Impact of Illness Management and Recovery Programs on Hospital and Emergency Room Use by Medicaid Enrollees

Objective—Illness management and recovery is a structured program that helps consumers with severe mental illness learn effective ways to manage illness and pursue recovery goals. This study examined the impact of the program on health service utilization. Methods—This was a retrospective cohort study of five assertive community treatment (ACT) teams in Indiana that implemented illness management and recovery. With Medicaid claims data from July 1, 2003, to June 30, 2008, panel data were created with person-months as the level of analysis, resulting in 14,261 observations, for a total of 498 unique individuals. Zero-inflated negative binomial regression models were used to predict hospitalization days and emergency room visits, including covariates of demographic characteristics, employment status, psychiatric diagnosis, and concurrent substance use disorder. The main predictor variables of interest were receipt of illness management and recovery services, dropout from the program, and program graduation status. Results—Consumers who received some illness management and recovery services had fewer hospitalization days than those receiving only ACT. Graduates had fewer emergency room visits than did ACT-only consumers. Conclusions—This is the first study to examine the impact of illness management and recovery on service utilization. Controlling for a number of background variables, the study showed that illness management and recovery programs were associated with reduced inpatient hospitalization and emergency room use over and above ACT

Courting the South: Lula’s Trade Diplomacy

Scholarly consensus regarding Brazil's Lula government characterizes its economic policy as surprisingly conservative but its foreign policy as roughly in line with the traditionally leftist principles of the Workers' Party. While broadly accurate, this perspective tells us little about trade diplomacy, which cuts across these two policy areas. In this article we explain why Lula's trade diplomacy has hewed much more closely to his broader foreign policy strategy than his economic model, despite the critical role of trade in Brazil's recent economic growth. We argue that two key factors have lowered the costs of adopting a combative, South-South orientation, allowing Lula to use trade diplomacy as a tool for appealing to party loyalists. One is the inherently muted short-term impact of trade diplomacy on key macro-economic outcomes. The other is the failure of the traditional trading powers to offer the incentives necessary to successfully conclude the major North-South trade talks they had initiated