Jeffrey Prottas

Jeffrey Prottas
Brandeis University · Schneider Institute for Health Policy

Ph.D.

About

57
Publications
3,065
Reads
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2,006
Citations

Publications

Publications (57)
Article
Full-text available
Background: Moderately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare...
Article
Coordinating medical and substance use disorder (SUD) services is associated with good health and treatment outcomes but it is not widely practiced. This may be due to a lack of real-world models for coordinating care. This study examined the operational practices associated with a sample of community health centers (CHCs) identified as effectively...
Article
Despite well-established benefits, only 10% to 20% of eligible candidates in the United States currently use formal cardiac rehabilitation (CR) services. Existing studies identify both patient- and provider-level barriers to physician referral and patient uptake. This study, which was driven by new evidence indicating that utilization rates vary en...
Conference Paper
Introduction: Controlling access is one of the established strategies for reducing consumption of substances harmful to health. It is, however, not known how efficacious these access management strategies are. The literature shows a complex interaction of cultural variables and tobacco-sales-to-minors even in the light of laws that prevent youth ac...
Conference Paper
CR, a medically-supervised outpatient program, reduces morbidity and mortality in patients with established cardiac disease. Despite its many well-established benefits, participation is very low. An analysis of national Medicare claims undertaken for the Brandeis evaluation of Medicare's Lifestyle Modification Program Demonstration (LMPD) demonstra...
Article
Cardiac rehabilitation (CR) is effective in prolonging survival and reducing disability in patients with coronary heart disease. However, national use patterns and predictors of CR use have not been evaluated thoroughly. Using Medicare claims, we analyzed outpatient (phase II) CR use after hospitalizations for acute myocardial infarctions or corona...
Article
DNA evidence has rapidly become a significant and routine feature of modern criminal prosecutions. The first introduction of DNA evidence in a U.S. Court occurred in 1987. By 1994, 42 percent of local prosecutors reported that they had used DNA evidence in a felony case at least once. By 2001 that number had increased to 68 percent. Moreover, from...
Article
To gain consensus on aspects of the process of gaining consent for organ donation that should be mainstream daily practice. A 3-day consensus conference of transplant professionals that provided a forum for research and innovative ideas about gaining consent for organ donation. Four work groups were assembled to address issues of gaining consent fr...
Article
Purpose To gain consensus on aspects of the process of gaining consent for organ donation that should be mainstream daily practice. Methods A 3-day consensus conference of transplant professionals that provided a forum for research and innovative ideas about gaining consent for organ donation. Four work groups were assembled to address issues of g...
Article
Medical debt, often the result of seeking costly needed care, has recently been identified as a barrier to care as well as a threat to families' financial well-being. Surveying households that seek credit counseling services, the authors offer new insight into the financial consequences of medical problems and the conditions under which they occur....
Article
Since 1985, the proportion of for-profit community hospitals has hovered around 15 percent (AHA 1988, 2002). Although nonprofit hospital conversions to for-profit status have yet to significantly alter the overall distribution of investor ownership in the hospital sector, the consequences continue to cause considerable concern (Claxton et al. 1997;...
Article
Full-text available
A panel of ethicists, organ procurement organization executives, physicians, and surgeons was convened by the sponsorship of the American Society of Transplant Surgeons to determine whether an ethically acceptable pilot trial could be proposed to provide a financial incentive for a family to consent to the donation of organs from a deceased relativ...
Chapter
Rationing is a ubiquitous element in health care allocation. The demand for health care is effectively infinite because the aspirations of modern medicine are utopian. Everyone must die, but doctors insist that any specifiable cause of death can be resisted and ultimately conquered. Demand is infinite but the supply of healers and the time for heal...
Article
To the Editor. —The plea by Dr Spital1 for a system of mandated choice in organ donation is flawed as a plan to increase the supply of organs and as an ethical proposition. He reports that 63% of those surveyed would agree to donate under a mandated choice system, but this is barely more than the estimated 60% of families that now permit donation...
Article
With tens of thousands of waiting recipients but only 4000-5000 organs available annually, there is a chronic and largely insatiable demand for organ transplants. This article draws on three sources of data regarding the sources of organs donated: a survey of the families of organ donors, a survey of the general public, and a prospective data colle...
Article
The number of "units" of human bone used during surgical procedures has grown to almost a quarter of a million. Medical demand for such bone is expanding rapidly and the nation's bone-banking system is struggling to grow apace. Unfortunately, because of this growth, bone banks must compete with organ banks for access both to hospitals and to potent...
Article
We report the results of a representative random-sample telephone survey of the public's willingness to donate organs. Our goal was to identify differences within the public and target groups who might be receptive to educational efforts to increase donation. We distinguish differences in attitude and demographic characteristics in three groups: th...
Article
This evaluation of 24 hospital-based case management services found that case management could take a variety of forms, ranging from postacute medical management service to planning community-based care for potential long-term care users. Future research should concentrate on documenting the costs and outcomes of various models of case management i...
Article
The present policies for allowing nonresident aliens access to organ transplantation are neither fair nor consistent. They apply only to some transplants, and they take no account of their discriminatory effect among foreigners. Much less do they deal with the meaning of fair access, given our complete ignorance of the number and character of those...
Article
The American organ procurement system has improved and matured in the last five years. At the same time, the basic challenges facing it have remained substantially the same because the moral and legal framework of the system has not changed. Success at organ procurement continues to depend on the voluntary cooperation of medical professionals and t...
Article
Full-text available
Changes in demographics and in the operating environments of acute care hospitals have resulted in the development of new geriatric service products. Presented in this article is a framework for describing the variety of new services in terms of sponsor goals and core activities. Five broad types of geriatric service developments are described: ger...
Chapter
Organ supply depends on the active cooperation of several groups. The general public is the ultimate source of all human organs, but certain medical professionals have a key role in the process as well. In fact, the cooperation of these medical professionals antedates in time and overshadows in impact the role the giving public plays. The sequence...
Article
THE AMERICAN organ-procurement system is demonstrably the best in the world (J. Prottas, PhD, S. Hecht, and H. Batten, MA, unpublished data, June 1987).1 The foundation of this success has been the attitudes of the American people. Dozens of surveys over almost 20 years have demonstrated the extraordinary level of public support for organ donation...
Article
Full-text available
The responses of hospital administrators, directors of nursing, intensive care unit nurses, and neurosurgeons are reported to a range of inquiries designed to measure their commitment to organ procurement and thereby identify impediments limiting their cooperation with organ procurement efforts. Descriptive and multivariate statistical techniques a...
Article
For the past 2½ years, four Social Health Maintenance Organization (SHMO) sites have been delivering integrated, prepaid, acute, and chronic care to Medicare beneficiaries. Because SHMOs enroll a mix of able-bodied and frail members, sites have had to develop systems for identifying disabled members who may qualify to receive expanded chronic care...
Article
Book reviewed in this article:The Foetus as Transplant Donor: Scientific, Social, and Ethical Perspectives. By Peter McCullagh. New York: John Wiley & Sons. vi + 215 pp. $45.00, cloth.
Article
Full-text available
Many advances in medical technology have brought with them ethical dilemmas for which our society and philosophy provide no satisfactory answers. However, these dilemmas ought not to completely obscure the positive social impacts of technical advances. Since the development of safe blood transfusions, medical treatments have come into common use th...
Article
The implementation of state-sponsored voluntary case management programs for public assistance recipients creates provider and recipient recruiting problems that are unique to the state's economic environment, its political climate, its historic relationship with providers, its program goals, and its implementation strategies. This implementation s...
Article
This case study involves a foreigner who has come to the United States hoping to obtain a kidney transplant. The woman's chances are not good because her funds are exhausted, kidneys are scarce, and U.S. citizens normally are given priority for available organs. Three commentators are asked on what grounds the decision to transplant non-immigrant a...
Article
Improvements in the medical/technical ability to transplant human organs have led to similar--yet importantly different--societal and organizational responses among the nations of the "Atlantic Community." The highly decentralized system of organ procurement in the United States yields greater numbers; centrally directed European systems reflect lo...
Article
Despite the overall success of the U.S. organ procurement network, local success rates vary widely, from three kidneys procured for transplantation per million population in some areas to 40 per million in others. Of the two kinds of organ procurement agencies (OPAs) that operate within the network--independently organized and hospital based--the f...
Article
For an organization, innovation is the occasion for both risks and opportunities. The risks are obvious—the innovation may fail and the organization's investment in it thereby will be wasted. Much of the study of innovation has been about the nature of these risks and the probability of failure. This article discusses the failure of an innovation a...
Article
The dialysis treatment rate is more than 50 percent higher in the United States than it is in any West European nation. Relman and Rennie's analysis of this difference in rates raised the possibility that the extra care provided in the United States is unnecessary and is partially attributable to the existence of a private market for renal dialysis...
Article
Medical progress has increased the potential of organ transplantation to relieve the hardship of many restricted and sickly lives. Society has already committed itself-through law, technology, and demand-on the matter of kidney transplantation, but a shortage of donors persists. The altruism identified in and necessary for organ donation can be har...
Article
In the last ten years there has grown up, in the United States, the most extensive organ procurement system in the world. This system, consisting of approximately 120 organ procurement agencies, retrieved 4435 cadaveric kidneys for transplant purposes in 1981. The nation's organ procurement agencies vary greatly in terms of size, organizational str...
Article
Public service bureaucracies often distribute valuable goods and services yet many eligible citizens do not participate in their programs. Although available figures are somewhat inconsistent, nonparticipation rates appear to hover around 50 percent. Many of the decisions made by those who organize, administer, and work in these programs contribute...
Article
Student workshops provide a useful adjunct to curricula emphasizing political and institutional analysis. A workshop consists of a student team that helps a government or nonprofit agency solve a pressing policy related problem. As such, they can give students insights into the political and organizational contexts in which policy decisions are mad...
Article
The difficulties of controlling the daily behavior of low level bureaucrats has been widely appreciated by both administrators and academic students of bureaucracy. This article provides a theoretically oriented explanation for this fact. Building on the concept of "boundary actor," it places the source of the low level bureaucrat's power in his/ h...
Article
The probable adoption of a national health insurance system in the near future makes the Veterans Administration's health care program vulnerable to change. The last major turning point in the program occurred at the end of World War II when a decision was made to link VA hospitals to medical schools. This linkage in large measure has been responsi...

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