Search

Background: In the United States, a long-standing debate has existed over advantages/disadvantages of general versus specialty hospitals. A recent stream of research has investigated whether general hospitals accrue performance benefits from a focus strategy; a strategy of specializing in certain clinical conditions while remaining a multiproduct firm. In contrast, a substantial and long-standing body of research on hospitals has been concerned with the absolute volume of cases in a service area as an indication of experience based largely on the idea that absolute volume confers learning opportunities. Purpose: We investigated whether hospital focus and experience in a service area have complementary effects or are largely substitutive for hospital performance. Methodology/Approach: Key data sources were patient discharge records and hospital discharge profiles from California's Office of Statewide Health Policy and Development for years 2010--2014. We specified hospital focus as the proportion of total cardiology-related discharges and hospital experience as the cumulative volume of cardiology-related discharges for each hospital. Performance was specified using quality (inpatient mortality and 30-day readmission) and efficiency (length of stay and cost) patient-level performance metrics. We analyzed the data using logistic and log-linear ordinary least squares regression models. Results: Study results generally supported our hypotheses that focus and experience are related to better quality and efficiency performance and that the effects are largely substitutive for hospitals. Conclusion: Our study extends the literature by finding that hospitals exhibit distinct and stable patterns regarding their positioning on focus and experience and that these patterns have important implications for hospitals' performance in terms of quality and efficiency. Practice Implications: Many general hospitals in the United States may be stretched too thin across service areas for which they lack necessary patient volumes for clinical proficiency. A viable alternative is to select a limited set of service areas on whichtofocus. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to examine access, engagement, and quitting behaviors of American Indian/Alaska Native (AIAN) callers to the California Smokers' Helpline. Telephone counseling is the primary function of the quitline. The overarching theoretical framework for California's quitline is social cognitive theory, although it also utilizes motivational interviewing and cognitive-behavioral strategies.Aims and Methods: AIAN (n = 16 089) and White (n = 173 425) California quitline callers from 2009 to 2018 were compared on their characteristics, engagement, and quitting behaviors. Quitline callers responded to a telephone survey at intake. A random selection was called for evaluation 7 months later (White n = 8194, AIAN n = 764). Data from the 2009 to 2017 California Health Interview Survey (CHIS) were used as a reference point for AIANs (AIAN n = 1373).Results: The quitline and CHIS had similar proportions of AIANs (4.6% vs. 4.3%, respectively). AIAN smokers were more likely than White smokers to report physical (53.6% vs. 44.9%) and mental (65.7% vs. 57.8%) health conditions at intake. AIANs were more likely to participate in counseling than White callers (67.1% vs. 65.7%). Among those who received counseling, AIANs had greater odds than White smokers of making a quit attempt (adjusted odds ratio = 1.39 [1.06, 1.81]) and similar odds of quitting for 180 days (adjusted odds ratio = 0.95 [0.69, 1.31]).Conclusions: Rates of access, engagement, and quitting suggest that individualized quitline counseling was as effective with AIANs as it was with White smokers. Increasing efforts to refer AIANs to existing state quitlines can help more smokers quit.Implications: This study showed that AIAN smokers were well represented among California quitline callers, even without a targeted campaign. It also found that AIAN smokers engaged in quitline services and were as able to quit as their White counterparts were, even after adjusting for other baseline characteristics. One implication is that public health programs can promote quitlines using broad-based campaigns knowing that they will still motivate AIAN smokers to seek help. Another implication is that a standard, individualized counseling protocol delivered by culturally competent quitline staff can effectively help AIAN smokers to quit. [ABSTRACT FROM AUTHOR]

Many low-angle normal faults (dip =30°) accommodate tens of kilometers of crustal extension, but their mechanics remain contentious. Most models for low-angle normal fault slip assume vertical maximum principal stress s1, leading many authors to conclude that low-angle normal faults are poorly oriented in the stress field (=60° from s1) and weak (low friction). In contrast, models for low-angle normal fault formation in isotropic rocks typically assume Coulomb failure and require inclined s1 (no misorientation). Here, a data-based, mechanical-tectonic model is presented for formation of the Whipple detachment fault, southeastern California. The model honors local and regional geologic and tectonic history and laboratory friction measurements. The Whipple detachment fault formed progressively in the brittle-plastic transition by linking of "minidetachments," which are small-scale analogs (meters to kilometers in length) in the upper footwall. Minidetachments followed mylonitic anisotropy along planes of maximum shear stress (45° from the maximum principal stress), not Coulomb fractures. They evolved from mylonitic flow to cataclasis and frictional slip at 300-400 °C and ~9.5 km depth, while fluid pressure fell from lithostatic to hydrostatic levels. Minidetachment friction was presumably high (0.6-0.85), based upon formation of quartzofeldspathic cataclasite and pseudotachylyte. Similar mechanics are inferred for both the minidetachments and the Whipple detachment fault, driven by high differential stress (~150-160 MPa). A Mohr construction is presented with the fault dip as the main free parameter. Using "Byerlee friction" (0.6-0.85) on the minidetachments and the Whipple detachment fault, and internal friction (1.0-1.7) on newly formed Reidel shears, the initial fault dips are calculated at 16°-26°, with s1 plunging ~61°-71° northeast. Linked minidetachments probably were not well aligned, and slip on the evolving Whipple detachment fault probably contributed to fault smoothing, by off-fault fracturing and cataclasis, and to formation of the fault core and fractured damage zone. Stress rotation may have occurred only within the mylonitic shear zone, but asymmetric tectonic forces applied to the brittle crust probably caused gradual rotation of s1 above it as a result of: (1) the upward force applied to the base of marginal North America by buoyant asthenosphere upwelling into an opening slab-free window and/or (2) basal, top-to-the-NE shear traction due to midcrustal mylonitic flow during tectonic exhumation of the Orocopia Schist. The mechanical-tectonic model probably applies directly to low-angle normal faults of the lower Colorado River extensional corridor, and aspects of the model (e.g., significance of anisotropy, stress rotation) likely apply to formation of other strong low-angle normal faults. [ABSTRACT FROM AUTHOR]

A dramatic change in the hospital industry is the increasing emphasis on linking provider payment to quality performance metrics. This is one of several considerations leading hospitals to employ physicians. Yet, there is little evidence regarding whether physician employment as a form of hospital‐physician integration leads to better operational performance. Using data from 201 California hospitals that experienced a total of 405,766 eligible opportunities to conform to external performance metrics (conformance quality) for treating patients in the cardiovascular service area, we empirically evaluated the relationship between physician employment and conformance quality. We also evaluated whether the presence of core capabilities in the hospital's cardiovascular service area complements or substitutes for physician employment. Findings suggest that physician employment is not only positively associated with conformance quality, but also associated with more consistent conformance quality. Moreover, the presence of core capabilities in the service area substitutes for physician employment. Theoretical, managerial, and policy implications are discussed. [ABSTRACT FROM AUTHOR]

Under the current policy decision making paradigm we make or evaluate a policy decision by intervening different socio-economic parameters and analyzing the impact of those interventions. This process involves identifying the causal relation between interventions and outcomes. Matching method is one of the popular techniques to identify such causal relations. However, in one-to-one matching, when a treatment or control unit has multiple pair assignment options with similar match quality, different matching algorithms often assign different pairs. Since all the matching algorithms assign pairs without considering the outcomes, it is possible that with the same data and same hypothesis, different experimenters can reach different conclusions creating an uncertainty in policy decision making. This problem becomes more prominent in the case of large-scale observational studies as there are more pair assignment options. Recently, a robust approach has been proposed to tackle the uncertainty that uses an integer programming model to explore all possible assignments. Though the proposed integer programming model is very efficient in making robust causal inference, it is not scalable to big data observational studies. With the current approach, an observational study with 50,000 samples will generate hundreds of thousands binary variables. Solving such integer programming problem is computationally expensive and becomes even worse with the increase of sample size. In this work, we consider causal inference testing with binary outcomes and propose computationally efficient algorithms that are adaptable for large-scale observational studies. By leveraging the structure of the optimization model, we propose a robustness condition that further reduces the computational burden. We validate the efficiency of the proposed algorithms by testing the causal relation between the Medicare Hospital Readmission Reduction Program (HRRP) and non-index readmissions (i.e., readmission to a hospital that is different from the hospital that discharged the patient) from the State of California Patient Discharge Database from 2010 to 2014. Our result shows that HRRP has a causal relation with the increase in non-index readmissions. The proposed algorithms proved to be highly scalable in testing causal relations from large-scale observational studies. [ABSTRACT FROM AUTHOR]

Efficiency in supply chain operations is increasingly a key strategic goal as organizations focus on containing cost. This is especially the case for hospitals where supply chain costs account for a substantial portion of operating budgets. In this study, we examine the impact of incentive mechanisms for internal stakeholders and negotiating leverage with external partners on supply chain efficiency in the hospital industry. We premise the study on agency, stewardship, and power theories. We use data from over 200 California hospitals in a five-year period (pooled data) to estimate regression models using generalized estimating equation. We find that physician employment and contract management enhance supply chain efficiency. Surprisingly, we did not find that better supply chain efficiency was associated with either hospital affiliation with systems or high-volume purchases through large national group purchasing organizations. The results have important theoretical and managerial implications for supply chain management. [ABSTRACT FROM AUTHOR]

Much recent research on sexual minorities has used couples-based samples, which--by construction--provide no information on nonpartnered individuals. We present the first systematic empirical analysis of partnership and cohabitation among self-identified gay men and lesbians using two independent, large, population-wwbased data sources from California. These data indicate that 37%-46% of gay men and 51%-62% of lesbians aged 18-59 are in cohabiting partnerships (compared with 62% of heterosexual individuals in coresidential unions at comparable ages). Unlike previous research, we find that white and highly educated gay men and lesbians are more likely to be partnered, and we confirm that same-sex cohabiting partners in our data have demographic characteristics that are similar to California same-sex couples from Census 2000. We also present the first detailed analysis of officially registered domestic partnerships in California. We find that almost half of partnered lesbians are officially registered with the local or state government, while less than a quarter of partnered gay men are officially registered. We conclude with implications of our findings for couples-based research on gay men and lesbians, as well as recommendations for survey data collection. [ABSTRACT FROM AUTHOR]

Between Utopian visions of a profoundly suburban American idyll that appeared in gallery spreads in magazines and pompous architectural journal epistles in the 1920s and '30s and the epically ignorant and sophomoric self-satisfaction of Ozzie and Harriet in the 1960s lay just a few decades that produced an historically rare episode in the United States — a pause for introspection and uncertainty. While some of this is owed to The Bomb, HUAC, and an upheaval of collective national sacrifice through the 1940s and early 1950s, the literature and film produced at the time was routinely of high caliber and often singularly inventive. None outstrips film noir, the celluloid expression of a collective national unease, and no place offers a better geography for noir than Los Angeles. Examining three of what can be considered classic L.A. noir films, we then jump ahead to look at the genre's reemergence in Chinatown, Blade Runner, L.A. Confidential, and Pulp Fiction, each offering a novel reconditioning of noir themes. [ABSTRACT FROM AUTHOR]

Focuses on the similarity between market concentration and pricing patterns of nonprofit hospitals in California. Effects of market concentration and horizontal mergers on hospital costs and prices; Impact of hospital market structure on patient volume; Influence of hospital competition in a market on price inflation.

Presents data suggesting that differential stress was elevated around the Whipple detachment. Character of the state of stress; Angle between the conjugate faults ; Effective least principal stress during conjugate faulting; Impact of rapid mineralization in the surroundings of major fault zones.

Fiscal pressures on California cities have been severe since the passage of Proposition 13. Federal and state aid policies have, in fact, exacerbated an already wrenching pattern of revenue losses since FY 77-78. State aid, in particular, has perversely dropped the most for those cities hit hardest by reductions in other revenues outside their direct control. Despite this, California cities have kept total real per capita revenues and expenditures constant over this period by increasing revenues from a variety of local sources—and especially from current service charges for enterprise activities. Furthermore, cities hit hardest by exogenous revenue losses have increased locally raised revenues the most. In short, cities in California have responded to reductions in revenues outside their direct control by increasing revenues from sources within their direct control, rather than by reducing expenditures and their revenue-increasing responses have tended to be in proportion to the losses they have faced in exogenous revenues. [ABSTRACT FROM AUTHOR]

Examines the results of the study which shows a continuation of the Oak Ridge fault system as the source of the January 17, 1991 Northridge earthquake in California. Description of the fault; Analysis of the earthquake; Results of footwall uplift in the fault system.

Objective: There are very few population-based studies of long-term outcomes after lower extremity (LE) bypass graft surgery. This study analyzes perioperative and long-term limb salvage and amputation-free survival outcomes for patients undergoing initial aortoiliac or femoropopliteal bypass graft surgery in California hospitals from 1996 to 1999. Methods: Administrative data with encrypted identifiers were used to identify a chronologically first, index admission of all patients undergoing LE bypass procedures for occlusive disease from 1996 to 1999. A 1993 to 1995 look-back period was used to exclude patients who had undergone prior bypass surgery or amputation procedures. Patients with incident procedures were then followed forward to determine subsequent hospitalizations and vital status through 2004. The study comprised 28,128 patients discharged from 345 California hospitals with a median 61.5-month follow-up. Risk factors included demographic characteristics, comorbid conditions, admission type, gangrene or ulceration, operation level, hospital LE bypass surgery volume, and year of discharge. Logistic regression was used to analyze 30-day outcomes, and Kaplan-Meier analysis and Cox proportional hazard models were used to analyze amputation-free survival. Results: Overall 30-day mortality was 4.3, and the 30-day major amputation rate was 2.6%. Limb salvage was 81.9% at 5 years and 76.4% at 9 years. Amputation-free survival was 51.5% at 5 years and 34.1% at 9 years. Risk factors were generally similar for both perioperative and late outcomes. Advanced age, higher comorbidity level, gangrene, and emergency or nursing home admission conferred significantly greater risk. Hospital volume was associated with both perioperative and late outcomes. African American and Hispanic patients had much higher amputation rates but did not have higher mortality risk after controlling for baseline severity of illness. Conclusions: Long-term outcomes of LE bypass surgery were superior for high-volume hospital patients. Graft surveillance and risk factor follow-up care provide a major opportunity for quality improvement efforts. The contrast between traditional limb salvage and amputation-free survival outcomes raises questions about the value of surgical treatment, particularly for patients with limited life expectancy and without coding of tissue loss or critical limb ischemia. [Copyright &y& Elsevier]

Describes the subsurface geometry of active faults that cut the surface and Quarternary blind faults and folds of the northern Los Angeles fault system in California. Regional setting; Alluvial fan deposits; Three types of crystalline basement rocks; Santa Monica fault system; Structures east of the west Beverly Hills lineament; Newport-Inglewood fault zone.

A multichannel seismic (MCS) experiment spanning 600 km across the Alarcón Rise and its conjugate rifted margins in the southern Gulf of California (western North America) provides insight into the spatial and temporal evolution of extension between Baja California and the mainland (Mexico). Stratigraphic analysis of multiple rift basins within the Alarcón spreading corridor indicates an initial stage of oblique extension starting ca. 14-12 Ma. This initial phase of extension was characterized by the formation of several large basins in the center of the gulf and on the southeast margin with negligible synrift sedimentation. A second phase of oblique extension, likely synchronous with large-scale basin opening in the central and northern Gulf of California, began ca. 8-5 Ma and was characterized by the formation of smaller half-grabens distributed across the conjugate margins that contain both synrift and postrift deposits. A key feature imaged within the MCS data is a highly refl ective, ropey layer at the top of basement, interpreted to be either volcanic rocks from the 25-12 Ma Comondú Group, and/or early rifting volcanic rocks that are between 11 and 9 Ma, or younger. This volcanic layer is extensively faulted, suggesting that it predates the episode of early extension. Upper crustal extension appears to be equally distributed across conjugate margins, forming a symmetrical continental rift. Two styles of rifted basin are observed; older basins (estimated as 14-11 Ma using sedimentation rates) show distributed extension with extensive basement faulting. In contrast, the younger basins (likely post-6 Ma) are asymmetrical with synrift deposits thickening into the basin-bounding faults. The northeastsouthwest geomorphic expression of the Tamayo bank and trough and other features provides additional evidence that northwestsoutheast oblique extension began ca. 12 Ma. These new spatial and temporal constraints, when combined with a crustal thickness profi le obtained across the entire Alarcón corridor, suggest that signifi cant northwestsoutheast oblique extension within the Gulf of California started well before 6 Ma, in contrast to earlier models. [ABSTRACT FROM AUTHOR]

Structural and stratigraphic analyses along the western margin of the Salton Trough show that the San Andreas fault system was reorganized in early Pleistocene time from a system dominated by two fault zones (the San Andreas fault and the West Salton detachment fault) to a network of dextral faults that include the San Andreas and at least four dextral faults to the southwest. The San Felipe fault zone, one of these dextral faults, has ~5.8 ± 2.8 km of right separation and consists of three principal faults in the Peninsular Ranges. These are the San Felipe fault in the WNW, Sunset fault in the middle, and Fish Creek Mountains fault in the ESE. They form a left-stepping array and bound domains in which the Sunset Conglomerate, the older West Salton detachment fault, and Cretaceous mylonitic rocks below the detachment are folded about WNW-trending folds. A complex flower structure within the left-stepovers probably produced this fault-parallel folding. Because all the rocks within stepovers of the San Felipe fault zone, from Cretaceous to Pleistocene, are deformed about WNW-trending folds and record broadly similar shortening strains, we infer a Quaternary age of deformation. Parts of the San Felipe fault zone cut latest Pleistocene to Holocene surficial deposits, and the fault zone is likely active. Evidence for early Pleistocene initiation of the San Felipe fault zone is preserved in conglomerate NE of the Sunset fault. Poorly sorted angular boulder conglomerate and pebbly sandstone of the Sunset Conglomerate are ~600 m thick and lie in angular unconformity on the Pliocene Palm Spring Group. The conglomerate coarsens upward and toward the fault, and is dominated by plutonic clasts derived from SW of it. Conglomerate beds contain up to 10% sandstone clasts recycled from older basin fill and accumulated in proximal to medial alluvial fans that were shed to the NE from uplifted rocks along the then-active Sunset fault. Based on lithologic, stratigraphic, structural, and compositional similarities, we correlate the Sunset Conglomerate to the Pleistocene Ocotillo Formation. Clasts of recycled sandstone record erosion of detachment-related basin fill that predates the San Felipe fault and once covered the Vallecito and Fish Creek mountains. These crystalline-cored mountain ranges first emerged from beneath basin fill during early slip above the nascent San Felipe fault ca. 1.1-1.3 Ma. Later, the San Felipe fault zone cut upward, folded, cut across, and deactivated the West Salton detachment fault within a ~9-km-wide contractional bend and pair of left-steps. Areas that accumulated sediment within this step-over zone between ca. 1.1 and ca. 0.6 Ma are currently being inverted and folded. Initiation of the San Felipe fault in early Pleistocene time was a significant event in the reorganization of the southern San Andreas fault system. The Quaternary dextral faults broadened the plate boundary zone southwestward from roughly 25 km (during coeval slip on the San Andreas fault and West Salton detachment fault) to 50-70 km, and mark a change in the dominant structural style from transtension to distributed dextral faulting south of the Big Bend. [ABSTRACT FROM AUTHOR]

We used submerged paleoshorelines as strain markers to investigate Holocene and late Pleistocene vertical tectonic movement at the intersection of the offshore Santa Cruz--Catalina Ridge with the southern boundary of the Western Transverse Ranges, within the California Continental Borderland. Past submerged shoreline positions were identified using high-resolution multibeam bathymetry, side-scan sonar, submersible observations, and the presence of intertidal and subtidal invertebrate fossils. Numerous accelerator mass spectrometry (AMS) 14C ages of shells from these paleoshorelines were found to be between ~27,000 yr radiocarbon (RC) and 11,500 yr before present, indicative of shoreline colonization during and following the Last Glacial Maximum (LGM), establishing these paleoshorelines as a usable datum for measuring vertical change since this time. Removal of the nontectonic component of vertical change using an ice-volume-equivalent eustatic sea-level compilation indicates between 20 and 45 m of uplift of the eastern part of the Northern Channel Islands block since the LGM lowstand, resulting in an uplift rate of 1.50 ± 0.59 mm/yr over the last 23 k.y. This rate closely matches uplift predicted by published slip rates for the Channel Islands thrust, which underlies the Northern Channel Islands platform. Results from post-LGM shoreline features on Pilgrim Banks are somewhat more ambiguous. Submarine paleoshoreline uplift, together with the extensive upper-crustal fold-thrust style of deformation, illustrates the transpressional interaction of the Borderland and the Western Transverse Ranges blocks where the Santa Cruz-Catalina Ridge and northern Channel Islands intersect. [ABSTRACT FROM AUTHOR]

Late Miocene to early Pliocene deposits at Split Mountain Gorge, California, preserve a record of basinal response to changes in regional tectonics, paleogeography, and evolution of the Colorado River. The base of the Elephant Trees Formation, magnetostratigraphically dated as 8.1 ± 0.4 Ma, provides the earliest well-dated record of extension in the southwestern Salton Trough. The oldest marine sediments are ca. 6.3 Ma. The nearly synchronous timing of marine incursion in the Salton Trough and northern Gulf of California region supports a model for localization of Pacific-North America plate motion in the Gulf ca. 6 Ma. The first appearance of Colorado River sand at the Miocene-Pliocene boundary (5.33 Ma) suggests rapid propagation of the river to the Salton Trough, and supports a lake-spillover hypothesis for initiation of the lower Colorado River. [ABSTRACT FROM AUTHOR]

Introduction: Cigarette smoking continues to decline in the U.S., but cannabis use is increasing. Many people who smoke cigarettes also use cannabis. This study examines the characteristics of persons who co-use and those who do not co-use and the likelihood of quitting cigarettes for callers to Kick It California, a large state tobacco quitline., Methods: Data were examined from Kick It California callers from January 2020 through December 2023 (N=45,151), including those from a subgroup randomly sampled and reached for evaluation at 7 months after quitline enrollment (n=3,545). The rate of cigarette smoking cessation at 7 months after enrollment for people who co-use cannabis was compared with that for people who do not. Analyses started in 2023 and concluded in January 2024., Results: More than a quarter (27.2%) of Kick It California callers co-used cannabis. They were more likely to be male, to be younger, and to have a mental health condition than those who did not. Those who co-use cannabis and those who do not have similar rates of receiving quitline counseling or using Food and Drug Administration-approved cessation aids. Controlled for effects of personal characteristics and use of smoking-cessation services, people who co-use cannabis were less likely to quit cigarette smoking 7 months after enrollment (23.2% vs 28.9%; p<0.001). Among those who co-use, 42.9% intended to quit using cannabis in the next 30 days., Conclusions: A substantial percentage of tobacco quitline callers use cannabis. Those who do co-use quit cigarette smoking at a lower rate than those who do not. Over 40% of people who co-use reported intention to quit cannabis, making tobacco quitlines a rich environment to learn about people who co-use and develop strategies for intervention., (Copyright © 2024 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Sipha maydis Passerini (Heteroptera: Aphididae) is a cereal pest with an extensive geographical range that includes countries in Europe, Asia, Africa, and South America. Reports of S. maydis in the United States have been infrequent since it was first detected in California, 2007. Two studies, focused (NW CO) and multistate (OK, TX, NM, CO, UT, WY), were conducted to determine the distribution and host range of S. maydis in the Rocky Mountain and Southern Plains states over a 3-yr period, 2015-2017. In 2015, focused sampling in NW Colorado found S. maydis at 59% of the 37 sites, primarily on wheat. Sipha maydis did not survive extreme winter temperatures from late December 2015 to early January 2016 that ranged from -9.0 to -20.9°C over a 9-d period, which resulted in no aphids detected in 2016. In the multistate study, S. maydis occurred in 14.6% of 96 sites sampled in 2015, 8% of 123 sites in 2016, and 9% of 85 sites in 2017 at wide range of altitudes from 1,359 to 2,645 m. Sipha maydis occurred mainly in NW and SW Colorado and NE New Mexico along with a few sites in NE Colorado, SE Utah, and SE Wyoming. This aphid mainly infested wheat followed by a variety of eight wild grass species. No parasites, predators, sexual morphs, or significant plant damage occurred at the sites. Sipha maydis utilized 14 hosts in the United States including 8 new host records, which expands its host range to 52 plant species worldwide. Sipha maydis may be of concern to wheat, barley, and sorghum production in the United States if its populations continue to increase., (Published by Oxford University Press on behalf of Entomological Society of America 2019.)

Background: Although telephone counseling services (quitlines) have become a popular behavioral intervention for smoking cessation in the United States, such services are scarce for Asian immigrants with limited English proficiency. In this study, we tested the effects of telephone counseling for smoking cessation in Chinese-, Korean-, and Vietnamese-speaking smokers., Methods: A culturally tailored counseling protocol was developed in English and translated into Chinese, Korean, and Vietnamese. We conducted a single randomized trial embedded in the California quitline service. Smokers who called the quitline's Chinese, Korean, and Vietnamese telephone lines between August 2, 2004, and April 4, 2008, were recruited to the trial. Subjects (N = 2277) were stratified by language and randomly assigned to telephone counseling (self-help materials and up to six counseling sessions; n = 1124 subjects) or self-help (self-help materials only; n = 1153 subjects) groups: 729 Chinese subjects (counseling = 359, self-help = 370), 848 Korean subjects (counseling = 422, self-help = 426), and 700 Vietnamese subjects (counseling = 343, self-help = 357). The primary outcome was 6-month prolonged abstinence. Intention-to-treat analysis was used to estimate prolonged abstinence rates for all subjects and for each language group. All statistical tests were two-sided., Results: In the intention-to-treat analysis, counseling increased the 6-month prolonged abstinence rate among all smokers compared with self-help (counseling vs self-help, 16.4% vs 8.0%, difference = 8.4%, 95% confidence interval [CI] = 5.7% to 11.1%, P < .001). Counseling also increased the 6-month prolonged abstinence rate for each language group compared with self-help (counseling vs self-help, Chinese, 14.8% vs 6.0%, difference = 8.8%, 95% CI = 4.4% to 13.2%, P < .001; Korean, 14.9% vs 5.2%, difference = 9.7%, 95% CI = 5.8% to 13.8%, P < .001; Vietnamese, 19.8% vs 13.5%, difference = 6.3%, 95% CI = 0.9% to 11.9%, P = .023)., Conclusions: Telephone counseling was effective for Chinese-, Korean-, and Vietnamese-speaking smokers. This protocol should be incorporated into existing quitlines, with possible extension to other Asian languages.

Background: Smokers seeking treatment to quit smoking are generally not assessed for current depression, yet depression among smokers may influence quitting outcome., Purpose: This study aims to formally assess current major depression among smokers calling a state tobacco quitline., Methods: A total of 844 smokers calling the California Smokers' Helpline in 2007 were screened for depression by the mood module of the Patient Health Questionnaire (PHQ-9). The Social Functioning Questionnaire (SFQ) also was administered to these callers. Two months after the screening, follow-up evaluations were conducted to assess cessation outcome., Results: In all, 24.2% of smokers met criteria for current major depression and 16.5% reported symptoms indicating mild depression. Callers with current major depression were more likely to be heavy smokers and on Medicaid. Moreover, 74.0% of smokers with current major depression had substantial social and occupational functioning deficits. Two months later, those with major depression at baseline were significantly less likely to have quit smoking (18.5% vs 28.4%)., Conclusions: Almost one in four smokers who called the California Smokers' Helpline met criteria for current major depression. More than 400,000 smokers call state quitlines in the U.S. for help with quitting each year, which means that as many as 100,000 smokers with serious depressive symptoms are using these services annually. The large number of depressed smokers who seek help suggests a need to develop appropriate interventions to help them quit successfully., (Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

The shift from local, community-based organizations to more complex delivery systems raises questions about the community orientation and accountability of health systems and their affiliates. This study examines whether hospitals affiliated with health care systems are more or less likely to engage in practices that reflect responsibility to their local communities by providing benefits in the form of uncompensated care, community engagement, Medicaid caseload, and accessible pricing policies. Using audited state data and other sources, we performed a longitudinal analysis on a pooled cross-sectional data file for the years 1989-2003 for all hospitals in Texas, California, and Florida. Results indicate that when compared to independent hospitals, system affiliation is associated with less community benefit. However, the level of community benefit varies depending on the type of community benefit examined and the structural characteristics of the system with which a hospital is affiliated. Results further suggest that the level and type of community benefit is conditioned by the market under which system-affiliated hospitals operate.

Objective: To compare the costs of physician-owned cardiac, orthopedic, and surgical single specialty hospitals with those of full-service hospital competitors., Data Sources: The primary data sources are the Medicare Cost Reports for 1998-2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database., Study Design: We identified all physician-owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full-service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t-tests of significance compared the inefficiency measures of specialty hospitals with those of full-service hospitals to make general comparisons between these classes of hospitals., Principal Findings: Results do not provide evidence that specialty hospitals are more efficient than the full-service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect., Conclusions: Policymakers should not embrace the assumption that physician-owned specialty hospitals produce patient care more efficiently than their full-service hospital competitors.

Pay-for-quality (P4Q) initiatives are becoming an increasingly popular mechanism for improving quality performance and reducing health care costs in the United States. Because these programs often target primary care physicians, it is important to understand how these physicians perceive and respond to P4Q to design successful programs going forward. This study reports results of a survey regarding attitudes toward P4Q among physicians participating in such programs in Massachusetts and California. Findings indicate physicians have generally positive attitudes toward the concept of P4Q, but are ambivalent about certain features of these programs as currently designed and implemented.

Background: Telephone services that offer smoking-cessation counseling (quitlines) have proliferated in recent years, encouraged by positive results of clinical trials. The question remains, however, whether those results can be translated into real-world effectiveness., Methods: We embedded a randomized, controlled trial into the ongoing service of the California Smokers' Helpline. Callers were randomly assigned to a treatment group (1973 callers) or a control group (1309 callers). All participants received self-help materials. Those in the treatment group were assigned to receive up to seven counseling sessions; those in the control group could also receive counseling if they called back for it after randomization., Results: Counseling was provided to 72.1 percent of those in the treatment group and 31.6 percent of those in the control group (mean, 3.0 sessions). The rates of abstinence for 1, 3, 6, and 12 months, according to an intention-to-treat analysis, were 23.7 percent, 17.9 percent, 12.8 percent, and 9.1 percent, respectively, for those in the treatment group and 16.5 percent, 12.1 percent, 8.6 percent, and 6.9 percent, respectively, for those in the control group (P<0.001). Analyses factoring out both the subgroup of control subjects who received counseling and the corresponding treatment subgroup indicate that counseling approximately doubled abstinence rates: rates of abstinence for 1, 3, 6, and 12 months were 20.7 percent, 15.9 percent, 11.7 percent, and 7.5 percent, respectively, in the remaining subjects in the treatment group and 9.6 percent, 6.7 percent, 5.2 percent, and 4.1 percent, respectively, in the remaining subjects in the control group (P<0.001). Therefore, the absolute difference in the rate of abstinence for 12 months between the remaining subjects in the treatment and control groups was 3.4 percent. The 12-month abstinence rates for those who made at least one attempt to quit were 23.3 percent in the treatment group and 18.4 percent in the control group (P<0.001)., Conclusions: A telephone counseling protocol for smoking cessation, previously proven efficacious, was effective when translated to a real-world setting. Its success supports Public Health Service guidelines calling for greater availability of quitlines., (Copyright 2002 Massachusetts Medical Society)