Air, water, places, and data--public health in the information age.

This article discusses the implications of the Health Insurance Portability and Accountability Act of 1996, the National Health Information Infrastructure project of the National Committee on Vital and Health Statistics, and other standard development initiatives for future public health information systems.

Issues and opportunities in public health informatics: a panel discussion.

A panel was convened at the American Medical Informatics Association Spring Congress to discuss issues and opportunities that arise when informatics methods, theories, and applications are applied to public health functions. Panelists provided examples of applications that connect efforts between public health and clinical care, emphasizing the need for integration of clinical data with public health data and the analysis of those data to support surveillance and informed decision making. Benefits to be gained by both medical informatics and public health at the interface were evident; both encounter the same major issues including privacy, systems integration, standards, and many more.

Excess hospital admissions during the July 1995 heat wave in Chicago.

INTRODUCTION: This study describes medical conditions treated in all 47 non-VA hospitals in Cook County, IL during the 1995 heat wave. We characterize the underlying diseases of the susceptible population, with the goal of tailoring prevention efforts. METHODS: Primary and secondary discharge diagnoses made during the heat wave and comparison periods were obtained from computerized inpatient hospital discharge data to determine reasons for hospitalization, and comorbid conditions, respectively. RESULTS: During the week of the heat wave, there were 1072 (11%) more hospital admissions than average for comparison weeks and 838 (35%) more than expected among patients aged 65 years and older. The majority of this excess (59%) were treatments for dehydration, heat stroke, and heat exhaustion; with the exception of acute renal failure no other primary discharge diagnoses were significantly elevated. In contrast, analysis of comorbid conditions revealed 23% (p = 0.019) excess admissions of underlying cardiovascular diseases, 30% (p = 0.033) of diabetes, 52% (p = 0.011) of renal diseases, and 20% (p = 0.027) of nervous system disorders. Patient admissions for emphysema (p = 0.007) and epilepsy (p = 0.009) were also significantly elevated during the heat wave week. CONCLUSIONS: The majority of excess hospital admissions were due to dehydration, heat stroke, and heat exhaustion, among people with underlying medical conditions. Short-term public health interventions to reduce heat-related morbidity should be directed toward these individuals to assure access to air conditioning and adequate fluid intake. Long-term prevention efforts should aim to improve the general health condition of people at risk through, among other things, regular physician-approved exercise.

Impact of Medicaid resources on core public health responsibilities of local health departments in Illinois.

With Illinois' plan to embark on a statewide Medicaid managed care program, the impact of Medicaid resources on core public health responsibilities of local health departments (LHDs) was assessed and found to be substantial. A reduction of $330,000 in core public health activities would likely accompany each $1 million in Medicaid resources lost by these LHDs. Only by actively participating in the planning and implementation of these conversions can public health agencies maintain high productivity and efficiency in addressing core public health responsibilities in their communities.

Cancer incidence and age at northern migration of African Americans in Illinois, 1986-1991.

We compared the proportional cancer incidence of Illinois-born African Americans with those who migrated to Illinois from southern US states as children and adults, and with African American residents of the south. Adult Illinois residents, born between 1913 and 1966, who were diagnosed with cancer from 1986 through 1991 were classified by both birthplace and the state and year their social security number was assigned to determine their migration status: native, early (as child) migrant or late (as adult) migrant. African Americans of Atlanta were used to represent southern homeland ratios. Only lung cancer in African American females showed a statistically significant trend among the four groups, with Illinois native having the highest ratio. Although no trend was identified, Illinois natives had statistically significantly different ratios than both migrant groups and the southern homeland for cancers of the oral cavity (males), colon (females) and leukemias (females). The data also suggested that US regional differences in cancer ratios among African Americans exist (cancers of the prostate and testis, and in females, cancers of the oral cavity, esophagus and kidney), and among those African Americans that migrate to the north from the south, some cancer ratios also change (in males, cancers of the stomach colon, bladder and myeloma and in females, rectal cancer). Further, evidence was found in some cancer sites for the effect of the timing of northern migration on cancer risk (cancer of the rectum (males), liver (both sexes), and in females, cancer of the breast, stomach and nervous system).

Six principles of public health information.

The collection and analysis of data has been a fundamental activity of public health since the earliest times. Automated systems have enabled public health agencies to accumulate vast amounts of data. This data becomes useless without a systematic approach to convert it into information that directs action. Public health systems that manage service delivery should be integrated to maximize efficiency and minimize burdens upon program staff.

Motorcycle trauma in the state of Illinois: analysis of the Illinois Department of Public Health Trauma Registry.

STUDY OBJECTIVE: To assess the current morbidity and mortality of motorcycle trauma in the state of Illinois and, specifically, to assess the incidence and cost of head injury to motorcycle crash patients according to their helmet use. DESIGN: Retrospective, cross-sectional examination of the Illinois Department of Public Health Trauma Registry, for which data are available from July 1, 1991, through December 31, 1992. Data are collected from all hospitals designated as Level I or Level II trauma centers in Illinois. PARTICIPANTS: All patients involved in motorcycle crashes and subsequently taken to a Level I or Level II trauma center in Illinois and entered into the trauma registry during the period studied. RESULTS: Head injury, spinal injury, helmet use, demographic data, hospital charges, days in ICU, and source of payment were selected as outcome measures. During the 18-month study period, 1,231 motorcycle trauma patients were entered into the trauma registry. Eighteen percent were helmeted and 56.0% were nonhelmeted. In 26.0% the helmet status at the time of the crash was unknown. Thirty percent of the helmeted patients sustained head injury and 4% sustained spinal or vertebral injury, compared with 51% and 8%, respectively, for nonhelmeted patients. Nonhelmeted patients were significantly more likely to sustain severe (Abbreviated Injury Score [AIS], 3 or more) or critical (AIS, 5 or more) head injury. Patients with these serious head injuries incurred almost three times the hospital charges and used a disproportionately larger share of ICU days than those with mild or no head injuries. There was a trend toward greater use of public funds or self-pay status (no insurance) for payment of hospital charges in nonhelmeted patients. CONCLUSION: Motorcycle helmet nonuse was associated with an increased incidence of serious head injury. Motorcycle trauma patients with severe or critical head injuries used a significantly greater proportion of ICU days and hospital charges than those with mild or no head injuries.

Adaptation and customer expectations of health care options.

Customer expectations change as competition intensifies. The authors use adaptation and exchange theories to explain customer expectations, disconfirmation, and satisfaction as applied to three types of health care providers: physicians, walk-in clinics, and hospital emergency rooms. The results show how new referents for expectations challenge competitors to increase performance in order to match changing industry standards.

The effect of consumer perceptions on generic OTC usage among the elderly.

The rise of generic alternatives to branded over-the-counter products in the U.S. posits new strategic positioning challengers to marketers. Health care marketers who employ an "imitation strategy" have captured market share by emulating market leaders' product attributes. This implicitly calls for an understanding of the influence that consumers' product perceptions have on their choice of OTC offerings. This study investigates the influence of an elderly sample's perceptions of generic OTC characteristics on their adoption behavior.

Psychology of computer use: XXV. Locus of control, information-system dialogues, and end-users' satisfaction.

This study examined the correlation of locus of control and end-users' satisfaction for three computer dialogue treatments--question/answer, menu, and command language. In the present study, 390 subjects were classified as internally or externally oriented according to an abbreviated form of Rotter's I-E Scale. Subjects then utilized an information system possessing one of three randomly selected dialogues to solve a problem in selecting employees. Their over-all satisfaction with the system was measured. Analysis of variance did not support the hypothesis that locus of control is associated with users' satisfaction.

Catalysts for OTC drug communication strategies: perceptions of information source characteristics by the elderly.

The elderly are the prime users of all medication and especially self-medication using Over-the-Counter (OTC) drugs. This group also has the greatest risk from misuse or interaction of multiple medications. To minimize the risk, information about OTC consumption must be provided to the elderly. This research reports on the importance of various information sources to light and heavy users of OTC medications among the elderly and an evaluation of those information sources with respect to perceived expertise, credibility, understandability and relevance. Communication strategies are suggested for reaching this at-risk group.

Private physicians or walk-in clinics: do the patients differ?

The authors use a consumer-oriented framework to compare patients of private physicians with those of walk-in clinics in terms of factors that influence selection of health care providers. Data suggest few differences in the way the two types of providers are perceived by their patients. Instead, a fairly strong income effect suggests that segmentation strategies for health care delivery systems should be reevaluated. The results provide insights for applying strategic marketing concepts within health care delivery systems.

Stability of the isolation/disengagement relationship across age groups.

Research has indicated isolated elderly persons are either engaged or voluntarily disengaged. The present assessment was whether this relationship holds across age subgroups. While the general relationship did hold true for all age groups, the 55-64 age group was less engaged than their older cohorts. The level and type of disengagement appears to be dependent upon life situations and can decrease with age.

A short course on motor vehicle injury for emergency medicine residents.

Despite growing interest and activity by emergency physicians in injury prevention, we found no reports of any attempts to include injury control concepts in emergency medicine residency training. An existing course for graduate level public health students on motor vehicle injury was modified for emergency medicine residents, presented as a one-day short course, and evaluated. The objective of the course was to provide information regarding the dynamics and prevention of motor vehicle crashes. An equally important second objective was to demonstrate to the residents the need for emergency physicians as part of the injury control research team. The content of the course was based on the conceptual model in which a motor vehicle crash is analyzed in terms of precrash, crash, and post-crash factors. The correlation between the mechanism of injury and the types of injuries experienced was of particular interest. A one-day format was found to be too concentrated. The incorporation of injury prevention concepts and research methods into the grand rounds, journal club, and conferences of the emergency medicine residency is recommended. Educational objectives and practical suggestions for implementation are provided. A comprehensive reading list is available on request.

Building an effective competitive intelligence system for health care service providers.

With the increasing competitiveness of the health care marketplace, the need for information by service providers has increased concomitantly. In response to this need, strategic and competitive intelligence systems have emerged as a vital source of information. This article establishes a basis for the development and operation of a competitive intelligence system. Initially, strategic and competitive intelligence systems are conceptualized, then followed by a discussion of the areas which are candidates for inclusion in the intelligence system. The remainder of the article focuses on system development and operation. Attention also is directed toward information utilization and integration.

Walk-in-clinics versus private practitioners: determinant attributes of health care provider choice among the elderly.

This study investigated the perceptions of elderly individuals concerning their choice between two types of health care facilities: walk-in-clinics and private practitioners. A determinant attribute approach was employed using the perceptions of the elderly on twenty-six attributes and the importance of each of these attributes in choosing a health care facility. It was found that quality, sociopsychological, and economic attributes were determinant while convenience attributes were not determinant. Implications for health care providers are discussed.

Vital records in the development of injury control research.

Most of the resources of the emergency physician are devoted to persons already injured, with little emphasis on prevention. Analyses of state and local injury statistics are necessary to identify local prevention needs in order to set program priorities. We discuss an example, an analysis of statewide injury fatalities identified through the Illinois Vital Records database. The overall death rate for injuries in illinois was lower than that found for the United States. However, the need for research on several high-risk age groups for certain injuries was identified. Most notably, the homicide rate for those 15 to 24 years old was 140% of the national rate. Other specific nonwhite age groups were overrepresented in poisoning, fire, and firearm deaths, while specific white age groups were overrepresented in suicide, fall, and drowning deaths. The research regarding the etiologies of these injuries and the formulation and evaluation of prevention strategies based on this research must be interdisciplinary. The emergency physician is in a unique position to serve as a member of such an interdisciplinary injury control team, but currently there is little emphasis on or training for this role.