The role of data in health care disparities in medicaid managed care

BACKGROUND: The Affordable Care Act includes provisions to standardize the collection of data on health care quality that can be used to measure disparities. We conducted a qualitative study among leaders of Medicaid managed care plans, that currently have access to standardized quality data stratified by race and ethnicity, to learn how they use it to address disparities. METHODS: We conducted semi-structured interviews with 21 health plan leaders across 9 Medicaid managed care plans in California. We used purposive sampling to maximize heterogeneity in geography and plan type (e.g., non-profit, commercial). We performed a thematic analysis based on iterative coding by two investigators. RESULTS: We found 4 major themes. Improving overall quality was tightly linked to a focus on standardized metrics that are integral to meeting regulatory or financial incentives. However, reducing disparities was not driven by standardized data, but by a mix of factors. Data were frequently only examined by race and ethnicity when overall performance was low. Disparities were attributed to either individual choices or cultural and linguistic factors, with plans focusing interventions on recently immigrated groups. CONCLUSIONS: While plans' efforts to address overall quality were often informed by standardized data, actions to reduce disparities were not, at least partly because there were few regulatory or financial incentives driving meaningful use of data on disparities. Standardized data, as envisaged by the Affordable Care Act, could become more useful for addressing disparities if they are combined with policies and regulations that promote health care equity

Adapting clinical guidelines to take account of multimorbidity

Most people with a chronic condition have multimorbidity, but clinical guidelines almost entirely focus on single conditions. It will never be possible to have good evidence for every possible combination of conditions, but guidelines could be made more useful for people with multimorbidity if they were delivered in a format that brought together relevant recommendations for different chronic conditions and identified synergies, cautions, and outright contradictions. We highlight the problem that multimorbidity poses to clinicians and patients using guidelines for single conditions and propose ways of making them more useful for people with multimorbidity

An acoustic analog to the dynamical Casimir effect in a Bose-Einstein condensate

We have realized an acoustic analog to the Dynamical Casimir effect. The density of a trapped Bose-Einstein condensate is modulated by changing the trap stiffness. We observe the creation of correlated excitations with equal and opposite momenta, and show that for a well defined modulation frequency, the frequency of the excitations is half that of the trap modulation frequency.Comment: Includes supplemental informatio

Response to Comment on "Pairing and Phase Separation in a Polarized Fermi Gas"

Zwierlein and Ketterle rely on subjective arguments and fail to recognize important differences in physical parameters between our experiment and theirs. We stand by the conclusions of our original report

Do managed clinical networks improve quality of diabetes care? : Evidence from a retrospective mixed methods evaluation

Peer reviewedPostprin

Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial:designing the intervention (ClinicalTrials.gov registration NCT01602705)

Peer reviewedPublisher PD

Chain Galaxies are Edge-On Low Surface Brightness Galaxies

Deep HST WFPC2 images have revealed a population of very narrow blue galaxies which Cowie et al. (1996) have interpreted as being a new morphological class of intrinsically linear star forming galaxies at $z=0.5-3$. We show that the same population exists in large numbers at low redshifts (z=0.03) and are actually the edge-on manifestation of low surface brightness disk galaxies.Comment: 18 pages + 3 pages of figures. Uuencoded, gzipped, tar file of 1 latex file, 5 figures, and 2 latex style files. To appear in the Astrophysical Journal Letter

Spontaneous Four-Wave Mixing of de Broglie Waves: Beyond Optics

We investigate the atom-optical analog of degenerate four-wave mixing of photons by colliding two Bose-Einstein condensates (BECs) of metastable helium and measuring the resulting momentum distribution of the scattered atoms with a time and space resolved detector. For the case of photons, phase matching conditions completely define the final state of the system, and in the case of two colliding BECs, simple analogy implies a spherical momentum distribution of scattered atoms. We find, however, that the final momenta of the scattered atoms instead lie on an ellipsoid whose radii are smaller than the initial collision momentum. Numerical and analytical calculations agree well with the measurements, and reveal the interplay between many-body effects, mean-field interaction, and the anisotropy of the source condensate