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Biomedical subjects

Beth A Virnig

Publications and source records attributed to Beth A Virnig.

At least 19 recordsLinked to original sources
PubMed2007

External review of health plan denials of mental health services: lessons from Minnesota.

There has been concern that health plans unfairly deny claims for mental health services. This study examines a unique Minnesota program that resulted from a legal settlement. An independent panel reviews all mental health service denials in the state's three largest health plans. Our study analyzed every case file (N = 4717) the panel reviewed from January 2002 to August 2005. This unique dataset provides insight into health plan behavior. The findings show that the panel reversed only 2.9% of denied claims, suggesting inappropriate denials were rare. However, the panel decisions have made important improvements in contract language and patient communications.

Humans↗
PubMed2007

Efforts to reduce racial disparities in Medicare managed care must consider the disproportionate effects of geography.

OBJECTIVE: To examine the impact of geographic variation on racial differences in 7 of 15 Health Plan Employer Data and Information Set (HEDIS) measures that assess the quality of the Medicare managed care program (also known as Medicare+Choice). STUDY DESIGN: Cross-sectional analysis using the 2004 individual-level HEDIS for Medicare managed care plans and 2003 Medicare enrollment and demographic (ie, denominator) data for more than 5.1 million Medicare+Choice enrollees. METHODS: Individual-level HEDIS data were linked with Medicare enrollment data. Hierarchical generalized linear models were used to assess statistical significance of region and race. Direct standardization was used to estimate the rate of meeting each HEDIS standard while controlling for differences in age and sex. RESULTS: Quality of care for white Medicare+Choice enrollees was strongly correlated with the racial composition of the geographic area. Except for cholesterol management after an acute cardiac event, between-region racial variation was consistently greater than within-region racial variation. CONCLUSION: Removing within-region racial variation while ignoring geographic differences will not equalize the experiences of black and white elders. Rather, both racial and geographic components of healthcare quality must be addressed if the Medicare managed care program is to provide care of equal quality to all elders regardless of race.

Black or African American↗
PubMed2006

Functional limitations in elderly female cancer survivors.

BACKGROUND: The elderly population, including many who are long-term cancer survivors, is increasing. Aspects of quality of life in elderly cancer survivors are not well understood. METHODS: Subjects were women who enrolled in a population-based cohort study in 1986. At follow-up in 1997, 25,719 women, at a median age of 72 years, reported on functional limitations. We used logistic regression to calculate prevalence odds ratios (ORs) and proportional hazards regression to calculate prevalence ratios (PRs) for associations between cancer survivor status and functional limitations, adjusting for baseline (precancer) characteristics including obesity, smoking, and diabetes. RESULTS: Women who were cancer survivors for less than 2 years reported the most functional limitations, but long-term (5 or more years) cancer survivors remained more likely than cohort members who had not had cancer to report that they were unable to do heavy household work (42% of 1068 5-year survivors, versus 31% of 23 501 who never had cancer, multivariable OR = 1.47, 95% confidence interval [CI] = 1.27 to 1.69; PR = 1.22, 95% CI = 1.10 to 1.34), unable to walk a half mile (26% versus 19%, OR = 1.31, 95% CI = 1.1 to 1.54; PR = 1.16, 95% CI = 1.02 to 1.32), and unable to walk up and down stairs (9% versus 6%, OR = 1.34, 95% CI = 1.05 to 1.72; PR = 1.25, 95% CI = 1.00 to 1.56). The increased prevalence of functional limitations was apparent for 5-year survivors of breast cancer and also certain other cancers. CONCLUSIONS: Our findings support the need to target elderly cancer survivors for interventions to maintain or regain physical function.

Activities of Daily Living↗
PubMed2006

Access to home-based hospice care for rural populations: Identification of areas lacking service.

BACKGROUND: Many persons dying of cancer enroll in home-based hospice prior to death. It is established in the literature that persons in rural settings are less likely to use hospice than persons living in urban areas. We examine whether this is due, in part, to a lack of hospice providers serving rural areas. METHODS: The 100% Medicare enrollment and hospice files for 2000-2002 were the basis for this study. We used a Bayesian smoothing technique to estimate the ZIP-code-level service area for each Medicare-certified hospice in the United States. These service areas were combined to identify ZIP codes not served by any hospice. RESULTS: Overall, approximately 332,000 elders (7.5% of ZIP codes) reside in areas not served by home-based hospice. Each year over 15,000 deaths occur in these unserved areas. There was a strong association between lack of service and urban/rural gradient. One hundred percent of the ZIP codes in the most urban areas (>1,000,000 people) are served by hospice and only 2.8% of the ZIP codes in urban areas of less than 1,000,000 are unserved. In rural areas adjacent to urban areas, over 9% of ZIP codes are unserved and in rural areas not adjacent to an urban area almost 24% of ZIP codes are not served by hospice. CONCLUSIONS: While the majority of the elderly population of the US resides in areas currently served by Medicare-certified hospice, there is a geographically large area that lacks home-based hospice services. Current payment policies may need to be adjusted to facilitate hospice availability to these rural populations.

Catchment Area, Health↗
PubMed2006

Trends in the incidence of invasive and in situ vulvar carcinoma.

OBJECTIVE: To characterize the incidence of vulvar carcinoma in situ and vulvar cancer over time. METHODS: We used the Surveillance Epidemiology and End Results database to assess trends in the incidence of vulvar cancer over a 28-year period (1973 through 2000) and determined whether there had been a change in incidence over time. Information collected included patient characteristics, primary tumor site, tumor grade, and follow-up for vital status. We calculated the incidence rates by decade of age, used chi(2) tests to compare demographic characteristics, and tested for trends in incidence over time. RESULTS: A total of 13,176 in situ and invasive vulvar carcinomas were identified; 57% of the women were diagnosed with in situ, 44% with invasive disease. Vulvar carcinoma in situ increased 411% from 1973 to 2000. Invasive vulvar cancer increased 20% during the same period. The incidence rates for in situ and invasive vulvar carcinomas are distributed differently across the age groups. In situ carcinoma incidence increases until the age of 40-49 years and then decreases, whereas invasive vulvar cancer risk increases as a woman ages, increasing more quickly after 50 years of age. CONCLUSION: The incidence of in situ vulvar carcinoma is increasing. The incidence of invasive vulvar cancer is also increasing but at a much lower rate.

Adolescent↗
PubMed2006

Using a Spanish surname match to improve identification of Hispanic women in Medicare administrative data.

OBJECTIVE: To assess the effectiveness of a Spanish surname match for improving the identification of Hispanic women in Medicare administrative data in which Hispanics are historically underrepresented. DATA SOURCES: We collected self-identified race/ethnicity data (N=2,997) from a mailed survey sent to elderly Medicare beneficiaries who resided in 11 geographic areas consisting of eight metropolitan counties and three nonmetropolitan areas (171 counties) in the fall of 2004. The 1990 Census Spanish Surname list was used to identify Hispanics in the Medicare data. In addition, we used data published on the U.S. Census Bureau website to obtain estimates of elderly Hispanics. STUDY DESIGN: We used self-identified race/ethnicity as the gold standard to examine the agreement with Medicare race code alone, and with Medicare race code+Spanish surname match. Additionally, we estimated the proportions of Hispanic women and men, in each of the 11 geographic areas in our survey, using the Medicare race code alone and the Medicare race code+Spanish surname match, and compared those estimates with estimates derived from U.S. Census 2000 data. PRINCIPAL FINDINGS: The Spanish surname match dramatically increased the accuracy of the Medicare race code for identifying both Hispanic and white women, producing improvements comparable with those seen for men. CONCLUSIONS: We recommend the addition of a proxy race code in the Medicare data using the Spanish surname match to improve the accuracy of racial/ethnic representation.To assess the effectiveness of a Spanish surname match for improving the identification of Hispanic women in Medicare administrative data in which Hispanics are historically underrepresented. We collected self-identified race/ethnicity data (N=2,997) from a mailed survey sent to elderly Medicare beneficiaries who resided in 11 geographic areas consisting of eight metropolitan counties and three nonmetropolitan areas (171 counties) in the fall of 2004. The 1990 Census Spanish Surname list was used to identify Hispanics in the Medicare data. In addition, we used data published on the U.S. Census Bureau website to obtain estimates of elderly Hispanics. We used self-identified race/ethnicity as the gold standard to examine the agreement with Medicare race code alone, and with Medicare race code+Spanish surname match. Additionally, we estimated the proportions of Hispanic women and men, in each of the 11 geographic areas in our survey, using the Medicare race code alone and the Medicare race code+Spanish surname match, and compared those estimates with estimates derived from U.S. Census 2000 data. The Spanish surname match dramatically increased the accuracy of the Medicare race code for identifying both Hispanic and white women, producing improvements comparable with those seen for men. We recommend the addition of a proxy race code in the Medicare data using the Spanish surname match to improve the accuracy of racial/ethnic representation.

Data Collection↗
PubMed2005

Risk of pelvic fractures in older women following pelvic irradiation.

CONTEXT: Pelvic fractures, including hip fractures, are a major source of morbidity and mortality in older women. Although therapeutic pelvic irradiation could increase the risk of such fractures, this effect has not been studied. OBJECTIVE: To determine if women who undergo pelvic irradiation for pelvic malignancies (anal, cervical, or rectal cancers) have a higher rate of pelvic fracture than women with pelvic malignancies who do not undergo irradiation. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) cancer registry data linked to Medicare claims data. A total of 6428 women aged 65 years and older diagnosed with pelvic malignancies from 1986 through 1999 were included. We compared results for women who did (n = 2855) vs did not (n = 3573) undergo radiation therapy. To assess the influence of selection bias, we also evaluated the effect of irradiation on osteoporotic fractures in nonirradiated sites (arm and spine). MAIN OUTCOME MEASURE: We evaluated the effect of irradiation on the incidence of pelvic fractures over time, and adjusted for potential confounders using a proportional hazards model. RESULTS: Women who underwent radiation therapy were more likely to have a pelvic fracture than women who did not undergo radiation therapy (cumulative 5-year fracture rate, 14.0% vs 7.5% in women with anal cancer, 8.2% vs 5.9% in women with cervical cancer, and 11.2% vs 8.7% in women with rectal cancer); the difference was statistically significant and most fractures (90%) were hip fractures. We controlled for potential confounders including age, race, cancer stage, and geographic location. The impact of irradiation varied by cancer site: treatment for anal cancer was associated with a higher risk of pelvic fractures (hazard ratio, 3.16; 95% confidence interval, 1.48-6.73); than for cervical cancer (hazard ratio, 1.66; 95% confidence interval, 1.06-2.59); or rectal cancer (hazard ratio, 1.65; 95% confidence interval, 1.33-2.05). No statistically significant difference was found in the rate of arm or spine fractures between the irradiated and nonirradiated groups (hazard ratio, 1.15; 95% confidence interval, 0.89-1.48). CONCLUSIONS: Pelvic irradiation substantially increases the risk of pelvic fractures in older women. Given the high baseline risk of pelvic fracture, this finding is of particular concern.

Aged↗
PubMed2005

A self-assessment tool was reliable in identifying hazards in the homes of elders.

BACKGROUND AND OBJECTIVES: Falls are a leading cause of fatal and nonfatal injuries, particularly among the elderly. A reliable instrument for self-assessment of home falls hazards would facilitate screening for falls risk. This study examined the reliability of self-assessment of home falls hazards by elderly women. METHODS AND SETTING: Participants were 52 elderly women, aged 67 to 97. All evaluations were performed in the participants' homes. Home falls hazards were evaluated independently by study participants and by trained observers. RESULTS: Kappa statistics indicated good to excellent agreement for most of the environmental factors. However, observers were significantly more likely than the study participants to report certain tripping hazards, particularly objects in walkways. CONCLUSION: This home checklist is an important step towards a reliable self-report instrument for measuring home falls hazards. Self-assessment appears to be a reliable method for assessing many putative hazards of falling in the home. However, our findings raise questions regarding the reliable assessment of tripping hazards.

Accidental Falls↗
PubMed2005

Lymph node evaluation in colorectal cancer patients: a population-based study.

BACKGROUND: Adequate lymph node evaluation is required for proper staging of colorectal cancer, and the number of lymph nodes examined is associated with survival. According to current guidelines, the recommended minimum number of lymph nodes examined to ensure adequate sampling is 12. We used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program to determine the proportion of colorectal cancer patients in the United States who receive adequate lymph node evaluation. METHODS: For 116,995 adults with colorectal adenocarcinoma, diagnosed from 1988 through 2001, who underwent radical surgery and did not receive neoadjuvant radiation, we evaluated the number of lymph nodes, the likelihood of receiving adequate lymph node evaluation (i.e., at least 12 lymph nodes examined), and the influence of tumor and patient factors on lymph node evaluation. All statistical tests were two-sided. RESULTS: Among all patients, the median number of lymph nodes examined was nine. Only 37% of all patients received adequate lymph node evaluation. The proportion of patients receiving adequate lymph node evaluation increased from 32% in 1988 to 44% in 2001 (P(trend)<.001, Cochran-Armitage test). Advanced tumor stage was statistically significantly associated with adequate lymph node evaluation (odds ratio [OR] of receiving adequate lymph node evaluation=2.27, 95% confidence interval [CI] = 2.18 to 2.35). Older patients (> or =71 years, OR = 0.45, 95% CI = 0.44 to 0.47) were less likely to receive adequate lymph node evaluation than younger patients, and those with left-sided (OR = 0.45, 95% CI = 0.44 to 0.47) or rectal (OR = 0.52, 95% CI = 0.50 to 0.54) cancers were less likely to receive adequate lymph node evaluation than patients with right-sided cancers. In all analyses, geographic location was an important predictor of adequate lymph node evaluation, which ranged from 33% to 53%, depending on geographic location. CONCLUSIONS: In 2001, the majority of patients with colorectal cancer still received inadequate lymph node evaluation. The association of demographic variables, particularly patient age and geographic location, with adequate lymph node evaluation indicates that local surgical and pathology practice patterns may affect adequacy of lymph node evaluation.

Adult↗
PubMed2005

Increased risk of rectal cancer after prostate radiation: a population-based study.

BACKGROUND & AIMS: Radiation therapy for prostate cancer has been associated with an increased rate of pelvic malignancies, particularly bladder cancer. The association between radiation therapy and colorectal cancer has not been established. METHODS: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) registry data from 1973 through 1994. We focused on men with prostate cancer, but with no previous history of colorectal cancer, treated with either surgery or radiation who survived at least 5 years. We evaluated the effect of radiation on development of cancer for 3 sites: definitely irradiated sites (rectum), potentially irradiated sites (rectosigmoid, sigmoid, and cecum), and nonirradiated sites (the rest of the colon). Using a proportional hazards model, we evaluated the effect of radiation on development of colorectal cancer over time. RESULTS: A total of 30,552 men received radiation, and 55,263 underwent surgery only. Colorectal cancers developed in 1437 patients: 267 in irradiated sites, 686 in potentially irradiated sites, and 484 in nonirradiated sites. Radiation was independently associated with development of cancer over time in irradiated sites but not in the remainder of the colon. The adjusted hazards ratio for development of rectal cancer was 1.7 for the radiation group, compared with the surgery-only group (95% CI: 1.4-2.2). CONCLUSIONS: We noted a significant increase in development of rectal cancer after radiation for prostate cancer. Radiation had no effect on development of cancer in the remainder of the colon, indicating that the effect is specific to directly irradiated tissue.

Aged↗
PubMed2005

Improved care and outcomes among elderly medicare managed care beneficiaries with diabetes.

OBJECTIVE: To examine individual- and plan-level factors related to improved diabetes care and outcomes between 1999 and 2001 among elderly Medicare managed care beneficiaries with diabetes. STUDY DESIGN: Retrospective analysis of Medicare and individual-level Health Plan and Employer Data Information Set data. METHODS: We merged Medicare demographic information with person-level data regarding 6 comprehensive diabetes care measures provided by the National Committee on Quality Assurance for Medicare managed care enrollees for 1999. Then we identified those beneficiaries for whom comprehensive diabetes care information was also reported in 2001, and determined the improvement for each measure. Data on persons not meeting the comprehensive diabetes care criteria in 1999 were analyzed to determine the factors associated with appropriate care and outcomes in 2001. RESULTS: Of the 174 combinations of individual- or plan-level factors and comprehensive diabetes care measures, 167 showed significant improvements. Nonetheless, for most of the 6 comprehensive diabetes care measures, poor care occurred more frequently for black patients than for white patients, among individuals in for-profit versus not for profit plans, and among individuals in independent practice association plans compared with group and staff model plans. Among the beneficiaries whose healthcare failed to meet the comprehensive diabetes care guidelines in 1999, by 2001, care guidelines were met in approximately three fourths for hemoglobin A1c and low-density lipoprotein cholesterol testing, but in only one half for eye examinations, low-density lipoprotein cholesterol control, and nephropathy monitoring. CONCLUSIONS: Between 1999 and 2001, care of elderly Medicare patients with diabetes improved, including among individuals who previously had not received appropriate care. However, more improvement is needed to achieve equality among members of all race groups and plan types.

Aged↗
PubMed2004

Trends in the treatment of ductal carcinoma in situ of the breast.

BACKGROUND: An increase in incidence of ductal carcinoma in situ (DCIS) of the breast has been documented, and concerns regarding overly aggressive treatment have been raised. This study was designed to evaluate the use of surgery and radiation therapy in treating DCIS. METHODS: We used the National Cancer Institute's Surveillance, Epidemiology, and End Results database to assess treatment of patients with DCIS with no evidence of microinvasion who were diagnosed from January 1, 1992, through December 31, 1999. We assessed the rates of mastectomy, breast reconstruction, radiation therapy after lumpectomy, and axillary dissection. Associations were analyzed by logistic regression. RESULTS: During the study period, 25 206 patients met selection criteria. The incidence of DCIS dramatically increased with time; however, the incidence of comedo lesions did not change. The rate of mastectomy decreased from 43% in 1992 to 28% in 1999, after controlling for age, race, tumor size, comedo histology, and geographic location. However, because of the increase in the diagnosis of DCIS, the age-adjusted incidence of mastectomy for DCIS in the population did not change (7.8 per 100 000 women in 1992 and 1999). Almost half the patients undergoing lumpectomy did not undergo radiation therapy (55% in 1992 and 46% in 1999); in those with comedo histology, 33% did not undergo radiation therapy after lumpectomy, even in 1999. Overall, patients were less likely to have axillary dissection over time (34% in 1992 versus 15% in 1999), yet the rate of axillary dissection was still high (30%) in patients undergoing mastectomy in 1999. Large, statistically and clinically significant variation by geographic location was found in treatment. CONCLUSIONS: Treatment of DCIS changed in a clinically significant fashion between 1992 and 1999. Throughout this study, many patients were found to undergo aggressive surgical therapy, including mastectomy and axillary dissection, whereas others appeared to be undertreated, e.g., not receiving radiation therapy after lumpectomy, even in the presence of adverse histologic features. Variation in demographic and geographic factors indicates that at least some of these treatment differences reflect individual and institutional practice patterns that may be modifiable.

Adult↗
PubMed2004

Low-intensity exercise and reduction of the risk for falls among at-risk elders.

BACKGROUND: Among elderly persons, falls account for 87% of all fractures and are contributing factors in many nursing home admissions. This study evaluated the effect of an easily implemented, low-intensity exercise program on the incidence of falls and the time to first fall among a clinically defined population of elderly men and women. METHODS: This community-based, randomized trial compared the exercise intervention with a no-intervention control. The participants were 294 men and women, aged 60 years or older, who had either a hospital admission or bed rest for 2 days or more within the previous month. Exercise participants were scheduled to attend exercise sessions lasting 45 minutes, including warm-up and cool-down, 3 times a week for 8 weeks (24 sessions). Assessments included gait and balance measures, self-reported physical function, the number of medications being taking at baseline, participant age, sex, and history of falling. Falls were tracked for 1 year after each participant's baseline assessment. RESULTS: 29% of the study participants reported a fall during the study period. The effect of exercise in preventing falls varied significantly by baseline physical function level (p < or =.002). The risk for falls decreased for exercise participants with low baseline physical functioning (hazard ratio,.51) but increased for exercise participants with high baseline physical functioning (hazard ratio, 3.51). CONCLUSIONS: This easily implemented, low-intensity exercise program appears to reduce the risk for falls among elderly men and women recovering from recent hospitalizations, bed rest, or both who have low levels of physical functioning.

Accidental Falls↗
PubMed2004

Improving identification of Hispanic males in Medicare: use of surname matching.

OBJECTIVES: Medicare administrative and claims files maintained by the Centers for Medicare and Medicaid Services (CMS) are frequently used to examine racial and ethnic disparities in healthcare use. However, identification of Hispanic ethnicity for beneficiaries in the Medicare claims files is problematic, greatly limiting the use of these administrative data for examining race/ethnicity differences. This article reports on 2 studies assessing the effectiveness of a Hispanic surname match for improving the accuracy of race/ethnicity codes for elderly males in the Medicare data sets. METHODS: Study 1 used survey data to compare a Medicare race code + Spanish surname composite indicator to self-identification as Hispanic. Study 2 used Medicare administrative files and U.S. Census 2000 data to identify how well the Medicare race code alone and the Medicare race code + Spanish surname composite indicator compared with estimates obtained from census data for 16 U.S. counties dispersed across 5 states. RESULTS: Using self-identification as the gold standard, including the Spanish surname match increased accuracy for Hispanics and whites compared with the Medicare race code alone. The Spanish surname match also dramatically improved the Medicare code's estimation of elderly Hispanic and white males compared with county-level census data. CONCLUSIONS: Augmenting the Medicare race code with a match to Spanish surnames yields substantial improvement in the identification of elderly Hispanic and white non-Hispanic male Medicare beneficiaries. Using surname information to supplement the Medicare race code could greatly enhance researchers' ability to examine healthcare equity.

Aged↗
PubMed2004

Do rural elders have limited access to Medicare hospice services?

OBJECTIVES: To examine whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries. DESIGN: Observational study using 100% of Medicare enrollment, hospice, and hospital claims data. SETTING: Inpatient hospitals and hospices. PARTICIPANTS: Persons aged 65 and older in the Medicare program who died in 1999. MEASUREMENTS: Rates of hospice use before death and in-hospital death rates were calculated. RESULTS: In 1999, there were 1.76 million deaths of Medicare beneficiaries aged 65 and older. Hospice services were used by 365,700 of these beneficiaries. Rates of hospice care before death were negatively associated with degree of rurality. The lowest rate of hospice use, 15.2% of deaths, was seen in rural areas not adjacent to an urban area. The highest rate of use, 22.2% of deaths, was seen in urban areas. Rural areas adjacent to urban areas had an intermediate level of hospice use (17.0% of deaths). Hospices based in rural areas had a smaller number of elderly patients each year than hospices based in urban areas (P<.001) and were more likely to have very low volumes (average daily census of three patients or less). CONCLUSION: The consistently lower use of Medicare hospice services before death and smaller sizes of rural hospices suggest that the combination of Medicare hospice payment policies and hospice volumes are problematic for rural hospices. Adjusting Medicare payment policies might be a critical step to assure availability of hospice services forterminally ill beneficiaries regardless of where they live.

Aged↗
PubMed2003

Racial variation in the control of diabetes among elderly medicare managed care beneficiaries.

OBJECTIVE: To examine racial variation in the poor control of GHb, a GHb value >9.5%, or GHb not tested in 1999 among Medicare beneficiaries aged 65-75 years enrolled in managed care plans. RESEARCH DESIGN AND METHODS: The National Committee on Quality Assurance provides person-level data regarding diabetes care services and control for Medicare beneficiaries enrolled in managed care to the Centers for Medicare and Medicaid Services (CMS). We merged this information with information on each individual's race, as well as other person-level and plan-level characteristics obtained from CMS. Bivarate and multivariate analyses were performed. RESULTS: The overall rate of poor GHb control was 32.7%. The age- and sex-adjusted rate of poor control among whites was 32.0%. This rate was significantly higher than the rate among Asians (24.7%) but significantly lower than the rate among blacks (40.6%) and Hispanics (36.5%) (P < 0.001). An increase in the number of comprehensive diabetes care measures received by an individual was associated with a significantly lower percentage of individuals with poor GHb control in all race groups. After controlling for the individual-level, plan-level, and diabetes care measure variables, the difference in GHb control between Asians and whites disappeared. However, blacks and Hispanics continued to have significantly higher rates of poor control than whites. CONCLUSIONS: There is room for significant reduction in the number of patients with poor control of GHb among all races, particularly among blacks and Hispanics.

Aged↗
PubMed2003

Prevention of perinatal group B streptococcal disease in Minnesota: results from a retrospective cohort study and new prevention guidelines.

Group B Streptococcus (GBS) is an important cause of perinatal morbidity and mortality in the United States. In 1996, guidelines from the Centers for Disease Control and Prevention (CDC) recommended that prenatal care providers either screen all pregnant women for GBS carriage and offer intrapartum antibiotic prophylaxis (IAP) to women who test positive, or offer IAP to women who have risk factors for early-onset GBS (EOGBS) disease during pregnancy. A recent multi-state retrospective cohort compared the efficacy of the 2 methods and found the screening-based method to be significantly more effective at reducing the incidence of EOGBS. One of the study sites was the 7-county Minneapolis-St. Paul metropolitan area. Analysis of Minnesota data also found screening to be more effective in reducing EOGBS than the risk-based approach. In August 2002, the CDC published new guidelines that recommend adoption of a universal screening approach to management of perinatal GBS infections.

Adult↗