A Department of Social Work uses data to prove its case [corrected].

The introductions of managed care with its emphasis on cost containment has led a Department of Social Work Services at a large urban teaching center to better document and justify its roles. A concrete result was the saving of social work positions during budget cutbacks and downsizing. There is also information in these data to help clarify the differential roles of social workers and utilization review nurses in the hospital case management/discharge planning processes. The system came about because of concerns around cost containment, the need for more systematic discharge planning and the advent of the Prospective Payment System and Diagnosis Related Groups (DRG's) as a means of reimbursement to hospitals.

Diet and physical activity patterns of Lakota Indian adults.

OBJECTIVES: This study assessed specific dietary practices and overall physical activity patterns of Lakota adults residing on Indian reservations in South Dakota. Perceived barriers to changing dietary and physical activity behaviors were also examined. DESIGN: A convenience sample of Lakota adults was surveyed. Data on consumption of higher-fat foods, fruit and vegetable intake, use of sugar-sweetened beverages, physical activity patterns, and barriers to change in diet and physical activity were collected via in-person interviews. SUBJECTS/SETTING: A total of 219 adults from 2 adjacent reservations in South Dakota participated. RESULTS: Higher-fat foods consumed most frequently included margarine and butter (32.0% > or = 5 times per week); eggs (30.1% > or = 5 times per week); whole milk (25.7% > or = 5 times per week); potato chips, corn chips, and popcorn (15.1% > or = 5 times per week); and bacon and sausage (13.3% > or = 5 times per week). Few subjects reported consuming fruit on a daily basis. Vegetables were consumed somewhat more frequently. Most subjects reported engaging in mild or moderate physical activities 3 or more times per week, although women were found to engage in moderate and strenuous physical activities less frequently than men. Major barriers to fruit intake included expense (16.4%), quality (14.2%), and availability (13.2%). Barriers to vegetable intake mentioned most frequently included availability (11.4%), cost (10.4%), and quality (9.1%). Taste was the most frequently mentioned barrier to cutting intake of high-fat foods (27.9%). Lack of child care (15.8%), lack of time (14.7%), and safety concerns (14.6%) were the most salient barriers to regular exercise. APPLICATIONS/CONCLUSIONS: Nutrition interventions are needed that address the major barriers to diet change reported by Lakota adults. Efforts to increase physical activity should focus on Lakota women and should address the identified barriers to regular exercise.

The new confidentiality for the 21st century in a managed care environment.

As society becomes more dependent on technology to store and obtain information quickly and effectively, there has been increasing concern in the social work community about protecting privacy and maintaining confidentiality, especially in a managed care environment. The concept of confidentiality is very different in a technologically advanced environment. This article reviews relevant social work, legal, and other professional literature on confidentiality, technology, and managed care. A three-level topology of client problems and behaviors is delineated and illustrated through practice examples, which demonstrate the different types of information that can be computer stored and retrieved and electronically transmitted. The articles discussed the levels of security, including log-on procedures, firewalls, and encryption, which can be used at each level to protect sensitive information, and presents guidelines to help professionals protect and promote confidentiality within the constraints of technology and managed care.

Management of alternate level of care patients using a computerized database.

The term "alternate level of care" (ALC) refers to the status of hospitalized patients who are no longer acutely ill but cannot be discharged because posthospital plans are not yet in place. ALC is a major problem for patients, families, and hospitals. This article describes the experiences of an urban teaching hospital with ALC and the development of a computerized database to better manage the ALC population. Among the findings were that age, waiting for a nursing home placement, family-related discharge problems, and pending Medicaid eligibility all significantly contributed to length of stay beyond the acute phase of the illness. Using these data, the hospital developed an innovative program in which the preparation of Medicaid applications was transferred from the Department of Finance to the Department of Social Work Services.

Psychosocial factors as predictors of length of stay of Medicare patients under the prospective payment system.

The Prospective Payment System methodology is designed to predict inpatient hospital resource utilization. The system sets standards based on medical diagnosis (Diagnosis Related Groups), but it ignores psychosocial characteristics which often determine discharge options and therefore, directly affect a patient's length of stay. A study is described which examined the psychosocial characteristics of 234 elderly hospitalized patients in relation to length of stay and route of admission (elective or emergency room). Such data can be very useful to discharge planners in identifying high social risk patients, as well as to health planners attempting to modify the DRG methodology to incorporate psychosocial factors.