Gatekeeping and Children’s Health Care Costs

In the 1990’s, primary care gatekeeping became a hallmark of managed care and a major model of health care delivery. Proponents claimed that gatekeeping—requiring that primary care providers preauthorize specialty visits— could control costs and improve coordination of care. However, much of this potential has remained unrealized, and managed care organizations are beginning to loosen these restrictions. This Issue Brief adds to the growing literature on the ineffectiveness of gatekeeping in controlling costs in pediatric care. The following study focuses on privately insured children, and analyzes the impact of gatekeeping on their health care expenditures

The Relationship between Parental Educational Attainment and Perceived Racial Discrimination among African-American Female Adolescents

Background: Perceived racial discrimination acts as a considerable stressor for African- Americans and is associated with adverse health outcomes among adults and adolescents. The relationship between perceived discrimination and socioeconomic dimensions has been studied among adult African-American populations to assess the role of social patterning in reports of discrimination. However, less is known about the relationship between parental educational attainment and adolescents’ perceived discrimination. Methods: We explored the relationship between parental educational attainment and adolescents’ reports of racial discrimination using written surveys from 135 African-American female adolescents seeking family planning services at an urban hospital-based adolescent clinic in Pennsylvania. Dimensions of perceived discrimination that were captured in this study included personal experiences, vicarious racial discrimination, and perceived discrimination against African-Americans as a group. Parental educational attainment was categorized as “some or completed high school/GED” and “some or completed college.” To account for missing parental education data, a sensitivity analysis was performed in which missing data were recoded into parental education categories and used in chi-square cross tabulations. Results: Most of the sample (mean age = 17.04; SD = 1.33) had completed high school or were currently enrolled in school, and were living in single-parent homes. Close to half (41.5%) of respondents did not know their father’s educational attainment, and 17.8% did not know their mother’s educational attainment. To account for missing education data, a sensitivity analysis was performed, which revealed no significant association between parental educational attainment and adolescents’ perceived discrimination. However, although the respondents in our study do not appear to experience frequent discrimination, 85.9% reported at least one dimension of discrimination measured in this study. Conclusions: The large percentage of African-American female adolescents who reported at least one dimension of discrimination implies an added burden and vulnerability to social stressors in their life

Medical improvisation improves communication skills among healthcare professionals

While medical improvisation is emerging as a promising strategy for communication training, little is known about its effects on interdisciplinary healthcare teams and there is a need to advance knowledge about the impact of engagement during the training on communication skill improvement. We evaluated changes in communication skills among 132 healthcare professionals from one department at a large U.S. medical center who participated in medical improvisation (improv) communication training developed by a multidisciplinary team at a provost-level university-based center dedicated to communicating science. Participants took part in one of 15 single session in-person workshops delivered in October 2020 and co-facilitated by an improv expert and a seasoned clinician-scientist leader. Participants completed questionnaires regarding their communication skills before and after taking part in the training. Most of the self-reported communication skills that were assessed showed improvement following the workshop. Improvements were reported in 7 out of 8 communication skills that were assessed. Moreover, engagement moderated the effects of the training — among those with lowest pre-training communication skills, higher levels of engagement predicted greater improvement in communication skills, whereas low engagement predicted little change following the training. Medical improvisation is a promising approach to improve communication in healthcare. Further research is needed to estimate long-term effects of medical improvisation training and investigate ways to increase participant engagement

Public Spending on Elders and Children: The gap is Growing

Social welfare programs support the income, education, nutrition, and medical care needs of many of this country’s elders and children. Over the past twenty years, however, three times as many children as elders have lived in poverty, and poverty rates for children have consistently exceeded those for the elderly. Given the continued disparity in poverty rates, it is important to track levels of public spending for each group and the generational balance in allocating limited public funds. This Issue Brief evaluates trends in social welfare spending for children and the elderly from 1980 to 2000, and the relationship of national economic trends to public spending patterns

The Task Force Initiative: Local Interventions at the Department Level—A Key Component of a Multi-tiered Approach to Promote Institutional Change

This NIH Transforming Academic Culture (NIH-TAC) trial is a multi-level coordinated intervention to enhance institutional culture, increase academic productivity, and improve job satisfaction for women faculty. This poster details a task force initiative in which each department and division reviewed their current practices and policies to recommend and implement change. This particular task force resulted in a list of interventions which were disseminated and implemented throughout the institution

Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants

<p>Abstract</p> <p>Background</p> <p>Changes in well child care (WCC) adherence over time have not previously been examined. Our objective is to describe adherence rates to WCC over time in a low-income urban population of infants 0-24 months of age, and to identify predictors of WCC adherence in this population.</p> <p>Methods</p> <p>This is a secondary analysis of a cohort of Medicaid-eligible children followed from birth to 2 years between 2005 and 2008 with structured telephone surveys to assess maternal well-being, social support, and household and demographic information. For the 260 children attending 4 urban pediatric practices, WCC adherence was assessed based on visit data abstracted from electronic medical records. A random-intercept mixed effects logit model clustered on subject was used.</p> <p>Results</p> <p>92% of the mothers were African-American, 27% had not finished high school, 87% were single, and 43% earned < $500/month; mean age was 23. WCC adherence decreased from 88% at 6 months to 47% (12 mo), 44% (18 mo), and 67% (24 mo). The difference across time periods was statistically significant (p < 0.001). Married (OR 1.71, p = 0.02) and primiparous (OR 1.89, p < 0.001) mothers had significantly greater odds of adherence, along with women who reported having been adherent to prenatal care visits (OR 1.49, p = 0.03) and those with the lowest household income (OR 1.40, p = 0.03).</p> <p>Conclusions</p> <p>Maternal education efforts should emphasize the importance of establishing WCC, especially for mothers of more than one child. Further studies using larger, more broadly defined populations are needed to confirm our findings that efforts to increase WCC adherence should be intensified after 6 months of age, particularly for children at higher risk.</p

Early identification of young children at risk for poor academic achievement: preliminary development of a parent-report prediction tool

<p>Abstract</p> <p>Background</p> <p>Early school success is clearly related to later health. A prediction index that uses parent report to assess children's risk for poor academic achievement could potentially direct targeted service delivery to improve child outcomes.</p> <p>Methods</p> <p>We obtained risk factors through literature review and used the National Longitudinal Survey of Youth 1979 Child Files to examine the predictive associations of these factors with academic achievement scores.</p> <p>Results</p> <p>Twenty predictors were identified including four strong predictors (maternal education, child gender, family income, and low birth weight). Significantly, 12 predictors explained 17-24% of score variance.</p> <p>Conclusions</p> <p>Parent-reported factors provide predictive accuracy for academic achievement.</p

The role of health insurance on Pap smear and mammography utilization by immigrants living in the United States

Nearly half of recent immigrants to the United States lack health insurance. Access to cancer screening services for this group is problematic. We examine the role of health insurance and having a usual source of care (USC) on Pap smear and mammography utilization by immigrant women using a nationally representative sample. We used a telephone survey that oversampled racial and ethnic minorities. We analyzed data on 3,622 women age 18-70. We classified the 822 foreign-born women as recent immigrants if they had resided in the United States for under 10 years; LT immigrants were those with a longer tenure. Among recent immigrants, 73% and 78% (SE 4%) reported a Pap smear or mammogram, respectively, in the previous 2 years versus 89% and 89% of U.S.-born women (P < 0.05 for both comparisons). Among those with insurance or a USC, differences in screening between recent immigrants and U.S.-born women were four percentage points or less and not statistically significant. However, uninsured recent immigrants were less likely than uninsured U.S.-born women to have Pap smears [60% (SE 7%) versus 71%, P < 0.05]. Adjusting for differences in sociodemographics, health attitudes or beliefs, patient or provider communication, and the medical care environment, insurance remained the strongest predictor of screening. Disparities in screening were greatly attenuated among the insured population. Increasing awareness of available safety net sources of care may also improve cancer screening among uninsured recent immigrants