Improving Medicaid: Assessment of District of Columbia Agencies\u27 Claims Processes and Recommendations for Improvements in Efficiency and Customer Service

The District of Columbia Department of Health Care Finance (DHCF), like other state Medicaid agencies, is constantly challenged to improve service delivery and reimbursement for Medicaid services. In the District, several governmental agencies ( Partner Agencies ) play an instrumental role in Medicaid – either as a Medicaid provider or in operating a Medicaid program. Today, each Partner Agency may retain its own system and process for claims submission, provider enrollment, and administrative claiming as it relates to Medicaid. For these reasons, the DHCF initiated an assessment of the Medicaid claims processes for Partner Agencies. The purpose of the assessment is to identify areas of duplication and inefficiencies and recommend a solution(s) to the DHCF to improve efficiency and customer service. The central recommendation arising from this assessment is that the District of Columbia procure the services of a single administrative services organization (ASO) to perform billing, claims submittal, and related administrative functions for the identified DC agencies examined as a means of achieving greater efficiency and improved customer service

Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection

Although the pathogenesis of human immunodeficiency virus (HIV) infection and the general virologic and immunologic principles underlying the use of antiretroviral therapy are similar for all HIV-infected persons, there are unique considerations needed for HIV-infected infants, children, and adolescents, including; A acquisition of infection through perinatal exposure for many infected children, In utero, intrapartum, and/or postpartum neonatal exposure to zidovudine (ZDV) and other antiretroviral medications in most perinatally infected children, Requirement for use of HIV virologic tests to diagnose perinatal HIV infection in infants under age 15 to 18 months old, Age-specific differences in immunologic markers (i.e., CD4+ T cell count), Changes in pharmacokinetic parameters with age caused by the continuing development and maturation of organ systems involved in drug metabolism and clearance, Differences in the clinical and virologic manifestations of perinatal HIV infection secondary to the occurrence of primary infection in growing, immunologically immature persons, and Special considerations associated with adherence to antiretroviral treatment for infants, children and adolescents. This report addresses the pediatric-specific issues associated with antiretroviral treatment and provides guidelines to health care providers caring for infected infants, children, and adolescents. It is recognized that guidelines for antiretroviral use in pediatric patients are rapidly evolving. The Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children will review new data on an ongoing basis and provide regular updates to the guidelines

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies

Enhancing Credibility of Chemical Safety Studies: Emerging Consensus on Key Assessment Criteria

Objectives: We examined the extent to which consensus exists on the criteria that should be used for assessing the credibility of a scientific work, regardless of its funding source, and explored how these criteria might be implemented. Data sources: Three publications, all presented at a session of the 2009 annual meeting of the Society for Risk Analysis, have proposed a range of criteria for evaluating the credibility of scientific studies. At least two other similar sets of criteria have recently been proposed elsewhere. Data extraction/synthesis: In this article we review these criteria, highlight the commonalities among them, and integrate them into a list of 10 criteria. We also discuss issues inherent in any attempt to implement the criteria systematically. Con c l u s i o n s: Recommendations by many scientists and policy experts converge on a finite list of criteria for assessing the credibility of a scientific study without regard to funding source. These criteria should be formalized through a consensus process or a governmental initiative that includes discussion and pilot application of a system for reproducibly implementing them. Formal establishment of such a system should enable the debate regarding chemical studies to move beyond funding issues and focus on scientific merit

Event-based record linkage in health and aged care services data: a methodological innovation

<p>Abstract</p> <p>Background</p> <p>The interface between acute hospital care and residential aged care has long been recognised as an important issue in aged care services research in Australia. However, existing national data provide very poor information on the movements of clients between the two sectors. Nevertheless, there are national data sets which separately contain data on individuals' hospital episodes and stays in residential aged care, so that linking the two data sets–if feasible–would provide a valuable resource for examining relationships between the two sectors. As neither name nor common person identifiers are available on the data sets, other information needs to be used to link events relating to inter-sector movement.</p> <p>Methods</p> <p>Event-based matching using limited demographic data in conjunction with event dates to match events in two data sets provides a possible method for linking related events. The authors develop a statistical model for examining the likely prevalence of false matches, and consequently the number of true matches, among achieved matches when using anonymous event-based record linkage to identify transition events.</p> <p>Results</p> <p>Theoretical analysis shows that for event-based matching the prevalence of false matches among achieved matches (a) declines as the events of interest become rarer, (b) declines as the number of matches increases, and (c) increases with the size of the population within which matching is taking place. The method also facilitates the examination of the trade-off between false matches and missed matches when relaxing or tightening linkage criteria.</p> <p>Conclusion</p> <p>Event-based record linkage is a method for linking related transition events using event dates and basic demographic variables (other than name or person identifier). The likely extent of false links among achieved links depends on the two event rates, the match rate and population size. Knowing these, it is possible to gauge whether, for a particular study, event-based linkage could provide a useful tool for examining movements. Analysis shows that there is a range of circumstances in which event-based record linkage could be applied to two event-level databases to generate a linked database useful for transition analysis.</p

Bans of WHO Class I Pesticides in Bangladesh –Suicide Prevention without Hampering Agricultural Output

Pesticide self-poisoning is a major problem in Bangladesh. Over the past 20-years, the Bangladesh government has introduced pesticide legislation and banned highly hazardous pesticides (HHPs) from agricultural use. We aimed to assess the impacts of pesticide bans on suicide and on agricultural production.We obtained data on unnatural deaths from the Statistics Division of Bangladesh Police, and used negative binomial regression to quantify changes in pesticide suicides and unnatural deaths following removal of WHO Class I toxicity HHPs from agriculture in 2000. We assessed contemporaneous trends in other risk factors, pesticide usage and agricultural production in Bangladesh from 1996 to 2014.Mortality in hospital from pesticide poisoning fell after the 2000 ban: 15.1% vs 9.5%, relative reduction 37.1% [95% confidence interval (CI) 35.4 to 38.8%]. The pesticide poisoning suicide rate fell from 6.3/100 000 in 1996 to 2.2/100 000 in 2014, a 65.1% (52.0 to 76.7%) decline. There was a modest simultaneous increase in hanging suicides [20.0% (8.4 to 36.9%) increase] but the overall incidence of unnatural deaths fell from 14.0/100 000 to 10.5/100 000 [25.0% (18.1 to 33.0%) decline]. There were 35 071 (95% CI 25 959 to 45 666) fewer pesticide suicides in 2001 to 2014 compared with the number predicted based on trends between 1996 to 2000. This reduction in rate of pesticide suicides occurred despite increased pesticide use and no change in admissions for pesticide poisoning, with no apparent influence on agricultural output.Strengthening pesticide regulation and banning WHO Class I toxicity HHPs in Bangladesh were associated with major reductions in deaths and hospital mortality, without any apparent effect on agricultural output. Our data indicate that removing HHPs from agriculture can rapidly reduce suicides without imposing substantial agricultural costs

An integrated mid-range theory of postpartum family development: a guide for research and practice.

AIM: This paper is a report of a study to identify parents' perceptions of postpartum family experiences. BACKGROUND: There is a growing worldwide emphasis on family support. Government policy in the United Kingdom advocates a family-centred approach in which a core universal postbirth service is offered to all families with additional support for parents of children with complex needs. Health visitors provide family postpartum care without an agreed theory directing or standardizing practice. There is a need to identify parental experiences to define family-centred care. METHOD: A qualitative, exploratory approach was undertaken using a purposive sample of 17 postpartum families. Data were collected in one region of Northern Ireland in 2001-2002. Participants' experiences and views were accessed during two focus groups with a total of seven participants, and six in-depth interviews. Thematic analysis was conducted. FINDINGS: One core theme, 'thriving and surviving', and three main themes, 'baby nurture', 'life changes', 'coping and adapting resources', were identified to describe how parents developed during the first 8-week postpartum. These were influenced by the physical, the psychosocial and the environmental factors. The identified themes were mapped together to form an Integrated Mid-Range Theory of Postpartum Parent Development. CONCLUSION: As parents need to negotiate successfully both present coping and future development during the postpartum period, there is a need for professionals to offer services that are orientated to holistic short- and long-term well-being. The findings, further to additional research, may be used by health visitors and other professionals to direct universal postpartum care

Persistence of low drug treatment coverage for injection drug users in large US metropolitan areas

<p>Abstract</p> <p>Objectives</p> <p>Injection drug users (IDUs) are at high risk for HIV, hepatitis, overdose and other harms. Greater drug treatment availability has been shown to reduce these harms among IDUs. Yet, little is known about changes in drug treatment availability for IDUs in the U.S. This paper investigates change in drug treatment coverage for IDUs in 90 metropolitan statistical areas (MSAs) during 1993-2002.</p> <p>Methods</p> <p>We define <it>treatment coverage </it>as the percent of IDUs who are in treatment. The number of IDUs in drug treatment is calculated from treatment entry data and treatment census data acquired from the Substance Abuse and Mental Health Service Administration, divided by our estimated number of IDUs in each MSA.</p> <p>Results</p> <p>Treatment coverage was low in 1993 (mean 6.7%; median 6.0%) and only increased to a mean of 8.3% and median of 8.0% coverage in 2002.</p> <p>Conclusions</p> <p>Although some MSAs experienced increases in treatment coverage over time, overall levels of coverage were low. The persistence of low drug treatment coverage for IDUs represents a failure by the U.S. health care system to prevent avoidable harms and unnecessary deaths in this population. Policy makers should expand drug treatment for IDUs to reduce blood-borne infections and community harms associated with untreated injection drug use.</p

Responses of Massachusetts hospitals to a state mandate to collect race, ethnicity and language data from patients: a qualitative study

<p>Abstract</p> <p>Background</p> <p>A Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients' race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. This study assessed implementation of the regulation and its impact on the use of race and ethnicity data in performance monitoring and quality improvement within hospitals.</p> <p>Methods</p> <p>Thematic analysis of semi-structured interviews with executives from a representative sample of 28 Massachusetts hospitals in 2009.</p> <p>Results</p> <p>The number of hospitals using race, ethnicity and language data internally beyond refining interpreter services increased substantially from 11 to 21 after the regulation. Thirteen of these hospitals were utilizing patient race and ethnicity data to identify disparities in quality performance measures for a variety of clinical processes and outcomes, while 16 had developed patient services and community outreach programs based on findings from these data. Commonly reported barriers to data utilization include small numbers within categories, insufficient resources, information system requirements, and lack of direction from the state.</p> <p>Conclusions</p> <p>The responses of Massachusetts hospitals to this new state regulation indicate that requiring the collection of race, ethnicity and language data can be an effective method to promote performance monitoring and quality improvement, thereby setting the stage for federal standards and incentive programs to eliminate racial and ethnic disparities in the quality of health care.</p