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PubMed2001

Child health insurance outreach through the emergency department: a pilot study.

UNLABELLED: In 1997 the U.S. government funded the Children's Health Insurance Program (CHIP), but the 48 billion dollars initiative has had limited success in finding and enrolling uninsured children. While such children are more likely to receive care in emergency departments (EDs), no national initiative has targeted EDs for child health insurance outreach. OBJECTIVE: As a pilot study for a national multicenter study, this study evaluated the effectiveness of child health insurance outreach in an ED setting. METHODS: This was a prospective observational study of the outreach efforts of a single case manager from August 1998 to July 1999, performed at Foote Hospital ED in Jackson, Michigan (45,000 visits/year). All patients <or=18 years old presenting during the duty-hours of the intervention worker were eligible. The case manager approached the parent of all uninsured children and provided information and an application for government-sponsored health insurance. She followed up with a brief phone interview of each parent to determine whether the targeted child had received the insurance, and whether the new coverage was due to the ED referral. Missing information was confirmed from state insurance records. Data were analyzed with frequency tabulations and 95% confidence intervals. RESULTS: Seventy-eight children participated (median age 7 years; 55% male; 87% white). Forty-four percent (95% CI = 32% to 55%) of families referred for government-sponsored child health insurance successfully obtained it; 31% (95% CI = 21% to 42%) could be traced directly to intervention efforts by interview (n = 17) or by state records (n = 7). Nineteen percent (95% CI = 11% to 30%) got other private insurance. Of those who got government-sponsored insurance due to the intervention, all but one were covered by Medicaid. CONCLUSIONS: The ED may be an important outreach site for child health insurance programs. National efforts to address the lack of insurance among children should include partnerships with the ED.

Adolescent↗
PubMed2000

A RACOG sponsored pilot study of a quality assurance program regarding management of labour by provincial Fellows. Royal Australian College of Obstetricians and Gynaecologists.

OBJECTIVE: To develop an effective and practical self-administered obstetric audit program for use by clinicians within their own practice. SETTING: The private and public practices of specialists in provincial practice. SAMPLE: Two periods of 3 months in each Fellow's practice, separated by a period of 3 months to allow for data review, resulting in the review of management of 6708 singleton births. METHODS: All provincial Fellows in active practice in Australia in early 1998 were invited to take part in a voluntary 'quality cycle' obstetric practice audit. The data from the first 3 month period was fed back to participating Fellows for review before a second 3-month audit period was undertaken. RESULTS: One hundred and twenty provincial Fellows were invited to take part; 62 registered for the study, 58 commenced the project, and 52 completed the entire cycle. 60.1% of the 6708 women studied laboured spontaneously, 25.8% had labour induced, and 14.1% had elective Caesarean sections. 87.8% of the 5759 women who laboured gave birth vaginally. There was little change in the incidence of intervention in labour between the first and second study periods. CONCLUSIONS: It is possible to design a worthwhile self-administered clinical audit in obstetric practice with which specialists in full-time practice can cope and which provides useful personalised feedback for the specialist.

Australia↗
PubMed1998

Good clinical practice and audits for dual X-ray absorptiometry and X-ray imaging laboratories and quality assurance centers involved in clinical drug trials, private practice, and research.

Good Clinical Practice (GCP) guidelines, with an emphasis on quality and validation of processes and data, must be applied to the use of imaging in clinical drug development. All participants, including the sponsor, principal investigator, site staff, quality assurance centers, and contract research organizations, must be cognizant of the need for application of these principles to their activities related to the imaging programs. This article discusses the various aspects of GCP as they need to be applied to the use of dual X-ray absorptiometry (DXA) for bone densitometry and X-rays for vertebral fracture assessment in clinical trials for osteoporosis, as well as research and private practice settings. The theory of proper audit conduct to verify clinical trial data is presented.

Journal Article↗
PubMed2001

Targeting communities with high rates of uninsured children.

Data from the first two rounds of the Community Tracking Study household survey show that coverage expansions through the State Children's Health Insurance Program (SCHIP) have virtually eliminated differences across communities in children's eligibility for public or private health coverage. Nevertheless, some communities continue to have very high rates of uninsured children, in large part because of lower participation rates in public programs and higher costs for employer-sponsored coverage. Participation in SCHIP may increase in high-uninsurance communities as the new programs mature, although low participation rates in public programs prior to SCHIP suggest that enrollment barriers may still be greater in such communities.

Adolescent↗
PubMedDate not supplied

Duration of breast milk expression among working mothers enrolled in an employer-sponsored lactation program.

BACKGROUND: Maternal employment has been one of the greatest barriers to breastfeeding. Women are increasingly solving this problem by expressing milk at work and taking it home to their infants. PURPOSE: The objective was to determine duration of breast milk expression among working mothers enrolled in an employer-sponsored lactation program. DESIGN AND METHODS: Retrospective reviews were conducted on the lactation records of 462 women employed by 5 corporations in order to describe and characterize their experiences. The lactation program included the employees' choice of (a) a class on the benefits of breastfeeding; (b) services of a certified lactation consultant (CLC); and (c) private room in the workplace with equipment for pumping. RESULTS: Breastfeeding was initiated by 97.5% of the participants, with 57.8% continuing for at least 6 months. Of the 435 (94.2%) who returned to work after giving birth, 343 (78.9%) attempted pumping milk at work, and 336 (98%) were successful. They expressed milk in the workplace for a mean of 6.3 months (SD = 3.9, range 2 weeks to 21 months). The mean age of infants when the mothers stopped pumping at work was 9.1 months (SD = 4.1, range 1.9 to 25 months). Most of the women who pumped their milk at work were working full time (84.2%). The mean postnatal maternity leave was 2.8 months. The proportion of women who chose to pump at work was higher among women who were salaried than among those who were paid hourly wages (p < 0.01). CONCLUSIONS: Company-sponsored lactation programs can enable employed mothers to provide breast milk for their infants as long as they wish, thus helping the nation attain the Healthy People 2010 goals of 50% of mothers breastfeeding until their infants are 6-months-old.

Breast Feeding↗
PubMed1992

For the good of the child.

Legislative activities of the past 10 years have led many hospitals to develop grassroots advocacy programs that focus on specific issues. At Cardinal Glennon Children's Hospital, St. Louis, advocacy efforts involve employees, physicians, board members, and others. Situated near the Missouri-Illinois border, Cardinal Glennon serves patients from both states and deals with the legislatures and government agencies of each. Cardinal Glennon has formed alliances with children's hospitals in Missouri and in Illinois to lobby for fair funding from both states' Medicaid programs. Cardinal Glennon has formed a public policy committee that evaluates issues, sets priorities, and identifies trends. Hospital staff work with legislators from both states, inviting them for a first-hand look at children's needs. The hospital has also formed the Letter-Writing Advocacy Committee. Committee members write their representatives, stating their viewpoint on specific issues. Cardinal Glennon sponsors the Southern Illinois Perinatal Program. The hospital is also home to Missouri's regional poison control center, which in 1991 saved the state of Missouri $400,000 in Medicaid funds and saved private insurance carriers approximately $2.2 million. Cardinal Glennon's advocacy efforts extend beyond specific hospital programs, however, Hospital representatives often testify to legislative committees on more universal issues such as child abuse, lead poisoning, primary care needs, and trauma care.

Catholicism↗
PubMed1998

Visualizing physiological concepts and research hypotheses: a hypermedia module of the drainage of the cerebrospinal fluid by lymphatics.

Hypermedia, animation and color coding were used to develop a module to visualize the lymphatic drainage of the cerebrospinal fluid and the research procedures that quantitate this drainage, to help researchers present their findings to a variety of audiences. Basic and clinical science evaluators found the method successful. Suggested uses for the module included teaching, conference and Web presentation, and liaising with research sponsors. Respondents emphasized that researchers need private investment to afford the cost of hypermedia modules. A thorough literature review, formative feedback, and post-evaluation proved fundamental to the development of this hypermedia program.

Anatomy↗
PubMed1999

The Americans with Disabilities Act: implications for managed care for persons with mental illness and addiction disorders.

This Issue Brief, prepared for the Substance Abuse and Mental Health Services Administration, examines the Americans with Disabilities Act ("the ADA") and its application to managed care. The ADA provides important protections for persons with disabilities who are members of managed care arrangements, regardless of whether their membership is sponsored by an employer, Medicare, or Medicaid or is purchased privately. The interaction between the ADA and managed care is complex, and different issues can arise under publicly and privately sponsored plans.

Adult↗
PubMed1990

The performance of urban and public hospitals and NHCs (neighborhood health centers) under Medicaid capitation programs.

This article reports the results of a study that examined what happened to the utilization of Medicaid beneficiaries, eligible under Aid to Families with Dependent Children, who were mandatorily enrolled in several capitated alternatives in the Kansas City area. Their experience is contrasted with that of a comparison group selected from the St. Louis area. The types of plans analyzed include those sponsored by hospitals, neighborhood health centers, HMOs, and private physicians (IPAs). With the exception of emergency room use, all plans controlled utilization equally well. Results are explained in light of their management and policy implications.

Adult↗
PubMed1982

Prescription drug products; revocation of patient package insert requirements--Food and Drug Administration. Final rule.

The Food and Drug Administration (FDA) is revoking its final rule establishing requirements for the preparation and distribution of patient package inserts (PPI's) for prescription drug products for human use. This action is taken because the agency has determined that a mandatory pilot PPI program is unjustifiable, and that it is now preferable to encourage alternative patient information efforts. The agency believes that cooperation with health professionals and others in both the public and private sectors and reliance upon expanding privately sponsored initiatives in patient education should serve to provide patients with needed information about prescription drugs.

Drug Labeling↗
PubMed1989

Multidisciplinary response of San Francisco General Hospital to the AIDS epidemic.

Acquired immunodeficiency syndrome (AIDS)-related services offered by San Francisco General Hospital (SFGH); programs to protect employees who are at occupational risk for infection with human immunodeficiency virus (HIV); and the legal, ethical, and economic implications of such infection are discussed. Support from public officials, health-care professionals, and the community has enabled SFGH to develop an extensive program of AIDS-related services. The program consumes 10% of SFGH's budget and was responsible for treating 1693 patients between January 1981 and June 1988. The hospital has two internationally recognized units dedicated to the care of AIDS patients. Many of the medical and support departments at SFGH contribute expertise directly; clinical and basic research are also conducted. Other services sponsored by the hospital include HIV testing and counseling; special training for physicians and nurses; assisting patients with finances, housing, and home care; emotional support; and community education. Expenses per patient are lower at SFGH than nationally because of contributions from the private and public sectors, but costs are not fully recovered. Hospital employees are protected by a body substance precautions program, a comprehensive needle-stick program, mandatory reporting and evaluation of all exposures, and enrollment in a study to document seroconversions. Confidentiality and compensation remain major concerns. San Francisco General Hospital has a model program of caring for patients with AIDS and protecting its workers, but the issue of compensating those employees who do become infected with HIV has not yet been resolved.

AIDS Serodiagnosis↗
PubMed1996

Business, households, and government: health spending, 1994.

During the 1990s, growth in health care costs slowed considerably, helping to lessen the spending strain on business, government, and households. Although cost growth has slowed, the Federal Government continues to pay an ever-increasing share of the total health care bill. This article reviews important health care spending trends, and for the first time, provides separate estimates of the employer and employee share of the premium costs for employer-sponsored private health insurance. This article also highlights some of the emerging trends in the employer-sponsored insurance market, including managed care, cost-sharing, and employment shifts.

Data Collection↗
PubMed1984

Essential health care: a framework for its definition and implementation in health districts.

This paper presents a framework for the definition and implementation of essential health care. It is based upon current experiences in developing countries. Its aim is to facilitate the description, in operational terms, of a range of activities for clearly defined targets--individuals, families and communities. It seeks to bring to the attention of responsible citizens and professionals the major areas which they should address in the search for "Health for All by the year 2000". It is hoped that this will facilitate integration of health care into socio-economic development activities; and promote a partnership between people and governments in community health development.

Community Mental Health Services↗