The impact of provider service networks in Florida Medicaid managed care on enrollees’ satisfaction

Two counties in Florida were selected as pilots in 2006 for the Medicaid Demonstration Program. In reform counties, Medicaid enrollees were required to pick a managed care plan; either a Health Maintenance Organization or a Provider Service Network (PSN). PSNs are a form of managed care that provides health care services directly through a provider or network of organizations to a defined population without an intermediary. There are two types of PSNs: Physician-based PSNs and Healthcare system-based PSNs. The objective of this study is to find the differences in enrollees’ satisfaction between two different types of PSNs. To assess the differences in enrollees’ satisfaction between physician-based PSNs and health system-based PSNs over time, this study used difference-in-difference study design with CAHPS data from 2006 to 2008. The study findings showed that, compared to enrollees in physician-based PSNs, health system-based PSN enrollees had higher satisfaction during the post-reform period. However, the trends in satisfaction for enrollees in health system-based PSNs declined at a greater rate relative to the trends for enrollees in physician-based PSNs. Findings from this study may give other states, facing similar decisions to reform their Medicaid managed care system, information to decide whether to adopt a similar plan or to consider other interventions to improve Medicaid beneficiaries’ satisfaction. PSNs are structured similarly to the new accountable care organizations (ACO) models emerging as a result of the Affordable Care Act. Therefore, study findings may be helpful to in improving patient satisfaction with care in ACOs

The Political Uses and Abuses of Civility and Incivility

After exploring the challenges involved in defining incivility, this chapter addresses the evolution of the concept, notes the dispute over trend lines, and précises work on its psychological effects. It then outlines some functions that civility and incivility serve, such as the functions of differentiating and mobilizing, marginalizing the powerless, expressing, and deliberating. The use of calls for civility as a means of social control is discussed, and then the chapter flags questions worthy of additional attention

The comparative impact of different patient-centered medical home domains on satisfaction among individuals living with type II diabetes

Chronic illnesses like type 2 diabetes are costly and difficult to treat. Patient-centered medical homes (PCMH) have the potential to improve patient satisfaction in this population. However, which domains have the most impact on patient satisfaction has not been established. The aim of this study was to assess the relative strength of association between seven PCMH domains and two measures of satisfaction. Cross-sectional data were used in this observational study collected from a random sample of adults aged 18-89 with type 2 diabetes (n=1301) seen at 4 PCMHs. The Ambulatory Care Experiences Survey instrument was used to assess all measures. Dependent variables included 2 measures of patient satisfaction: overall care and personal doctor. Independent variables included patient perceptions of implementation level of 7 PCMH domains categorized into two dimensions: administrative features of care and physician-patient interactions. Administrative features of care include organizational access, integration of care and office staff helpfulness. Physician-patient interactions include communication, comprehensive knowledge and interpersonal treatment. Analysis was conducted using linear regression. The results reveal all physician-patient interaction PCMH domains were significantly associated with both measures of satisfaction. The relationships for administrative features of care were dependent upon the satisfaction outcome being analyzed. Communication and comprehensive knowledge had the strongest association of all domains. The authors conclude variations in importance of PCMH domains on satisfaction exist. Physician-patient interaction domains are the strongest contributors to patient satisfaction and overall experience. Understanding which PCMH domains have the largest impact can inform physician practice’s efforts to improve outcomes of care

Public Health Nursing Case Management for Women Receiving Temporary Assistance for Needy Families: A Randomized Controlled Trial Using Community-Based Participatory Research

Objectives. We evaluated the effectiveness of a community-based participatory research–grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status. Methods. We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait control group. We assessed Medicaid outcomes pre- and posttraining; other outcomes were assessed at 3, 6, and 9 months. Results. Medicaid knowledge and skills improved (P<.001 for both). Intervention group participants were more likely to have a new mental health visit (odds ratio [OR]=1.92; P=.007), and this likelihood increased in higher-risk subgroups (OR=2.03 and 2.83; P=.04 and .006, respectively). Depression and functional status improved in the intervention group over time (P=.016 for both). No differences were found in routine or preventive care, or general health. Conclusions. Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population

Breast Cancer Fatalism: The Role of Women\u27s Perceptions of the Health Care System

Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents\u27 knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, to rate their quality of care as fair or poor, to believe that not much could be done to prevent breast cancer, to believe that breast cancer could not be cured if found early, and to believe that treatment could be worse than the disease

Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation

Introduction: Older, chronically ill patients with limited health literacy are often under-engagedin managing their health and turn to the emergency department (ED) for healthcare needs. Wetested the impact of an ED-initiated coaching intervention on patient engagement and follow-updoctor visits in this high-risk population. We also explored patients’ care-seeking decisions. Methods: We conducted a mixed-methods study including a randomized controlled trial andindepth interviews in two EDs in northern Florida. Participants were chronically ill older EDpatients with limited health literacy and Medicare as a payer source. Patients were assignedto an evidencebased coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitativeinterviews (n=9) explored patients’ reasons for ED use. We assessed average between-groupdifferences in patient engagement over time with the Patient Activation Measure (PAM) tool,using logistic regression and a difference-in-difference approach. Between-group differences infollow-up doctor visits were determined. We analyzed qualitative data using open coding andthematic analysis. Results: PAM scores fell in both groups after the ED visit but fell signi ficantly more in “usualcare” (average decline -4.64) than “intervention” participants (average decline -2.77) (β=1.87,p=0.043). There were no between-group differences in doctor visits. Patients described wellinformedreasons for ED visits including onset and severity of symptoms, lack of timely provideraccess, and immediate and comprehensive ED care. Conclusion: The coaching intervention significantly reduced declines in pati ent engagementobserved after usual post-ED care. Patients reported well-informed reasons for ED use andwill likely continue to make ED visits unless strategies, such as ED-initiated coaching, areimplemented to help vulnerable patients better manage their health and healthcare

Key attributes of patient centered medical homes associated with patient activation of diabetes patients

Abstract Background Approximately 24 million Americans are living with diabetes. Patient activation among individuals with diabetes is critical to successful diabetes management. The Patient Centered Medical Home (PCMH) model holds promise for increasing patient activation in managing their health. However, what is not well understood is the extent to which individual components of the PCMH model, such as the quality of physician-patient interactions and organizational features of care, contribute to patient activation. This study’s objective is to determine the relative importance of the PCMH constructs or domains to patient activation among individuals living with diabetes. Methods This study is a cross-sectional analysis of 1253 primary care patients surveyed with type II diabetes. The dependent variable, patient activation, was assessed using the Patient Activation Measure (PAM). Independent variables included 7 PCMH domains- organizational access, integration of care, comprehensive knowledge, office staff helpfulness, communication, interpersonal treatment and trust. Ordered logistic regression was performed to determine whether each PCMH domain was independently associated with patient activation, followed by a final ordered logistic regression that included all the PCMH domains in a single adjusted model. Results Using the full adjusted model, the odds of patients reporting higher activation scores (PAM) were found to be significant in the domains that represented organizational access (OR 1.56, 95% CI 1.31–1.85) and comprehensive knowledge (OR 1.44, 95% CI 1.13–1.85). Conclusions Many practices have struggled with the challenge to develop fully functional patient-centered medical homes. In an effort to become more patient-centered, this study aimed to address what factors activated diabetic patients to adhere to diabetes management plan. Understanding these factors can help identify PCMH attributes that practices can prioritize and improve upon to assist their patients in improving health outcomes. Trial registration Study was not a clinical trial; therefore it was not registered

Accrediting Graduate Programs in Healthcare Quality and Safety

The number of master\u27s degree programs in healthcare quality and safety (HQS) has increased significantly over the past decade. Academic accreditation provides assurance that educational programs are of a high quality and meet the needs of students, employers, and the general public. Under the guidance of the Commission on Accreditation of Healthcare Management Education, faculty from 9 universities collaborated in the development of criteria and related content domains to be used in the accreditation of graduate programs in HQS. Thirteen content domains were identified. Four of the content domains, safety and error science, improvement science and quality principles, evidence-based practice, and measurement and process improvement are thought to be foundational domains for graduate education in HQS. This article describes the development of the content domains and accompanying standards for accreditation of graduate programs in HQS

Fractionated radioimmunotherapy with 90Y-clivatuzumab tetraxetan and low-dose gemcitabine is active in advanced pancreatic cancer: A phase 1 trial

It has been demonstrated that the humanized clivatuzumab tetraxetan (hPAM4) antibody targets pancreatic ductal carcinoma selectively. After a trial of radioimmunotherapy that determined the maximum tolerated dose of single-dose yttrium-90-labeled hPAM4 (90Y-hPAM4) and produced objective responses in patients with advanced pancreatic ductal carcinoma, the authors studied fractionated radioimmunotherapy combined with low-dose gemcitabine in this disease