Medicare, Medicaid and the Deficit Debate

Examines 2000-10 Medicare and Medicaid expenditures; projections for 2011-20 from the Centers for Medicare and Medicaid Services and the Congressional Budget Office; contributing factors, including enrollment growth; and proposals for curbing spending

Diabetes Type II Quality Improvement Using the My Own Health Report

Diabetes Mellitus Type II Quality Improvement Using the My Own Health Report Lynn Bennett McMorrow Rationale: To maintain Primary Care Medical Home status, Cold Hollow Family Practice (CHFP) is mandated to perform continuous quality improvement for chronically ill patients. To achieve this goal at CHFP, a formal quality improvement (QI) process using a validated health risk assessment tool, My Own Health Report (MOHR) was used to engage patients with Type 2 Diabetes (T2D) in dialogue regarding self change behaviors. The goal was to improve patient self-care management as evidenced by decreased HbA1c readings or weight as compared to non-participating patients, over a six-month period. From 1980 through 2012, the number of adults with diagnosed diabetes in the United States nearly quadrupled, from 5.5 million to 21.3 million and 1.7 million more persons over 20 years of age are diagnosed each year. The estimated direct medical costs in 2012 were 176 billion and the indirect costs (lost wages, disability and death) for the same time frame were 69 billion. Individualized patient care, as the corner stone of evidence based practice, is vital to improve self-management in patients who have Type 2 Diabetes (T2D). Methods: The QI process began with 27 patients. We had 10 patients who did not participate and 17 who did the MOHR as administered by the medical assistant. The provider reviewed the MOHR summary and used motivational interviewing to discuss the results with each patient scheduled for a T2D visit, for willingness to discuss or change modifiable life styles. Quantitative analysis was done with Fisher’s Exact Test comparing those who were in the MOHR group to those not participating. Qualitative analysis was not done secondary to time and EHR constraints. Results: Comparison of the MOHR group to the non-MOHR group, 47% improved both weight and HbA1c whereas the non-MOHR group had 0% improvement (P=0.01). Using the same comparison in HbA1c only, the MOHR group decreased by 58% compared to 10% for the non-MOHR group (P= 0.02). Conclusions: Generalizability is limited by a number of factors: a small group study of 27 patients and provider use of motivational interviewing and historical patient/provider relationships. Furthermore, it was a self-selected group that may have been ready to change. Without randomization, motivational interviewing, and requiring that the MOHR be completed we cannot absolutely determine the impact of the MOHR on T2D disease marker improvements. Further study using the MOHR report with motivational interviewing is needed to support these findings. Keywords: Diabetes Type 2, MOHR, HbA1

What Would Health Care Reform Mean for Small Employers and Their Workers?

Analyzes the implications of the House and Senate reform bills for improving access to and affordability of insurance for small employers. Examines the proposed insurance exchanges, market reforms, subsidies for low-income individuals, and tax provisions

Knowledge Gaps and Misinformation About Birth Control Methods Persist in 2016

Beyond Birth Control: Family Planning and Women's Lives is a multiyear project examining the current state of access to contraception and how this access influences women's lives in the short and long term. Supported by the William and Flora Hewlett Foundation, the Urban Institute is using mixed research methods to answer two main questions under the project: how does expanded access to affordable contraception affect short- and long-term socioeconomic and health outcomes for women and their families, and what are the persistent barriers to contraceptive access and use, who faces these barriers, and how can these barriers be reduced? This brief is one of a series of Beyond Birth Control products that will provide new and timely information to influence policy debates and highlight areas where progress has been most challenging and where additional resources could most productively be directed

Employer and student perspectives on skills for engineers in the twenty first century and beyond

This research focused on skills identified among final year engineering students. It provided evidence of different levels of skills by students and identifies their greatest learning influences in these areas. The skills were self-assessed by students and covered seven areas designated by Engineers Ireland. Competency levels such as science, software, creativity, engineering practice, social and business, ethics, discipline specific were assessed. It also investigated the important role that work placements play in skills developed by students. Key skills sought by leading Engineering firms from graduates now and in the next five years were also researched in this paper. Employers were surveyed to determine and investigate skills needed from graduate engineers and how best to meet these challenges. The emphasis on work placements and its impact on skills’ development in engineering students such as business acumen and working effectively and efficiently in industry were highlighted

The Effects of Health Reform on Small Businesses and Their Workers

Synthesizes research findings about how the 2010 healthcare reform will affect small business owners and employees, including savings in healthcare costs and premium contributions, coverage for workers and dependents, offer rates, and number of uninsured

Addressing Coverage Challenges for Children Under the Affordable Care Act

Explores reform implementation issues for ensuring that children in families with varying eligibility for different types of insurance have access to coverage. Estimates the number of such children and examines the implications of specific provisions

Color-to-speech sensory substitution device for the visually impaired

A hardware device is presented that converts color to speech for use by the blind and visually impaired. The use of audio tones for transferring knowledge of colors identified to individuals was investigated but was discarded in favor of the use of direct speech. A unique color-clustering algorithm was implemented using a hardware description language (VHDL), which in-turn was used to program an Altera Corporation's programmable logic device (PLD). The PLD maps all possible incoming colors into one of 24 color names, and outputs an address to a speech device, which in-turn plays back one of 24 voice recorded color names. To the author's knowledge, there are only two such color to speech systems available on the market. However, both are designed to operate at a distance of less than an inch from the surface whose color is to be checked. The device presented here uses original front-end optics to increase the range of operation from less than an inch to sixteen feet and greater. Because of the increased range of operation, the device can not only be used for color identification, but also as a navigation aid

Addressing Barriers to Health Insurance Coverage Among Children: New Estimates for the Nation, California, New York, and Texas

Outlines obstacles to children's health coverage under federal healthcare reform such as living with neither parent or parents being ineligible for Medicaid. Estimates the number and share of such children among all, uninsured, and CHIP-eligible children