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At least 415 records · Page 23Linked to original sources
PubMed2000

"Narrowing the Gap": decreasing emergency department use by children enrolled in the Medicaid program by improving access to primary care.

OBJECTIVE: To evaluate the effectiveness of increased primary care access created by North Carolina's Medicaid managed care plan, Carolina Access (CA), in reducing unnecessary emergency department (ED) use in Guilford County. METHODS: Emergency department records of pediatric visits before and after the implementation of CA were analyzed. Variables included patient age, International Classification of Diseases, Ninth Revision discharge diagnosis, insurance status, date of visit, time of visit, and ZIP code. Visits were classified as either urgent or nonurgent based on discharge diagnosis. Rates of ED use per 1000 persons were calculated using county population and Medicaid enrollment figures. RESULTS: A total of 54,742 ED visits occurred between January 1, 1995, and December 31, 1997. Thirty-eight percent of these visits were by children (defined as those aged 0-18 years in this study) enrolled in the Medicaid program. After the implementation of CA, monthly ED rates per 1000 children with Medicaid insurance decreased 24% from 33.5 +/- 5.3 to 25.6 +/- 2.3 (P<.001), which translates to 158 fewer visits per month by children enrolled in the Medicaid program. Nonurgent visits among the population enrolled in the Medicaid program decreased from an average monthly rate per 1000 of 17.9 +/- 3.5 to 11.2 +/- 2.5 after the implementation of CA (P<.001), accounting for most of the decrease in total visits. (All data are given as mean +/- SD.) The rates of total and nonurgent visits among the population not enrolled in the Medicaid program increased slightly. CONCLUSIONS: For children with Medicaid insurance, we found a strong temporal relation between decreased visits to the ED and increased access to primary care services, services that were made available by the implementation of North Carolina's Medicaid managed care plan, CA. Specific services that may be responsible for the decreased ED use include the expanded availability of primary care physicians and the use of telephone triage systems. No similar decrease in ED use was seen among the non-Medicaid-insured group. Arch Pediatr Adolesc Med. 2000;154:791-795

Adolescent↗
PubMed1985

[The " Accès " intervention program.].

In this article, the author describes the help program provided for the employees at the Royal Bank. Named "Access", this program is available to all employees of the bank, their immediate family and also retired personnel. In the first part of the article the author gives a detailed description of the program. In the second part, using a question and answer format, he reviews the main questions the employee asks himself before joining the program. Finally, the author quotes statistics showing that the program "Access" answers a real need.

English Abstract↗
PubMed1995

Access to hospice programs in end-stage dementia: a national survey of hospice programs.

OBJECTIVE: Because care of end-stage dementia is a significant clinical problem for which alternative modes of care are needed, this study examined the extent to which hospice programs served dementia patients. DESIGN: A survey of 1694 hospices with 1184 respondents (70%). PATIENTS: Identified patients had end-stage dementia, with no concurrent terminal illness. MEASURE: The proportion of end-stage dementia patients in hospice was measured. RESULTS: Fewer than 1% of hospice patients had a primary diagnosis of end-stage dementia, and only 21% of the hospices served such patients. However, 7% of hospice patients had a dementia secondary to another terminal illness, and 56% of the hospices served such patients. For 80% of the hospices, the major problem in serving dementia patients was the difficulty in predicting their survival time. A higher proportion of for-profit hospices served dementia patients (42%) compared with non-profit programs (22%) or public programs (15%), P < .001. CONCLUSIONS: A national survey of hospices revealed that few patients with primary dementia are currently treated by these programs, unless they have other terminal illnesses. An inability to predict survival was the major reason offered to explain this phenomenon. The higher percentage of patients with secondary dementia in hospice suggests that dementia per se does not make hospices care unfeasible. Similarly, the high proportion of for-profit hospices that enrolled patients whose dementia was primary implies the fiscal feasibility of providing hospice care for these patients. Further study is needed concerning the determinants of survival time in end-stage dementia.

Dementia↗
PubMed1996

Childbirth education in the 1990s and beyond.

Childbirth education has been evolving for centuries. It has been a part of the experience of pregnancy and birth since the beginning of time, although it did not exist in the formal structure that exists today. It began in response to a need to improve prenatal care and maternal-infant outcomes. It experienced an awakening fueled by the women's movement and the grass roots consumer movement between 1960 and 1980 and had an impact on the development of family-centered maternity care. It has been influenced by institutional control in the 1980s and 1990s. Throughout these decades the goals of childbirth education have changed and evolved. As we near the year 2000, childbirth education approaches a crossroads and faces many challenges for the future. A number of factors will influence the direction that childbirth education takes in the next century. These factors include demographic trends, health care reform, the philosophy of health care providers, goals and responsibilities of consumers, goals of educational programs, consumer access to education programs, the philosophy and role of childbirth educators, research, and standards of practice.

Female↗
PubMedDate not supplied

Evaluation of Alabama's mandatory continuing education program for reasonableness, access, and value.

BACKGROUND: As a measure of quality control, the Alabama Board of Nursing subjected the regulations for mandatory continuing education (MCE) for licensure to an evaluation of their impact and effectiveness. This study focused on licensees' perceptions of the regulations regarding reasonableness, access, and value. METHOD: Evaluation research methods were used to answer research questions related to the rules governing continuing education (CE) requirements for nursing licensure. Data were obtained from a survey of a random sample (N = 406) of RNs and licensed practical nurses. Both qualitative and quantitative methods were applied to data analysis. FINDINGS: Requirements for CE were perceived as reasonable; however, concerns were identified related to cost, access, and quality of presentations. Licensees perceived CE to be of value, and applied CE to decision-making and action in nursing practice. Chi-square analysis was significant to license type related to selected variables (e.g., rights and responsibilities). Qualitative analysis provided insight regarding licensees' concerns and recommendations for change. CONCLUSION: Mandatory continuing education (MCE) plays a significant role in promoting competence in nursing practice and is a mechanism for enhancing public protection. A high noncompliance rate on the MCE audit has ramifications for enforcement regulations.

Alabama↗