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At least 271 records · Page 15Linked to original sources
PubMed2002

Missouri Blues' bonus system working well for capitated physician groups.

To give physicians in their capitated medical groups an incentive to provide high-quality care, the Missouri Blues began a pilot program in the mid-1990s to reward doctors who met various quality benchmarks. Under the plan, doctors could earn an additional 4% of their capitated income if they made targets in the areas of childhood immunizations, retinal exams for patients with diabetes, and hospital admissions for both child and adult asthmatics. The incentives have been a smash success--here are the details.

Benchmarking↗
PubMedDate not supplied

The public health burden of obesity in Missouri.

The prevalence of obesity continues to rise in Missouri, affecting all age groups, genders and races. The consequences of obesity range from economic and physical burdens to psychological and social manifestations, impacting an individual's quality of life. Among obese individuals, there is a major impact on health with increased likelihood of developing diabetes, hypertension, and cardiovascular disease. Integration of community efforts and support from healthcare providers may be beneficial for obesity prevention and control.

Comorbidity↗
PubMed1992

The Missouri Cardiovascular Health Plan: a focus on prevention.

The authors describe a framework for planning, implementing, and evaluating cardiovascular health programs in Missouri. Populations targeted for intervention are identified, and the role of the physician in supporting community-based cardiovascular health promotion is explored.

Black or African American↗
PubMedDate not supplied

Saint Francis adapts women's cardiac risk campaign for Missouri.

Saint Francis Medical Center, Cape Girardeau, Mo., became the first hospital in Missouri to promote the VHA national initiative, Women's HeartAdvantage. Marketers incorporated Women's HeartAdvantage materials into the broader marketing plan for the Saint Francis Heart Institute. Using both traditional and innovative media, they're spreading the word that heart disease is woman's greatest health risk.

Community-Institutional Relations↗
PubMedDate not supplied

Detection of pathogenic Ehrlichia in ticks collected at acquisition sites of human ehrlichiosis in Missouri.

We collected 385 ticks from sites in Missouri associated with human monocytic ehrlichiosis. Using PCR, we detected E. chaffeensis or E. ewingii in 2 of 19 pools of adult Amblyomma americanum, 0 of 32 pools of Dermacentor variabilis, and 6 (18%) of 39 pools of unspeciated nymphal ticks from 3 of 6 sites associated with disease and one site not associated with disease. We also detected a variant of A. phagocytophila in one nymph pool.

Animals↗
PubMed2004

Missouri overrules the United States Supreme Court on capital punishment for minors.

Under the U.S. Supreme Court's 1989 decision in Stanford v. Kentucky, the Eighth Amendment's cruel and unusual punishments clause does not shield minors 16 or 17 years of age from the death penalty. Holding, astonishingly, that Stanford is no longer the law of the land, the Missouri Supreme Court recently reversed the death sentence of a 17-year-old murderer in Simmons v. Roper. The U.S. Supreme Court has granted certiorari to consider whether Stanford survives its own burial by the state court.

Adolescent↗
PubMed2005

Pseudomonas bloodstream infections associated with a heparin/saline flush--Missouri, New York, Texas, and Michigan, 2004-2005.

On January 26, 2005, CDC was notified of four cases of Pseudomonas fluorescens bloodstream infection among patients at an oncology clinic in Missouri. All patients had received a heparin/saline flush to prevent clotting of indwelling, central venous catheters. The flushes were preloaded in syringes by IV Flush and distributed by Pinnacle Medical Supply (Rowlett, Texas). On January 31, a nationwide alert against use of all heparin or saline flushes preloaded in syringes by IV Flush was issued by the Food and Drug Administration; the company recalled these products. As of February 15, state and local health departments and CDC had identified a total of 36 Pseudomonas species infections in patients in four states who were administered the heparin/saline flushes from multiple lots. This report describes the ongoing investigation and provides recommendations for investigation and management of potential cases.

Adolescent↗
PubMed2005

The Richard Cory phenomenon: suicide and wealth in Kansas City, Missouri.

This case-control study investigates the relationship between suicide and wealth in Kansas City, Missouri. House and personal property appraisal data on all victims of suicide from 1998 and 2002 and victims from a control population of deaths reported to the Jackson County Medical Examiner during the same time interval were obtained from the Jackson County Government website. The controls were matched to suicide cases by race, gender, year of death, and age at death (+/- 1 year). Data from the 426 members of each group of suicides and controls indicate that suicide victims were: 1) 77% more likely than controls to have lived in houses rather than in apartments or trailers, 2) more likely than controls to have lived in more expensive houses (mean values dollar 70,143 versus dolllar 61,513 respectively, p = 0.04) and 3) more likely to have killed themselves because of factors other than financial strain (8.0% of suicides showed financial strain).

Adolescent↗
PubMed2005

Social support and health-related quality of life among older adults--Missouri, 2000.

Overall health can be influenced by multiple factors, including a person's psychological, behavioral, and social well-being. Studies have demonstrated an association between increased levels of social support and reduced risk for physical disease, mental illness, and mortality. Social support includes real or perceived resources provided by others that enable a person to feel cared for, valued, and part of a network of communication and mutual obligation. Social support can be critical for those older adults who rely on family, friends, or organizations to assist them with daily activities, provide companionship, and care for their well-being. The 1965 Older Americans Act recognized the need for social support by requiring that agencies on aging provide in-home services and group meals to foster social interactions. To examine how social support is related to health-related quality of life (HRQOL), CDC analyzed data from the 2000 Missouri Older Adults Needs Assessment Survey (MOANAS) of adults aged > or =60 years. This report describes the results of that analysis, which indicated that visits with friends or relatives, having close friends for emotional support, and the perception of help being available if sick or disabled were associated with better HRQOL and particularly with better mental health among older adults. Implementing effective prevention programs for older adults and encouraging interventions by agencies on aging can help improve HRQOL among older adults who have little social support.

Aged↗
PubMed2005

Implementation of mandatory Medicaid managed care in Missouri: impacts for pregnant women.

OBJECTIVES: To assess the impact of mandatory Medicaid managed care in Missouri on prenatal care, maternal behavior, and low birth weight among pregnant women enrolled in Medicaid. STUDY DESIGN: Pre-post design using a comparison group with birth certificate and Medicaid enrollment data in 1995 and 2000. METHODS: Pregnant women delivering in 38 counties that implemented managed care in Medicaid were compared preimplementation and postimplementation with pregnant women delivering under Medicaid in 78 counties that remained fee-for-service (FFS) for separate samples of white (37,561) and black (13,640) non-Hispanic women. We calculated difference-in-difference estimates using linear probability regression models that controlled for maternal characteristics and time-invariant county differences. Analyses were stratified based on Medicaid enrollment before and after conception, managed care region, and marital status. RESULTS: Both managed care and FFS counties showed large improvements in prenatal care measures over time for both white and black women. Managed care was associated with a smaller percentage point increase relative to FFS counties in adequate care among whites of 1.9 and among blacks of 8.5, and a larger decrease in smoking of 4.8 and in Women, Infants, and Children Program enrollment of 2.3 among white women. No pattern across managed care regions was found with respect to timing of implementation. Smaller effects were evident among black and single women. CONCLUSIONS: Although women experienced significant improvements statewide in prenatal care under Medicaid, improvements were smaller for managed care counties. Managed care may have a positive impact on smoking cessation, but other policy changes may be needed to improve birth outcomes.

Adolescent↗
PubMed2005

A community-wide media campaign to promote walking in a Missouri town.

INTRODUCTION: Engaging in moderate physical activity for 30 minutes five or more times per week substantially reduces the risk of coronary heart disease, stroke, colon cancer, diabetes, high blood pressure, and obesity, and walking is an easy and accessible way to achieve this goal. A theory-based mass media campaign promoted walking and local community-sponsored wellness initiatives through four types of media (billboard, newspaper, radio, and poster advertisements) in St Joseph, Mo, over 5 months during the summer of 2003. METHODS: The Walk Missouri campaign was conducted in four phases: 1) formative research, 2) program design and pretesting, 3) implementation, and 4) impact assessment. Using a postcampaign-only, cross-sectional design, a telephone survey (N = 297) was conducted in St Joseph to assess campaign impact. Study outcomes were pro-walking beliefs and behaviors. RESULTS: One in three survey respondents reported seeing or hearing campaign messages on one or more types of media. Reported exposure to the campaign was significantly associated with two of four pro-walking belief scales (social and pleasure benefits) and with one of three community-sponsored activities (participation in a community-sponsored walk) controlling for demographic, health status, and environmental factors. Exposure was also significantly associated with one of three general walking behaviors (number of days per week walking) when controlling for age and health status but not when beliefs were introduced into the model, consistent with an a priori theoretical mechanism: the mediating effect of pro-walking beliefs on the exposure-walking association. CONCLUSION: These results suggest that a media campaign can enhance the success of community-based efforts to promote pro-walking beliefs and behaviors.

Adult↗
PubMedDate not supplied

A decade of humanitarian aid and medical knowledge exchange between Missouri and European Georgia physicians.

Missouri physicians have shared humanitarian aid and exchanged medical knowledge for the past decade with European Georgia physicians. Donations have been made of medications, medical publications, used equipment and supplies as well as organizational knowledge exchange with sister medical organizations, sister medical schools and sister cities. The medical specialty exchanges include family medicine, neonatology, pediatrics, diabetology, endocrinology, ophthalmology, obstetrics, gynecology, anesthesiology and surgery.

Altruism↗
PubMed2006

The Charles Drew program in Missouri: a description of a partnership among a blood center and several hospitals to address the care of patients with sickle cell disease.

Sickle cell disease (SCD) is an inherited blood disorder which can be complicated by stroke in infancy and childhood. The primary and secondary prevention of stroke in this patient population is regular RBC transfusion therapy at least every three weeks, but there is no consensus on the ideal RBC transfusion therapy. The Charles Drew Program, a partnership among a blood center and several hospitals affiliated with academic medical centers in Missouri, provides RBCs for the care of patients with SCD. There are three basic aims: the RBC components are phenotypically matched on three minor RBC antigens, the units are less than 7 days old, and each patient has a limited number of dedicated donors, so that the donor exposure is minimized. This report describes the operational phases of this program and summarizes its performance with respect to each of these aims.

Anemia, Sickle Cell↗
PubMed1991

Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes--Wisconsin and Missouri.

Flexible fiber-optic endoscopes are widely used in the United States for diagnostic and therapeutic procedures. Between uses, endoscopes should be cleaned and disinfected either manually or by using automated machines. However, outbreaks have occurred among patients exposed to contaminated endoscopes or to inadequately disinfected bronchoscopes (1-4). This report summarizes one outbreak of nosocomially acquired infection (Wisconsin) and one of pseudoinfection (Missouri) linked to endoscopes contaminated during cleaning and disinfection by automated reprocessing machines.

Bacterial Infections↗
PubMedDate not supplied

Differentiating the barriers to adequate prenatal care in Missouri, 1987-88.

Inadequate prenatal care has previously been identified as a significant risk factor for women who have low birth weight infants and infants who die during the neonatal period. Postpartum interviews with 1,484 primarily low-income women were conducted during 1987-88 in three areas of Missouri with the highest rates of inadequate prenatal care. The purpose of the study was to identify barriers to prenatal care and to determine which barriers differentiated between women receiving adequate and those receiving inadequate prenatal care. Women who received inadequate prenatal care were more likely to be black, unmarried, higher parity, and have less education than those who received adequate care. These women were also more likely to be poor, Medicaid-eligible, to have had an unwanted pregnancy, more stress and problems during pregnancy, and less social support. In the multivariate analysis, race and marital status lost their importance. The strongest predictor of inadequate prenatal care was women not knowing that they were pregnant in the first 4 months of pregnancy (adjusted odds ratio 9.28). To improve the rate of adequate prenatal care, society must address the issues of poverty and wantedness of pregnancy.

Black or African American↗
PubMed1990

Improving perinatal outcome for rural Missouri.

Improving perinatal outcome in rural Missouri as reflected by a lowering of the perinatal mortality rate is a realistic and achievable goal for the state. The authors present information and data with suggestions for reaching this goal.

Female↗
PubMed1990

A survey of Missouri doctors of optometry who have not been certified to use therapeutic pharmaceutical agents.

This study surveyed all optometrists in Missouri who had not been certified to use TPAs to determine their attitudes regarding this recent expansion in the legally permitted scope of practice. About half of those who were DPA certified doctors plan to seek TPA certification, however only about a third of those without DPA certification plan on doing so. The most common reason given by DPA certified optometrists for not obtaining TPA certification was lack of time to meet the educational requirements. Most non-DPA certified doctors did not plan to seek TPA credentials because of impending retirement. Few of either group felt that their interactions with ophthalmologists had been adversely affected by the change in the optometric practice act.

Certification↗