Feasibility of Using Technology to Disseminate Evidence to Rural Nurses and Improve Patient Outcomes

Background: Rural African American women receive less frequent mammography screening and die of breast cancer at a higher rate than is seen in the general population. To overcome this disparity, it is necessary to assist rural providers in their efforts to influence women to obtain screening. Method: This study examined the feasibility of using distance education to disseminate knowledge about timely and appropriate mammography screening to rural nurses, using patient outcome data to evaluate the effectiveness of this intervention. Results: Overall, there was a decline in referrals and mammography screening, but the intervention group centers showed a smaller decline after the educational intervention than did the control group. Conclusion: The findings show the effect of dissemination of information and the feasibility of using patient outcome data for educational evaluation. Neighboring academic health centers and nursing schools should include in their mission the provision of educational programs for relatively isolated rural nurses.health technology, rural health

Empirical Search Models

This chapter discusses various methods that have been used to estimate structural models of search and survival models. Most of the focus is on using available data, usually on unemployment spell lengths and accepted wage o¤ers, to estimate the parameters of speci…c search models. In particular, we focus on estimating the parameters of the wage o¤er distribution, the reservation wage or reservation wage function, the cost of search, o¤er arrival rate, and discount rate. There is an added section on survival models because survival models have been used so extensively to look at unemployment spell data.empirical search

Economics of marriage and divorce

In order to understand these ideas, we have to develop a model of both marriage and divorce (or, in other words, a model that allows for changes over time in the utility from marriage). In this chapter, we will set the stage for this analysis by discussing trends in marriage and divorce in Section 1. The major changes in matrimonial patterns in North America and Europe that we will highlight serve as a backdrop for the analysis we will introduce in the rest of the chapter. Then, to keep things simple, we will discuss separately the gains from marriage versus living together (Section 2), the reasons why people marry (Section 3), the nature of decision-making within marriage (Section 4), and the nature of the decisions to marry and to divorce (Section 5).marriage, divorce

Shared Caregiving Responsibilities of Adult Siblings with Elderly Parents

This paper uses a nonstructural, ordered discrete choice model to measure the effects of various parent and child characteristics upon the independent caregiving decisions of the adult children of elderly parents sampled in the 1982 and 1984 National Long Term Care Survey (NLTCS). While significant effects are noted, emphasis is placed on test statistics constructed to measure the independence of caregiving decisions. The test statistic results are conclusive: the caregiving decisions of adult children are dependent across time and family members. Structural models taking dependencies among family members into account note effects similar to those in the nonstructural model.

Survival Models of Community Tenure and Length of Hospital Stay for the Seriously Mentally Ill: A 10-year Perspective

Objective: To examine the effects of personal and community characteristics, specifically race and rurality, on lengths of state psychiatric hospital and community stays using maximum likelihood survival analysis with a special emphasis on change over a ten year period of time. Data Sources: We used the administrative data of the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) from 1982- 1991 and the Area Resources File (ARF). Given these two sources, we constructed a history file for each individual who entered the state psychiatric system over the ten year period. Histories included demographic, treatment, and community characteristics. Study Design: We used a longitudinal, population-based design with maximum likelihood estimation of survival models. We presented a random effects model with unobserved heterogeneity that was independent of observed covariates. The key dependent variables were lengths of inpatient stay and subsequent length of community stay. Explanatory variables measured personal, diagnostic, and community characteristics, as well as controls for calendar time. Data Collection: This study used secondary, administrative and health planning data. Principal Findings: African-American clients leave the community more quickly than whites. After controlling for other characteristics, however, race does not affect hospital length of stay. Rurality does not affect length of community stays once other personal and community characteristics are controlled for. However, people from rural areas have longer hospital stays even after controlling for personal and community characteristics. The effects of time are significantly smaller than expected. Diagnostic composition effects and a decrease in the rate of first inpatient admissions explain part of this reduced impact of time. We also find strong evidence for the existence of unobserved heterogeneity in both types of stays and adjust for this in our final models. Conclusions: Our results show that information on client characteristics available from inpatient stay records is useful in predicting not only the length of inpatient stay but also the length of the subsequent community stay. This information can be used to target increased discharge planning for those at risk of more rapid readmission to inpatient care. Correlation across observed and unobserved factors affecting length of stay has significant effects on the measurement of relationships between individual factors and lengths of stay. Thus, it is important to control for both observed and unobserved factors in estimation.community tenure, length of psychiatric inpatient stay, survival analysis, state psychiatric hospital, maximum likelihood estimation

Will You Still Want Me Tomorrow? The Dynamics of Families' Long-Term Care Arrangements

We estimate dynamic models of elder-care arrangements using data from the Assets and Health Dynamics Among the Oldest Old Survey. We model the use of institutional care, formal home health care, care provided by a child, and care provided by a spouse in the selection of each care arrangement, the primary arrangement, and hours in each arrangement. Our results indicate that both observed heterogeneity and true state dependence play roles in the persistence of care arrangements. We find that positive state dependence (i.e., inertia) dominates caregiver burnout, and that formal care decisions depend on the cost and quality of care.Dynamic Models, Long-Term Care, Home Health Care, Informal Care

Ranking International Limited-Overs Cricket Teams using a Weighted, Heteroskedastic Logistic Regression with Beta Distributed Outcomes

A regression-based ranking method is developed and applied to international lin1ited-overs cricket, using a database of matches played between September 1999 and December 2007. The stn1cture employed is a generalised linear model with logistic link function and beta distributed outcomes and is used to estimate team strength parameters which in turn yield ranking scores. The outcome variable for the regression is a newly proposed measure of the margin of victory based on the Duckwo1ih-Lcwis methodology. The model uses Weibull weighting to discount the impact of matches played in the past and incorporates a heteroskedastic structure to account for the potentially skewing effects of uncom1nonly large victories. Finally, the model is flexible enough to allow exan1ination of the effects of other factors such as home ground advantage