In partnership with the Army Medical Department, RAND worked to implement clinical practice guidelines. This report evaluates the asthma guideline demonstration. It documents the actions, assesses effects, and measures the quality and limitations of data for monitoring outcomes. The authors found that the implementation scored successes but resource limitations and organizational barriers curbed progress. They conclude that flexibility, monitoring, and training are the keys to implementing the guidelines. They also found that patient education needed improvement.
This report addresses patient acceptance of a new device called a Health Buddy used to communicate between patients chronically ill with congestive heart failure and a health care provider (usually a nurse) in a case management programme.
In partnership with the Army Medical Department, RAND worked to implement clinical practice guidelines. This report evaluates the asthma guideline demonstration. It documents the actions, assesses effects, and measures the quality and limitations of data for monitoring outcomes. The authors found that the implementation scored successes but resource limitations and organizational barriers curbed progress. They conclude that flexibility, monitoring, and training are the keys to implementing the guidelines. They also found that patient education needed improvement.
Although competition among health plans has been encouraged as a means to control health care expenditures, some fee-for-service (FFS) insurers attribute part of their increased average expenditures to favorable selection of low users into newly offered health maintenance organization (HMO) plans. To test this hypothesis, the health care expenditure patterns of approximately 30,000 employees in a large, multi-site aerospace firm were examined. FFS system expenditure patterns for people who joined HMOs were compared with those of people who remained in the FFS system. Information on socioeconomic status, plan choice, employee dependents, and filed claims were reviewed. The unit of observation was a family year of claimed expenditures. Expenditure data for families that switched between FFS and HMO plans between 1978 and 1982 were classified into four groups: (1) one year preHMO; (2) other years preHMO; (3) one year postHMO; and (4) other years postHMO. For families remaining in FFS plans, all years of data were "stayer" years. Family year expenditures were compared across these five groups. The results revealed that families selecting HMOs had lower mean expenditures than did families who remained in the FFS system. Families who left HMOs had higher mean expenditures than did those who entered HMOs. Some, but not all, of these differences were explained by family characteristics. (NB)
From the Master of Horror comes the first gripping book in the twelve book New York Times bestselling Saga of Darren Shan. Start the tale from the beginning in the book that inspired the feature film The Vampire's Assistant and petrified devoted fans worldwide. A young boy named Darren Shan and his best friend, Steve, get tickets to the Cirque Du Freak, a wonderfully gothic freak show featuring weird, frightening half human/half animals who interact terrifyingly with the audience. In the midst of the excitement, true terror raises its head when Steve recognizes that one of the performers-- Mr. Crepsley-- is a vampire! Stever remains after the show finishes to confront the vampire-- but his motives are surprising! In the shadows of a crumbling theater, a horrified Darren eavesdrops on his friend and the vampire, and is witness to a monstrous, disturbing plea. As if by destiny, Darren is pulled to Mr. Crepsley and what follows is his horrifying descent into the dark and bloody world of vampires. This is the beginning of Darren's story.
Outnumbered, outsmarted, and desperate, the hunters are on the run, pursued by the vampaneze, the police, and an angry mob. With their enemies clamoring for blood, the vampires prepare for a deadly battle. Is this the end for Darren and his allies?
Outnumbered, outsmarted and desperate, the hunters are on the run, pursued by the vampaneze, the police, and an angry mob. With their enemies clamoring for blood, the vampires prepare for a deadly battle. Is this the end for Darren and his allies?
One boy's life ripped to shreds before his eyes... One wrathful demon master hell-bent on revenge... An army of grisly Demonata on the rampage... It's the end of the world as we know it. The sixth novel in the chilling Demonata series by Darren Shan, author of the New York Times bestselling Cirque Du Freak series, will terrify readers long after the last page.
Beranabus and Dervish are gone. Bec has formed an unholy alliance with Lord Loss. Kernel is blind, held on Earth against his will. Grubbs is mad with grief and spinning out of control. The demons are crossing. The Disciples are falling. The Shadow is waiting. Welcome to the end. The tenth and final novel in the chilling Demonata series by Darren Shan, author of the New York Times bestselling Cirque Du Freak series, will bring everything to a terrifying, cataclysmic conclusion.
Time seemed to collapse... There was a sharp stabbing sensation in my stomach... Steve crowed, "Now I have you! Now you're gonna die!" Dead if he loses - damned if he wins. The time has finally come for Darren to face his archenemy, Steve Leopard. One of them will die. The other will become the Lord of the Shadows - and destroy the world. Is the future written, or can Darren trick destiny?
Living nightmare: Two boys who are best friends visit an illegal freak show, where an encounter with a vampire and a deadly spider forces them to make life-changing choices.
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