Richard Conviser - Academia.edu (original) (raw)
Papers by Richard Conviser
Medical care, 2005
Rapid changes in HIV epidemiology and antiretroviral therapy may have resulted in recent changes ... more Rapid changes in HIV epidemiology and antiretroviral therapy may have resulted in recent changes in patterns of healthcare utilization. The objective of this study was to examine sociodemographic and clinical correlates of inpatient and outpatient HIV-related health service utilization in a multistate sample of patients with HIV. Demographic, clinical, and resource utilization data were collected from medical records for 2000, 2001, and 2002. This study was conducted at 11 U.S. HIV primary and specialty care sites in different geographic regions. In each year, HIV-positive patients with at least one CD4 count and any use of inpatient, outpatient, or emergency room services. Sample sizes were 13,392 in 2000, 15,211 in 2001, and 14,403 in 2002. Main outcome measures were number of hospital admissions, total days in hospital, and number of outpatient clinic/office visits per year. Inpatient and outpatient costs were estimated by applying unit costs to numbers of inpatient days and outpatient visits. Mean numbers of admissions per person per year decreased from 2000 (0.40) to 2002 (0.35), but this difference was not significant in multivariate analyses. Hospitalization rates were significantly higher among patients with greater immunosuppression, women, blacks, patients who acquired HIV through drug use, those 50 years of age and over, and those with Medicaid or Medicare. Mean annual outpatient visits decreased significantly between 2000 and 2002, from 6.06 to 5.66 visits per person per year. Whites, Hispanics, those 30 years of age and over, those on highly active antiretroviral therapy (HAART), and those with Medicaid or Medicare had significantly higher outpatient utilization. Inpatient costs per patient per month (PPPM) were estimated to be 514 dollars in 2000, 472 dollars in 2001, and 424 dollars in 2002; outpatient costs PPPM were estimated at 108 dollars in 2000, 100 dollars in 2001, and 101 dollars in 2002. Changes in utilization over this 3-year period, although statistically significant in some cases, were not substantial. Hospitalization rates remain relatively high among minority or disadvantaged groups, suggesting persistent disparities in care. Combined inpatient and outpatient costs for patients on HAART were not significantly lower than for patients not on HAART.
Environmental Ethics, 1984
Quality and Quantity, 1973
Our discussion is initiated as a response to the claim that sociologists should become "more hist... more Our discussion is initiated as a response to the claim that sociologists should become "more historical" in their orientations. The issues are old, but every generation frames its own response. Our response is developed by appeal to intuitive convictions arising out of experience with mathematical models of social phenomena. We make a distinction between historical and sociological processes at a metaphysical level; that is, these two types of processes exemplify different categories of existence. Next we make this point of view concrete by using the idea of a m.~del of social mobility as an example.
The Journal of Mathematical Sociology, 1971
Journal of Health Care for the Poor and Underserved, 2007
Although a comprehensive evaluation of the Care System Assessment Project is still several years ... more Although a comprehensive evaluation of the Care System Assessment Project is still several years off, the project quickly catalyzed changes in each of the communities in which it was piloted. All the sites found the system assessment model useful in identifying gaps in services. The project also clarified ways to engage underserved minorities in both care and planning for HIV care, and it helped to create community consensus in shaping initiatives to bring these populations into care. At all three sites, immigrant and refugee populations had to change beliefs that tended to delay their entry into care, and HIV-related stigma remained a significant barrier to entering care. However, all three communities also faced financial constraints that were likely to impede their ability to implement needed changes quickly. All of the sites identified needs for expanded public information campaigns and support services.
American Journal of Public Health, Oct 10, 2011
AIDS & public policy journal
Health care financing review
In recent years, State Medicaid programs have begun adopting health-based payment systems to help... more In recent years, State Medicaid programs have begun adopting health-based payment systems to help ensure quality care for people living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and to ensure equity for the managed care organizations (MCOs) in which these people are enrolled. In this article, the authors discuss reasons why such payment systems are needed and describe AIDS-specific capitation rates that have been adopted in several State Medicaid waiver programs. The authors also examine comprehensive risk-adjustment systems both within Medicaid and outside the program. Several research questions needing further work are discussed.
American Journal of Public Health
1. Am J Public Health. 1992 Feb;82(2):303-4. A statewide early intervention program for HIV-infec... more 1. Am J Public Health. 1992 Feb;82(2):303-4. A statewide early intervention program for HIV-infected people. Coye MJ, Grant C, Hummel RP, Conviser R. PMID: 1739171 [PubMed - indexed for MEDLINE]. Publication Types: News. MeSH Terms. ...
Pediatrics
Surveillance data on incidence of twins among reported cases of pediatric AIDS in New York City a... more Surveillance data on incidence of twins among reported cases of pediatric AIDS in New York City are presented. Most pairs are concordant for HIV infection. Three discordant pairs have been described elsewhere. Possible reasons for the association are discussed, including the most likely explanation that twins show symptoms early and are overrepresented in the early years of surveillance of pediatric AIDS.
Health care financing review, 1998
In recent years, State Medicaid programs have begun adopting health-based payment systems to help... more In recent years, State Medicaid programs have begun adopting health-based payment systems to help ensure quality care for people living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and to ensure equity for the managed care organizations (MCOs) in which these people are enrolled. In this article, the authors discuss reasons why such payment systems are needed and describe AIDS-specific capitation rates that have been adopted in several State Medicaid waiver programs. The authors also examine comprehensive risk-adjustment systems both within Medicaid and outside the program. Several research questions needing further work are discussed.
American Journal of Public Health, 1994
The Oregon Health Plan took effect in February 1994; it extends Medicaid eligibility but limits c... more The Oregon Health Plan took effect in February 1994; it extends Medicaid eligibility but limits coverage to conditions and treatments above a threshold on a prioritized list. Retrospective analysis was conducted on records of visits to two Oregon HIV outpatient clinics in 1991 and 1992 to determine Medicaid coverage had the Plan been operational. Of 1,129 patients, 21.1% were Medicaid-eligible; an additional 56.5% would have been eligible under the Plan. Just 5.0% to 6.8% of their visits were for conditions below the Plan's coverage threshold, almost none for HIV-specific conditions.
American Journal of Public Health, 2002
Journal of Health Education, 1998
Journal of Drug Issues, 1989
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - display, print, save, export, and email selected records - get My List count - save record to My List - get references ...
Http Dx Doi Org 10 1080 09540120220150018, May 27, 2010
The studies in this issue reflect the operation of the Ryan White CARE Act's holistic mod... more The studies in this issue reflect the operation of the Ryan White CARE Act's holistic model of health and support services for people living with HIV in the USA. Ancillary services available through the CARE Act are responsive to predisposing factors, enabling factors, and system characteristics that pose barriers to clients' receipt of primary medical care. That nearly all of the studies use cross-sectional rather than longitudinal data makes it difficult to draw causal inferences. Taken as a whole, however, the studies suggest that receipt of ancillary services such as case management, mental health and substance abuse treatment, transportation, and housing assistance is associated with primary care entry and retention among CARE Act clients. The studies and the literature out of which they arise suggest that there is a need to refine further our understanding of care systems so that we can refine the care systems themselves. Among the concepts proposed for the study of care systems are comprehensiveness, capacity, coordination, integration, cultural competence, and client-centredness.
Medical care, 2005
Rapid changes in HIV epidemiology and antiretroviral therapy may have resulted in recent changes ... more Rapid changes in HIV epidemiology and antiretroviral therapy may have resulted in recent changes in patterns of healthcare utilization. The objective of this study was to examine sociodemographic and clinical correlates of inpatient and outpatient HIV-related health service utilization in a multistate sample of patients with HIV. Demographic, clinical, and resource utilization data were collected from medical records for 2000, 2001, and 2002. This study was conducted at 11 U.S. HIV primary and specialty care sites in different geographic regions. In each year, HIV-positive patients with at least one CD4 count and any use of inpatient, outpatient, or emergency room services. Sample sizes were 13,392 in 2000, 15,211 in 2001, and 14,403 in 2002. Main outcome measures were number of hospital admissions, total days in hospital, and number of outpatient clinic/office visits per year. Inpatient and outpatient costs were estimated by applying unit costs to numbers of inpatient days and outpatient visits. Mean numbers of admissions per person per year decreased from 2000 (0.40) to 2002 (0.35), but this difference was not significant in multivariate analyses. Hospitalization rates were significantly higher among patients with greater immunosuppression, women, blacks, patients who acquired HIV through drug use, those 50 years of age and over, and those with Medicaid or Medicare. Mean annual outpatient visits decreased significantly between 2000 and 2002, from 6.06 to 5.66 visits per person per year. Whites, Hispanics, those 30 years of age and over, those on highly active antiretroviral therapy (HAART), and those with Medicaid or Medicare had significantly higher outpatient utilization. Inpatient costs per patient per month (PPPM) were estimated to be 514 dollars in 2000, 472 dollars in 2001, and 424 dollars in 2002; outpatient costs PPPM were estimated at 108 dollars in 2000, 100 dollars in 2001, and 101 dollars in 2002. Changes in utilization over this 3-year period, although statistically significant in some cases, were not substantial. Hospitalization rates remain relatively high among minority or disadvantaged groups, suggesting persistent disparities in care. Combined inpatient and outpatient costs for patients on HAART were not significantly lower than for patients not on HAART.
Environmental Ethics, 1984
Quality and Quantity, 1973
Our discussion is initiated as a response to the claim that sociologists should become "more hist... more Our discussion is initiated as a response to the claim that sociologists should become "more historical" in their orientations. The issues are old, but every generation frames its own response. Our response is developed by appeal to intuitive convictions arising out of experience with mathematical models of social phenomena. We make a distinction between historical and sociological processes at a metaphysical level; that is, these two types of processes exemplify different categories of existence. Next we make this point of view concrete by using the idea of a m.~del of social mobility as an example.
The Journal of Mathematical Sociology, 1971
Journal of Health Care for the Poor and Underserved, 2007
Although a comprehensive evaluation of the Care System Assessment Project is still several years ... more Although a comprehensive evaluation of the Care System Assessment Project is still several years off, the project quickly catalyzed changes in each of the communities in which it was piloted. All the sites found the system assessment model useful in identifying gaps in services. The project also clarified ways to engage underserved minorities in both care and planning for HIV care, and it helped to create community consensus in shaping initiatives to bring these populations into care. At all three sites, immigrant and refugee populations had to change beliefs that tended to delay their entry into care, and HIV-related stigma remained a significant barrier to entering care. However, all three communities also faced financial constraints that were likely to impede their ability to implement needed changes quickly. All of the sites identified needs for expanded public information campaigns and support services.
American Journal of Public Health, Oct 10, 2011
AIDS & public policy journal
Health care financing review
In recent years, State Medicaid programs have begun adopting health-based payment systems to help... more In recent years, State Medicaid programs have begun adopting health-based payment systems to help ensure quality care for people living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and to ensure equity for the managed care organizations (MCOs) in which these people are enrolled. In this article, the authors discuss reasons why such payment systems are needed and describe AIDS-specific capitation rates that have been adopted in several State Medicaid waiver programs. The authors also examine comprehensive risk-adjustment systems both within Medicaid and outside the program. Several research questions needing further work are discussed.
American Journal of Public Health
1. Am J Public Health. 1992 Feb;82(2):303-4. A statewide early intervention program for HIV-infec... more 1. Am J Public Health. 1992 Feb;82(2):303-4. A statewide early intervention program for HIV-infected people. Coye MJ, Grant C, Hummel RP, Conviser R. PMID: 1739171 [PubMed - indexed for MEDLINE]. Publication Types: News. MeSH Terms. ...
Pediatrics
Surveillance data on incidence of twins among reported cases of pediatric AIDS in New York City a... more Surveillance data on incidence of twins among reported cases of pediatric AIDS in New York City are presented. Most pairs are concordant for HIV infection. Three discordant pairs have been described elsewhere. Possible reasons for the association are discussed, including the most likely explanation that twins show symptoms early and are overrepresented in the early years of surveillance of pediatric AIDS.
Health care financing review, 1998
In recent years, State Medicaid programs have begun adopting health-based payment systems to help... more In recent years, State Medicaid programs have begun adopting health-based payment systems to help ensure quality care for people living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and to ensure equity for the managed care organizations (MCOs) in which these people are enrolled. In this article, the authors discuss reasons why such payment systems are needed and describe AIDS-specific capitation rates that have been adopted in several State Medicaid waiver programs. The authors also examine comprehensive risk-adjustment systems both within Medicaid and outside the program. Several research questions needing further work are discussed.
American Journal of Public Health, 1994
The Oregon Health Plan took effect in February 1994; it extends Medicaid eligibility but limits c... more The Oregon Health Plan took effect in February 1994; it extends Medicaid eligibility but limits coverage to conditions and treatments above a threshold on a prioritized list. Retrospective analysis was conducted on records of visits to two Oregon HIV outpatient clinics in 1991 and 1992 to determine Medicaid coverage had the Plan been operational. Of 1,129 patients, 21.1% were Medicaid-eligible; an additional 56.5% would have been eligible under the Plan. Just 5.0% to 6.8% of their visits were for conditions below the Plan's coverage threshold, almost none for HIV-specific conditions.
American Journal of Public Health, 2002
Journal of Health Education, 1998
Journal of Drug Issues, 1989
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - display, print, save, export, and email selected records - get My List count - save record to My List - get references ...
Http Dx Doi Org 10 1080 09540120220150018, May 27, 2010
The studies in this issue reflect the operation of the Ryan White CARE Act's holistic mod... more The studies in this issue reflect the operation of the Ryan White CARE Act's holistic model of health and support services for people living with HIV in the USA. Ancillary services available through the CARE Act are responsive to predisposing factors, enabling factors, and system characteristics that pose barriers to clients' receipt of primary medical care. That nearly all of the studies use cross-sectional rather than longitudinal data makes it difficult to draw causal inferences. Taken as a whole, however, the studies suggest that receipt of ancillary services such as case management, mental health and substance abuse treatment, transportation, and housing assistance is associated with primary care entry and retention among CARE Act clients. The studies and the literature out of which they arise suggest that there is a need to refine further our understanding of care systems so that we can refine the care systems themselves. Among the concepts proposed for the study of care systems are comprehensiveness, capacity, coordination, integration, cultural competence, and client-centredness.