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PubMed1986

Overview of Medicaid capitation and case-management initiatives.

Case-management programs have grown in number and in acceptance in the Medicaid program since 1981. In this article, we review their structure and incentives as well as what is known about their impact on cost and use. These programs also have been difficult to implement, posing myriad management challenges for prepaid program managers and State administrators. We highlight the problems in the following areas: eligibility, enrollment, rate setting, and management information systems.

Aged↗
PubMed1999

Developing a managed care delivery system in New York State for Medicaid recipients with HIV.

In the state of New York, models of care known as HIV Special Needs Plans (HIV SNPs) are being developed to meet the unique health and medical needs of Medicaid recipients with HIV. Establishing managed care plans for the 80,000 to 100,000 HIV-infected Medicaid recipients residing in the state has required considerable effort, including distributing planning grants to solicit information and recommendations regarding program and fiscal policy; convening a workgroup to facilitate discussions between the state and the provider and consumer communities; conducting a longitudinal survey to assess the impact of managed care on persons with HIV; and developing a longitudinal, person-based, encounter-level database representing the clinical and service utilization histories of more than 100,000 patients for state fiscal years 1990 to 1996. The key fiscal issues identified and discussed were capitation rates, initial capitalization levels, and risk-adjustment mechanisms. Other pertinent issues included the importance of a benefits package supporting a comprehensive, integrated continuum of state-of-the-art services; marketing and enrollment; attention to provider and consumer training and education needs; and interdependence of financial reimbursement and benefits packages. From our experience in New York State, we conclude that a successful model of Medicaid managed care for persons with HIV should build on the existing infrastructure of services, using a collaborative process among government agencies, healthcare providers, and HIV/AIDS consumer communities. A future challenge lies in the implementation of the HIV SNP model and evaluation of its soundness and ability to ensure quality healthcare services.

Capitation Fee↗
PubMed2001

Creating more effective health plan quality reports for consumers: lessons from a synthesis of qualitative testing.

OBJECTIVE: Social marketing techniques such as consumer testing have only recently been applied to develop effective consumer health insurance information. This article discusses lessons learned from consumer testing to create consumer plan choice materials. DATA SOURCES/STUDY SETTING: Data were collected from 268 publicly and privately insured consumers in three studies between 1994 and 1999. STUDY DESIGN: Iterative testing and revisions were conducted to design seven booklets to help Medicaid, Medicare, and employed consumers choose a health plan. DATA COLLECTION METHODS: Standardized protocols were used in 11 focus groups and 182 interviews to examine the content, comprehension, navigation, and utility of the booklets. PRINCIPAL FINDINGS: A method is suggested to help consumers narrow their plan choices by breaking down the process into smaller decisions using a set of guided worksheets. CONCLUSION: Implementing these lessons is challenging and not often done well. This article gives examples of evidence-based approaches to address cognitive barriers that designers of consumer health insurance information can adapt to their needs.

Consumer Advocacy↗
PubMed2001

Advances in protein microarray technology for protein expression and interaction profiling.

Protein microarrays address a great demand for high-throughput protein analysis techniques. Because protein microarrays detect many proteins in parallel, are quantitative, and have minimal reagent and sample consumption requirements due to miniaturization, they are potentially powerful tools for applications in basic and applied biology. Advances in manufacturing, protein immobilization and detection methods have enabled high-throughput protein quantitation and interaction studies. Protein microarrays can be applied to protein function studies, screening the production of antibodies and recombinant proteins, discovery of proteins implicated in disease or that are potential drug targets, and rapid detection or diagnosis of disease. A remaining challenge for the full implementation of protein microarrays in the acquisition of large sets of high-affinity and highly specific protein capture reagents.

Animals↗
PubMed1998

Evidence-based medical practice: ethical considerations.

The practice of medicine according to ethical principles requires that decisions regarding treatment, preventive or interventional strategies, or quality of life of patients in relation to life-support treatment should be based on evidence as far as possible. Available evidence for Hong Kong is reviewed under the following categories: use of drugs, management strategies, service provision, and interventions to prevent disease and/or disability. These examples highlight the need for studies to obtain evidence in the local population, as findings from studies in other countries may not be applicable. Although evidence exists in many areas to guide practice, the biggest challenge is how to implement such practice to ensure equitable access to prevention and treatment, particularly in the presence of health care resource limitations.

Journal Article↗
PubMedDate not supplied

Sensitivity-encoded diffusion tensor MR imaging of the cervical cord.

The aim of this study was to apply sensitivity-encoding (SENSE) echo-planar imaging (EPI) to diffusion tensor MR imaging of the cervical cord, an anatomic region where MR imaging is particularly challenging. This technique was implemented with a SENSE reduction factor of 2 and used for imaging a water phantom and five healthy volunteers. Off-resonance artifacts were notably reduced compared with those of full-FOV EPI sequences. This approach to diffusion tensor MR imaging of the cervical cord is promising for future, more extensive clinical applications.

Adult↗
PubMed2004

Dividing a trillion-dollar pie.

Four trends are likely to dominate development of healthcare payments in coming years: Consolidation and dissemination of new methods used by Medicare to pay for outpatient hospital care, skilled nursing care, home health care, and specialty hospital care. A return to 1990s-style struggles over risk allocation between providers and private-sector payers. Growing experimentation with paying for quality, especially in the hospital sector An uneven pace of change, reflecting shifts in bargaining power and technical challenges in designing and implementing new methods.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

Human rights and HIV/AIDS in the context of 3 by 5: time for new directions?

Over the last decade, the success of the human rights-based approach to HIV/AIDS has been spotty, says Mark Heywood. In this feature article, the author describes the challenges that remain in implementing a human rights approach. He presents an analysis of questions raised by De Cock et al concerning the applicability of the human rights approach. The author argues that human rights advocacy needs to continue, but that new directions are required. The article outlines new directions in the areas of (a) confidentiality and openness, (b) HIV testing, and (c) health systems. The author concludes that the most serious threat to human rights remains the unwillingness of national governments to take all necessary measures to build health services and prevent epidemics.

Canada↗
PubMedDate not supplied

Host factors and genetic susceptibility: a paradigm of the conundrum of pesticide exposure and cancer associations.

Millions of people are exposed to pesticides in non-trivial ways though their work, their leisure and their home environment. Women and children are understudied populations. The mode and types of pesticides to which women and children are exposed are often different from exposures experienced by men. A relatively small proportion of exposed individuals develop the uncommon cancers that have been associated with exposure to specific pesticides. Host factors, including such variables as gender, age at exposure, previous personal and family history, medical history, and genetic susceptibility have been implicated as explanations. The challenges of designing and implementing studies of pesticide exposure and cancer are examined with a special focus on the complexities of studying the environmental and occupational exposure of women to pesticides of varying toxicity using gender-appropriate methodology.

Environmental Exposure↗
PubMed2006

Chronic disease management systems registries in rural health care.

UNLABELLED: Health care quality is being addressed from a variety of policy perspectives. The 2001 Institute of Medicine report, Crossing the Quality Chasm, calls for sweeping action involving a five-part strategy for change in the U.S. health care system. This agenda for change includes use of evidence-based approaches to address common conditions, the majority of which are chronic. A Chronic Disease Management System (CDMS), or registry, is a tool that helps providers efficiently collect and analyze patient information to promote quality care for the rural population. CDMSs can provide a technological entry point for the impending use of Electronic Medical Records. A CDMS is a patient-centered electronic database tool that helps providers diagnose, treat, and manage chronic diseases. The purpose of this brief is to discuss the different types of CDMSs used by a sample of 14 state organizations and 19 local rural clinics in Maine, Nebraska, New Mexico, South Carolina, Washington, and Wisconsin. As part of a larger study examining the challenges and innovations in implementing disease management programs in rural areas, we conducted interviews with national, state, and local contacts. During interviews, respondents helped us understand the usefulness and functionalities of commonly used CDMSs in rural facilities. Our focus was on the use of CDMSs in the management of diabetes, a disease prevalent in rural populations. KEY FINDINGS: (1) CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology. (2) Use of a standardized system in a collaborative helps provide data comparisons and share costs involved with technical assistance services across the group.

Chronic Disease↗
PubMed2006

Protecting children's rights in the collection of health and welfare data.

Program managers and researchers promoting children's rights to health, education, and an adequate standard of living often gather data directly from children to assess their needs and develop responsive services. Gathering information within a participatory framework recognizing children's views contributes to protection of their rights. Extra precautions, however, are needed to protect children because of the vulnerabilities associated with their developmental needs. Using case studies of ethical challenges faced by program implementers and sociobehavioral researchers, this article explores ways in which data collection activities among children may affect their rights. We suggest ways in which rights-based principles may be used to derive safeguards to protect against unintentional harm and abuses, based on a multidisciplinary consultation with researchers and service providers.

Cambodia↗
PubMed2005

Monitoring vaccine safety during an influenza pandemic.

In the event that a vaccine is available during an influenza pandemic, vaccine safety monitoring will occur as part of comprehensive public health surveillance of the vaccination campaign. Though inactivated influenza vaccines have been widely used in the United States and much is known about their safety profile, attention will need to be paid to both common self-limited adverse reactions and rarer, more serious events that may or may not be causally related to vaccination. The primary surveillance systems used to generate and test hypotheses about vaccine safety concerns are the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD), respectively. Examples of recent use of these systems to investigate influenza vaccine safety and enhancements planned for use during a pandemic are presented. Ethical issues that will need to be addressed as part of an overall vaccine safety response include risk communication and injury compensation. Advance planning and the use of available technologic solutions are needed to respond to the scientific and logistic challenges involved in safely implementing mass vaccination during a pandemic.

Adverse Drug Reaction Reporting Systems↗
PubMed1990

The older adult. A comparative assessment.

Thorough assessment of older men and women is a complex but vital part of their health care. The ability to differentiate the changes owing to normal aging from those resulting from pathologic processes is necessary if their lives are to be as productive and enjoyable as they are prolonged. Each body system and function must be examined or tested with this difference in mind. Because aging occurs in different individuals at differing rates, a variety of functions may all be considered healthy or normal. Assessment findings must be viewed through the focus of the individual person as well as that of the population. The nurse will find opportunities to use assessment skills for older adults in many settings, ranging from independent living arrangements to institutional residential areas. In the community, social meeting places, day-care facilities, meal sites, and shopping areas are but a few of the places where older adults may be found, alone or in groups. Assessment opportunities can be identified or structured in any milieu. The setting itself, as well as the needs of the older adult(s), will help to determine the complexity of the assessment activities. The benefit to nursing of increased and expanded ability to assess the older adult is considerable. The organized concern of science and health care with aging is a relatively recent phenomenon. The older adults of today are unique--there are more of them than ever before, and they are living longer. Although their lives are not without health complications, they are, in a sense, role models for the rest of us: pathfinders in aging who can, if we observe them carefully, give us insight and direction for our own healthy aging processes and those of generations to come. Nursing is uniquely poised to use our caring methodology with the older adult. The elderly are interested in their health and willingly cooperate with those whose assessments are knowledgeable and realistic. Nursing is challenged to develop and implement advanced and specialized ways to identify and meet their needs.

Aged↗
PubMed1985

Strategies for increasing productivity.

In today's arena of competition, cost-containment, quality assurance, and high technology, the dietitian is challenged to develop and implement strategies that will assure an increase in productivity. Within a government system, such strategies must address the political climate as well as administrative and management issues. Prior to modifying any system or part of a system, it is critical to develop evaluation criteria. Each of the eight strategies discussed in this article is effective in promoting an increase in productivity.

Cost Control↗
PubMed1994

Practical issues in the application of case management to substance abuse treatment.

Interest in case management has grown in the substance abuse treatment field because of changes in the way we think about substance abuse, problems in the current delivery of treatment, subgroups of people have been identified who are unresponsive to currently available treatments or for whom special access problems are apparent. Case management is appealing because it involves accessing services and coordinating the care of individuals over long periods of time. This article briefly reviews the conduct of case management in substance abuse treatment by defining case management and discussing prevalent models, and then examining practical challenges faced in the implementation of case management.

Humans↗
PubMed1994

Enhancing preventive practice.

Health professionals can play a major role in prevention. They are perceived as a reliable and credible source of health information and they have contact with a large percentage of the population every year. In Canada, a key development for the integration of prevention in clinical practice was the establishment of the Canadian Task Force on the Periodic Health Examination. The Task Force has provided guidance on effective preventive interventions in the clinical setting over the past 15 years. The challenge lies in the implementation of these guidelines. We need to find innovative ways to disseminate and promote them. In this context, the creation of a National Partnership for Quality in Health is an important avenue for the coordination of practice guideline development and implementation in this country. An emerging concern in the delivery of preventive services is the coordination of activities of health professionals within the public health sector, with those of clinical care. In Canada, such a comprehensive and coordinated approach has been put into practice through the Canadian Heart Health Initiative.

Canada↗