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PubMed1999

Physicians' perceptions of risk adjustment and health policy formation in Minnesota.

A questionnaire was used to assess Minnesota physicians' knowledge of and opinions about risk adjustment, a policy designed to modify payments to health providers based on the relative "sickness" level of the provider's patient population. Additionally, attitudes toward this policy were measured to examine physicians' perceptions of health policy formation in Minnesota. Although familiarity with this policy appears low, respondents support the concept of diagnosis-based risk adjustment. Physicians are divided on whether to further modify risk-adjusted rates with a conversion factor; their written comments suggest a mistrust of the policymaking process. Physicians most often listed the Minnesota Medical Association as a primary source for health policy information, while few respondents reported any communication with state legislators in health policy matters. Respondents perceive an imbalance in the influence wielded by various entities in health policy formation. Only 5% believe individual physicians have significant influence in policymaking. Increased communication between physicians and their legislators may be one way for physicians to gain such influence.

Attitude of Health Personnel↗
PubMed1997

Facing market changes: a health care cooperative in rural Minnesota.

The Minnesota Health Care Cooperative Act, enacted as an article of the Minnesota Health Care Act of 1994, allows the creation of "health care provider cooperatives," corporations where members are licensed health care providers. Organized under Minnesota Statutes 62R, health care provider cooperatives (referred to hereafter as cooperatives) market their services to health care purchasers, including licensed health plan companies, health maintenance organizations (HMOs), and government plans on a "substantially capitated or similar risk sharing basis." Solvency and reserve standards do not apply to cooperatives because they are not engaged in the business of insurance.

Community Networks↗
PubMed2000

New records of the blacklegged tick, Ixodes scapularis (Acari: Ixodidae) in Minnesota.

The Minnesota distribution of the blacklegged tick, Ixodes scapularis, was studied during 1998 and 1999. The majority of tick collecting was done by grouse hunters, who sent in specimens collected during the fall of 1998 and 1999. I. scapularis specimens were received from 17 counties, including eight counties in northern and central Minnesota that previously had no reports of I. scapularis. This brings the number of Minnesota counties with reported populations of I. scapularis to 30, mostly in the east-central, central, and northern parts of the state.

Animals↗
PubMed2001

Minnesota payers agree to work on same page with medical protocols.

In March, five of Minnesota's largest health plans--Blue Cross and Blue Shield of Minnesota, Medica, Preferred One, UCare Minnesota, and HealthPartners--agreed to work together as sponsors of the Institute for Clinical Systems Improvement to use best medical practice protocols developed at the institute.

Health Care Coalitions↗
PubMed2002

They've got the blues. Minnesota Blues and hospitals point fingers regarding who is ultimately responsible for the nation's soaring healthcare costs.

A battle is escalating between hospitals and Blues plans over who is responsible for soaring healthcare costs, and Blue Cross and Blue Shield of Minnesota has launched the latest volley. The insurer recently irritated hospital officials with its report criticizing Minnesota's hospital construction boom. Colleen Reitan (left), senior vice president of the Minnesota Blues, says a financial reality must be faced.

Blue Cross Blue Shield Insurance Plans↗
PubMed1992

The Patient Self-Determination Act. Advance directives available to Minnesota patients.

The Patient Self-Determination Act requires most health care institutions to inform patients of their right to refuse medical care and their right to provide advance direction regarding their wishes should they become incompetent. Although the PSDA does not apply to physicians, it will probably increase the demand for communication with patients on such matters. Patients will undoubtedly ask how to formulate advance directives. While physicians should make it clear that they are not providing legal advice to patients on such issues, they may wish to indicate that a guardianship and a living will are options available under Minnesota law. Additionally, as indicated above, a number of arguments exist that durable powers of attorney for health care are valid in Minnesota, as well. Physicians should familiarize themselves with living will forms and may wish to make them available to patients upon request. (Living will forms can be obtained by contacting the Minnesota Medical Association at 612/378-1875.) Patients with questions regarding durable powers of attorney should be advised to seek legal counsel.

Advance Directives↗
PubMed2003

Treatment patterns for female breast cancer in Minnesota, 1995-1996.

Breast-conserving surgery (BCS) followed by radiation is an accepted alternative to mastectomy for treatment of early-stage breast cancer. This study evaluated age-group, geographic, and cancer-stage variables associated with the likelihood of receiving BCS or receiving mastectomy and the likelihood of receiving radiation therapy following BCS. Minnesota Cancer Surveillance System data on 6,594 women diagnosed with breast cancer in Minnesota during the years 1995-1996 were analyzed. Of those women who underwent breast cancer surgeries, 39% received BCS. Seventy-two percent of cases in which BCS was used were followed by radiotherapy. Women 65 years and older were less likely than younger women to receive BCS. Age and the stage of the cancer were independently associated with the likelihood of receiving radiation therapy following BCS. Breast cancer patients 75 years and older were 73% less likely to receive radiation following BCS than patients ages 40 to 49. Radiation following BCS was more likely among women in the Twin Cities metropolitan area and south central Minnesota than among women in other regions.

Adult↗
PubMed2004

Enhanced pregnancy-associated mortality surveillance: Minnesota, 1990-1999.

Comprehensive surveillance is critical to accurate identification of pregnancy-associated deaths and risk factors and is the first step in implementing programs to prevent such deaths in young women. In Minnesota, surveillance is currently based on analysis of data from death records. This study sought to demonstrate that the state's current surveillance method underestimates the actual burden of maternal deaths in Minnesota. It proposes that ongoing enhanced surveillance--analysis of death certificate data combined with the linking of death records of women of reproductive age with live birth records or fetal death records--provides a more complete and accurate accounting of pregnancy-associated mortality in Minnesota.

Cause of Death↗
PubMed2004

Minnesota's Midwest AIDS Training and Education Center: helping health care providers remain current on a rapidly changing epidemic.

Since 1990, the number of people in Minnesota living with HIV/AIDS has been steadily increasing. The demographics of who is infected with HIV have changed, with more women and people of color being diagnosed. In addition, with new therapies and continually updated treatment recommendations, the information needed to provide quality medical care to HIV-infected patients is constantly evolving. Thus, providers who care for patients with HIV/AIDS need ongoing education about the disease. The Midwest AIDS Training and Education Center (MATEC) is a federally funded program that helps health care providers stay abreast of HIV clinical care and management knowledge. Based at the University of Illinois at Chicago, MATEC provides services in seven states, including Minnesota. This article describes how MATEC's HIV/AIDS training and education programs are being implemented in Minnesota and the different ways MATEC is delivering provider education in this important area.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Epidemiology of trauma in Minnesota.

Injury accounts for more than 2,500 deaths and 300,000 hospital admissions in Minnesota each year. Using the 2002 Minnesota hospital discharge database, we examined the subset of hospital-treated injuries that received trauma care and categorized claims into trauma-related deaths, cases of nonfatal major trauma, and other cases that received specialized trauma care. We also examined where trauma patients received their care, the leading diagnoses for trauma deaths and nonfatal major trauma, and whether a statewide trauma system that would identify and equip more hospitals as trauma centers would have significant potential for improving trauma care in Minnesota.

Cross-Sectional Studies↗
PubMed2005

Prevalence of elevated blood lead levels and evaluation of a lead-risk-screening questionnaire in rural Minnesota.

The objectives of the study reported here were to determine the prevalence of elevated blood lead levels in rural Minnesota and to evaluate a lead-risk-screening questionnaire. Blood lead tests and lead risk questionnaires were obtained for a sample of 1,090 children younger than 48 months of age (72 percent of the eligible population) from three rural counties of west-central Minnesota between September 1, 2001, and August 31, 2002. It was found that overall, 2.4 percent of children in the study had blood lead levels of > or = 10 microg/dL (0.48 micromol/L) (results for capillary and venous tests combined), 0.9 percent had venous blood lead levels of > or = 10 microg/dL, and 0.5 percent of study participants had blood lead levels of > or = 20 microg/dL (0.96 micromol/L). Three risk factor questions, when taken together, predicted 90 percent of blood lead levels of > or = 10 microg/dL and all blood lead levels of > or = 20 microg/dL. The study estimated the prevalence of lead poisoning using a sample of the entire population rather than a clinic-based convenience sample. The authors conclude that targeted screening is an effective way to identify lead-poisoned children in rural areas of Minnesota.

Child, Preschool↗
PubMed2005

The Minnesota Oral Health Care Solutions Project: implications for people with special needs.

Disparities in oral health status and access to dental care are major problems for people with special needs in Minnesota and across the country. The current delivery system for people with special needs is failing. Patients, community leaders, private dentists, safety net clinics, and state agencies are frustrated with the Medicaid program that funds the current system; and everyone is looking for new solutions. What would an improved oral health care system and Medicaid model look like? This paper describes Minnesota's Oral Health Care Solutions Project that seeks to answer this question and highlights the implications of a new model for people with special needs. The low reimbursements and administrative burdens of Minnesota's Medicaid program have led many dentists to reduce or stop seeing public program patients. As a result, many people with special needs have been unable to obtain routine dental care and therefore seek treatment in emergency rooms.

Delivery of Health Care↗
PubMed1991

The impact of judicial review of patients' refusal to accept antipsychotic medications at the Minnesota Security Hospital.

In 1988, the Minnesota Supreme Court ruled that premedication judicial review was required to force antipsychotic medications on incompetent committed patients in Minnesota. Before this decision all patients refusing antipsychotic medications at state hospitals were reviewed by an internal multidisciplinary peer review organization called the Treatment Review Panel (TRP). The author examined the impact of judicial review of medications at the Minnesota Security Hospital. Thirty-one patients reviewed by the Treatment Review Panel (TRP) between July 1986 and December 1987 were compared with 37 patients reviewed by the TRP and the court between January 1988 and December 1989. There was nearly unanimous agreement between the TRP and the court in approving antipsychotic medications for patients. However, for patients awaiting judicial review for medication, an average delay of 80 days was encountered, and there was a significant increase in the number of emergencies occurring on the treatment unit before the initiation of treatment. Complications of the long delay in approving medications included the diversion of limited mental health money to cover the costs of judicial review, diversion of physicians from direct patient care to provide testimony, inconsistent judicial medication and monitoring decisions, and compromise of medical judgment to meet judicial requirements. The study concluded that there was no advantage of judicial review over the previous Treatment Review Panel function.

Adult↗
PubMed1991

Economic cost of diabetes mellitus--Minnesota, 1988.

For diabetes mellitus (DM) and other chronic diseases, important indicators of disease burden include morbidity, mortality, measures of disability and quality of life, and economic burden. Because of limited data, however, the economic burden of DM has been difficult to measure. Although national costs for DM have been estimated recently (1-5), state-specific estimates have, in general, not been possible. This report summarizes an analysis prepared by the Minnesota Diabetes Surveillance Project (MDSP), Minnesota Department of Health, that estimated the economic impact of DM in Minnesota for 1988.

Diabetes Complications↗
PubMedDate not supplied

Trends in rates for mortality from all causes among Indians in Minnesota, 1960-79.

Trends in age- and sex-specific mortality rates for all causes of death for Indians in Minnesota during the years 1960-79 were examined using the Mantel-Haenszel chi-square extension test. Indians younger than 15 years of age were not included in the analysis because of the changes in classification for Indian race in census reports for Indian children and adolescents, known decreases in Indian infant mortality, and the small number of deaths among Indian children and adolescents during the years 1960-79. Declines in mortality rates were observed for Indian men and women 75 years of age and older, men 65 through 74 years of age, and women 25 through 54 years of age. Overall, only 8 percent of men and 53 percent of women were in age groups that showed declining mortality rates for all causes of death during the years 1960-79. The greatest decline in mortality rates for men and women occurred among those 75 years of age and older. Mortality rates for Indians in Minnesota declined during the study period for fewer than half of the age groups. Such strategies as risk factor surveillance, public health programs, and medical interventions need to be directed toward these groups that have not experienced the same declines in mortality rates as nearly all age groups of whites, both nationwide and in Minnesota, during the same period.

Adolescent↗
PubMed1988

Mortality of workers in two Minnesota taconite mining and milling operations.

Mortality during the years 1947 to 1983 was studied in 3,444 men employed for at least 3 months in Minnesota taconite mining operations during the years 1947 to 1958. During 86,307 person-years of observation, there were 801 deaths for a standardized mortality ratio (SMR) of 88 (US white male rates) or 98 (Minnesota rates). The 41 deaths from respiratory cancer were fewer than expected, the SMR being 61 (P less than or equal to .01) (US rates) and 85 (Minnesota rates). There were 25 respiratory cancers 20 or more years after first taconite employment, for an SMR of 57 (P less than or equal to .01) (US rates). SMRs for colon cancer, kidney cancer, and lymphopoietic cancer were elevated, but below the level of statistical significance. There was one death from pleural mesothelioma, 11 years after first taconite employment, in a man with long prior employment as a locomotive operator. The pattern of deaths did not suggest asbestos-related disease in taconite miners and millers.

Asbestos↗
PubMed1988

Lack of efficacy of Haemophilus b polysaccharide vaccine in Minnesota.

We evaluated the efficacy of Haemophilus b polysaccharide vaccine in children in Minnesota using a case-control study. The vaccine became available in Minnesota in August 1985. During the subsequent 28 months, 88 cases of invasive H influenzae type b disease were identified in children 24 to 71 months of age, the group targeted for vaccination. Of the 88 cases, 36 (41%) occurred in vaccinated children. Fifty-eight (33%) of 176 controls were vaccinated during a similar period. The vaccine's protective efficacy for children with any history of vaccination was -58% (95% confidence interval = -204% to 18%). The vaccine's protective efficacy for children who were most likely to be protected by vaccination was -55% (95% confidence interval = -238% to 29%). Our results indicate that vaccination with Haemophilus b polysaccharide vaccine had no effect in preventing H influenzae type b disease in Minnesota children.

Bacterial Capsules↗
PubMed1977

The Minnesota Rural Physician Redistribution Plan, 1971 to 1976.

The Rural Physician Associate Program was developed by the University of Minnesota Medical School faculty in an attempt to meet the demands of the citizens of Minnesota to improve the distribution of primary physicians to rural areas. The program is offered to students who have completed 2 2/3 academic years of medical school. There were no regulations requiring the students' return to rural areas after completion of training. Thus far, 163 students have completed the program. Forty-three have continued in medical school and another 27 are in residency-training programs. Primary care residencies have been chosen by 68; another 31 have completed their medical education and are in rural practice. Of the 22 practicing in Minnesota, 21 have returned to rural communities.

Counseling↗