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There is a complex relationship between the physiological and psychological components of health and illness and between the objective and subjective components of these states [1]. Since elderly people are prone to several health problems which have physical, psychological and social components, perceived health is an important factor in old age.

ResultsAfter assessing the standard of care for each therapy, a cost analysis was performed taking into consideration the number of office visits required for eradication of the wart, physician costs for delivery of the therapy, and medication costs (Figure 1).[FIGURE 1 OMITTED]The costs for the treatment of non-genital warts using cryotherapy with liquid nitrogen, topical squaric acid, carbon dioxide and pulsed-dye lasers, intralesional bleomycin, intralesional interferon alpha, or intralesional Candida immunotherapy ranged from approximately $157 to $1227. Based on our data, carbon dioxide laser therapy was found to be the least expensive ($157). Immunotherapy utilizing Candida antigen was found to be the next-least expensive treatment option for the treatment of non-genital warts ($190), requiring an average of three treatments and a minimal medication expense (Table 4) (12-13). In contrast, interferon alpha was the most expensive modality ($1227), requiring an average of fifteen treatments (Table 5) to attain a complete response.

[H.sub.1]: Veterans Affairs nursing homes differ in their implementation of QI practices.Determinants of quality improvement implementation have been actively investigated. Zinn and colleagues (1998) have hypothesized that nursing homes adopt QI as a management tool in response to environmental pressures as conceptualized by resource dependence and institutional theory. They found that perceived competition, the Medicare share of hospital discharges in the market, and the Medicare census within the nursing home were associated with QI adoption. These factors, though, are likely to be less important in the VA.Studies from nonnursing home settings have demonstrated that organizational culture, those values, beliefs, and norms of an organization that shape its behavior, is an important determinant of QI implementation (Parker et al. 1999; Shortell et al. 1995). Shortell et al. reported that the implementation of QI practices among hospitals is associated with a group! developmental culture, that is, a culture where innovation, risk-taking, and teamwork are highly valued. This finding makes sense intuitively since in health care delivery organizations, QI represents a substantial departure from traditional quality assurance methods. For a health care organization to implement QI successfully, employees must be willing to take chances and learn new ways of doing their work. Moreover, because QI in health care settings requires communication among employees from different clinical disciplines, a culture that emphasizes teamwork also seems essential. The generalizability of this earlier research to nursing homes, where much care is provided by aides with little formal education and clinical training, is uncertain. We therefore test the hypothesis:

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