How Much Does Churning in Medi-Cal Cost?

Looks at how the instability of children's enrollment in Medi-Cal affects the quality of health care they receive. Explores the cost inefficiencies involved with processing and re-processing the same eligible children

Stability and Churning in Medi-Cal and Healthy Families

This report examines enrollment patterns and gaps overall and for specific groups within Medi-Cal and Healthy Families, as well as medical costs after a gap. We use this information to examine the possible effect of the Governor's plan to reinstate Quarterly Status Reports in Medi-Cal. Highlights include:Overall, approximately 50% of newly enrolled children "survive" after 21 months of enrollment in both Medi-Cal and Healthy Families;The sharpest drop in enrollment is seen at the 12-month renewal point, especially for children in Healthy Families and those in the 1931(B) and children's percent programs in Medi-Cal;For children in other Medi-Cal -- especially those who are also receiving food stamps or cash assistance -- the drop is more gradual over time. These families need to renew more frequently to maintain the other social supports and thus, stay in closer touch with county assistance agencies.More frequent renewals will hit hardest children in the 1931(b) and percent programs of Medi-Cal. It is likely that half the children in these programs will be dropped at every renewal period.These families are teetering on the brink of poverty, are likely to be affected by an economic downturn, and may need the support health coverage offers for their children.Costs of medical care are substantially higher immediately after a gap. The longer the gap, the higher the cost afterwards.In Medi-Cal, it is likely that costs saved in the short-term by reducing enrollment using Quarterly Status Reports will be offset by pent up needs later on (or transferred to the safety net in the shorter term)

Implementation Choices for the Children's Health Insurance Program Reauthorization Act of 2009

Synthesizes policy analyses and discussions with experts of provisions in the Children's Health Insurance Program Reauthorization Act to strengthen outreach and enrollment and improve quality of care. Recommends steps to ensure effective implementation

Health Services Utilization Among Adolescents: Results from the 2005 NHIS

This series of graphs depicts findings and results from the 2005 National Health Interview Survey

Evaluation Design and Technical Assistance Opportunities: Early Findings From the Beacon Community Program Evaluation Teams

Examines study designs, evaluation approaches, outcome measures, data sources, challenges, and technical assistance needs among sites in a project under the American Recovery and Reinvestment Act to strengthen health information technology capabilities

Unmet Need for Counseling Services by Children in New York City After the September 11th Attacks on the World Trade Center: Implications for Pediatricians

Objective. The objectives of this study were to describe the prevalence of counseling services, contrasted with the need after the terrorist attacks of September 11, 2001, the types of counseling received, and the predictors of receipt of counseling services. Methods. A cross-sectional, random-digit-dial survey was conducted in New York City (NYC) of parents (N 434) of children who were 4 to 17 years of age 4 months after the September 11th terrorist attacks on the World Trade Center. Results. Overall, 10% of NYC children received some type of counseling after the September 11th attacks, according to parental report. Among these, 44% received counseling in schools, 36% received counseling from medical or professional providers, and 20% received counseling from other sources. However, only 27% of the children who had severe/very severe posttraumatic stress reactions (PTSR) after the attacks received counseling services. In a multivariate model, receipt of counseling before the September 11th attacks (odds ratio: 4.44) and having severe/very severe PTSR (odds ratio: 3.59) were the most important predictors of use of counseling services after the September 11th attacks. Minority status and having a parent who experienced the loss of a friend or a relative were also associated with receipt of services. Conclusions. There was substantial disparity between apparent need (as indicated by severe/very severe PTSR) for and receipt of mental health services for children after the September 11th attacks. There is need for intensified efforts to identify, refer, and treat children in need, especially for children who are not already in a therapeutic relationship. An enhanced role for pediatricians is indicatedPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40387/1/Fairbrother_Unmet Need for Counseling Services_2004.pd

Determinants of Counseling for Children in Manhattan After the September 11 Attacks

Objective: After the September 11 terrorist attacks, many adults and children received counseling. The authors assessed the prevalence and correlates of counseling for experiences related to the disaster received by children aged four to 18 years living in Manhattan. Methods: From a representative sample of 1,008 adult residents of Manhattan who were living below 110th Street five to eight weeks after the attacks, the authors interviewed 112 parents or primary caretakers about their child’s level of exposure to the disaster, the extent of loss, receipt of counseling services, and behavioral reaction. Results: Overall, 22 percent of the children had received some form of counseling related to their experiences after the disaster. More than half of the counseling received (58 percent) was delivered in schools. Predictors of counseling in a multivariate model were male sex (odds ratio=5.3), having a parent with current posttraumatic stress disorder related to the attacks (OR=4.3), and having at least one sibling living in the household (OR=3.6). Conclusions: Parents’ own level of posttraumatic stress was associated with whether their children received counseling related to the September 11 attacks. This finding has important implications, because parents act as decision makers for their children in seeking health care. After the terrorist attacks, school and health care personnel provided early intervention counseling in Manhattan.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40295/2/Stuber_Determinants of Counseling for Children_2002.pd

Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and Multivessel Disease

BACKGROUND: The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain.   OBJECTIVES: CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only.   METHODS: After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U.K. centers were randomized through an interactive voice-response program to either in-hospital complete revascularization (n = 150) or IRA-only revascularization (n = 146). Complete revascularization was performed either at the time of P-PCI or before hospital discharge. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤3 h or >3 h). The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 12 months.   RESULTS: Patient groups were well matched for baseline clinical characteristics. The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% in the IRA-only revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24 to 0.84; p = 0.009). A trend toward benefit was seen early after complete revascularization (p = 0.055 at 30 days). Although there was no significant reduction in death or MI, a nonsignificant reduction in all primary endpoint components was seen. There was no reduction in ischemic burden on myocardial perfusion scintigraphy or in the safety endpoints of major bleeding, contrast-induced nephropathy, or stroke between the groups.   CONCLUSIONS: In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the IRA. In such patients, inpatient total revascularization may be considered, but larger clinical trials are required to confirm this result and specifically address whether this strategy is associated with improved survival. (Complete Versus Lesion-only Primary PCI Pilot Study [CvLPRIT]; ISRCTN70913605)

Behavior Problems in New York City's Children After September 11, 2001, Terrorist Attacks

Children’s behavior was assessed with 3 cross-sectional random-digit-dial telephone surveys conducted 11 months before, 4 months after, and 6 months after September 11, 2001. Parents reported fewer behavior problems in children 4 months after the attacks compared with the pre-September 11 baseline. However, 6 months after the attacks, parents’ reporting of behavior problems was comparable to pre-September 11 levels. In the 1st few months after a disaster, the identification of children who need mental health treatment may be complicated by a dampened behavioral response or by a decreased sensitivity of parental assessment to behavioral problems.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40274/2/Stuber_Behavior Problems in New York City's Children_2005.pd

Short pediatric Crohnʼs disease activity index for quality improvement and observational research:

Practical and objective instruments to assess pediatric Crohn’s disease (CD) activity are required for observational research and quality improvement