The Merger of Rural Primary Care and Home Health Services *

The merger of rural primary care and home health services offers the potential for increasing the administrative efficiency of health care, and thereby enhancing the quality of care and increasing access to services, particularly health promotion. However, the proposed benefits of any merger can only be realized if the merger process is successfully completed. An analysis of the factors that were important in a case study of successful and unsuccessful mergers of rural health centers and home health care agencies in northeastern Vermont is presented. Three components were found to be necessary to start the merger process: complementary needs, opportunity, and common philosophy. The involvement and support of key individuals was crucial to sustaining merger interest. Good communication throughout the process contributed substantially to the maintenance of both community and staff support. Others considering similar mergers should recognize that the process of consolidating organizations and satisfying regulations takes some time to complete.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73135/1/j.1748-0361.1991.tb00702.x.pd

Effects of Miles Per Gallon Feedback on Fuel Efficiency in Gas-Powered Cars

This study tested the impact of continuous miles per gallon (MPG) feedback on driving behavior and fuel efficiency in gas-powered cars. The authors compared an experimental condition, where drivers received real-time MPG feedback and a tip sheet, to a control condition without such feedback at the time the experimental participants received it. The authors had three study aims: (1) to modify the fuel efficiency obtained while driving gas-powered cars; (2) to modify the driving behaviors of drivers of gas-powered cars; and (3) to explore ways to improve the feedback display among users. The study found an average MPG improvement of 7.5% over a one-month feedback period, an effect that 15% of the time would be observed by chance. This provides an unclear foundation for broad implementation of the fuel-economy feedback intervention. Although the appeal of a low-cost and easy-to-distribute feedback device that would improve fuel economy by 7.5% is strong, it must be tempered by an analysis of cost effectiveness

An approach to developing a prediction model of fertility intent among HIV-positive women and men in Cape Town, South Africa: a case study

As a ‘case-study’ to demonstrate an approach to establishing a fertility-intent prediction model, we used data collected from recently diagnosed HIV-positive women (N = 69) and men (N = 55) who reported inconsistent condom use and were enrolled in a sexual and reproductive health intervention in public sector HIV care clinics in Cape Town, South Africa. Three theoretically-driven prediction models showed reasonable sensitivity (0.70–1.00), specificity (0.66–0.94), and area under the receiver operating characteristic curve (0.79–0.89) for predicting fertility intent at the 6-month visit. A k-fold cross-validation approach was employed to reduce bias due to over-fitting of data in estimating sensitivity, specificity, and area under the curve. We discuss how the methods presented might be used in future studies to develop a clinical screening tool to identify HIV-positive individuals likely to have future fertility intent and who could therefore benefit from sexual and reproductive health counselling around fertility options