We estimate the effect of changes in the per capita expenditures of county departments of public health on county-level general health status. Using panel data on 40 counties in California (2001-2009), dynamic panel estimation techniques are combined with the Lewbel instrumental variable technique to estimate an aggregate demand for health function that measures the causal cumulative impact that per capita public health expenditures have on county-level general health status. We find that a $10 long-term increase in per capita public health expenditures would increase the percentage of the population reporting good, very good or excellent health by 0.065 percentage points. Each year expenditures were increased would result in ∼24,000 individuals moving from the 'poor or fair health' category to the 'good, very good or excellent health' category across these 40 counties. In terms of the overall impact of county public health departments on general health status, at current funding levels, each annual expenditure cycle results in over 207,000 individuals being in the 'good, very good or excellent' categories of health status rather than the 'poor or fair' categories.
Objectives: The objective was to assess the efficiency and safety of an interactive computer kiosk module for the management of uncomplicated urinary tract infections (UTI) in emergency departments (EDs).Methods: This was a prospective unblinded randomized trial. Women age 18 to 64 years seeking care for suspected UTI in three urban EDs were referred to a computer kiosk after triage. The kiosk evaluated women for uncomplicated UTI (based on patient report of at least one irritable voiding symptom within 7 days and absence of complicating features), and eligible patients were randomized to expedited management or usual ED care. Expedited management consisted of a brief clinician encounter to confirm computer kiosk responses and selection of one of four standard antibiotic regimens. Study outcomes included urine culture results, duration of ED visit, time to illness resolution, return visits, and satisfaction with care.Results: Seventeen percent (n = 103) of 624 participants with suspected UTI fulfilled uncomplicated criteria and were randomized. Sixty-nine percent of these women had a positive urine culture. 2,3 One approach to reduce crowding has been to reroute patients with low-acuity illnesses to primary care clinics. 4 However, this approach has not had a significant effect on the problem for a variety of reasons-one being limited access to primary care for underserved patient populations, such as those seeking care at safety net EDs.
5A computer kiosk module for expedited management of UTIs was found to be accurate, acceptable, and safe in an urgent care clinic setting.6 However, it is unclear whether the technology is suitable for the ED or whether these findings can be generalized to the ED, an often chaotic environment where care is more complicated and the patient population is particularly diverse. If successful in the ED, computer kioskexpedited management of low-acuity illnesses could be an important tool in efforts to improve efficiency of care, reduce ED wait times, and ease crowding.Our aim was to assess the efficiency and safety of kiosk management for women presenting to the ED with symptoms of UTI compared with usual (traditional)
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