Quality Improvement in Maryland: Partnerships and Progress

This one-and-a-half-day site visit to Easton, Maryland, explored the activities of the Delmarva Foundation, the Quality Improvement Organization (QIO) for Maryland and the District of Columbia. The program reviewed Delmarva’s responsibilities under their Medicare contract and the initiatives they have undertaken with hospitals and other providers to improve health care outcomes and to define, collect, and report quality data. Local hospital officials added their perspective on quality programs and working with Delmarva. Topics of particular interest were health information technology, patient safety, and quality reporting both to government agencies and to consumers

Reinventing Medicaid: Hoosier Healthwise and Children\u27s Health Insurance in Indiana

This site visit explored the factors that have made Indiana so successful in enrolling children in its Medicaid and SCHIP plans under the brand name Hoosier Healthwise. Site visitors met with legislators and state officials to gain understanding of the genesis and development of Hoosier Healthwise and its aggressive outreach component. A panel of representatives from partner organizations engaged in enrolling children provided further insight into this process. The site visit participants traveled to observe enrollment and operations in both urban (Marion) and rural (Clay) county offices. They also met with health care executives at hospitals, clinics, and neighborhood health centers delivering care to Hoosier Healthwise beneficiaries

Insuring Virginia\u27s Children: Local Outreach and Enrollment (Northern Virginia)

This one-day visit to a nearby jurisdiction was designed to allow participation by federal staff who have been unable to commit the three days required by a typical Forum site visit. Site visitors were given an overview of health care in Virginia and an introduction to the Children\u27s Medical Income Security Program (CMSIP) as well as its proposed replacement, the Family Access to Medical Insurance Security program (FAMIS). A panel representing community organizations and providers shared their experience, touching on provider concerns, coordination of outreach efforts across counties, and assistance for clients after they are enrolled. The group visited the Arlington County Department of Human Services and the Inova-sponsored Partnership for Healthier Kids in Fairfax County

The Medicare and Medicaid Intersection: Caring for Arizona\u27s Seniors

This site visit to Phoenix examined the interplay between Medicare and Medicaid and how payment streams and regulatory requirements affect the delivery of health and long-term care services. The visit explored trends related to Medicare+Choice plan participation, physician acceptance of Medicare patients, and care management for individuals with chronic illnesses, such as Alzheimer’s disease. It also considered Arizona’s capitated Medicaid long-term care program, which recently implemented competitive bidding among plans in Maricopa County

Site Visit to Arizona — Managed Medicaid: Arizona\u27s AHCCCS Experience

This site visit featured a review of a unique Medicaid managed care system, the Arizona Health Care Cost Containment System (AHCCCS), which has operated as a research and demonstration waiver since its inception in 1982. Site visitors heard from speakers who provided historical and background information, a discussion of competitive bidding, contracting and performance management, and insights into the delivery of behavioral health under the mandatory AHCCCS program. The group also heard discussions about services to the uninsured and Arizona\u27s safety net providers. Other topics covered during the visit included the state\u27s KidsCare program under the State Child Health Insurance Program; AHCCCS quality, outreach, enrollment, and data systems; and the provision of pharmacy services to enrollees. Visits to providers, health plans, and state offices were included during the Arizona stay

Community-Based Long-Term Care: Wisconsin Stays Ahead

This report describes a site visit to Wisconsin in August 2007 that focused on the use of home and community-based services, both public and private, to delay or avoid the need for institutional care. Wisconsin was chosen because it has long been a leader among states in developing such services for the elderly and persons with disabilities. At the time of the visit, a managed long-term care program, Family Care, was operating on a pilot basis in five counties. The Partnership Program, a four-site demonstration integrating acute and long-term care for the dual eligible population (both frail elderly and younger persons with disabilities who are eligible for Medicare and Medicaid), was in the process of transitioning to a set of Medicare Special Needs Plans. Site visit participants visited Partnership operations in Madison and talked with representatives of Family Care in rural Richland County. Researchers from the University of Wisconsin, state officials, service providers, caregivers, and beneficiaries also participated in panel sessions and informal discussions

Community-Based Long-Term Care in Milwaukee: Wisconsin Still Ahead

The National Health Policy Forum has made two site visits to Wisconsin in two years. The first, in August 2007, focused on an overview of Family Care, the state\u27s managed long-term care program, and looking at service delivery in a rural setting. The August 2008 site visit focused on the operations of MCOs and Family Care service providers in the urban environment of Milwaukee. Issues examined included the link between housing and social services, care management, capitation and rate-setting, measuring quality, and integrating people with disabilities into a program that initially targeted the elderly

Pan-Proteomic Analysis and Elucidation of Protein Abundance among the Closely Related Brucella Species, Brucella abortus and Brucella melitensis

Brucellosis is a zoonotic infection caused by bacteria of the genus Brucella. The species, B. abortus and B. melitensis, major causative agents of human brucellosis, share remarkably similar genomes, but they differ in their natural hosts, phenotype, antigenic, immunogenic, proteomic and metabolomic properties. In the present study, label-free quantitative proteomic analysis was applied to investigate protein expression level differences. Type strains and field strains were each cultured six times, cells were harvested at a midlogarithmic growth phase and proteins were extracted. Following trypsin digestion, the peptides were desalted, separated by reverse-phase nanoLC, ionized using electrospray ionization and transferred into an linear trap quadrapole (LTQ) Orbitrap Velos mass spectrometer to record full scan MS spectra (m/z 300–1700) and tandem mass spectrometry (MS/MS) spectra of the 20 most intense ions. Database matching with the reference proteomes resulted in the identification of 826 proteins. The Cluster of Gene Ontologies of the identified proteins revealed differences in bimolecular transport and protein synthesis mechanisms between these two strains. Among several other proteins, antifreeze proteins, Omp10, superoxide dismutase and 30S ribosomal protein S14 were predicted as potential virulence factors among the proteins differentially expressed. All mass spectrometry data are available via ProteomeXchange with identifier PXD006348

High frequency of chlamydial co-infections in clinically healthy sheep flocks

<p>Abstract</p> <p>Background</p> <p>The epidemiological situation of ovine chlamydial infections in continental Europe, especially Germany is poorly characterised. Using the German state of Thuringia as a model example, the chlamydial sero- and antigen prevalence was estimated in thirty-two randomly selected sheep flocks with an average abortion rate lower than 1%. Seven vaccinated flocks were reviewed separately.</p> <p>Results</p> <p>A wide range of samples from 32 flocks were examined. Assumption of a seroprevalence of 10% (CI 95%) at flock level, revealed that 94% of the tested flocks were serologically positive with ongoing infection (i.e. animals with seroconversion) in nearly half (47%) of the flocks. On the basis of an estimated 25% antigen prevalence (CI 95%), PCR and DNA microarray testing, together with sequencing revealed the presence of chlamydiae in 78% of the flocks. The species most frequently found was <it>Chlamydophila (C</it>.) <it>abortus </it>(50%) followed by <it>C. pecorum </it>(47%) and <it>C. psittaci </it>genotype A (25%). Mixed infections occurred in 25% of the tested flocks. Samples obtained from the vaccinated flocks revealed the presence of <it>C. abortus </it>field samples in 4/7 flocks. <it>C. pecorum </it>was isolated from 2/7 flocks and the presence of seroconversion was determined in 3/7 flocks.</p> <p>Conclusions</p> <p>The results imply that chlamydial infections occur frequently in German sheep flocks, even in the absence of elevated abortion rates. The fact that <it>C. pecorum </it>and the potentially zoonotic <it>C. psittaci </it>were found alongside the classical abortifacient agent <it>C. abortus</it>, raise questions about the significance of this reservoir for animal and human health and underline the necessity for regular monitoring. Further studies are needed to identify the possible role of <it>C. psittaci </it>infections in sheep.</p

Comprehensive Identification of Immunodominant Proteins of Brucella abortus and Brucella melitensis Using Antibodies in the Sera from Naturally Infected Hosts

Brucellosis is a debilitating zoonotic disease that affects humans and animals. The diagnosis of brucellosis is challenging, as accurate species level identification is not possible with any of the currently available serology-based diagnostic methods. The present study aimed at identifying Brucella (B.) species-specific proteins from the closely related species B. abortus and B. melitensis using sera collected from naturally infected host species. Unlike earlier reported investigations with either laboratory-grown species or vaccine strains, in the present study, field strains were utilized for analysis. The label-free quantitative proteomic analysis of the naturally isolated strains of these two closely related species revealed 402 differentially expressed proteins, among which 63 and 103 proteins were found exclusively in the whole cell extracts of B. abortus and B. melitensis field strains, respectively. The sera from four different naturally infected host species, i.e., cattle, buffalo, sheep, and goat were applied to identify the immune-binding protein spots present in the whole protein extracts from the isolated B. abortus and B. melitensis field strains and resolved on two- dimensional gel electrophoresis. Comprehensive analysis revealed that 25 proteins of B. abortus and 20 proteins of B. melitensis were distinctly immunoreactive. Dihydrodipicolinate synthase, glyceraldehyde-3-phosphate dehydrogenase and lactate/malate dehydrogenase from B. abortus, amino acid ABC transporter substrate-binding protein from B. melitensis and fumarylacetoacetate hydrolase from both species were reactive with the sera of all the tested naturally infected host species. The identified proteins could be used for the design of serological assays capable of detecting pan- Brucella, B. abortus- and B. melitensis-specific antibodies