The relationship between health literacy and medication adherence is statistically significant but weak. It is plausible that health literacy has a mediator relationship with other adherence determinants. Future research should explore such relationships.

As the world's most populous country with the largest aging population and a rapidly growing economy, China is receiving increased attention from both the Chinese government and the governments of other countries that face low fertility and aging problems. This unprecedented shift of demographic structure has repercussions for many aspects of development including economic growth, social welfare, elder care, and other public welfare issues in China. Balancing population aging and economic growth requires innovative strategies and represents both challenges and opportunities for China.

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This analysis investigates what patients and practitioners can do to improve their interactive communications to achieve optimal patient-centric (PC) care. One goal of this clinical practice approach is to improve patient satisfaction, compliance, and outcomes. The mutual responsibilities required of both the patients and practitioners to attain PC care are discussed. Innovative, information technology techniques in the healthcare environment in general and in care delivery in particular are explored. Practitioner-to-patient encouragement vis-a-vis self education on their conditions is also provided.

Research Objective. To assess the impact of recent Medicare prospective payment system (PPS) changes on efficiency in skilled nursing homes. Data Source/Study Setting. Medicare Cost Reports (MCR), On-line Survey Certification and Reporting System (OSCAR), Area Resource Files (ARF), a Centers for Medicare and Medicaid Services (CMS) hospital wage index website, a Consumer Price Index (CPI) database, and a survey of state Medicaid reimbursement rates. The sample was 8,361 nursing homes in the Medicare Cost Report databases from the years 1997 to 2003. Study Design. Data-envelopment analyses (DEA) calculated efficiency scores for three separate DEA models: unadjusted, acuity-adjusted, and acuity-and-qualityadjusted efficiency. The efficiency scores from these models were regressed on the Medicare PPS changes (the Balanced Budget Act [BBA], the Balanced Budget Refinement Act [BBRA] and the Benefits Improvement and Protection Act) and other organizational and market explanatory variables using a panel-data truncated regression. Principal Findings. Mean values for all efficiency measures decreased over time, the acuity-quality-adjusted efficiency measures decreasing the most. All policy variables were significantly negatively related to all efficiency measures. Higher nurse staffing was negatively related to efficiency in all but the acuity-quality-adjusted model. Other explanatory variables varied in their relationships to the efficiency variables. Conclusions. The results suggest that the reimbursement policy changes had a significantly negative impact on efficiency. Higher nurse staffing contributed to lower efficiency only when efficiency was not adjusted for quality. Various organizational and market factors also played significant roles in all efficiency models.Key Words. Nursing home efficiency, SNF PPS, BBA, nurse staffing and nursing home efficiency, DEA analysis of efficiency in nursing homesThe Medicare prospective payment system (PPS) for skilled nursing facility (SNF) reimbursement was implemented with the Balanced Budget Act (BBA) of 1997 in order to reduce nursing home costs and align reimbursement with r Health Research and Educational Trust