by the Centers for Medicare and Medicaid Services for the use of physicians, health plans and organizations, care providers, carriers, Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4335

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Consumer Fraud Pamphlet: Medicare and Home Medical Equipment Summary: This consumer information pamphlet is the first of a series on Medicare fraud and how you can spot and report it. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2732

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Consumer Medicare Health Information Summary: Medicare is adding benefits to help you to stay healthy. Visit this site for details about the health screenings, tests and diseases and conditions that are covered. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2605

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Fight Flu and Pneumonia Summary: This publication describes the flu, explains which groups of people should get the flu shot and why, directs people on when to get the shot, and informs people on Medicare where they can go to get flu Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3187

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Financial Help for Diabetes Care Summary: An overview of financial resources that may be helpful in diabetes care: Medicaid, Medicare, managed care, health insurance. Includes suggestions for obtaining help from local resources. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6505

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Financial Help for Treatment of Kidney Failure Summary: Provides an overview of financial help that may be available for the treatment of kidney failure: Medicare, Medicaid, private insurance, VA, SSDI, and SSI benefits. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6506

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Frequently Asked Questions about the Medicare Prescription Drug Improvement and Modernization Act of 2003 Summary: These are answers to frequently asked questions about the Medicare Prescription Drug Improvement and Modernization Act of 2003. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=8029

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Frequently Asked Questions: Medicare Summary: Answers for the most frequently asked questions by callers to the Medicare + Choice Toll Free Line. New questions and answers are posted periodically. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3638

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Glossary of Medicare Terms Summary: Understanding Medicare means knowing the meaning of many unfamiliar terms. This glossary contains key words and acronyms. Source: Medicare Rights Center http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7799

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Guide to Health Insurance For People With Medicare: Choosing a Medigap Policy Summary: A guide to help beneficiaries with purchasing Medigap supplemental insurance, using Medigap supplemental insurance and other kinds of health insurance. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=610

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Home Health Compare Summary: Home Health Compare rates all Medicare-certified home healthcare agencies based on 11 quality measurements. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7498

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If You Have Cancer and Have Medicare.You Should Know About Clinical Trials Summary: Resource for Medicare recipients who have cancer. It provides general information about cancer clinical trials, Medicare coverage, and questions to ask before joining a clinical trial. Source: National Cancer Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7039

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Medicaid Alliance for Program Safeguards Summary: The Centers for Medicare and Medicaid Services' effort to detect and prevent fraud and abuse in the Medicaid program is based on a partnership and cooperative effort with beneficiaries, Medicaid Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1398

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Medicaid Information Summary: This main page to the Centers for Medicare and Medicaid Services links to consumer information, state and territorial information, and national account representatives. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6894

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Medicare and Mammography Summary: Information about mammograms and Medicare coverage for screening mammograms. Medicare also covers diagnostic mammograms when ordered by a physician for a patient who receives Medicare coverage. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=138

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Medicare and Medicaid Feedback and Customer Service Summary: Instructions on how to contact Medicare/Medicaid customer service offices for concerns related to Medicare/Medicaid claims, payments, enrollment, quality of care, managed care, and more. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=320

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Medicare and Medicaid Paper-Based Manuals Summary: This site provides access to electronic and print versions of program manuals from the Centers for Medicare and Medicaid Services. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1873

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Medicare and You 2004 Summary: Medicare and You is the latest version of Your Medicare Handbook. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=609

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Medicare Coordination of Benefits Initiative Summary: An overview of the Medicare Coordination of Benefits Initiative (COB) and Medicare as the Secondary Payer (MSP) and administration of this program. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5607

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Medicare Coverage of Kidney Dialysis and Kidney Transplant Services Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3191

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Medicare Fraud Summary: The effort to prevent Medicare fraud is a cooperative one. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=470

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Medicare Health Insurance Source: National Asian Pacific Center on Aging http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7527

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Medicare Health Plan Compare Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2728

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Medicare Information in Chinese Summary: Link to publications online in Adobe Acrobat PDF and graphic formats, all in Chinese. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5139

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Medicare Integrity Program Summary: This page contains the text of the Medicare Integrity Program legislative provision as well as a link to the full text of the entire statute. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=761

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Medicare Issue of the Day Summary: The Medicare Issue of the Day is a new series designed to introduce and explain the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=8030

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Medicare Managed Care Home Page Summary: This page contains managed care information for current and future contracting managed care (including Medicare+Choice) organizations and other parties interested in the operational and regulatory Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5074

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Medicare Participating Physician Directory Summary: This directory contains names, addresses, and specialties of Medicare participating physicians who have agreed to accept assignment on all Medicare claims and covered services. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6615

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Medicare Personal Plan Finder Summary: The Medicare Personal Plan Finder is designed to help you learn about the health plan choices you have as a person with Medicare. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6604

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Medicare Premium Amounts for 2004 Summary: A statement of Medicare hospital and medical insurance deductibles, coinsurance, and premiums. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=469

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Medicare Prescription Drug Improvement and Modernization Act of 2003 Summary: This Medicare reform law preserves and strengthens the current Medicare program, adds important new prescription drug and preventive benefits, and provides extra help to people with low incomes. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=8028

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Medicare Preventive Services: Influenza/Pneumococcal Campaign Summary: Medicare beneficiaries and health care professionals will find answers to questions about Medicare Influenza/Pneumococcal vaccination benefits, including recent policy changes, on this web site. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5606

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Medicare Program Glossary Summary: This glossary explains terms in the Medicare program. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5244

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Medicare Publications Page Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3889

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Medicare Quality Improvement Organizations (QIOs) Summary: The Centers for Medicare and Medicaid Services (CMS) administers the Quality Improvement Organization (QIO) Program, which is designed to monitor and improve utilization and quality of care for Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=760

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Medicare.gov: Consumer Medicare Web Site Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2142

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Medicare/Medicaid Survey and Certification of Nursing Homes Summary: Medicare nursing home policies and other related resources for beneficiaries, nursing home providers, researchers and Federal and state surveyors. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3888

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Medigap Compare Summary: This is an interactive tool for Medicare beneficiaries and people who assist them with their care. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6616

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National Diabetes Eye Exam Program Summary: A program for Medicare beneficiaries age 65 and older who have diabetes and haven’t had a medical eye exam in up to three years. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6016

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News Page - National Medicare Education Program Summary: This news services site provides a direct link to Medicare and related activities of the Centers for Medicare and Medicaid Services, the National Medicare Education Program (NMEP) and other HHS Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3542

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Partnerships & Medicare Education, Caregivers Resources Summary: The Centers for Medicare & Medicaid Services has two publications on the subject of Caregiving: Medicare Basics: A Guide for Caregivers and When Employees Become Caregivers: A Manager's Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7605

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Pay It Right! Protecting Medicare from Fraud Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7335

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Prescription Drug Assistance Programs Summary: Information on programs -- prescription drug assistance programs, Medicare managed care plans, and Medigap plans -- that offer prescription drug coverage, discounts or free medication to individuals Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6127

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State and Federal Medicaid Contacts Summary: This service, provided by the Centers for Medicare and Medicaid Services, links to Medicaid resources including state-by-state listings of toll-free numbers and Medicaid officials, CMS regional Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1396

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State Contacts for Medicare Information Summary: A search engine that allows users to select States for local information and contacts regarding Medicare. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=471

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Supplier Directory Summary: This database provides names, addresses, and contact information for suppliers that provide services or products under the Medicare program. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6620

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What is Medicare? Summary: The Centers for Medicare and Medicaid Services administer Medicare, the Nation's largest health insurance program, which covers 37 million Americans. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2141

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What the Medicare Modernization Act (MMA) Means for African-American Beneficiaries Summary: Under the MMA, for the first time in the history of the Medicare program, all beneficiaries are provided with access to a prescription drug benefit. All Medicare beneficiaries, including nearly 3. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=8033

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What the Medicare Modernization Act (MMA) Means for Hispanic Beneficiaries Summary: Under the MMA, for the first time in the history of the Medicare program, all beneficiaries are provided with access to a prescription drug benefit. All Medicare beneficiaries, including over 2. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=8032

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What the Medicare Modernization Act (MMA) Means for Minority Beneficiaries Summary: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provides minority beneficiaries with the best possible care, better benefits, greater protections, and more choices. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=8031

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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Medicare. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Associations and Medicare The following is a list of associations that provide information on and resources relating to Medicare: •

Medicare Rights Center Telephone: (212) 869-3850 Fax: (212) 869-3532 Email: [email protected] Web Site: www.Medicarerights.org Background: Medicare Rights Center (MRC) is a national, not-for-profit organization exclusively dedicated to ensuring that seniors and people with disabilities on Medicare have access to quality, affordable health care. Through direct services, education and public policy programs, Medicare Rights Center empowers people on Medicare to make informed choices regarding their health care benefits-for example, choosing a Medicare Supplemental Insurance policy, learning about HMOs, or understanding how Medicare works in conjunction with an employer's health plan. Relevant area(s) of interest: Medicare

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Medicare. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Medicare. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Medicare. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Medicare” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Medicare”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Medicare” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

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The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “Medicare” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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MEDICARE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Air Pollutants: Substances which pollute the air. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH]

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Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]

Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino Acid Substitution: The naturally occurring or experimentally induced replacement of one or more amino acids in a protein with another. If a functionally equivalent amino acid is substituted, the protein may retain wild-type activity. Substitution may also diminish or eliminate protein function. Experimentally induced substitution is often used to study enzyme activities and binding site properties. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH]

Dictionary 231

Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antidepressive Agents: Mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several monoamine oxidase inhibitors are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents also appear to act through brain catecholamine systems. A third group (antidepressive agents, secondgeneration) is a diverse group of drugs including some that act specifically on serotonergic systems. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic

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and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Artificial Limbs: Prosthetic replacements for arms, legs, and parts therof. [NIH] Astigmatism: A condition in which the surface of the cornea is not spherical; causes a blurred image to be received at the retina. [NIH] Atherectomy: Endovascular procedure in which atheromatous plaque is excised by a cutting or rotating catheter. It differs from balloon and laser angioplasty procedures which enlarge vessels by dilation but frequently do not remove much plaque. If the plaque is removed by surgical excision under general anesthesia rather than by an endovascular procedure through a catheter, it is called endarterectomy. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here)

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considered to be part of the autonomic nervous system itself. [NIH] Autosuggestion: Suggestion coming from the subject himself. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Blood Glucose: Glucose in blood. [NIH]

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Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breast-conserving surgery: An operation to remove the breast cancer but not the breast itself. Types of breast-conserving surgery include lumpectomy (removal of the lump), quadrantectomy (removal of one quarter of the breast), and segmental mastectomy (removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor). [NIH] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Carcinoma in Situ: A malignant tumor that has not yet invaded the basement membrane of the epithelial cell of origin and has not spread to other tissues. [NIH] Cardiac: Having to do with the heart. [NIH]

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Cardiac catheterization: A procedure in which a thin, hollow tube is inserted into a blood vessel. The tube is then advanced through the vessel into the heart, enabling a physician to study the heart and its pumping activity. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. [NIH] Cataracts: In medicine, an opacity of the crystalline lens of the eye obstructing partially or totally its transmission of light. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Child Health Services: Organized services to provide health care for children. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Cholinesterase Inhibitors: Drugs that inhibit cholinesterases. The neurotransmitter

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acetylcholine is rapidly hydrolyzed, and thereby inactivated, by cholinesterases. When cholinesterases are inhibited, the action of endogenously released acetylcholine at cholinergic synapses is potentiated. Cholinesterase inhibitors are widely used clinically for their potentiation of cholinergic inputs to the gastrointestinal tract and urinary bladder, the eye, and skeletal muscles; they are also used for their effects on the heart and the central nervous system. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Civil Rights: Legal guarantee protecting the individual from attack on personal liberties, right to fair trial, right to vote, and freedom from discrimination on the basis of race, religion, national origin, age, or gender. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colitis: Inflammation of the colon. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector

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not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computer Literacy: General learning, knowledge, and fluency with computer terms; also, becoming familiar with how computers operate and how they are programmed. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH]

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Consciousness: Sense of awareness of self and of the environment. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumer Organizations: Organized groups of users of goods and services. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]

Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Custodial Care: Board, room, and other personal assistance services generally provided on a long term basis. It excludes regular medical care. [NIH] Cutaneous: Having to do with the skin. [NIH]

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Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. [NIH] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Day Care: Institutional health care of patients during the day. The patients return home at night. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH]

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Diabetic Foot: Ulcers of the foot as a complication of diabetes. Diabetic foot, often with infection, is a common serious complication of diabetes and may require hospitalization and disfiguring surgery. The foot ulcers are probably secondary to neuropathies and vascular problems. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diagnostic Services: Organized services for the purpose of providing diagnosis to promote and maintain health. [NIH] Dialysate: A cleansing liquid used in the two major forms of dialysis--hemodialysis and peritoneal dialysis. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disabled Persons: Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disease-Free Survival: Period after successful treatment in which there is no appearance of the symptoms or effects of the disease. [NIH] Disease-specific survival: The percentage of subjects in a study who have survived a particular disease for a defined period of time. Usually reported as time since diagnosis or treatment. In calculating this percentage, only deaths from the disease being studied are counted. Subjects who died from some other cause are not included in the calculation. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

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Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Dispenser: Glass, metal or plastic shell fitted with valve from which a pressurized formulation is dispensed; an instrument for atomizing. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Donepezil: A drug used in the treatment of Alzheimer's disease. It belongs to the family of drugs called cholinesterase inhibitors. It is being studied as a treatment for side effects caused by radiation therapy to the brain. [NIH] Drug Costs: The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (fees, pharmaceutical or prescription fees). [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Ductal carcinoma in situ: DCIS. Abnormal cells that involve only the lining of a duct. The cells have not spread outside the duct to other tissues in the breast. Also called intraductal carcinoma. [NIH] Duodenum: The first part of the small intestine. [NIH] Durable Medical Equipment: Devices which are very resistant to wear and may be used over a long period of time. They include items such as wheelchairs, hospital beds, artificial limbs, etc. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dystrophic: Pertaining to toxic habitats low in nutrients. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejection fraction: A measure of ventricular contractility, equal to normally 65 8 per cent; lower values indicate ventricular dysfunction. [EU] Elder Abuse: Emotional, nutritional, or physical maltreatment of the older person generally by family members or by institutional personnel. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electroconvulsive Therapy: Electrically induced convulsions primarily used in the treatment of severe affective disorders and schizophrenia. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The

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numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Episode of Care: An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided. [NIH]

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Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Excrete: To get rid of waste from the body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flatus: Gas passed through the rectum. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH]

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Fold: A plication or doubling of various parts of the body. [NIH] Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Formularies: Lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from pharmacopoeias in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy. [NIH] Formulary: A book containing a list of pharmaceutical products with their formulas and means of preparation. [NIH] Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU]

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Geriatric Psychiatry: A subspecialty of psychiatry concerned with the mental health of the aged. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Government Programs: Programs and activities sponsored or administered by local, state, or national governments. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Survival: The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Group Homes: Housing for groups of patients, children, or others who need or desire emotional or physical support. They are usually established as planned, single housekeeping units in residential dwellings that provide care and supervision for small groups of residents, who, although unrelated, live together as a family. [NIH] Group Practice: Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Hallucinogens: Drugs capable of inducing illusions, hallucinations, delusions, paranoid ideations, and other alterations of mood and thinking. Despite the name, the feature that distinguishes these agents from other classes of drugs is their capacity to induce states of altered perception, thought, and feeling that are not experienced otherwise. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or

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as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Care Reform: Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hearing aid: A miniature, portable sound amplifier for persons with impaired hearing, consisting of a microphone, audio amplifier, earphone, and battery. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of

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glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin M: A group of abnormal hemoglobins in which amino acid substitutions take place in either the alpha or beta chains but near the heme iron. This results in facilitated oxidation of the hemoglobin to yield excess methemoglobin which leads to cyanosis. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Home Care Services: Community health and nursing services providing coordinated multiple service home care to the patient. It includes home-offered services provided by a visiting nurse, home health agencies, hospitals, or organized community groups using professional staff for care delivery. It differs from home nursing which is provided by nonprofessionals. [NIH] Home Nursing: Nursing care given to an individual in the home. The care may be provided by a family member or a friend. Home nursing as care by a non-professional is differentiated from home care services provided by professionals: visiting nurse, home health agencies, hospital, or other organized community group. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment,

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etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Host: Any animal that receives a transplanted graft. [NIH] Housekeeping: The care and management of property. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperopia: Farsightedness; ability to see distant objects more clearly than close objects; may be corrected with glasses or contact lenses. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotherapy: Sleeping-cure. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH]

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Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH]

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Information Systems: Integrated set of files, procedures, and equipment for the storage, manipulation, and retrieval of information. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insurance Benefits: Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed. [NIH] Insurance Pools: An organization of insurers or reinsurers through which particular types of risk are shared or pooled. The risk of high loss by a particular insurance company is transferred to the group as a whole (the insurance pool) with premiums, losses, and expenses shared in agreed amounts. [NIH] Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Intermediate Care Facilities: Institutions which provide health-related care and services to individuals who do not require the degree of care which hospitals or skilled nursing facilities provide, but because of their physical or mental condition require care and services above the level of room and board. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU]

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Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intraductal carcinoma: Abnormal cells that involve only the lining of a duct. The cells have not spread outside the duct to other tissues in the breast. Also called ductal carcinoma in situ. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ipsilateral: Having to do with the same side of the body. [NIH] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH]

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Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: An area of abnormal tissue change. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]

Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Local Government: Smallest political subdivisions within a country at which general governmental functions are carried-out. [NIH] Localized: Cancer which has not metastasized yet. [NIH]

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Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Low vision: Visual loss that cannot be corrected with eyeglasses or contact lenses and interferes with daily living activities. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumpectomy: Surgery to remove the tumor and a small amount of normal tissue around it. [NIH]

Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphedema: Edema due to obstruction of lymph vessels or disorders of the lymph nodes. [NIH]

Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Mammogram: An x-ray of the breast. [NIH] Mammography: Radiographic examination of the breast. [NIH] Manic: Affected with mania. [EU] Mastectomy: Surgery to remove the breast (or as much of the breast tissue as possible). [NIH]

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Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical oncologist: A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often serves as the main caretaker of someone who has cancer and coordinates treatment provided by other specialists. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Health Services: Organized services to provide mental health care. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Metastatic cancer: Cancer that has spread from the place in which it started to other parts of the body. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of

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the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Morals: Standards of conduct as right or wrong. [NIH] Motility: The ability to move spontaneously. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopia: That error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina, as a result of the eyeball being too long from front to back (axial m.) or of an increased strength in refractive power of the media of the eye (index m.). Called also nearsightedness, because the near point is less distant than it is in emmetropia with an equal amplitude of accommodation. [EU]

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Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nonmelanoma skin cancer: Skin cancer that arises in basal cells or squamous cells but not in melanocytes (pigment-producing cells of the skin). [NIH] Non-small cell lung cancer: A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nurse Practitioners: Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Process: The sum total of nursing activities which includes assessment (identifying needs), intervention (ministering to needs), and evaluation (validating the effectiveness of the help given). [NIH] Nursing Services: A general concept referring to the organization and administration of nursing activities. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH]

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Occult: Obscure; concealed from observation, difficult to understand. [EU] Occult Blood: Chemical, spectroscopic, or microscopic detection of extremely small amounts of blood. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Oncology: The study of cancer. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmic: Pertaining to the eye. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Optometrist: A primary eye care provider who diagnoses, manages, and treats disorders of the visual system and eye diseases. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH]

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Pancreatic: Having to do with the pancreas. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Admission: The process of accepting patients. The concept includes patients accepted for medical and nursing care in a hospital or other health care institution. [NIH] Patient Discharge: The administrative process of discharging the patient, live or dead, from hospitals or other health facilities. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perineal: Pertaining to the perineum. [EU] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH]

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Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacopoeias: Authoritative treatises on drugs and preparations, their description, formulation, analytic composition, physical constants, main chemical properties used in identification, standards for strength, purity, and dosage, chemical tests for determining identity and purity, etc. They are usually published under governmental jurisdiction (e.g., USP, the United States Pharmacopoeia; BP, British Pharmacopoeia; P. Helv., the Swiss Pharmacopoeia). They differ from formularies in that they are far more complete: formularies tend to be mere listings of formulas and prescriptions. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Podiatrist: A doctor who treats and takes care of people's feet. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Population Growth: Increase, over a specific period of time, in the number of individuals living in a country or region. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH]

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Poultice: That made by mixing mustard and flour with water. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Prescription Fees: The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primum: The first atrial septum to appear in the embryonic heart. [NIH] Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Problem-Based Learning: Instructional use of examples or cases to teach using problemsolving skills and critical thinking. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective Payment System: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary

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approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostate-Specific Antigen: Kallikrein-like serine proteinase produced by epithelial cells of both benign and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. EC 3.4.21.77. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proxy: A person authorized to decide or act for another person, for example, a person having durable power of attorney. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychological Theory: Principles applied to the analysis and explanation of psychological or behavioral phenomena. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Psychotropic Drugs: A loosely defined grouping of drugs that have effects on psychological function. Here the psychotropic agents include the antidepressive agents, hallucinogens, and tranquilizing agents (including the antipsychotics and anti-anxiety agents). [NIH] Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among

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alternatives to guide and determine present and future decisions. [NIH] Public Relations: Relations of an individual, association, organization, hospital, or corporation with the publics which it must take into consideration in carrying out its functions. Publics may include consumers, patients, pressure groups, departments, etc. [NIH] Public Sector: The area of a nation's economy that is tax-supported and under government control. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quadrantectomy: Surgical removal of the region of the breast (approximately one quarter) containing cancer. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation oncologist: A doctor who specializes in using radiation to treat cancer. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [NIH] Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is

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transformed in the liver to its active metabolite ramiprilat. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Rape: Unlawful sexual intercourse without consent of the victim. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reentry: Reexcitation caused by continuous propagation of the same impulse for one or more cycles. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management,

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and operation of registers, e.g., disease registers. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal Dialysis: Removal of certain elements from the blood based on the difference in their rates of diffusion through a semipermeable membrane. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Research Support: Financial support of research activities. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respite Care: Patient care provided in the home or institution intermittently in order to provide temporary relief to the family home care giver. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of

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the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmental mastectomy: The removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor. Usually some of the lymph nodes under the arm are also taken out. Sometimes called partial mastectomy. [NIH]

Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selection Bias: The introduction of error due to systematic differences in the characteristics between those selected and those not selected for a given study. In sampling bias, error is the result of failure to ensure that all members of the reference population have a known chance of selection in the sample. [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH]

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Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skilled Nursing Facilities: Extended care facilities which provide skilled nursing care or rehabilitation services for inpatients on a daily basis. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small cell lung cancer: A type of lung cancer in which the cells appear small and round when viewed under the microscope. Also called oat cell lung cancer. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smiling: A facial expression which may denote feelings of pleasure, affection, amusement, etc. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Welfare: Organized institutions which provide services to ameliorate conditions of need or social pathology in the community. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Software Design: Specifications and instructions applied to the software. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ

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systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Speech-Language Pathology: The study of speech or language disorders and their diagnosis and correction. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH]

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Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Sulfates: Inorganic salts of sulfuric acid. [NIH] Sulfuric acid: A strong acid that, when concentrated is extemely corrosive to the skin and mucous membranes. It is used in making fertilizers, dyes, electroplating, and industrial explosives. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Systems Analysis: The analysis of an activity, procedure, method, technique, or business to determine what must be accomplished and how the necessary operations may best be accomplished. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Taboo: Any negative tradition or behavior that is generally regarded as harmful to social welfare and forbidden within a cultural or social group. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH]

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Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Tranquilizing Agents: A traditional grouping of drugs said to have a soothing or calming effect on mood, thought, or behavior. Included here are the anti-anxiety agents (minor tranquilizers), antimanic agents, and the antipsychotic agents (major tranquilizers). These drugs act by different mechanisms and are used for different therapeutic purposes. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Translations: Products resulting from the conversion of one language to another. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Transurethral resection of the prostate: Surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. Also called TURP. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

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Trustees: Board members of an institution or organization who are entrusted with the administering of funds and the directing of policy. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tunica Intima: The innermost coat of blood vessels, consisting of a thin lining of endothelial cells longitudinally oriented and continuous with the endothelium of capillaries on the one hand and the endocardium of the heart on the other. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Uncompensated Care: Medical services for which no payment is received. Uncompensated care includes charity care and bad debts. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Universal Coverage: Health insurance coverage for all persons in a state or country, rather than for some subset of the population. It may extend to the unemployed as well as to the employed; to aliens as well as to citizens; for pre-existing conditions as well as for current illnesses; for mental as well as for physical conditions. [NIH] Urban Health: The status of health in urban populations. [NIH] Urban Population: The inhabitants of a city or town, including metropolitan areas and suburban areas. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond

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to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Insufficiency: Inadequacy of the venous valves and impairment of venous return (venous stasis) usually from the legs, often with edema and sometimes with stasis ulcers at the ankle. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]

Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Vital Statistics: Used for general articles concerning statistics of births, deaths, marriages, etc. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Watchful waiting: Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called observation. [NIH] Wheelchairs: Chairs mounted on wheels and designed to be propelled by the occupant. [NIH]

White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly

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used to induce a state of intoxication. [EU] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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INDEX A Abdominal, 173, 229, 254, 257, 258, 265, 270 Abdominal Pain, 229, 270 Acceptor, 229, 257 Acquired Immunodeficiency Syndrome, 206, 229 Activities of Daily Living, 9, 12, 44, 229, 240 Acute renal, 172, 229 Adaptation, 17, 39, 229, 250 Adenocarcinoma, 21, 229, 256 Adjustment, 9, 12, 16, 17, 19, 60, 98, 99, 229 Adjuvant, 22, 61, 73, 229 Adverse Effect, 229, 266 Age Groups, 71, 229 Aged, 80 and Over, 229 Agonist, 229, 268 Air Pollutants, 53, 229 Airway, 88, 229 Algorithms, 230, 233 Alimentary, 230, 258 Alpha Particles, 230, 262 Alternative medicine, 187, 230 Ambulatory Care, 110, 124, 174, 230 Ameliorated, 68, 230 Amino Acid Substitution, 230, 247 Ampulla, 230, 242 Amputation, 15, 93, 177, 230 Anal, 23, 26, 44, 98, 230, 242, 244, 253, 255, 259 Analogous, 153, 230, 269 Anaphylatoxins, 230, 237 Anatomical, 107, 230, 232, 249 Anemia, 8, 230 Anesthesia, 88, 125, 229, 230, 231, 232, 242 Anesthesiology, 91, 230 Anesthetics, 230 Angiography, 116, 230 Ankle, 92, 230, 271 Anti-Anxiety Agents, 231, 261, 269 Antibacterial, 231, 267 Antibiotic, 92, 115, 231, 267 Antibody, 231, 236, 249, 254, 255, 262, 267 Antidepressant, 26, 32, 48, 231 Antidepressive Agents, 231, 261 Antigen, 231, 237, 248, 249, 254

Antigen-Antibody Complex, 231, 237 Antihypertensive, 28, 231 Anti-inflammatory, 18, 45, 231 Antimetabolite, 231, 265 Antimicrobial, 125, 231 Antipsychotic, 231, 256, 269 Antiviral, 170, 232, 250, 265 Anuria, 232, 251 Anus, 230, 232, 234, 263 Anxiety, 51, 231, 232 Aorta, 232, 238, 271 Apathy, 232, 256 Aphasia, 177, 232 Apolipoproteins, 232, 252 Aqueous, 232, 233, 252 Arterial, 232, 235, 248, 261, 268 Arteries, 232, 234, 238, 251, 253, 255 Arthroplasty, 93, 111, 232 Artificial Limbs, 232, 241 Astigmatism, 232, 263 Atherectomy, 232, 242 Atrial, 120, 121, 232, 260 Atrial Fibrillation, 120, 121, 232 Atrium, 232, 271 Auditory, 232, 246 Autonomic, 153, 232, 267, 268 Autonomic Nervous System, 153, 232, 267, 268 Autosuggestion, 233, 248 B Bacteria, 231, 233, 242, 255, 266, 267, 271 Bacterial Physiology, 229, 233 Bacteriuria, 233, 270 Basal cells, 233, 256 Base, 44, 47, 52, 60, 151, 233, 239, 251, 268 Benign, 187, 233, 245, 256, 261, 262 Benign prostatic hyperplasia, 187, 233 Bile, 80, 233, 244, 252 Biochemical, 231, 233, 251, 266 Biological response modifier, 233, 250 Biological therapy, 233, 254 Biological Transport, 233, 240 Biopsy, 59, 233 Biotechnology, 74, 76, 187, 195, 233 Bipolar Disorder, 47, 233 Bladder, 190, 233, 236, 239, 249, 260, 261, 264, 270

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Blood Glucose, 5, 11, 171, 206, 233, 246, 250 Blood Platelets, 234, 266 Blood pressure, 11, 152, 153, 175, 231, 234, 235, 240, 248, 255 Blood vessel, 230, 234, 235, 254, 267, 268, 269, 270, 271 Body Fluids, 234, 241 Bolus, 127, 234 Bolus infusion, 234 Bone Marrow, 234, 243, 249, 253 Bowel, 21, 176, 230, 234, 238, 240, 249, 251, 258, 267, 270 Bowel Movement, 234, 238, 240, 267 Brachytherapy, 234, 250, 262 Branch, 225, 234, 242, 244, 258, 261, 267, 268 Breakdown, 234, 240, 244 Breast-conserving surgery, 26, 93, 234 Buffers, 39, 234 C Calcium, 120, 126, 234, 237 Carcinoma, 37, 116, 234, 256, 267 Carcinoma in Situ, 234 Cardiac, 54, 64, 65, 232, 234, 235, 255 Cardiac catheterization, 64, 235 Cardiovascular, 21, 71, 124, 235, 266, 267 Cardiovascular disease, 21, 235 Case-Control Studies, 57, 235, 242 Cataracts, 70, 235 Catheterization, 235 Catheters, 173, 190, 235, 249, 250 Causal, 21, 31, 39, 235, 242, 251 Central Nervous System, 232, 235, 236, 244, 246, 266 Cerebral, 77, 235, 238, 239, 261 Cerebrovascular, 65, 235 Cerebrum, 235, 238 Chemotactic Factors, 235, 237 Chemotherapy, 22, 29, 60, 73, 126, 127, 235, 254 Child Health Services, 49, 235 Chiropractic, 126, 127, 128, 130, 235 Cholecystectomy, 80, 235 Cholesterol, 28, 175, 233, 235, 236, 238, 248, 252, 253, 268 Cholesterol Esters, 235, 252 Cholinesterase Inhibitors, 235, 241 Chromosome, 236, 252 Chronic Disease, 40, 59, 66, 92, 175, 236 Chronic renal, 8, 236 Chylomicrons, 236, 252

Civil Rights, 61, 236 Clinical trial, 16, 19, 21, 29, 70, 73, 195, 204, 210, 236, 238, 258, 261, 263 Cloning, 233, 236 Cognition, 236, 256 Cohort Studies, 60, 70, 236, 242 Colitis, 236 Colonoscopy, 21, 82, 117, 236 Colorectal, 21, 22, 27, 45, 87, 236 Colorectal Cancer, 21, 22, 27, 45, 87, 236 Comorbidity, 9, 22, 30, 33, 34, 44, 61, 98, 106, 236 Complement, 53, 136, 230, 236, 237 Complementary and alternative medicine, 120, 123, 127, 131, 237 Complementary medicine, 123, 237 Computational Biology, 195, 237 Computer Literacy, 23, 237 Confounding, 27, 237 Confusion, 237, 241, 248, 256, 270 Congestive heart failure, 28, 65, 125, 237 Conjunctiva, 237, 249 Connective Tissue, 234, 237, 243, 244, 253 Consciousness, 231, 238, 239 Consultation, 39, 238 Consumer Organizations, 24, 238 Consumption, 39, 148, 238, 239, 264 Continence, 5, 41, 190, 238 Continuum, 14, 56, 238 Contractility, 238, 241 Contraindications, ii, 238 Contralateral, 177, 238 Control group, 11, 13, 18, 55, 238, 263 Convulsions, 238, 241, 248 Coordination, 50, 84, 128, 211, 238 Coronary, 21, 65, 109, 112, 235, 238, 255 Coronary Artery Bypass, 109, 238 Coronary heart disease, 235, 238 Coronary Thrombosis, 238, 255 Cortices, 238, 246 Creatinine, 11, 238, 251 Cross-Sectional Studies, 238, 242 Curative, 238, 268 Custodial Care, 173, 238 Cutaneous, 138, 238 Cyanosis, 239, 247 Cystoscopy, 188, 239 D Data Collection, 23, 26, 42, 54, 64, 71, 239, 243 Databases, Bibliographic, 195, 239 Day Care, 13, 174, 239

275

Decision Making, 172, 239 Degenerative, 239, 247 Delirium, 51, 231, 239 Delivery of Health Care, 42, 173, 239, 246 Dementia, 8, 9, 10, 11, 13, 14, 33, 39, 43, 51, 56, 63, 69, 85, 173, 229, 231, 239 Density, 64, 66, 151, 239, 252, 257 Dental Care, 46, 69, 239 Depressive Disorder, 47, 65, 239 Developed Countries, 33, 239 Diabetes Mellitus, 67, 239, 245, 246 Diabetic Foot, 8, 9, 240 Diagnostic Imaging, 105, 240 Diagnostic procedure, 147, 187, 240 Diagnostic Services, 173, 240 Dialysate, 173, 240 Dialyzer, 240, 246 Diastole, 240 Diastolic, 28, 240, 248 Diastolic pressure, 28, 240, 248 Diffusion, 22, 233, 240, 264 Digestion, 230, 233, 234, 240, 251, 252, 267 Digestive system, 240, 244 Dilatation, 240, 260 Direct, iii, 10, 15, 20, 24, 25, 33, 41, 43, 44, 54, 55, 58, 214, 217, 240, 247, 263 Disabled Persons, 38, 240 Discrimination, 3, 15, 61, 174, 236, 240 Disease Progression, 240, 264 Disease-Free Survival, 30, 240 Disease-specific survival, 61, 240 Dislocation, 14, 240 Disorientation, 237, 239, 241 Disparity, 61, 69, 241 Dispenser, 175, 241 Distal, 238, 241 Donepezil, 9, 13, 241 Drug Costs, 32, 58, 241 Drug Interactions, 241 Duct, 80, 230, 235, 241, 251, 257 Ductal carcinoma in situ, 26, 241, 251 Duodenum, 233, 241, 242, 267 Durable Medical Equipment, 5, 6, 13, 28, 155, 241 Dysphoric, 239, 241 Dystrophic, 107, 241 E Edema, 241, 253, 271 Effector, 236, 241 Efficacy, 18, 21, 25, 28, 29, 41, 48, 62, 241, 269 Ejection fraction, 101, 241

Elder Abuse, 15, 241 Elective, 14, 37, 93, 241 Electroconvulsive Therapy, 25, 241 Electrolyte, 239, 241, 251 Electrons, 233, 241, 251, 257, 262 Electrophysiological, 242, 271 Emaciation, 229, 242 Embolus, 14, 242, 249 Emphysema, 118, 242 Empirical, 23, 31, 52, 242 Endarterectomy, 48, 232, 242 Endometrial, 60, 70, 242 Endometrium, 242 Endoscope, 242 Endoscopic, 45, 236, 239, 242 Endotoxins, 237, 242 End-stage renal, 64, 171, 206, 236, 242 Environmental Health, 194, 196, 242 Enzymatic, 234, 237, 242, 264 Enzyme, 21, 95, 230, 241, 242, 261, 262 Epidemiologic Studies, 30, 242 Epidemiological, 171, 242 Epidural, 88, 242 Episode of Care, 24, 116, 242 Epithelial, 229, 233, 234, 243, 247, 261 Epithelial Cells, 243, 247, 261 Equipment and Supplies, 179, 243 ERV, 112, 196, 243 Erythrocytes, 230, 234, 243 Erythropoietin, 7, 8, 172, 243 Escalation, 148, 150, 243 Esophagus, 45, 240, 243, 259, 267 Estrogen, 66, 243, 265, 268 Estrogen receptor, 66, 243 Ethnic Groups, 46, 243 Excrete, 232, 243, 251 Exogenous, 69, 243 Expiratory, 243 Expiratory Reserve Volume, 243 External-beam radiation, 243, 262 Extremity, 15, 93, 177, 243 F Facial, 243, 266, 267 Family Planning, 195, 243 Fat, 234, 238, 242, 243, 252 Fatigue, 243, 246 Fetus, 243, 270 Fibrosis, 64, 243 Flatus, 243, 244 Focus Groups, 28, 172, 243 Fold, 16, 175, 244 Foot Care, 177, 244

276

Medicare

Foot Ulcer, 177, 240, 244 Foramen, 244, 258 Forearm, 234, 244 Formularies, 32, 244, 259 Formulary, 32, 244 Fraud, 5, 91, 92, 94, 129, 135, 136, 183, 202, 208, 210, 211, 215, 244 G Gallbladder, 229, 235, 240, 244 Gamma Rays, 244, 262 Ganglia, 232, 244, 256, 268 Gas, 153, 240, 243, 244, 248, 271 Gastrin, 244, 247 Gastroenterologist, 45, 244 Gastrointestinal, 45, 105, 236, 244, 266, 267 Gastrointestinal tract, 236, 244, 266, 267 Gene, 233, 244 General practitioner, 28, 244 Genetics, 48, 244 Genotype, 37, 244 Geriatric, 10, 20, 25, 44, 62, 173, 244, 245 Geriatric Psychiatry, 10, 245 Gland, 245, 253, 257, 260, 261 Glomerular, 245, 251, 264 Glucose, 206, 233, 239, 245, 246, 248, 250 Glucose Intolerance, 239, 245 Governing Board, 245, 260 Government Agencies, 154, 245, 260 Government Programs, 4, 245 Grade, 61, 66, 73, 245 Graft, 68, 109, 245, 248 Graft Survival, 68, 245 Grafting, 238, 245 Gravidity, 245, 258 Group Homes, 72, 245 Group Practice, 23, 245 Growth, 19, 34, 38, 39, 50, 83, 231, 245, 250, 253, 256, 259, 270 H Habitual, 28, 245 Hallucinogens, 245, 261 Headache, 245, 248, 249 Health Behavior, 34, 37, 46, 246 Health Care Costs, 9, 13, 27, 39, 78, 89, 148, 162, 246 Health Care Reform, 74, 166, 188, 246 Health Expenditures, 246 Health Policy, 20, 21, 27, 31, 36, 48, 53, 61, 77, 87, 115, 246 Health Status, 13, 19, 40, 50, 63, 71, 88, 109, 117, 148, 246 Hearing aid, 173, 175, 246

Hearing Disorders, 173, 246 Heart attack, 28, 116, 235, 246 Heart failure, 28, 65, 78, 95, 101, 106, 110, 121, 141, 246 Heme, 246, 247 Hemodialysis, 17, 19, 172, 173, 240, 246, 251 Hemoglobin, 9, 11, 230, 239, 243, 246, 247 Hemoglobin M, 9, 239, 247 Hemorrhage, 246, 247, 268 Hemostasis, 247, 266 Hepatic, 239, 247 Hepatitis, 37, 170, 247 Hepatocytes, 247 Heredity, 244, 247 Heterogeneity, 26, 247 Home Care Services, 13, 247 Home Nursing, 247 Homogeneous, 238, 247 Hormonal, 247, 254 Hormonal therapy, 247, 254 Hormone, 73, 243, 244, 247, 250 Hospice, 12, 28, 96, 129, 186, 201, 204, 205, 206, 247 Hospital Charges, 247, 248 Hospital Costs, 57, 247 Host, 29, 182, 245, 248, 249, 270, 271 Housekeeping, 245, 248 Hybrid, 52, 248 Hydrogen, 229, 233, 234, 248, 255, 256, 257, 261 Hydrophobic, 248, 252 Hypercholesterolemia, 64, 248 Hyperlipidemia, 65, 248 Hyperopia, 248, 263 Hypertension, 21, 175, 235, 246, 248 Hypertrophy, 233, 248 Hypnotherapy, 129, 248 Hypoglycaemia, 239, 248 Hypothalamus, 232, 248 Hypoxia, 239, 248 I Iatrogenic, 68, 248 Id, 122, 130, 217, 224, 226, 248 Immune response, 229, 231, 248, 249, 270, 271 Immune Sera, 248, 249 Immune system, 233, 248, 249, 253, 270, 271 Immunity, 229, 249, 269 Immunization, 99, 249 Immunodeficiency, 162, 205, 206, 229, 249

277

Immunodeficiency syndrome, 162, 249 Immunologic, 235, 249, 262 Immunology, 229, 249 Immunosuppressive, 6, 68, 87, 117, 188, 249 Impairment, 40, 43, 58, 239, 249, 254, 271 Implant radiation, 249, 250, 262 In vitro, 249 In vivo, 65, 249 Incision, 188, 249, 251, 261, 265 Incontinence, 41, 125, 128, 156, 204, 249 Indicative, 162, 249, 258, 271 Infant, Newborn, 229, 249 Infarction, 249 Infection, 11, 14, 30, 170, 229, 233, 235, 239, 240, 248, 249, 252, 253, 257, 268, 271 Inflammation, 231, 236, 243, 244, 247, 249, 270 Inflammatory bowel disease, 176, 249 Influenza, 9, 99, 213, 249 Information Systems, 153, 250 Infusion, 127, 250 Inotropic, 28, 250 Inpatients, 90, 250, 266 Insight, 38, 66, 250 Institutionalization, 40, 250 Insulin, 5, 206, 250 Insulin-dependent diabetes mellitus, 250 Insurance Benefits, 152, 155, 156, 190, 250 Insurance Pools, 176, 178, 250 Insurance, Health, 53, 250 Interferon, 37, 250 Interferon-alpha, 250 Intermediate Care Facilities, 177, 250 Intermittent, 250, 253, 258 Internal radiation, 250, 262 Interstitial, 234, 250, 264 Intervention Studies, 44, 251 Intestine, 234, 236, 251, 252 Intoxication, 239, 251, 272 Intracellular, 249, 251, 263 Intraductal carcinoma, 241, 251 Intramuscular, 251, 258 Intravenous, 28, 92, 250, 251, 258 Invasive, 26, 66, 87, 249, 251 Ions, 233, 234, 241, 248, 251 Ipsilateral, 177, 251 Ischemic stroke, 77, 121, 251 J Joint, 14, 17, 232, 251, 253, 268 K Kb, 194, 251

Kidney Failure, 11, 19, 161, 171, 190, 203, 206, 208, 242, 251 Kidney Failure, Acute, 251 Kidney Failure, Chronic, 251 Kidney Transplantation, 7, 68, 251 L Labile, 236, 252 Language Disorders, 252, 267 Large Intestine, 236, 240, 251, 252, 263, 266 Latent, 39, 252 Length of Stay, 57, 108, 134, 252 Lens, 235, 252, 264 Leprosy, 244, 252 Lesion, 238, 244, 252, 266, 270 Library Services, 224, 252 Life Expectancy, 26, 59, 252 Ligament, 252, 260 Linear Models, 39, 252 Linkage, 40, 46, 61, 66, 252 Lipid, 9, 120, 232, 250, 252 Lipoprotein, 64, 252, 253 Liver, 37, 170, 229, 233, 240, 243, 244, 247, 252, 263 Liver cancer, 170, 252 Liver Transplantation, 170, 252 Local Government, 252, 261 Localized, 111, 249, 252, 259, 270 Longitudinal Studies, 52, 238, 253 Longitudinal study, 17, 43, 253 Long-Term Care, 33, 38, 42, 45, 47, 52, 53, 56, 62, 72, 162, 166, 173, 253 Low vision, 29, 58, 253 Low-density lipoprotein, 252, 253 Lumbar, 34, 253 Lumpectomy, 234, 253 Luxation, 240, 253 Lymph, 253, 265 Lymph node, 253, 265 Lymphatic, 249, 253, 269 Lymphedema, 127, 253 Lymphocyte, 229, 231, 253, 254 Lymphocyte Count, 229, 253 M Macrophage, 64, 253 Malignant, 45, 229, 234, 252, 253, 256, 261, 262 Mammary, 238, 253, 268 Mammogram, 55, 253 Mammography, 9, 35, 55, 66, 70, 90, 94, 100, 115, 204, 210, 253 Manic, 231, 233, 253 Mastectomy, 26, 81, 99, 253, 265

278

Medicare

Mediator, 44, 254, 266 Medical oncologist, 29, 73, 254 Medical Records, 76, 150, 254 MEDLINE, 195, 254 Melanocytes, 254, 256 Melanoma, 138, 254 Membrane, 173, 234, 237, 240, 254, 256, 259, 264 Memory, 239, 254 Mental Disorders, 47, 51, 254, 261 Mental Health, iv, 16, 20, 31, 41, 44, 47, 48, 51, 52, 67, 146, 194, 196, 200, 204, 245, 254, 261 Mental Health Services, iv, 16, 47, 48, 52, 146, 196, 204, 254 Mentors, 20, 37, 42, 254 Mesentery, 254, 258 Meta-Analysis, 70, 254 Metabolite, 254, 260, 263 Metastasis, 254, 256 Metastatic, 73, 254 Metastatic cancer, 73, 254 MI, 88, 227, 254 Microbe, 255, 269 Microbiology, 229, 233, 255 Migration, 40, 255 Minority Groups, 205, 255 Mobility, 44, 255 Modeling, 37, 40, 53, 54, 60, 71, 255 Modification, 255, 262 Molecular, 195, 197, 233, 237, 255, 263 Molecule, 231, 233, 237, 241, 255, 257, 262, 263 Monitor, 11, 53, 69, 171, 214, 238, 255 Monoclonal, 255, 262 Mood Disorders, 47, 65, 255 Morals, 129, 255 Motility, 255, 266 Mucus, 255, 270 Multivariate Analysis, 9, 23, 255 Myalgia, 249, 255 Myocardial infarction, 48, 86, 98, 101, 105, 106, 110, 117, 120, 238, 254, 255 Myocardium, 254, 255 Myopia, 255, 263 N Nasal Mucosa, 249, 256 Necrosis, 249, 254, 255, 256 Neonatal, 30, 256 Neonatal period, 30, 256 Neoplasia, 21, 256 Neoplasms, 229, 256, 262

Nerve, 230, 235, 244, 254, 256, 265, 269 Nervous System, 153, 232, 235, 254, 256, 268 Networks, 40, 95, 125, 256 Neuroleptic, 4, 5, 231, 256 Neutrons, 230, 256, 262 Nonmelanoma skin cancer, 113, 256 Non-small cell lung cancer, 73, 256 Nucleic acid, 256, 265 Nurse Practitioners, 79, 256 Nursing Care, 7, 12, 134, 256, 258, 266 Nursing Process, 116, 256 Nursing Services, 169, 247, 256 Nursing Staff, 51, 256 O Occult, 91, 257 Occult Blood, 91, 257 Odds Ratio, 257, 264 Office Visits, 151, 175, 257 Oliguria, 251, 257 Oncologist, 73, 254, 257 Oncology, 22, 29, 73, 106, 125, 257 Opacity, 235, 239, 257 Ophthalmic, 29, 257 Ophthalmology, 113, 257 Opportunistic Infections, 229, 257 Optometrist, 204, 257 Oral Health, 36, 46, 257 Ostomy, 5, 6, 99, 125, 188, 257 Ownership, 86, 257 Oxidation, 64, 229, 247, 257 P Palliative, 73, 257, 268 Pancreas, 229, 240, 250, 257, 258 Pancreatic, 61, 258 Parenteral, 7, 258 Parietal, 258 Parity, 41, 258 Pathogenesis, 64, 258 Pathologic, 233, 238, 258 Patient Admission, 61, 258 Patient Discharge, 151, 258 Patient Education, 172, 173, 177, 203, 222, 224, 227, 258 Patient Satisfaction, 137, 258 Patient Selection, 49, 173, 181, 258 Pelvic, 258, 260 Perception, 9, 245, 246, 258 Perineal, 258, 262 Perioperative, 48, 177, 258 Peritoneal, 17, 19, 172, 240, 258 Peritoneal Cavity, 173, 258

279

Peritoneal Dialysis, 17, 19, 172, 240, 258 Peritoneum, 173, 254, 258 Pharmacist, 15, 89, 156, 258 Pharmacodynamic, 21, 259 Pharmacologic, 230, 259, 269 Pharmacopoeias, 244, 259 Pharynx, 249, 259 Phospholipids, 243, 252, 259 Physical Therapy, 204, 259 Physiologic, 229, 240, 259, 263 Pigment, 254, 256, 259 Pilot study, 17, 18, 50, 259 Pitch, 186, 259 Plants, 245, 259, 269 Plasma, 235, 245, 246, 247, 251, 259, 265 Podiatrist, 204, 259 Poisoning, 239, 251, 259 Policy Making, 24, 245, 259 Polyposis, 236, 259 Population Growth, 127, 259 Posterior, 230, 257, 259 Postoperative, 88, 259 Poultice, 74, 82, 260 Practicability, 260, 269 Practice Guidelines, 196, 260 Prescription Fees, 241, 260 Prevalence, 8, 14, 16, 28, 34, 43, 44, 61, 62, 65, 66, 69, 71, 107, 205, 257, 260 Primum, 59, 260 Private Sector, 10, 50, 165, 168, 260 Probe, 184, 260 Problem-Based Learning, 29, 260 Prodrug, 260, 262 Progression, 21, 38, 39, 43, 260 Progressive, 17, 64, 236, 239, 243, 245, 251, 256, 260, 264 Prone, 25, 260 Prophylaxis, 70, 260, 270 Proportional, 59, 68, 260 Prospective Payment System, 85, 144, 148, 150, 168, 169, 181, 260 Prospective Studies, 19, 260 Prospective study, 253, 260 Prostate, 20, 59, 111, 188, 233, 260, 261, 262, 265, 269 Prostatectomy, 59, 260, 262 Prostate-Specific Antigen, 59, 261 Prostatic Hyperplasia, 261 Protein C, 232, 252, 261 Protein S, 233, 261 Proteins, 231, 232, 236, 255, 259, 261, 263, 266, 269

Proteinuria, 11, 261 Proteolytic, 237, 261 Protocol, 58, 65, 72, 261 Protons, 230, 248, 261, 262 Proxy, 75, 261 Psychiatric, 10, 25, 47, 65, 85, 254, 261 Psychiatry, 10, 25, 48, 65, 86, 245, 261 Psychological Theory, 18, 261 Psychomotor, 239, 256, 261 Psychotropic, 31, 47, 51, 261 Psychotropic Drugs, 31, 261 Public Assistance, 176, 261 Public Health, 20, 27, 34, 37, 40, 43, 44, 53, 55, 67, 72, 92, 101, 126, 142, 174, 196, 202, 261 Public Policy, 25, 34, 36, 43, 66, 127, 148, 150, 195, 217, 261 Public Relations, 188, 262 Public Sector, 52, 262 Publishing, 4, 5, 74, 262 Pulmonary, 14, 125, 234, 238, 251, 262, 271 Pulmonary Artery, 234, 262, 271 Pulmonary Edema, 251, 262 Pulse, 152, 153, 255, 262 Q Quadrantectomy, 234, 262 Quality of Life, 6, 14, 17, 18, 26, 28, 39, 41, 54, 58, 62, 65, 72, 94, 173, 262 R Race, 16, 35, 39, 43, 46, 49, 63, 66, 67, 71, 236, 255, 262 Radiation, 26, 61, 73, 241, 243, 244, 250, 257, 262, 272 Radiation oncologist, 257, 262 Radiation therapy, 61, 73, 241, 243, 250, 262 Radical prostatectomy, 59, 262 Radioactive, 248, 249, 250, 262 Radiolabeled, 262 Radiotherapy, 234, 262 Ramipril, 21, 262 Random Allocation, 263 Randomization, 18, 41, 263 Randomized, 11, 21, 25, 26, 36, 41, 55, 62, 70, 72, 98, 241, 263 Randomized clinical trial, 26, 263 Randomized Controlled Trials, 70, 263 Rape, 72, 263 Receptor, 21, 64, 73, 229, 231, 263, 266 Receptors, Serotonin, 263, 266 Recombinant, 7, 8, 263 Rectal, 22, 263

280

Medicare

Rectum, 232, 234, 236, 240, 243, 244, 249, 252, 260, 263 Recurrence, 21, 26, 233, 263, 264 Reentry, 154, 263 Refer, 1, 4, 6, 236, 256, 263, 265 Refraction, 29, 255, 263, 267 Regimen, 11, 17, 47, 68, 241, 263 Registries, 66, 263 Relapse, 26, 41, 264 Relative risk, 70, 264 Reliability, 30, 72, 73, 264 Remission, 233, 263, 264 Renal Dialysis, 17, 264 Renal failure, 171, 239, 264 Reoperation, 34, 264 Research Design, 17, 20, 22, 23, 264 Research Support, 46, 51, 264 Resection, 264, 269 Resolving, 103, 174, 264 Respiration, 255, 264 Respite Care, 204, 264 Restoration, 259, 264 Retinal, 241, 264 Retropubic, 261, 262, 264, 265 Retropubic prostatectomy, 262, 265 Retrospective, 13, 22, 48, 57, 75, 265 Ribavirin, 37, 265 Risk factor, 10, 21, 27, 35, 66, 113, 121, 242, 260, 264, 265 S Saphenous, 238, 265 Saphenous Vein, 238, 265 Schizophrenia, 47, 51, 52, 241, 265, 271 Screening, 5, 21, 27, 35, 38, 45, 66, 70, 82, 85, 87, 94, 100, 113, 117, 210, 236, 265, 270 Sediment, 265, 270 Segmental, 234, 265 Segmental mastectomy, 234, 265 Seizures, 239, 265 Selection Bias, 8, 57, 265 Selective estrogen receptor modulator, 265, 268 Self Care, 229, 265 Semen, 260, 265 Sensor, 153, 265 Septum, 260, 265 Serine, 261, 265 Serotonin, 32, 231, 263, 266, 270 Serum, 11, 28, 230, 236, 248, 251, 253, 266 Shedding, 63, 266 Side effect, 70, 229, 232, 233, 241, 266, 269

Signs and Symptoms, 264, 266 Skeleton, 251, 266 Skilled Nursing Facilities, 96, 137, 250, 266 Skull, 266, 268 Small cell lung cancer, 73, 266 Small intestine, 236, 241, 247, 251, 266 Smiling, 75, 115, 266 Sneezing, 266 Social Environment, 262, 266 Social Support, 65, 266 Social Welfare, 266, 268 Social Work, 36, 53, 134, 266 Socioeconomic Factors, 63, 266 Software Design, 149, 266 Solitary Nucleus, 232, 266 Specialist, 60, 218, 267 Species, 248, 255, 262, 267, 269, 270, 271 Specificity, 30, 35, 66, 267 Spectrum, 3, 35, 267 Speech-Language Pathology, 178, 267 Spinal cord, 235, 242, 256, 267, 268 Spinal Stenosis, 34, 267 Squamous, 256, 267 Squamous cell carcinoma, 256, 267 Squamous cells, 256, 267 Stasis, 267, 271 Stem Cells, 243, 267 Stent, 257, 267 Stoma, 257, 267 Stomach, 229, 240, 243, 244, 247, 258, 259, 266, 267 Stool, 249, 252, 267 Stress, 17, 20, 65, 232, 267 Stroke, 40, 48, 56, 57, 70, 77, 120, 140, 194, 235, 251, 268 Subacute, 249, 268 Subclinical, 249, 265, 268 Subcutaneous, 241, 258, 268 Sulfates, 54, 268 Sulfuric acid, 268 Survival Rate, 67, 268 Sympathetic Nervous System, 232, 268 Symphysis, 260, 268 Symptomatic, 18, 231, 268 Systemic, 232, 234, 239, 249, 262, 268, 269 Systems Analysis, 36, 268 Systolic, 28, 248, 268 T Taboo, 72, 268 Tamoxifen, 26, 70, 265, 268 Temporal, 33, 63, 246, 268 Therapeutics, 13, 76, 127, 268

281

Thorax, 253, 268 Threshold, 248, 268 Thromboembolism, 70, 268 Thrombosis, 261, 268, 269 Thrombus, 238, 249, 251, 269 Thymus, 249, 253, 269 Tooth Preparation, 229, 269 Toxic, iv, 37, 241, 249, 269 Toxicity, 22, 29, 241, 269 Toxicology, 196, 269 Toxins, 173, 231, 242, 249, 269 Tranquilizing Agents, 261, 269 Transfection, 233, 269 Transfer Factor, 249, 269 Translations, 23, 269 Transmitter, 254, 269 Transplantation, 6, 7, 17, 19, 65, 68, 87, 170, 236, 249, 269 Transurethral, 188, 261, 269 Transurethral Resection of Prostate, 261, 269 Transurethral resection of the prostate, 188, 269 Trauma, 239, 246, 256, 269 Treatment Outcome, 37, 269 Trustees, 107, 184, 270 Tryptophan, 266, 270 Tuberculosis, 238, 270 Tunica Intima, 242, 270 U Ulcer, 62, 270 Ulcerative colitis, 176, 249, 270 Ultrasonography, 45, 270 Uncompensated Care, 45, 247, 270 Unconscious, 230, 248, 270 Universal Coverage, 84, 270 Urban Health, 144, 270 Urban Population, 270

Uremia, 251, 264, 270 Urethra, 233, 260, 269, 270 Urinalysis, 175, 270 Urinary, 41, 125, 233, 236, 239, 249, 257, 261, 264, 270 Urine, 232, 233, 238, 249, 251, 257, 261, 270 Uterus, 242, 270 V Vaccination, 9, 213, 270 Vaccine, 229, 261, 270 Valves, 271 Vascular, 40, 65, 105, 124, 240, 249, 269, 271 VE, 102, 271 Vein, 251, 265, 271 Venous, 70, 124, 261, 271 Venous Insufficiency, 124, 271 Ventricle, 248, 262, 268, 271 Ventricular, 95, 101, 241, 271 Ventricular Dysfunction, 241, 271 Ventricular Function, 95, 271 Veterinary Medicine, 195, 271 Viral, 249, 271 Virulence, 269, 271 Virus, 162, 170, 205, 206, 229, 250, 271 Visceral, 232, 258, 271 Visceral Afferents, 232, 271 Vital Statistics, 61, 271 Vivo, 271 W Wakefulness, 239, 271 Watchful waiting, 188, 271 Wheelchairs, 241, 271 White blood cell, 231, 253, 255, 271 Withdrawal, 239, 271 X X-ray, 244, 253, 262, 272

282

Medicare

283

284

Medicare