Biomedical subjects

Carol C Korenbrot

Publications and source records attributed to Carol C Korenbrot.

5 recordsLinked to original sources

PubMed2005

Rural American Indian Medicaid health care services use and health care costs in California.

OBJECTIVES: We determined differences in Medicaid service use and health care costs in a rural Indian Health Service (IHS) user population of American Indians and Alaska Natives as compared with Whites. METHODS: California Medicaid eligibility and claims files were linked to IHS user files to obtain a sample of Medicaid-eligible American Indian/Alaska Native users (n=7910). A random sample of Whites was matched for age, gender, aid category, length of eligibility, and county of residence (n=15075). We used generalized linear models to compare risk-adjusted use of resources-ambulatory visits, prescriptions, emergency room visits, hospitalizations, and costs-both adjusting and stratifying for dominant source of ambulatory visits. RESULTS: American Indians/Alaska Natives had significantly lower use of Medicaid-paid ambulatory visits, prescriptions, emergency room visits, and hospitalizations and lower associated costs than Whites. Medicaid-paid total costs and use of services were lower for those who predominantly used Indian health program clinics, as well as for those who predominantly used other sources of ambulatory care. CONCLUSIONS: Barriers to receiving Medicaid services and payments exist for American Indians/Alaska Natives in the rural IHS-user population. If American Indians/Alaska Natives are to have Medicaid resources comparable to those of Whites, these barriers must be reduced.

Adult↗

PubMed2005

Health promotion and psychosocial services and women's assessments of interpersonal prenatal care in Medicaid managed care.

OBJECTIVES: If prenatal health promotion and psychosocial support services are to remain accessible to Medicaid eligible women, evidence is needed as to whether the services improve care and benefit women in ways that matter to health plans. The aims of this study are to determine whether prenatal health promotion and psychosocial services are associated with better interpersonal care and greater satisfaction with care; and whether the effects on interpersonal care help explain satisfaction with care. RESEARCH DESIGN: A telephone survey of 363 African American, Latina (US and nonUS-born) and White women receiving prenatal care in four Medicaid public health plans in California in 2001. Multivariate regression analyses were done with adjustments for potentially confounding variables. MEASURES: Independent variables included dichotomous variables for health promotion advice (five separate areas) and composite scales for psychosocial assessment (six areas combined). Dependent variables included satisfaction with care, and indices for interpersonal care (communication, decision-making, and interpersonal style). RESULTS: Women who report receiving health promotion or psychosocial services also report receiving better interpersonal care and rate their satisfaction with care higher. Receiving either type of support service is associated with higher quality communication, decision-making and interpersonal style. The effects of the support services on satisfaction are, in turn, explained by the effects on interpersonal care. CONCLUSIONS: Prenatal health promotion and psychosocial services have associated benefits to enrollees that should matter to Medicaid health plans and their providers.

Adolescent↗

PubMed2003

Disparities in hospitalizations of rural American Indians.

BACKGROUND: Disparities in hospitalization rates, particularly rates for avoidable hospitalizations, are indicators of potentially unmet health needs and inefficient use of health resources. Hospitalization rates that the Indian Health Service (IHS) can report underestimate disparities for American Indians (AIs) and Alaska Natives (ANs) relative to other Americans, because the IHS cannot track all hospitalizations of AIs/ANs in their user population. OBJECTIVES: To compare hospitalization and avoidable hospitalization rates for a rural AI/AN user population with those of non-Indians living in the same counties where both groups use the same hospital system, regardless of the expected source of payment. RESEARCH DESIGN: Retrospective analysis of California hospital discharge data for 1996 linked to rural IHS user data for 1995 and 1996 (3920 hospitalizations) compared with a random sample of discharge data for the rest of the non-Indian population in the 37 counties of the IHS Contract Health Service delivery area (7840 hospitalizations). MEASURES: Hospitalization and avoidable hospitalization rates and risk ratios (RRs). RESULTS: Hospitalization and avoidable hospitalization rates were both higher for the AI/AN user population than for the non-Indian general population. The age-adjusted hospitalization ratios were 72% higher for men (RR 1.72, confidence interval [CI] 1.40-2.12) and 52% higher for women (RR 1.52, CI 1.36-1.92). The comparable ratios for avoidable hospitalizations were 136% higher for men (RR 2.36, CI 1.52-3.29) and 106% higher for women (RR 2.06, CI 1.32-3.50). CONCLUSIONS: Disparities in both hospitalization and avoidable hospitalization rates of rural AIs/ANs in California were previously undetected by either federal IHS or state hospital discharge data alone. At least some of the disparities are likely reducible with improved access to care.

Adolescent↗

PubMed2002

Preconception care: a systematic review.

OBJECTIVES: To perform a systematic review of published research trials of preconception care services to determine what evidence for effectiveness of care at improving the course of pregnancy or its outcomes has accumulated since the last major review in 1990. METHODS: The review was conducted adapting the systematic methods developed by the Cochrane Collaboration to collect evidence from published clinical research literature with as little bias as possible. The review included literature published after January 1990, and posted on MEDLINE by July 1999. RESULTS: Although more than 40 preconception risk conditions were searched and 470 articles were abstracted, only four problem areas and 19 research trials met the review criteria. New evidence of effectiveness was found for screening women who are seeking family planning for risk conditions; having sexually active women of reproductive age take dietary folate supplements; and providing women affected by certain metabolic conditions (diabetes and hyperphenylalanemia) with nutrition services. CONCLUSIONS: To help improve pregnancy outcomes MCH professionals need to promote the concept of readiness for pregnancy and help see that women are as healthy and appropriately nourished as possible before they become pregnant.

Abortion, Spontaneous↗

PubMedDate not supplied

Consumer assessment of the quality of interpersonal processes of prenatal care among ethnically diverse low-income women: development of a new measure.

PURPOSE: Consumer assessments of interpersonal processes of care during prenatal care provide important information about how well clinicians satisfy the perceived needs of the women they serve, but few measures are available that tap the various components of these processes. The purpose of this study is to develop a multidimensional measure of prenatal interpersonal processes of care (PIPC) that demonstrates reliability and validity in ethnically diverse women in Medicaid managed care plans. METHODS: A telephone survey of African American, Latino (U.S. and foreign born) and Caucasian pregnant women in four Medicaid managed care plans in California was conducted in English and Spanish in 2001. Factor analytic methods were used to test the PIPC measures. A psychometric evaluation, including reliability, variability, and construct validity, was conducted with the final scales for the total sample and for each racial/ethnic group. RESULTS: Three dimensions, Communication, Patient-Centered Decision Making, and Interpersonal Style, with seven scales were supported with 30 items. The scales for each dimension exhibit acceptable reliability for the total sample (Internal Consistency Reliability ranged from 0.66 to 0.85) and for all racial/ethnic groups. All scales had significant associations with satisfaction with prenatal care and explained considerable variation in satisfaction (19-43%). The scale qualities and validity associations held for all scales and ethnic groups except some scales for U.S.-born Latinas. CONCLUSIONS: The multidimensional PIPC measure for assessing what actually happens between providers and low-income pregnant women of diverse ethnic groups demonstrates acceptable reliability and construct validity.

Adult↗