Biomedical subjects

Sarah Shih

Publications and source records attributed to Sarah Shih.

3 recordsLinked to original sources

PubMed2004

Adolescent immunizations. are we ready for a new wave?

CONTEXT: Factors associated with vaccination coverage rates for the 20% of U.S. adolescents enrolled in managed care organizations (MCOs) are not known. OBJECTIVES: To examine recent trends in receipt of two doses of measles-mumps-rubella (MMR2) and three doses of hepatitis B (Hep B3) among U.S. adolescents enrolled in managed care organizations (MCOs); to determine whether specific characteristics of MCOs are associated with higher vaccination rates; and to assess the impact of state middle school immunization requirements on these rates. DESIGN: Longitudinal (1996-1999) and cross-sectional (1999) analyses of National Committee for Quality Assurance (NCQA) data to estimate adolescent vaccination coverage rates for MMR2 and Hep B3. In 2002, using 1999 data only, a cross-sectional analysis examined the relationship of specific plan characteristics and state immunization laws with immunization coverage. MAIN OUTCOME MEASURES: Percentage of 13 year olds in MCOs with documented receipt of MMR2 and Hep B3. RESULTS: From 1996 to 1999, MMR2 rates increased from 56% to 64%, and from 1997 to 1999, Hep B3 rates increased from 23% to 38%. By 1999, higher rates for both vaccines had been achieved in larger plans (p<0.001 and p<0.003 for MMR2 and Hep B3, respectively), those with the highest NCQA accreditation status (p<0.003), those in New England (p<0.001), and those in states with middle school immunization requirements (p<0.001). CONCLUSIONS: Despite encouraging increases, adolescent immunization rates are significantly below the Healthy People 2010 goal of 90%. State laws and accreditation incentives are effective. Research is needed to identify additional interventions to increase vaccination coverage in the adolescent population.

Accreditation↗

PubMed2004

The volume-quality relationship of mental health care: does practice make perfect?

OBJECTIVE: An extensive literature has demonstrated a relationship between hospital volume and outcomes for surgical care and other medical procedures. The authors examined whether an analogous association exists between the volume of mental health delivery and the quality of mental health care. METHOD: The study used data for the 384 health maintenance organizations participating in the Health Employer Data and Information Set (HEDIS), covering 73 million enrollees nationwide. Analyses examined the association between three measures of mental health volume (total annual ambulatory visits, inpatient discharges, and inpatient days) and the five HEDIS measures of mental health performance (two measures of follow-up after psychiatric hospitalization and three measures of outpatient antidepressant management), with adjustment for plan and enrollee characteristics. RESULTS: Plans in the lowest quartile of outpatient and inpatient mental health volume had an 8.45 (95% CI [confidence interval]=4.97-14.37) to 21.09 (95% CI=11.32-39.28) times increase in odds of poor 7- and 30-day follow-up after discharge from inpatient psychiatric hospitalization. Low-volume plans had a 3.49 (95% CI=2.15-5.67) to 5.42 (95% CI=3.21-9.15) times increase in odds of poor performance on the acute, continuation, and provider measures of antidepressant treatment. CONCLUSIONS: The large and consistent association between mental health volume and performance suggests parallels with the medical and surgical literature. As with that previous literature, further work is needed to better understand the mechanisms underlying this association and the potential implications for using volume as a criterion in plan choice.

Adolescent↗

PubMedDate not supplied

Differences in health care quality for children and adults under managed care: justification for separate quality assessments?

OBJECTIVE: To assess reported results of health care quality for children and adults in managed systems of care and to determine if variations exist between reported quality results for adults and children within the same plan. METHODS: We utilized Consumer Assessment of Health Plan Survey results reported from 424 managed care plans to the National Committee for Quality Assurance in 1999. Responses from 218 530 adults (515 per plan, 424 plans) and 55 081 parents of children 0-12 years of age (304 per plan, 181 plans) were available. Restricting analyses to the 178 plans reporting both adult and child results, we performed matched-pairs analyses to test the hypothesis that child results would be the same as their adult counterparts within the same plan. Regression methods were employed to test for potential demographic differences explaining observed differences. RESULTS: Within the same plan, reported results for care provided by specialists and primary care physicians to adults and children in the same plan revealed marked variation, including rating of doctor (Spearman correlation coefficient, r(S) =.504) and rating of specialist (r(S) =.326). Conversely, assessments of activities related directly to health plan activities showed little variation, including rating of health plan (r(S) =.850) and claims processing (r(S) =.857). Differences in demographic characteristics between adults and child survey respondents do not appear to explain observed variations. CONCLUSIONS: Separate quality of care assessments for adults and children within the same managed care system identify significant differences in reported quality. Having health plan quality information about adult care does not serve as a proxy for needed information on children, particularly the care related to primary care and specialist providers. Areas of health plan assessment common to both adults and children (eg, claims processing) could be replaced with more targeted assessments of importance to parents and purchasers (eg, children with chronic conditions).

Adult↗