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    <title><![CDATA[Medical Care - Current Issue]]></title>
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      <title><![CDATA[Medical Care - Current Issue]]></title>
      <link>http://journals.lww.com/lww-medicalcare/pages/currenttoc.aspx</link>
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    <item>
      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/You_Get_What_You_Pay_For.1.aspx</link>
      <author>Wall, Terry C.</author>
      <category>Editorial</category>
      <title><![CDATA[You Get What You Pay For]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00001</guid>
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    <item>
      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Enhancing_the_Medical_Homes_Model_for_Children.2.aspx</link>
      <author>Domino, Marisa E.; Humble, Charles; Lawrence, William W. Jr; Wegner, Steve</author>
      <category>Original Article</category>
      <title><![CDATA[Enhancing the Medical Homes Model for Children With Asthma]]></title>
      <description><![CDATA[Background: Medical Home is an evolving concept of patient-centered care yet little information is available on its effect on health care expenditures for children.
Objectives: To quantify differences in patterns of care and costs to the North Carolina (NC) Medicaid program for children with asthma across 3 programs: fee-for-service (FFS), primary care case management (PCCM), and Medical Homes.
Research Design: NC Medicaid claims from 1998-2001 for children with asthma were used to examine monthly expenditures and patterns of health care use, including emergency department and hospital use. Children in the FFS program served as controls for trends in asthma care over the study period. Tests examined the potential for selection by program and fixed-effect 2-part model regressions were used to control for differences in program enrollees.
Subjects: Children under age 21 with asthma.
Measures: Monthly Medicaid expenditures and measures of health service use.
Results: We found considerable evidence of quality improvement in patterns of care for children enrolled in both the PCCM and Medical Homes models in NC. After controlling for selection into these programs, use of maintenance as well as rescue medications increased, use of services increased, and emergency department and hospital use went down. Total spending (asthma and nonasthma related) on children in the Medical Homes program was $148 greater than spending for FFS children (95% bootstrapped confidence interval: $140-$158) per child per month and no difference in spending between Medical Homes and PCCM was detected.
Conclusions: Our results indicate that enhancement of PCCM programs is one way for Medicaid programs to improve care, but may require substantial investments by states.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00002</guid>
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    <item>
      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Pediatric_Clinicians_Can_Help_Reduce_Rates_of.3.aspx</link>
      <author>Kressin, Nancy R.; Nunn, Martha E.; Singh, Harpreet; Orner, Michelle B.; Pbert, Lori; Hayes, Catherine; Culler, Corinna; Glicken, Stephan R.; Palfrey, Sean; Geltman, Paul L.; Cadoret, Cynthia; Henshaw, Michelle M.</author>
      <category>Original Article</category>
      <title><![CDATA[Pediatric Clinicians Can Help Reduce Rates of Early Childhood Caries: Effects of a Practice Based Intervention]]></title>
      <description><![CDATA[Objective: Early childhood caries (ECC) is a serious and preventable disease which pediatric clinicians can help address by counseling to reduce risk.
Research Design: We implemented a multifaceted practice-based intervention in a pediatric outpatient clinic treating children vulnerable to ECC (N = 635), comparing results to those from a similar nearby clinic providing usual care (N = 452).
Intervention: We provided communication skills training using the approach of patient centered counseling, edited the electronic medical record to prompt counseling, and provided parents/caregivers with an educational brochure.
Outcome Measures: We assessed changes in provider knowledge about ECC after the intervention, and examined providers' counseling practices and incidence of ECC over time by site, controlling for baseline ECC, patient sociodemographics and parents'/caregivers' practice of risk factors (diet, oral hygiene, tooth-monitoring), among 1045 children with complete data.
Results: Provider knowledge about ECC increased after the intervention training (percentage correct answers improved from 66% to 79%). Providers at the intervention site used more counseling strategies, which persisted after adjustment for sociodemographic characteristics. Children at the intervention site had a 77% reduction in risk for developing ECC at follow up, after controlling for age and race/ethnicity, sociodemographics and ECC risk factors; P <= 0.004.
Conclusions: The multifaceted intervention was associated with increased provider knowledge and counseling, and significantly attenuated incidence of ECC. If validated by additional studies, similar interventions could have the potential to make a significant public health impact on reducing ECC among young children.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00003</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Trends_in_Prenatal_Ultrasound_Use_in_the_United.4.aspx</link>
      <author>Siddique, Juned; Lauderdale, Diane S.; VanderWeele, Tyler J.; Lantos, John D.</author>
      <category>Original Article</category>
      <title><![CDATA[Trends in Prenatal Ultrasound Use in the United States: 1995 to 2006]]></title>
      <description><![CDATA[Background: While controversy continues about the appropriateness of routine ultrasound screening, there are little data on actual clinical practices or trends in the United States.
Objectives: To examine changes in prenatal ultrasound utilization over time and determine whether ultrasound utilization is associated with maternal age, race/ethnicity, payer status, region of the country, or pregnancy risk group.
Research Design: Data on prenatal visits to office-based physicians and hospital outpatient departments from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey in 1995 to 2000, 2005, and 2006.
Measure: Prenatal ultrasound use as recorded by a checkbox on the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey survey forms. We calculated the percent of visits with ultrasound, average number of ultrasounds per pregnancy, and adjusted odds ratios (ORs) of receiving an ultrasound.
Results: Overall, the estimated average number of ultrasounds per pregnancy increased from 1.5 in 1995-1997 to 2.7 in 2005-2006. For low-risk pregnancies, the estimated number of ultrasounds during that time period increased from 1.3 to 2.1. For high-risk pregnancies, the number increased from 2.2 to 4.2. In an adjusted analysis, the odds of a woman receiving an ultrasound in 2005-2006 were twice those of a visit in 1995-1997 [OR = 2.02; 95% CI (1.36, 3.00); P < 0.01]. High-risk women had odds of receiving an ultrasound that were almost twice that of women in the low-risk group [OR = 1.91; 95% CI (1.41, 2.59); P < 0.01].
Conclusions: Both low-risk and high-risk pregnant women in the United States are much more likely to receive repeated ultrasound examinations today than they were 10 years ago.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00004</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Socioeconomic_Status_and_Utilization_of_Health.5.aspx</link>
      <author>Blackwell, Debra L.; Martinez, Michael E.; Gentleman, Jane F.; Sanmartin, Claudia; Berthelot, Jean-Marie</author>
      <category>Original Article</category>
      <title><![CDATA[Socioeconomic Status and Utilization of Health Care Services in Canada and the United States: Findings From a Binational Health Survey]]></title>
      <description><![CDATA[Objectives: Building on Andersen's behavioral model for the utilization of health care services, we examined factors associated with utilization of physician and hospital services among adults in Canada and the United States, with a focus on socioeconomic status (enabling resources in Andersen's framework).
Methods: Using the 2002-2003 Joint Canada/United States Survey of Health, we conducted country-specific multivariate logistic regressions predicting doctor contacts/visits and overnight hospitalizations in the past year, controlling for predisposing characteristics, enabling resources, and several factors representing perceived need for health care. All analyses were appropriately weighted to yield nationally representative results.
Results: Several measures of socioeconomic status-having a regular medical doctor, education, and, in the US income and insurance coverage-were associated with doctor contacts or visits in both countries, along with various predisposing and need factors. However, these same measures were not associated with hospitalizations in either country. Instead, only the individual's predisposing characteristics (eg, age and sex) and his/her need for health care predicted utilization of hospital services in Canada and the United States. Insurance coverage status in the United States became a significant predictor of hospitalizations when count data were analyzed via Poisson regression.
Conclusions: Given our particular outcome measures, adults in Canada and the United States exhibited similar patterns of hospital utilization, and socioeconomic status played no explanatory role. However, relative to Canadian adults, we found disparities in doctor contacts among US adults-between those with more income and those with less, between those with health insurance and those without-after adjusting for health care needs and predisposing characteristics.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00005</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Physician_Evaluation_and_Management_of_Medicare.6.aspx</link>
      <author>Wolff, Jennifer L.; Meadow, Ann; Boyd, Cynthia M.; Weiss, Carlos O.; Leff, Bruce</author>
      <category>Original Article</category>
      <title><![CDATA[Physician Evaluation and Management of Medicare Home Health Patients]]></title>
      <description><![CDATA[Objective: The Medicare home health benefit is predicated on physician referral and involvement. In this study, we investigated (1) the frequency and (2) implications of home health patients' evaluation and management by community physicians.
Methods: The 2005 and 2006 Medicare 5% Standard Analytic Files were linked to the Outcome and Assessment Information Set to examine physician visits among 74,462 fee-for service Medicare beneficiaries with a home health episode of care between July 1, 2005 and December 1, 2006. We examined whether receipt of community physician evaluation and management visits by home health patients was associated with subsequent discharge disposition, comparing discharge from the agency as opposed to inpatient facility transfer.
Results: More than one-third (34.6%) of patients did not receive physician evaluation and management visits during their home health episode. Home health patients most commonly incurred physician office visits exclusively (51.5%) or in combination with consultations (6.8%) or house call visits (2.2%), as well as house call visits exclusively (3.3%). Patients who incurred physician evaluation and management visits during their episode of care were more likely to be discharged from home health agencies than their counterparts who did not (77.9% vs. 70.6%, respectively). The association between physician visits and home health discharge was statistically significant in both simple regression models (odds ratio = 1.47; 95% confidence interval [CI], 1.42-1.52) and in multivariate analyses accounting for socio-demographic factors, health, and functioning (odds ratio = 1.45; 95% CI, 1.40-1.51).
Conclusions: More systematic integration of physicians in home care processes may reduce subsequent hospital and other inpatient facility use among home health patients.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00006</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/The_Role_of_Disability_in_Explaining_Long_Term.7.aspx</link>
      <author>de Meijer, Claudine A. M.; Koopmanschap, Marc A.; Koolman, Xander H. E.; van Doorslaer, Eddy K. A.</author>
      <category>Original Article</category>
      <title><![CDATA[The Role of Disability in Explaining Long-Term Care Utilization]]></title>
      <description><![CDATA[Objective: In view of aging populations, it is important to improve our understanding of the determination of long-term care (LTC) service use among the middle-aged and elderly population. We examined the likelihood of using 2 levels of LTC-homecare and institutional care-in the Netherlands and focused on the influence of the measured degree of disability.
Methods: We pooled 2 cross-sectional surveys-one that excluded institutionalized and one that was targeted at institutionalized individuals aged 50+. Disability is measured by impairment in (instrumental) activities of daily living (iADL, ADL) and mobility. Consistency with official Dutch LTC eligibility criteria resulted in the selection of an ordered response model to analyze utilization. We compared a model with separate disability indicators to one with a disability index.
Results: Age and disability, but not general health, proved to be the main determinants of utilization, with the composite index sufficiently representing the disaggregated components. The presence of at least 1 disability displayed a greater effect on utilization than any additional disabilities. Apart from disability and age, sex, living alone, psychologic problems, and hospitalizations showed a significant influence on LTC use. Some determinants affected the likelihood of homecare or institutional care use differently.
Conclusions: Even after extensive control for disability, age remains an important driver of LTC use. By contrast, general health status hardly affects LTC use. The model and disability index can be used as a policy tool for simulating LTC needs.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00007</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/The_Health_Consequences_of_Using_Physical.8.aspx</link>
      <author>Castle, Nicholas G.; Engberg, John</author>
      <category>Original Article</category>
      <title><![CDATA[The Health Consequences of Using Physical Restraints in Nursing Homes]]></title>
      <description><![CDATA[Background: Using a national longitudinal sample of nursing homes residents (N = 264,068), we examine whether physical restraint use contributes to subsequent physical or psychological health decline.
Methods: The minimum data set, the on-line survey certification and recording system, and the area resource file were the data sources used. This data represented the period of 2004 and 2005. To control for the difference in characteristics between residents who were subsequently physically restrained and who were not, we use a propensity score matching method.
Results: For all outcomes examined (except depression), that is, behavior issues, cognitive performance, falls, walking dependence, activities of daily living, pressure ulcers, and contractures, were all significantly worse for restrained residents compared with matched residents who were not restrained.
Discussion: Physical restraint use represents poor clinical practice, and the benefits to residents of further reducing physical restraint use in nursing homes are substantial.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00008</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/The_Concentration_and_Persistence_of_Health_Care.9.aspx</link>
      <author>Lin, Pei-Jung; Biddle, Andrea K.; Ganguly, Rahul; Kaufer, Daniel I.; Maciejewski, Matthew L.</author>
      <category>Original Article</category>
      <title><![CDATA[The Concentration and Persistence of Health Care Expenditures and Prescription Drug Expenditures in Medicare Beneficiaries With Alzheimer Disease and Related Dementias]]></title>
      <description><![CDATA[Background: Alzheimer disease and related dementias (ADRD) have become a major concern for Medicare because of the increasing prevalence rate and the associated high cost of care.
Objectives: This study investigated the extent of concentration and persistence in total health care expenditures and prescription drug expenditures among the elderly with ADRD, and identified characteristics associated with expenditure persistence that may provide targets for cost containment approaches.
Research Design: This retrospective cohort study analyzed cross-sectional Medicare Current Beneficiary Survey data to examine expenditure concentration by calculating the proportion of total and prescription drug expenditures incurred by the top 10%, top 25%, and top 50% of beneficiaries in each year. A transition probability matrix and logit models were estimated to predict expenditure persistence over a 2-year period.
Results: The top 10% of beneficiaries with ADRD accounted for nearly half of total health expenditures and one-third of drug expenditures. Inpatient care comprised the largest share of overall expenditures in the top 10% group, whereas physician visits and prescription medications were the cost drivers in the bottom 50% group. Expenditure persistence was very strong, especially for prescription drugs. Prior expenditures and comorbidity burdens were the strongest predictors of persistence.
Conclusions: The results of our study highlight the challenges to reducing expenditure growth and persistence for high-cost ADRD beneficiaries with prominent comorbidities. It will be important to examine whether better care coordination and disease management tailored to high-cost beneficiaries with ADRD can effectively contain costs.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00009</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Medicare_Managed_Care_Enrollment_by.10.aspx</link>
      <author>Maciejewski, Matthew L.; Birken, Sarah; Perkins, Mark; Burgess, James F. Jr; Sharp, Nancy; Liu, Chuan-Fen</author>
      <category>Original Article</category>
      <title><![CDATA[Medicare Managed Care Enrollment by Disability-Eligible and Age-Eligible Veterans]]></title>
      <description><![CDATA[Objective: To assess factors associated with enrollment in a Medicare advantage (MA) plan versus Medicare fee-for-service plan in 2000-2004 by Medicare-eligible veterans. We also assessed whether these factors differed between disability-eligible veterans and age-eligible veterans.
Methods: Medicare claims data, VA administrative data, and 2000 census data were constructed in a retrospective cohort study of 20,581 age-eligible veterans and 7541 disability-eligible veterans. MA enrollment in 2000-2004 was estimated in a logistic regression in a pooled sample of age-eligible and disability-eligible veterans that controlled for demographic, socioeconomic, and disease risk factors. Separate logistic regressions also were estimated for age-eligible and disability-eligible veterans.
Results: Minority veterans and veterans with lower disease risk scores were more likely to be enrolled in an MA plan in 2000-2004 than white veterans or veterans with higher risk scores. Age-eligible veterans were more likely to be enrolled if aged 75 or older, female, able to receive free VA care, or not enrolled in Medicaid. Disability-eligible veterans were more likely to be enrolled if they were married or elderly.
Conclusions: Medicare Advantage plans appeared to benefit from favorable selection of Medicare-eligible veterans.
(C) 2009 Lippincott Williams & Wilkins, Inc.]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00010</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Prescription_Standards_are_Necessary_to_Improve.11.aspx</link>
      <author>Kennedy, Amanda G.; DiParlo, Mark A.</author>
      <category>Letters to the Editor</category>
      <title><![CDATA[Prescription Standards are Necessary to Improve Health Literacy and Medication Safety]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00011</guid>
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    <item>
      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Prescription_Standards_are_Necessary_to_Improve.12.aspx</link>
      <author>Wolf, Michael S.; Shank, William H.</author>
      <category>Letters to the Editor</category>
      <title><![CDATA[Prescription Standards are Necessary to Improve Health Literacy and Medication Safety]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00012</guid>
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      <link>http://journals.lww.com/lww-medicalcare/Fulltext/2009/11000/Erratum.13.aspx</link>
      <category>Erratum</category>
      <title><![CDATA[Erratum]]></title>
      <description><![CDATA[No abstract available]]></description>
      <pubDate>11/1/2009 12:00:00 AM</pubDate>
      <guid isPermaLink="false">00005650-200911000-00013</guid>
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