=============================================================== == == == ----------- ALS INTEREST GROUP ----------- == == ALS Digest (#68, 18 November 1993) == == == == ----- amyotrophic lateral sclerosis (ALS) == == ----- motor neurone disease (MND) == == ----- Lou Gehrig's disease == == ----- == == This e-mail list has been set up to serve the world-wide == == ALS community. That is, ALS patients, ALS researchers, == == ALS support/discussion groups, ALS clinics, etc. Others == == are welcome (and invited) to join. Currently there are == == 170+ subscribers. == == == == To subscribe, to unsubscribe, to contribute notes, == == etc. to ALS Digest, please send e-mail to: == == bro@huey.met.fsu.edu (Bob Broedel) == == == == All interested people may "broadcast" messages to == == ALS Digest subscribers by sending to: == == als@huey.met.fsu.edu == == == == Bob Broedel; P.O. Box 20049; Tallahassee, FL 32310 USA == =============================================================== == Back issues are available via e-mail from: == == LISTSERV@mailer.fsu.edu == == send an e-mail message that says INDEX ALS == == Also available via anonymous FTP at mailer.fsu.edu == == directory ftp/pub/als == =============================================================== (1) ===== public access to the Internet ========== Those of you who are using the "Internet e-mail gateway" of a commercial e-mail system may want to be connected directly to the Internet. If so, you will may want to know about the list called PDIAL (The Public Dialup Internet Access List). In order to get it via e-mail, send a message to: info-deli-server@netcom.com with Send PDIAL on the _subject_ line. In order to continue receiving PDIAL updates, send another message and put Subscribe PDIAL on the subject line. There are also ways to get it via ftp, gopher, and several Usenet groups and the list will tell you how. (2) ===== target of the week ========== Date : Wed, 17 Nov 1993 20:51:02 EST >From : MHRM25A@prodigy.com (MR JOHN R NORTON III) X-Mailer: PRODIGY Services Company Internet Mailer Subject : target of the week Please consider writing this drug company CEO, our target of the week! We must keep Prodding and get a sense of urgency in these people...Please write! TAGETING RILUZOLE'S Robert Cawthorn. Late comers to this BB remember to write Amato of NY and Schleifer of Regeneron. Use the generic letter posted previously and give to your friends! We have to keep Prodding..We need access to these drugs in weeks not months. Put a sense of urgency in getting out the letters! TO: Robert E. Cawthorn; Rhone-Poulenc Rorer; 500 Arocla Rd; P.O. Box 1200; Collegeville,PA 19426. Dear Sir; Please release Riluzole immediately for Treatment IND. This drug is needed today to save the lives of thousands of ALS sufferers! FDA has advised that they will grant Treatment IND for Riluzole if only you will agree. Many have been waiting desperately to have access to the drug. The drug may not be a cure, but if it gives ALS patients additional months of life it should be our choice to take it! Please consider expediting the application to the FDA. Your decision will affect the lives of so many. Jack Norton (3) ===== home health & hospice care ========== Date : Sun, 31 Oct 1993 23:40:25 MST Sender : MEDNEWS - Health Info-Com Network Newsletter : >From : David Dodell Subject: HICN646 Medical News HICNet Medical News Digest / Sun, 31 Oct 1993 / Volume 06 : Issue 46 Today's Topics: [MMWR] Home-Health and Hospice Care Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210 Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-6135 Compilation Copyright 1993 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. ------------------------------ Home-Health and Hospice Care -- United States, 1992 =================================================== SOURCE: MMWR 42(42) DATE: Oct 29, 1993 An estimated 9.5 million persons in the United States have difficulty performing basic life activities because of mental or physical health conditions (1). In recent years, an increasing range of home-care services -- including home-health care and hospice care -- have been created for persons requiring long-term care, and access to such care has been increased through public programs such as Medicare and Medicaid (2). To better characterize the use of these services in the United States, CDC's National Center for Health Statistics conducted the 1992 National Home and Hospice Care Survey (NHHCS), the first survey of home-health agencies and hospices and their patients. This report presents preliminary findings from the survey. During September-December 1992, CDC used a three-stage probability sample design to survey 1500 agencies and approximately 14,000 patients that were selected from among 8036 agencies either classified by the 1991 National Health Provider Inventory as providing home-health or hospice care (3) or newly opened for business from November 1991 through June 1992. Differences are significant at the 0.05 level. Home-Health Care On any day during the survey period, an estimated 1,237,100 patients received care from approximately 7000 home-health agencies in the United States (4). Most patients were female (67%) and married (33%) or widowed (36%); the average age was 70 years, and 75% were aged greater than or equal to 65 years (Table 1). Most (55%) home-health patients received assistance in at least one of the activities of daily living (ADLs) crucial to independent community living (i.e., bathing, dressing, transferring in or out of a bed or chair, using the toilet, or eating). Approximately half (51%) received assistance in bathing; 44%, dressing; 33%, transferring in or out of a bed or chair; 24%, using the toilet; and 14%, eating. On average, agency staff assisted patients with 1.7 ADLs. In addition to assistance in self-care activities, home-health patients received a variety of restorative, therapeutic, and social services. The most common of these were skilled nursing services (80%), personal care (45%), physical therapy (15%), homemaker/companion services (11%), social services (9%), and medications (8%). First-listed diagnoses on admission to the agency varied among home-health patients. The most frequent diagnoses included heart disease (International Classification of Diseases, Ninth Revision, Clinical Modification {ICD-9-CM} codes 391-392.0, 393-398, 402-404, 410-416, and 420-429) (12%), diabetes mellitus (ICD-9-CM code 250) (8%), arthropathies and related disorders (ICD-9-CM codes 710-719) (6%), malignant neoplasms (ICD-9-CM codes 140-208 and 230-234) (6%), cerebrovascular disease (ICD-9-CM codes 430-436) (6%), essential hypertension (ICD-9-CM code 401) (4%), and fractures (ICD-9-CM codes 800-829) (4%). These diagnoses accounted for 46% of all first-listed diagnoses. During the 12 months preceding the survey, there were approximately 3,066,300 discharges from the care of home-health agencies. Reasons for discharge were improvement or stabilization of the condition causing enrollment (52%); transfer to a nursing home, hospital, or some other health facility (17%); death (8%); and discharge for some other reason (23%). Patients may have had more than one discharge during the year. The average length of service before discharge was 94 days. *Hospice Care* Hospice care provides palliative and supportive services that enhance the quality of life of terminally ill patients and their families. On any day during the survey period, an estimated 1000 hospices in the United States provided care to approximately 47,200 patients (4); 77% were aged greater than or equal to 65 years (average age on admission: 71 years). When compared with home-health patients, higher proportions of hospice patients were male (45%) and married (49%) (Table 1). In addition, hospice patients were more likely to receive skilled nursing services (86%), social services (52%), medications (33%), counseling (30%), and physician services (20%). Hospice patients usually were admitted with specific diagnoses; 65% of hospice patients were admitted with a first-listed diagnosis of malignant neoplasms, and 10% were admitted with a diagnosis involving heart disease. Eighty-seven percent of hospice patients received care in private or semiprivate residences; 8% received care in short-stay hospitals, nursing homes, or other health facilities. During the 12 months preceding the survey, an estimated 207,000 patients were discharged from hospices; of these, 91% died while receiving hospice care. The average completed length of service before discharge was 60 days. Reported by: Long-Term Care Statistics Br, Div of Health Care Statistics, National Center for Health Statistics, CDC. Editorial Note: The findings in this report indicate that home-health agencies and hospices play an increasing role in providing care to the population requiring long-term care. In addition to providing long-term maintenance care, home-health agencies provide skilled rehabilitative and therapeutic services (5). Hospice was first introduced in the United States in 1974, and these findings are among the first national estimates for hospice patients. Since 1965, when Title XVIII (Medicare) of the Social Security Act was enacted, Medicare coverage of home-health services has been limited to post-acute care, focusing on recuperative care rather than long-term maintenance care. In 1992, 90% of home-health agency patients received services from agencies certified by Medicare (4). Medicare added hospice benefits in 1983, and by 1992, 92% of hospice patients were in hospices certified by Medicare (4). The findings in this report indicate that home-health agencies primarily provide skilled rehabilitative and therapeutic services or "medically oriented" home care. In 1987, estimated annual national expenditures for medically oriented home-health care were $5 billion (6), while estimated annual expenditures for home-health care, including care provided by homemakers and personal-care providers, were $11.6 billion (2). Medically oriented home-health care represents less than half of formal home-health services rendered to the long-term-care population. Home-health care is the fastest growing segment of the health-care system. In 1991, expenditures for home-health care increased 29% over 1990 (6). The findings in this report can be used to monitor changes in the use of these services and in the range of services and types of patients using these services. References 1. LaPlante MP. People with disabilities in basic life activities in the U.S. {Disability statistics abstract no. 3}. Washington, DC: US Department of Education, National Institute on Disability and Rehabilitation Research, 1992. 2. Altman BM, Walden DC. Home health care: use, expenditures, and sources of payment. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1993; AHCPR publication no. (PHS)93-0040. (National Medical Expenditures Survey Research findings no. 15). 3. Delfosse R. Hospice and home health agency characteristics: 1991 National Health Provider Inventory. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, NCHS. Vital Health Stat (in press). 4. Strahan G. Overview of home health and hospice patients: preliminary data from the 1992 National Home and Hospice Care Survey. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993. (Advance data no. 235). 5. Keenan JM, Fanale JE. Home care: past and present, problems and potential. J Am Geriatr Soc 1989;37:1076-83. 6. Letsch SW, Lazenby HC, Levit KR, Cowan CA. National health expenditures, 1991. Health Care Financing R 1992;14:1-30. (4) ===== physicians & computers ========== Date : Thu, 21 Oct 1993 17:33:18 GMT Sender : Hospital Computer Network Discussion Group and Data Base : >From : Rogers Piercy Subject: physicians & computers Computers & Medicine, a journal mailed at no charge to 90,000 physicians each month. "Physicians & Computers" is soliciting manuscripts that describe changes brought about by the direct use of computers in the practice of medicine. Each manuscript should focus on a single area of medical care. Examples include: Computerized Diagnosis-- (various medical disciplines), Physican Authored, Medical Software, Handheld Computers--Patient History/Charting, Medical Practice Networking, Notebook Computers in Clinical Research, Computerized Reimbursement, Developming Trends in Clinical Computing, Computerized Medical Records, and Medical Decision Making. Articles requested in the 1500-2000 length word range. Physician authors are advised to contact: rpiercy@casbah.acns.nwu.edu (Rogers Piercy) == end of als 68 ==