Insurance Mandates for Diagnosis and Treatment of Children and Adolescents with Autism and Evaluative Data Sources: A Case Study of Two U.S. States

BACKGROUND: It is recognized among providers, parents and health organizations that the current health care system is unprepared for a rising number of children diagnosed with Autism Spectrum Disorder (ASD) worldwide. Meanwhile, differences in mandated insurance coverage for ASD across the U.S. could drastically impact the diagnosis and treatment strategies chosen by providers and families. PURPOSE OF RESEARCH: The present case study aimed to review and compare policies and programs for children and adolescents with ASD in Pennsylvania (PA) and Georgia (GA), focusing on private insurance mandates. Additionally, the case study intended to identify and evaluate data sources that can be used to assess the implementation and impact of ASD insurance mandates in those states. METHODS: Key advocates and health agencies’ representatives were contacted to collaborate in the identification of the state regulated initiatives and potential data sources that track children and adolescents with ASD. Insurance enrollment, pharmacy care, health care service utilization, and cost of care were the indicators used to evaluate data sources in their ability to evaluate the impact of the insurance mandates. RESULTS: PA showed a more comprehensive insurance mandate and state-driven health-related initiatives for children and adolescents with ASD than GA. Among the nine data sources reviewed, including claims and survey data, none provide essential indicators for a comprehensive evaluation of the impact of the ASD insurance mandate in PA or GA. CONCLUSION: The case study indicated that for GA and PA, ASD policy tracking and evaluation can be accomplished with some of the currently available data sources, however, important gaps in the surveillance of ASD-related outcomes exist. Thus, the study suggested that efforts towards more comprehensive data sources across all states is needed in order to evaluate ASD initiatives that inform ASD related- health policy and programs

Using Process Mining to Assess the Fidelity of a Home Visiting Program

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is a federal public health initiative which supports at-risk families through evidence-based programs and promising approaches for pregnant women, and childhood development for children aged 0 to 5. These public health program funding mechanisms commonly include process evaluation mandates. Purpose: The use of process mining was explored as a methodology to assess the fidelity of the MIECHV programs’ actual workflow to that of their intended models. Methods: Research Electronic Data Capture (REDCap) data files that were populated with program process data elements from the local implementing agencies were mined. The focus was on three main variables: participant identification, activity labels, and timestamps. These variables were imported into the Disco process-mining software. Disco was used to develop process maps to track process pathways and compare the actual workflow against the intended model. Results: Using process mining as a diagnostic tool, fidelity to the MIECHV process model was assessed, identifying a total of 262 different process variations. The 15 most frequent variations represent 60.7% of the total pool of process variations, 13 of which were deemed to have fidelity to the intended model. Analysis of the variations indicated that many activities in the intended process were skipped or implemented out of sequence. Implications: Process mining is a useful tool for organizations to visually display, track, understand, compare, and improve their workflow processes. This method should be considered by programs as complex as MIECHV to improve the data reporting and the identification of opportunities to strengthen programs

Visualizing Complex Adaptive Systems: A Case Study of the Missouri Maternal, Infant, and Early Childhood Home Visiting Program

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program was created by the 2010 Patient Protection and Affordable Care Act. MIECHV provides comprehensive services to at-risk families through evidence-based home visiting programs. Purpose: The following question is addressed: Does the Missouri MIECHV system meet the definition of a complex adaptive system (CAS)? Methods: A systematic review was conducted of documents related to MIECHV programs (federal, state, and local levels), and to affiliated programs with a home visiting and early childhood (aged birth to 5 years) scope. The organizations’ fit was identified for the scope of early childhood home visiting programs, and then its relationship extracted to MIECHV and its affiliates. Results: MIECHV meets the definition of a CAS, being dynamic, massively entangled, scale independent, transformative, and emergent. Over 250 organizations were identified; 19 federal and 79 state organizations; 24 nonprofits at the federal level, 31 at the state; over 150 community-level agencies; and 13 home visiting models implemented in Missouri. Implications: A considerable amount of organizational complexity exists within the MIECHV system and among its affiliates with a home visiting and early childhood scope. The complexity of the system challenges its potential for effective and efficient implementation, coordination, sustainability, and evaluation, and increases the potential for redundancy, overlap, and fragmentation. Evaluating a CAS requires acknowledgement of its complexity, beyond traditional approaches to evaluation. Creating visualization tools of federal, state, and local stakeholders and their relationships is a practical approach for aligning, organizing, and communicating the work flow

Pediatric epidemiological aspects of scorpionism and report on fatal cases from Tityus stigmurus stings (Scorpiones: Buthidae) in State of Pernambuco, Brazil

Introduction Envenomation by scorpion stings is a major public health problem in numerous tropical countries because of its frequent incidence and potential severity. Approximately 1,900 species of scorpions are known in the world, and at least 130 of these have been described in Brazil. Methods This work reports on 3 child deaths caused by Tityus stigmurus stings and characterizes epidemiological and clinical surveys on pediatric cases of scorpionism recorded in the Centro de Assistência Toxicológica de Pernambuco (Ceatox-PE). Results Scorpion stings accounted for more than 60% of all cases recorded for venomous animals. The children were from 37 cities of the Pernambuco state and accounted for 28.8% of the victims treated for scorpion stings, with the highest incidence in the metropolitan area of Recife. Stings occurred throughout the year and slightly increased during the rainy season. Independent of the elapsed time for a prognosis, most cases showed mild symptoms. Three moderate cases that resulted in death featured cardiogenic shock and/or pulmonary edema or severe neurological symptoms. For the first time, death attributed to T. stigmurus was confirmed by the presence of the scorpion. Conclusions These results suggest that scorpionism in Pernambuco is a public health problem that needs to be monitored carefully throughout the year by the government

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

PubMe

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes