MEDICAID A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
ii
ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Medicaid: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84593-X 1. Medicaid-Popular works. I. Title.
iii
Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.
iv
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Medicaid. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
v
About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
vi
About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
vii
Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON MEDICAID ................................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Medicaid........................................................................................ 8 The National Library of Medicine: PubMed ................................................................................ 71 CHAPTER 2. NUTRITION AND MEDICAID ..................................................................................... 115 Overview.................................................................................................................................... 115 Finding Nutrition Studies on Medicaid .................................................................................... 115 Federal Resources on Nutrition ................................................................................................. 118 Additional Web Resources ......................................................................................................... 118 CHAPTER 3. ALTERNATIVE MEDICINE AND MEDICAID ............................................................... 119 Overview.................................................................................................................................... 119 National Center for Complementary and Alternative Medicine................................................ 119 Additional Web Resources ......................................................................................................... 126 General References ..................................................................................................................... 127 CHAPTER 4. DISSERTATIONS ON MEDICAID ................................................................................. 129 Overview.................................................................................................................................... 129 Dissertations on Medicaid ......................................................................................................... 129 Keeping Current ........................................................................................................................ 143 CHAPTER 5. CLINICAL TRIALS AND MEDICAID............................................................................ 145 Overview.................................................................................................................................... 145 Recent Trials on Medicaid ......................................................................................................... 145 Keeping Current on Clinical Trials ........................................................................................... 146 CHAPTER 6. BOOKS ON MEDICAID ............................................................................................... 149 Overview.................................................................................................................................... 149 Book Summaries: Federal Agencies............................................................................................ 149 Book Summaries: Online Booksellers......................................................................................... 153 The National Library of Medicine Book Index ........................................................................... 160 Chapters on Medicaid ................................................................................................................ 161 Directories.................................................................................................................................. 168 CHAPTER 7. MULTIMEDIA ON MEDICAID..................................................................................... 171 Overview.................................................................................................................................... 171 Video Recordings ....................................................................................................................... 171 Audio Recordings....................................................................................................................... 172 Bibliography: Multimedia on Medicaid ..................................................................................... 173 CHAPTER 8. PERIODICALS AND NEWS ON MEDICAID.................................................................. 175 Overview.................................................................................................................................... 175 News Services and Press Releases.............................................................................................. 175 Newsletters on Medicaid............................................................................................................ 177 Newsletter Articles .................................................................................................................... 178 Academic Periodicals covering Medicaid................................................................................... 183 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 187 Overview.................................................................................................................................... 187 NIH Guidelines.......................................................................................................................... 187 NIH Databases........................................................................................................................... 189 Other Commercial Databases..................................................................................................... 210 APPENDIX B. PATIENT RESOURCES ............................................................................................... 211 Overview.................................................................................................................................... 211 Patient Guideline Sources.......................................................................................................... 211 Finding Associations.................................................................................................................. 233
viii Contents
APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 235 Overview.................................................................................................................................... 235 Preparation................................................................................................................................. 235 Finding a Local Medical Library................................................................................................ 235 Medical Libraries in the U.S. and Canada ................................................................................. 235 ONLINE GLOSSARIES................................................................................................................ 241 Online Dictionary Directories ................................................................................................... 241 MEDICAID DICTIONARY ......................................................................................................... 243 INDEX .............................................................................................................................................. 289
1
FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Medicaid is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Medicaid, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Medicaid, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Medicaid. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Medicaid, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Medicaid. The Editors
1
From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
3
CHAPTER 1. STUDIES ON MEDICAID Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Medicaid.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Medicaid, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “Medicaid” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Medicare, Medicaid, and Medigap Source: Diabetes Self-Management. 18(6): 61,63-64,66-67. November-December 2001. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: Evaluating health insurance needs and options is a tough job, whether one is enrolling private insurance or in a government sponsored plan such as Medicare or Medicaid. This article offers an overview of the major governmental health insurance programs, starting with some basic definitions. Medicare is a federal hospital-medical plan, designed primarily for the benefit of people over age 65 who are no longer participating in an employer or union group insurance program. Medicaid is a statemanaged program that provides medical care for people of any age who are of limited
4
Medicaid
financial means. Medigap is a package of private insurance policies, purchased at the option and expense of the Medicare participant, designed to cover any gaps in Medicare benefits. One sidebar offers contact information for government programs, including web sites and telephone numbers for Medicare, Medicaid, CHIP, PACE, Social Security, and Federally Qualified Health Centers (FQHC). The author concludes that the nation's entire medical care delivery system, both public and private, is a work in progress. New and innovative programs are being announced regularly as the United States heads toward comprehensive universal health care. •
Evaluation of Neuroleptic Drug Use by Nursing Home Elderly Under Proposed Medicare and Medicaid Regulations Source: JAMA. Journal of the American Medical Association. 265(4): 463-467. January 23, 1991. Summary: Federal regulations for use of neuroleptic drugs in Medicare- and Medicaidcertified nursing homes throughout the United States were implemented October 1, 1990. These regulations constitute the first time that prescription drugs are required, by law, to be justified by indications documented in the medical chart. The study described in this article used extant data to estimate ineligible neuroleptic use at the individual and nursing home levels had these regulations been in effect in 1976 through 1985. The subjects, randomly sampled admissions (5752) and residents (3191), were followed up for up to 24 months in 60 nursing homes. One half of neuroleptic use in each cohort could be considered ineligible under the regulations; all but one of the nursing homes had one or more individuals who were treated with the ineligible use of neuroleptics. Improvements in documentation and/or prescription of neuroleptic drugs for nursing home elderly will be needed to ensure compliance with these new regulations. 20 references. (AA-M).
•
Dental Visits to Hospital Emergency Departments by Adults Receiving Medicaid: Assessing Their Use Source: JADA. Journal of the American Dental Association. 133 (6): 715-724. June 2002. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org. Summary: For most Americans, relief from tooth pain is easily achieved with a visit to a dentist. However, people lacking access to private dental services may use hospital emergency departments (ED) for toothache care. In 1993, Maryland eliminated Medicaid reimbursement to dentists for adult emergency services. This article reports on a study in which the authors used this change in Medicaid policy to establish two study periods. A total of 3,639 people visited EDs for dental problems sometime during the four year study period. After controlling for age, race, and sex, the authors found that the rate of ED claims was 12 percent higher in the postchange period than in the prechange period. Comparisons between periods show significant rate increases during the postchange period for men, whites, African-Americans, and patients aged 21 through 33 years, and 45 through 64 years. The authors conclude that many EDs lack dental services and are not capable of providing definitive treatment. When definitive treatment is not provided, this pattern of care may be repeated if patients are forced to return for treatment. 6 tables. 28
•
Managed (Not To) Care: Medicaid and Children with Disabilities Source: Journal of Dentistry for Children. 66(1): 59-65. January-February 1999.
Studies
5
Contact: Available from American Society of Dentistry for Children. John Hancock Center, 875 Michigan Avenue, Suite 4040, Chicago, IL 60611-1901. (312) 943-1244. Summary: In this article, the authors consider the impact of managed care on children with disabilities and the current service provision through Medicaid. Most Medicaid managed care programs focus on the Aid to Families with Dependent Children (AFDC) program, and general welfare and low income populations. The authors comment on the increasing probable enrollment of millions of Medicaid recipients in managed care arrangements, and then evaluate the system for the delivery of health services and the potential impact on children, particularly on children with chronic and disabling conditions. The authors review the basic models of managed care systems, discuss the evolution of Medicaid and managed care, cost control programs, the costs of delivering health care services to children with chronic conditions, the impact of Medicaid managed care on this population, and managed care and dental practice. The authors outline the disadvantages and advantages of a managed care system on children with special health care needs. 34 references. •
Protecting Dental Services for People with Developmental Disabilities: The Impact of Medicaid Managed Care Source: New York State Dental Journal. 63(6): 12-14. June-July 1997. Contact: Available from Dental Society of the State of New York. 7 Elk Street, Albany, NY 12207. (518) 465-0044. Summary: People with developmental disabilities have traditionally turned to public health clinics, hospital clinics, or developmental centers for their dental care, rather than seeking out private dentists. This article considers the impact of Medicaid managed care for this population, focusing on strategies to protect dental services for people with developmental disabilities. Topics covered include the reasons why private dental practices are often reluctant to serve this population; the need for and use of sedation or anesthesia to deal with behavioral difficulties; the current New York state initiative to shift Medicaid beneficiaries to managed care plans (most people with significant developmental disabilities have their dental care covered by Medicaid); calculating reimbursement amounts and comparing them to standard rates paid to private practitioners; the lack of experience of Medicaid managed care providers in providing dental coverage; the experiences of other states converting their Medicaid services to managed care; quality assurance issues; and recommendations for New York state to take to meet the dental needs of people with developmental disabilities. The authors stress that there is no room for the private profit motive in the equation of Medicaid managed care and patients with developmental disabilities. The dollars available must be used to provide quality, appropriate care to patients by knowledgeable, competent professionals. 3 references.
•
Special edition: Public health strategies for Medicaid managed care Source: ASTHO Access Report. 4(1): 1-6. Summer 1995. Contact: Available from Association of State and Territorial Health Officials, 415 Second Street, N.E, Washington, DC 20002. Telephone: (202) 546-5400 / fax: (202) 544-9349. Summary: This article appears in a special issue of the newsletter and comprises the majority of the issue. The article presents information on ways that state initiatives tested in Medicaid 1115 waivers can be transferred to the operations of public health services. The article focuses on lessons learned regarding quality assurance, direct access
6
Medicaid
to care, and the provision of services to children with special health needs. Each topic is considered in detail, and the features of the state initiatives that can be incorporated into public health delivery systems are emphasized with regard to assessment, policy development, and quality assurance. [Funded by the Maternal and Child Health Bureau]. •
Sulfonylurea Pharmacotherapy Regimen Adherence in a Medicaid Population: Influence of Age, Gender, and Race Source: Diabetes Educator. 25(4): 531-532, 535, 537-538. July-August 1999. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article describes a study that determined the degree of patient adherence to second generation sulfonylurea pharmacotherapy among new cases of type 2 diabetes and examined the impact of patient age, gender, and race on adherence. The study used adjudicated patient level paid claims data from the computer archive of South Carolina's Medicaid program for the period January 1, 1990 through December 31, 1994. A total of 975 patients initiated sulfonylurea pharmacotherapy during the study period. The study found that regimen adherence, measured by the mean total number of days supply of sulfonylurea pharmacotherapy obtained over the 12-month study period, was extremely low among both whites and African Americans. Only 39.4 percent of the study population obtained a 6-month supply of the drug, and the percentage declined with each additional month thereafter. Findings also indicate that age, gender, and race were all statistically significant independent factors influencing sulfonylurea pharmacotherapy regimen adherence. Lower levels of adherence were associated with younger age, African American race, and male gender. Findings suggest that there will be a significant increase in the morbidity, mortality, and expenditures associated with the management of type 2 diabetes and question the usefulness of prescribing newer, more expensive pharmacotherapeutic options. 2 tables. 24 references.
•
Medicaid waiver programs: Lessons for the future or time-limited experiments? Source: State Initiatives in Health Care Reform. no. 6: 1-4. May/June 1994. Contact: Available from Alpha Center, 1350 Connecticut Avenue, N.W., Suite 1100, Washington, DC 20036. Telephone: (202) 296-1818 / fax: (202) 296-1825. Available at no charge. Summary: This article provides an overview of the streamlined Medicaid research and demonstration waiver process. Sections focus on expanded eligibility criteria, enrollment of clients in managed care plans, cost sharing with recipients, and lessons learned from existing programs. A table summarizes key characteristics of Medicaid waiver programs.
•
Surgical Management of Uncomplicated Otitis Media in a Pediatric Medicaid Population Source: Annals of Otology, Rhinology and Laryngology. 109(7): 623-627. July 2000. Contact: Available from Annals Publishing Company. 4507 Laclede Avenue, St. Louis, MO 63108. Summary: This article reports on a study that documented the frequency and timing of otitis media (middle ear infection) related visits to the physician, audiological
Studies
7
consultations, and surgical interventions following a new episode of otitis media. A retrospective descriptive study was performed on a Medicaid administrative database that follows individual patients over time. The study includes 14,453 children enrolled in Medicaid during 1991 and 1992 who were 30 months of age or younger and had a 'new' episode of otitis media. Among 14,321 patients with an uncomplicated episode of otitis media, there were 10,443 with additional otitis media visits. Audiological testing was performed in 1,134 children (10.9 percent). The testing occurred within 2 months of the onset of otitis media in 52.2 percent of the children and within 3 months in 66.6 percent of the children. Physicians referred 400 children (3.8 percent) to an otolaryngologist; 299 (75 percent) underwent 1 or more surgical procedures. These surgical interventions included placement of ventilating tubes in 296 children, adenoidectomy in 34 children (all of whom also had placement of ventilating tubes), mastoidectomy in 2 children, and tympanoplasty in 1 child. The proportion of children who underwent surgical placement of ventilating tubes who had prior audiological testing was 174 of 296 (58.8 percent). The overall surgical rate for ventilating tubes was 2.9 percent. Among children who underwent surgery, the procedure occurred within 2 months of the onset of otitis media in 21.4 percent of children. The authors conclude that attempts to rationalize the management of otitis media in early childhood must deal with the difficulties in distinguishing among the otitis media conditions. The findings of this study suggest a need to know whether insertions of ventilating tubes within 3 months after a new episode of otitis media are related to unresponsive or recurrent infections. The authors note that it would also be valuable to explore further the reasons for ethnic differences in referral rates for both audiological testing and ventilating tube surgery. 1 figure. 3 tables. 12 references. •
Medicare, Medicaid, and Diabetes Source: Diabetes Forecast. 53(9): 53-54. September 2000. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article, from a magazine for people with diabetes, describes the government sponsored health problems known as Medicare and Medicaid. The article explains the differences between the qualifications for these programs and the medical coverage they provide. The traditional Medicare program consists of Part A and Part B. Everyone who signs up for Medicare receives Part A insurance. This covers the cost of treatment while in the hospital, skilled nursing care outside the hospital, and hospice care under certain conditions. Medicare Part B is optional insurance that covers many more services but involves paying a premium. Many expenses are not covered by either Part A or Part B, so Medigap policies may be bought to cover these expenses. Aspects of Medicare that are of special interest to people who have diabetes include coverage for some therapeutic shoes, kidney treatments, diabetes education, and diabetes supplies. Medicaid qualifications and coverage vary from state to state, so people need to contact their state office to obtain specific information about their state's program.
•
Public health departments adapt to Medicaid managed care Source: Washington, DC: Center for Studying Health System Change. 1998. 4 pp. Contact: Available from Center for Studying Health System Change, 600 Maryland Avenue, S.W., Suite 550, Washington, DC 20024-2512. Telephone: (202) 484-5261 / fax: (202) 484-9258 / e-mail:
[email protected] / Web site: http://www.hschange.com.
8
Medicaid
Summary: This issue brief is based on a 1997 study of 12 public health departments. The discussion addresses how public health departments are adapting to the shift of Medicaid beneficiaries into private managed care. The report's conclusions reflect initial market assessments in a two-year study that tracks a sampling of health departments over time. •
Physicians and Their Elderly Patients' Legal Rights, Part I: Medicare, Medicaid, Elder Abuse Source: Geriatrics. 44(9): 57-58, 61-63, 66. September 1989. Summary: This journal article, presented in the form of a panel discussion between two physicians and three attorneys, describes the ways in which physicians can get involved with their elderly patients' legal affairs. Topics include Medicaid eligibility, financial planning, Medicare and Medicaid benefits, nursing home admission, and elder abuse. 1 reference.
•
Discrimination Against HIV - Infected Employee Can Result in Termination of Hospital's Medicare and Medicaid Funding Source: Health Care Law Newsletter; Vol. 8, No. 3, March 1993. Contact: Mathew Bender, Inc., 11 Penn Plaza, New York City, NY, 10001, (800) 833-9844. Summary: This newsletter article describes the legal consequences of discrimination against an HIV-infected employee. In the Westchester County Medical Center case, an employer faces the potential loss of Medicaid and Medicare funding due to discrimination against a potential employee, a pharmacist. The Americans with Disabilities Act and the Rehabilitation Act of 1973 require proof that a direct threat of communicating infections to others exists. Other arguments the employer raises include a concern for the health of the pharmacist as well as State laws prohibiting employment of actively-infected individuals. The employer ultimately loses all appeals and must hire the HIV- infected pharmacist without restrictions to avoid loss of Federal funding.
Federally Funded Research on Medicaid The U.S. Government supports a variety of research studies relating to Medicaid. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Medicaid. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use
2
Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
Studies
9
animals or simulated models to explore Medicaid. The following is typical of the type of information found when searching the CRISP database for Medicaid: •
Project Title: ACCESS PRACTITIONERS
&
TRAINING
FOR
RURAL
AND
INNER
CITY
Principal Investigator & Institution: Munro, Jane L.; Western New York Rural Area Hlth Ed Ctr 4156 W Main St Batavia, Ny 14020 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): The Western NY Rural Area Health Education Center (R-AHEC) will collaborate with University of Rochester's Edward G. Miner Library and Rochester General Hospital's Werner Health Services Library to facilitate access to medical information for rural and inner-city practitioners at 13 clinics in a 6county region. The goal is to ensure that health care professionals have access to and know how to use NLM databases and digital libraries, so that they can provide quality care for patients. Specific aims include: 1) provide equipment, installation, and Internet access, if needed; 2) provide a Loansome Doc account for each clinic with free delivery from Miner or Werner; 3) provide hands-on training and follow-up support for health care professionals and administrative staff onsite at each clinic in the use of PubMed, Loansome Doc, and MedlinePlus, as well as additional training in using local digital libraries; 4) encourage communication about the practical use of medical information between the clinics' preceptors and medical students, using an Educational Prescription assignment; 5) conduct a pilot project at 2 sites by providing Personal Digital Assistants (PDAs), PDA software, and instruction in their use to physician preceptors who complete the digital library training session. Health providers in rural and underserved areas can become isolated from colleagues and current medical information. Accessing information online is ideal for their situation. The 13 clinics participating in this project are either in Health Professional Shortage Areas (5 clinics), or serve Medicaid clients or other underinsured or uninsured patients; 11 clinics are in rural areas, and 2 in the inner city. Although these clinics have computers for administrative uses, very few providers have computer access for finding medical information. Although 7 clinics are members of Rochester General Hospital's Circuit Librarian program, and physicians at 7 clinics precept University of Rochester medical students, most providers surveyed were not aware of the available information options. The participating clinics all are committed to dedicating the necessary time for providers to learn how to use these resources. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ACCESS TO BEHAVIORAL HEALTH SERVICES FOR WOMEN ON TANF Principal Investigator & Institution: Southerland, Dannia G.; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 04-JAN-2002; Project End 31-DEC-2003 Summary: Key features of welfare reform from an income maintenance entitlement (AFDC) to temporary cash assistance in exchange for work (TANF) are strict work requirements, sanctions, and time limits on eligibility. The expected outcome of this reform is self-sufficiency through employment. Underlying welfare reform is the assumption that TANF recipients are as able to work as women in the general population. There is increasing recognition that a subset of the TANF population face barriers to work and self-sufficiency based on significant disability due to -serious mental illness (SMI). Access to behavioral health services by this at-risk population may
10
Medicaid
be in jeopardy as a consequence of changes to welfare entitlements and declines in Medicaid enrollment. Employment for these women can be facilitated by access to effective behavioral health services. This pilot study examines these research concerns by identifying patterns of service use of the AFDC/TANF population with SMI and determining whether female heads of households with SMI who had received behavioral health services before leaving welfare continue to receive services after leaving TANF. Findings from this pilot study will be used to determine the feasibility of conducting a full-scale longitudinal study of the impact of welfare reform outcomes on heads-of-households currently or formerly receiving welfare that have SMI. The specific aims of the pilot are to: Identify patterns of service use of the target population of current and former female heads-of households with SMI receiving AFDC/TANF who used Medicaid reimbursed behavioral health services in Philadelphia, PA, between 1997 and 2000. Determine whether leaving welfare reduces access to treatment for women with SMI who used Medicaid behavioral health services while on AFDC/TANF. Develop a research design for a longitudinal study of the impact of welfare reform outcomes on current and former heads-of-households receiving welfare that have SMI, to submit as an R01 or a career development award proposal. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ADHERENCE INTERVENTION FOR MINORITY CHILDREN WITH ASTHMA Principal Investigator & Institution: Rand, Cynthia S.; Associate Professor of Medicine; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: Low-income, minority children have disproportionately high rates of emergency department (ED) care for asthma compared to other children. Lack of access to asthma primary care and under-treatment of asthma have been implicated as contributing factors to this excess morbidity. Preliminary research by this group suggests that poor adherence with prescribed asthma therapies may also play a significant role. In a pilot study of low-income, minority children with symptomatic asthma we observed average daily adherence with anti-inflammatory therapy ranging from 1 percent to 32 percent of prescribed use. We hypothesize that improved adherence with asthma therapy can significantly reduce emergency room use for asthma care among high-risk children. To test this hypothesis, we will evaluate the effectiveness of an intensive adherence intervention that utilizes electronic medication monitors and medication measurement for monitoring and feedback, compared to a home-based asthma education intervention, and a usual care control group. The Johns Hopkins Pediatric Emergency Department (JHPED) will serve as our recruitment site. Families of asthmatic children ages 2-12 (N=270) with two or more emergency room visits or a hospitalization for asthma care in the past 12 months will be enrolled. Baseline measures will be collected after obtaining consent and prior to randomization. Participants will be randomly assigned to: 1) an Asthma Basic Care Intervention, or 2) an Adherence Monitoring and Feedback Intervention, or 3) a Usual Care Control Group. The duration of each intervention will be three months, with two booster visits at 6 months. Followup measures will be collected from families at 6, 12, and 18 months. The primary outcome measure will be medical record documented emergency care for asthma at the JHPED or other emergency or urgent care facilities over the eighteen-month follow-up period. Secondary outcomes include adherence with asthma therapy based on Medicaid pharmacy claims for asthma medications, other asthma health care (urgent and primary), self-reported medication adherence, barriers to health care, school absences,
Studies
11
restricted activity, nighttime symptoms, asthma medications, self and family asthma management, asthma management self-efficacy, functional status, and quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BBA EFFECTS ON GEOGRAPHIC VARIATION IN POST-ACUTE CARE Principal Investigator & Institution: Lin, Wen-Chieh; Family and Community Medicine; University of Missouri Columbia 310 Jesse Hall Columbia, Mo 65211 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (Provided by Applicant): In response to the rapid growth in payments for post-acute care (PAC) services, Congress enacted Medicare reforms as part of the Balanced Budget Act of 1997 (BBA) for each PAC service. The reforms mandated a series of separate case-mix adjusted prospective payment systems, each with its own implementation timeline. In addition to the overall effects, the BBA's effects on PAC use varied substantially across geographic areas. For example, in the case of skilled nursing facility use from 1998 to 2000, the average change relative to 1996 for stroke patients was 2.7%.at the national level, but it ranged from -12% to 24% across regions (the nine United States Census Bureau divisions). This varied response raises concerns that the hospital discharge process may be driven by payment policy rather than by clinical needs and individual preferences. Furthermore, varied changes in PAC use across regions might lead to untoward consequences, such as early hospital readmission. As efforts continue to reform PAC services and payment systems, it is essential that policymakers understand how different payment mechanisms associate with geographic variation in PAC use. The proposed study seeks to: 1) analyze geographic variation in PAC use before and after the BBA changes; 2) explore whether utilization and cost have shifted among PAC settings and whether early hospital readmission has increased; and 3) investigate how the contributions of patient, hospital, and market area characteristics in explaining PAC use differ between pre- and post-BBA periods. We will analyze the Center for Medicare & Medicaid Services' 5% sample of Medicare claims data from 1996 to 2000 to study the initial effect of the BBA changes on geographic variation in PAC use. We will focus on six diseases associated with high PAC use: stroke, hip procedure, hip fracture, chronic obstructive pulmonary disease, pneumonia, and congestive heart failure. The selected diseases provide a contrast between rehabilitative and medical conditions. The stability, the degree, and the association of geographic variation in PAC use before and after the BBA changes will be examined. Shifts in utilization and costs will be presented as correlations between changes in PAC use, hospital length of stay, and early hospital readmission. Finally, we will estimate multinomial logit models to explore changes in contribution to explain PAC use by patient, hospital, and market area characteristics after the BBA changes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: BLACK HEALTH/FUNCTION
RURAL
AND
URBAN
CAREGIVERS--MENTAL
Principal Investigator & Institution: Chadiha, Letha A.; Associate Professor & Hartford Geriatric; None; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2002 Summary: African-American women caregivers are vulnerable to poor mental health and social functioning due to their minority status and the high levels of care they provide to disabled elders. Moreover, African-American women provide such care in
12
Medicaid
the context of less formal service. Research and theory suggest that rural and urban African-American women caregivers differ in their mental health, social functioning, and service use; however, virtually no systematic research has addressed these issues. This study will assess the mental health and social functioning of rural and urban African-American women who provide unpaid care to an elder (65 years and older) and will identify factors related to their service use. Using a cross-sectional research design and random sample of elders, this study will yield data on 300 rural and 300 urban African-American women caregivers living in the St. Louis metropolitan and southeastern Missouri Bootheel area. Three years of funding are requested to address four specific aims: (1) To assess and compare caregivers' mental health and functioning; (2) To identify type and quality of caregivers' formal and informal service use; (3) To determine caregiver and care recipient factors associated with caregivers' mental health and social functioning; and (4) To determine caregiver and care recipient factors associated with caregivers' service use. Data will be obtained through personal interviews. Trained African-American female interviewers will screen elders by telephone for caregiver referrals and conduct face-to-face interviews through a structured questionnaire in their home. Data analysis and interpretation will be guided by a stress and coping framework with elements of a life course perspective model. Study results will guide development of policy, programs and services promoting African-American women caregivers' mental health, social functioning, and service use. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CAN ADMINISTRATIVE DATA MATCH CLINICAL TRIAL RESULTS? Principal Investigator & Institution: Hebert, Paul C.; Health Policy; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2005 Summary: (provided by applicant): The Heart Outcome Prevention Evaluation (HOPE) trial demonstrated the efficacy of the angiotensin converting enzyme (ACE) inhibitor ramipril in slowing the progression of cardiovascular disease for persons with diabetes and reducing the incidence of diabetes in persons with other cardiovascular risk factors. Despite compelling findings from this randomized controlled trial, some questions remain, including the efficacy of medications with similar pharmacodynamic properties to ramipril that were not included in the HOPE study, and the efficacy of these drugs in patients who have been under-represented in clinical trials. The purpose of this study is to test the feasibility of using Medicare and Medicaid administrative data in conjunction with results from the HOPE trial to address these questions. We propose to: 1. Use causal statistical models to estimate the impact of the ACE-inhibitor ramipril on cardiovascular disease in persons with hypertension and diabetes or other coronary risk factors using Medicaid and Medicare administrative databases. 2. Compare the results of this model with the results for clinically similar patients who participated in the HOPE trial. If the results compare favorably, we will 3. Use the same statistical techniques to analyze the effectiveness of medications with similar pharmacodynamic properties to ramipril, such as other ACE-inhibitors and Angiotensin Receptor Blockers (ARBs), and to 4. Analyze the effectiveness of ramipril and other ACE-inhibitors and ARBs in African-American patients who were under-represented in the HOPE and other trials. The proposed study will make two important contributions. First, we will provide evidence on pharmacological therapy for persons with diabetes that can shape clinical care for a highly prevalent and burdensome disease. Second, we will develop and test a methodological framework that can be duplicated in numerous situations and may
Studies
13
significantly enhance the utility of administrative and other secondary data sources for health outcomes research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CANCER CARE AND OUTCOMES FOR DISABLED MEDICARE PATIENTS Principal Investigator & Institution: Iezzoni, Lisa L.; Associate Professor; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2003; Project Start 02-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Information from the Surveillance, Epidemiology, and End Results (SEER) Program merged with Medicare claims offers important insights into patterns of health care services, costs, and outcomes for Medicare beneficiaries with cancer. These findings have virtually exclusively pertained to Medicare recipient age 65 and older. However, Medicare covers more than 5 million disabled persons under age 65, with annual total costs exceeding $20 billion, and millions more, now over age 65, initially received Medicare because of disability. Despite these large numbers and high costs, disabled Medicare beneficiaries who develop cancer have received little attention. The primary purpose of the proposed project is to describe cancer diagnoses, initial treatments, palliative care, longevity, and costs to Medicare among older and younger Medicare beneficiaries with disabilities. Secondary goals are to compare cancer diagnoses, interventions, and clinical and cost outcomes between persons with and without disabilities. The project will examine four high-frequency diseases (lung, breast, colorectal, and prostate cancers), and it will use merged SEER-Medicare data from cases diagnosed from 1986 through 1999. Using diagnosis, stage, and treatment information from SEER and diagnosis and procedure codes and payment information from Medicare claims, this study will address questions across the continuum of care, from diagnosis to end of life. Questions include: whether persons with disabilities are diagnosed at later stages than non-disabled persons; whether initial treatments differ; whether all-cause and cancer-specific mortality rates differ; whether use of home care and hospice services differ; whether insurance type matters (fee-for-service versus managed care); and additional costs to Medicare when disabled beneficiaries develop cancer. This study will provide the first comprehensive information on cancer detection, care, costs, and outcomes among disabled Medicare beneficiaries. These findings may suggest areas where more attention is needed, such as increasing cancer screening among disabled Medicare recipients or rethinking initial treatment strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: CHICAGO INNER CITY ASTHMA STUDY Principal Investigator & Institution: Evans, Richard; Children's Memorial Hospital (Chicago) Chicago, Il 606143394 Timing: Fiscal Year 2001; Project Start 01-AUG-1996; Project End 31-JUL-2004 Summary: Data from NCICAS indicate that a multiplicity of risk factors interact to increase the severity of asthma in poor, urban minority children. Any intervention to reduce morbidity in this Medicaid-dependent population should not only be multifaceted but also reasonably priced. Therefore, the Chicago Inner-City Asthma Study (CICAS) proposes to identify a cost- effective intervention that will reduce asthma morbidity in 4- to 12-year- old minority/low-income urban children with severe/moderately severe asthma. Primary outcome measures are reduction in mean
14
Medicaid
symptom days and cost-effectiveness. Secondary measures include other morbidity measures (reductions in hospitalization, unscheduled acute-care visits including to ER, and school absences); improved patient/caretaker knowledge of asthma management, medications, and use of delivery devices/peak flow meters; increased primary-care physicians' practice effectiveness and asthma-care knowledge (including written asthma management plans); improved communication between physician and patient/caretaker leading to greater adherence; decrease in indoor allergens; and a reduction in behavior problems. The CICAS will evaluate three HMO-based interventions and compare them to a control group (Group I) in which patients receive usual care. The intervention groups are designed on an add-on principle. Each succeeding group receives all the interventions of the previous group(s) plus one additional intervention. Eight physician-provider clinic sites affiliated with United Health Care of Illinois (an HMO that serves a large proportion of Chicago's Medicaid population) will be randomized to one of the four groups. Children/families from these sites will be screened and recruited for the study. Patients will receive skin testing and spirometry, and they/caretakers will complete various written assessments of asthma risk and asthma knowledge. Groups II-IV will receive patient education taught by a clinic-based asthma mentor, including the proper use of medications and devices. Primary-care physicians in these groups will participate in a case-based physician education program that will also stress use of asthma-care guidelines and written management plans. An inspector will visit homes of patients in Groups III and IV to assess environmental risk factors. Targeted interventions will be provided for patients who are dust-mite (e.g., pillow, mattress covers) or cockroach (extermination) sensitive. Selected patients in Group IV (those with behavioral or other intractable problems) will receive intensive case management. Throughout the interventions, patients will be monitored bimonthly by telephone. The asthma mentor will also play a key role in problem-solving in each clinic. A successful cost-effective intervention that reduces morbidity among inner-city minority children would be a significant health benefit, and it would provide economic relief to the overburdened urban healthcare system. The CICAS believes that its study design permits the determination of the most effective intervention that is also cost-effective. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: COLORECTAL CANCER CARE VARIATION IN VULNERABLE ELDERLY Principal Investigator & Institution: Baldwin, Laura-Mae; Associate Professor; Family Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 04-JUN-2001; Project End 31-JAN-2004 Summary: Specific Aims: This study's long-term goal is to improve colorectal cancer care for the elderly who have a high incidence of this highly treatable and potentially curable disease. In 1990, a National Institutes of Health Consensus Panel recommended adjuvant therapies for colorectal cancer patients with stage III colon and stage II and III rectal cancer. The degree to which the elderly, especially traditionally vulnerable groups, are receiving these recommended treatments is unclear. This study will (1) compare the receipt of recommended colorectal cancer treatments between AfricanAmerican and Hispanic versus white elderly, and rural versus urban elderly; (2) compare diffusion of these treatments from 1992-1996 between our study groups; (3) identify the physician, patient, hospital, and environmental factors that predict differences found in treatment or diffusion; (4) measure treatment cost differences between our study groups, and the cost implications to the Medicare program of
Studies
15
providing recommended treatments to all beneficiaries with colorectal cancer; and (5) evaluate several methodologies for cancer research using administrative databases, including different measures of comorbidity and costs. Research Design and Methods: This study will use the linked SEER-Medicare claims database in a retrospective cohort design to examine differences in receipt, diffusion, and cost of recommended colorectal cancer treatments between more and less vulnerable elderly populations. Using stage III colon and stage II and III rectal cancer cases identified in SEER between 1992 and 1996, we will identify different patterns of treatment and alternative measures of the costs for colorectal cancer care with Medicare claims data. Annual study cohorts will be tracked in a comprehensive database using 1991-1998 linked SEER-Medicare, AMA Masterfile, AHA, and Area Resource File data. Physician, hospital, and patient characteristics (including cancer stage and comorbidity) will be linked to the location, size, and socioeconomic profile of places of residence, travel distances to different treatment sites and cancer specialists, service utilization, and allowed charges. In the second phase of the study, we will use multivariate analysis to identify the degree to which physician, patient, hospital and environmental factors predict systematic differences in treatment patterns between our study populations. The cost analysis will include an estimate of the resources required to bring all patients up to the recommended standard of care. Alternate methods of defining comorbidity and costs will be used to evaluate their utility in cancer research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PHYSICIANS
COLORECTAL
SCREENING
DECISIONS:
PATIENTS
AND
Principal Investigator & Institution: Wackerbarth, Sarah B.; Martin School of Public Policy and Administration; University of Kentucky 109 Kinkead Hall Lexington, Ky 40506 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): The purpose of this research is to explore colorectal cancer screening utilization and delivery patterns as well as the underlying decision processes driving these patterns. Decisions surrounding colorectal cancer screening are complex and involve many perspectives. Physicians face multiple screening strategies without a clear consensus as they seek to balance clinical accuracy with factors that influence patient compliance in situations further complicated by differing health plan coverage levels. Patients face barriers to seeking cancer screening that are both pragmatic and personal in nature. The simultaneous understanding of physician and patient decision processes is essential to improve the quality of care. The proposed research focuses on health services utilization and delivery in a cross-sectional sample of residents of the state of Kentucky. Further, focused analyses of high-risk and underserved populations - Medicaid members and residents of Appalachia - as they are less likely to obtain colorectal cancer screening and experience consequences which are significantly more dire than the general population, both in terms of morbidity and mortality, is proposed. The Specific Aims are threefold: (1) to investigate the impact of colorectal cancer screening decisions on a high-risk population; (2) to develop models of patient and physician decision processes; and (3) to determine the predictive validity of the patient decision model through a survey of a high-risk population. To address these aims, a mixed-method design incorporating secondary data analysis, interviews techniques and surveys is proposed. Key research questions guiding this research include: What is the trend of colorectal screening utilization and delivery over time? How frequently does Medicaid enrollment coincide with colorectal cancer diagnosis?
16
Medicaid
How is screening strategy related to health outcome? What factors predict health outcome? What risks, barriers, and benefits do patients and physicians consider while making colorectal cancer screening decisions? How do demographic, psychosocial, colorectal cancer-specific knowledge and health care system factors influence the outcome of patients' decision processes? This research will identify, opportunities for behavioral interventions designed to improve patient and physician decisionmaking regarding colorectal cancer screening. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CONSUMER ASSESSMENTS OF HEALTH PLANS STUDY (CAHPS) II Principal Investigator & Institution: Garfinkel, Steven; Managing Research Scientist; American Institutes for Research 3333 K St Nw Washington, Dc 20007 Timing: Fiscal Year 2002; Project Start 24-JUN-2002; Project End 31-MAY-2007 Summary: This project will (1) advance empirical knowledge of health care quality measurement and reporting through a carefully planned, long-term program of research, (2) study alternatives for integrating CAHPS data with other quality indicators, (3) bring new theoretical grounding to CAHPS, and (4) move CAHPS research into practice more effectively by developing methods for new sponsors and audiences. The research design includes a series of integrated projects in the areas of instrumentation and survey procedures, reporting quality information, using CAHPS measures for quality improvement, and evaluating CAHPS implementation and effects. The specific projects include: (a) Maintenance of the CAHPS Survey and Reporting Kit, (b) Updates of the CAHPS analytic strategy, with particular attention to developing the theoretical basis and practical applications for the assessment of entities with small populations, (c) Continued development of the instrument and survey procedures for G-CAHPS, NH-CAHPS, and PWMI-CAHPS, (d) Development of IP-CAHPS, PPO Questions, translations, and Web data collection procedures for CAHPS, (e) Laboratory studies of CAHPS evaluability, narratives, and framing, especially among persons with low educational attainment and literacy, (f) Electronic reporting, especially for parents of children with special health care needs and persons with low computer literacy, (g) Report templates development and a Final Report on the results of the 5-year reporting research program, (h) Use of G-CAHPS for Q1 with group practices in Oklahoma that primarily serve the Native American population and practices that serve the general Medicaid population, (i) Use of NH-CAHPS for QI in Tennessee, and (j) Evaluation of a social marketing intervention to promote effective CAHPS dissemination and use in Oklahoma, using G-CAHPS, CSHCN CAHPS, and the electronic report template. These projects will improve the measurement and reporting of CAHPS information, focus CAHPS on the units of analysis and aspects of care most salient to the public, and develop the new methods and understanding about quality needed to broaden the acceptance and use of CAHPS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: CONSUMER DRIVEN MODEL FOR IMPROVING HEALTH CARE QUALITY Principal Investigator & Institution: Hopkins, David S.; Pacific Business Group on Health 221 Main St, Ste 1500 San Francisco, Ca 94105 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JAN-2007
Studies
17
Summary: This proposal describes the California Physician Performance Measurement and Reporting (CPPMR) project, which will be conducted by the Pacific Business Group on Health (PBGH) in partnership with major employers, health plans, and consumer groups. The primary goal of the CPPMR project is to improve health care quality by stimulating market demand for high-quality physicians through the publication of individual physician quality and efficiency performance information. PBGH anticipates that market forces will direct health care purchasers and consumers to high quality physicians after reliable information is made available to inform their decisions. We also anticipate that physicians who do not perform well will be motivated to improve. In short, we feel that good information about physician performance plus market dynamics will lead to substantial improvements in health care quality. The CPPMR will use the AHRQ-supported RAND Health Quality of Care series, in combination with methodological advancements in physician-level performance measurement, to develop reliable and useful measures. We will use these measures and CMS claims data to develop indicators of physician quality and efficiency. The CPPMR measurement system will be based on improved methodologies such as modified episode of care methods and improved severity-of-illness adjustments. We anticipate that performance results will be generated for over 30,000 physicians in California. The CPPMR has the potential to directly improve health care for tens of millions of people. CPPMR results will be published through HealthScope.org, PBGH's consumer information website. The general public, will have access to quality and efficiency information about tens of thousands of California physicians. We anticipate that several large health plans including Blue Cross of California, Blue Shield of California and United Health Plan will make the information available to their members. The impact of the CPPMR will be expanded through the involvement of major consumer organizations such as AARP. While initially based on California data, the project can be considered a pilot that represents 10% of all Medicare claims data nationally. There are immediate and direct applications as a national model for CMS. National health plans and employers are involved as partners, so they will specifically consider how the quality and efficiency metrics and applications tested in California could be applied in other states. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CORE--POLICY Principal Investigator & Institution: Leibowitz, Arleen; Senior Economist; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 15-APR-2002; Project End 31-DEC-2006 Summary: (provided by applicant): The Policy Core aims to promote research that informs HIV/AIDS policy making with relevant dat and will develop and disseminate unbiased information about how public and private policies affect services received and outcomes for persons with HIV. In the past, HIV/AIDS policies have not been grounded in scientific evidence. Thus, this Core will elucidate links between public policies and health outcomes and disseminate its findings to policy makers. For example, the differential impact of public policies (such as Medicaid) and of private policies (such as managed care) on different communalities (defined by ethnicity or gender or sexual orientation) may be a focus of this Core. We will assist our community partners in responding to policy makers' evolving needs for information about the effectiveness of their programs in terms of behavior, health outcomes, and costs. A multi-disciplinary group of economists, policy analysts, psychologists, and methodologists will work with out community partners to address emerging policy issues to assist researchers in securing funding examining the effects of existing policies on person's living with
18
Medicaid
HIV/AIDS, and to analyze proposed HIV/AIDS policies. The addition of a Policy Core to our Center is a natural outgrowth of our ongoing activities promoting research to inform policy making, assisting collaborators and government entities in implementing evidence-based planning relevant to HIV identification, prevention and treatment services. The proposed policy-related activities are generally not funded by traditional research funding sources and, therefore, this core must emphasize developing new information. Because site specific interventions or revaluations collecting primary data generally do not allow for examination of different policy environments, this Core will apply new econometric methodology to secondary data to isolate the effects of public policies relevant to HIV. This Core will also promote policy-related research by tracking and disseminating HIV relevant legislative developments to investigators and by training researchers and community collaborators in methods for collecting and analyzing data that address specific public policy concerns. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CORE--TREATMENT SERVICES Principal Investigator & Institution: Bing, Eric; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 15-APR-2002; Project End 31-DEC-2006 Summary: (provided by applicant): The goal of the Treatment Services Core is to promote and support HIV-related health and mental health services research that will enhance our understanding of the complex health delivery systems used by persons at risk for or infected with HIV. In addition, it will support innovative research to make these systems more effective at providing accessible, high quality, and cost- efficient prevention and care. Disparities exist in the access and quality of HIV care provided to African-American and Latino individuals with low income compared to persons of other ethnic groups. The disparities in HIV services reflect long-term inequities to the access and utilization of health and mental health care, which has lead to significant community mistrust, particularly towards researchers. Therefore, it is essential to CHIPTS that all research be conducted within collaborative, long-term relationships with representatives of the affected communities. This is operationalized by the Center through a Participatory Action Research (PAR) model, These disparities arise from many sources, but often our research has focused on deficits in the individual's HIVrelated knowledge, attitudes, or beliefs rather than focusing on structur4al factors or the organization of care (e.g., providers' attitudes and behaviors, funding streams, density of available services in a geographic region). Far more research needs to be focused on the system-of-care for HIV and the settings and providers delivering both prevention and treatment services. This is particularly important in order to assess the access, utilization, and quality of HIV care for persons with comorbid disorders and for immigrants. For consumers with multiple needs, it will be necessary to develop coordinated, comprehensive, and continuous models of integrated HIV services. The Treatment Services Core aims to increase our understanding of, and interventions for, providers within health and mental health settings, particularly for subpopulations with comorbid disorders. Finally, while our understanding of current HIV systems-of-care is limited, the system is undergoing dramatic change. Since the identification of the first case of AIDS, there has been a revolution in the health care industry with about onethird of care in California being managed. Medicaid services for HIV infected adults is carved out in LA and provided in specialty HIV-settings or private settings. More recently, the Internet has begun to change and will change in the future a number of aspects of health care delivery, from routine tasks such as keeping patient records to the
Studies
19
interaction of doctors and patients through e-mail. The delivery of HIV care in rural and international settings may potentially be improved through the utilization of electronic and web technologies. It is critical to anticipate how the web and such adaptations as telemedicine will impact the delivery of prevention and treatment services. The Treatment Services ore will begin to identify these issues and set a research agenda to be implemented over the how CHIPTS within health and mental health care delivery settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: COST EFFICIENT TREATMENT OF GERIATRIC DEPRESSION Principal Investigator & Institution: Mcdonald, William M.; Associate Professor; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 10-APR-1998; Project End 31-JAN-2003 Summary: (Applicant's abstract): The annual cost of depression in the United States has been estimated to be greater than 40 billion dollars, and includes the direct costs of treatment and indirect costs related to lost productivity. The elderly are particularly prone to increased disability from depression. Prospective studies demonstrate that up to two-thirds of elderly depressed patients have a poor outcome in one year, and over one-fourth are re-hospitalized in the year following the acute depressive episode. Yet the current public policy debates have focused on the cost of entitlement programs such as Medicare and have ignored the complex relationship between the cost of the initial treatment, efficacy and long term benefit in reducing overall healthcare costs. The primary aim of the present proposal is to develop practical guidelines for the acute and prophylactic therapy of treatment resistant geriatric major depression. In this proposal, severely depressed elderly patients will be evaluated, treated with either medication or electroconvulsive therapy (ECT) and followed for 18 months. The data generated will be used to develop statistical models of the most clinically effective and cost-efficient acute, continuation and maintenance treatments for severe geriatric depression,. 360 patients meeting DSM-IV criteria for Major Depression, severe (approximately half with psychotic features) and the American Psychiatric Association guidelines for ECT will be randomized to either an acute trial of ECT or a 6 week prospective medication trial. Medicare costs, neuropsychological, sociodemographic and clinical data will be analyzed to determine both the costs of an additional medication trial, and the patient characteristics which are associated with a response to medication/ECT. Patients who fail the prospective medication trial will be administered an acute course of ECT. The second and third phases of the study will evaluate alternative prophylactic therapies after an acute response to ECT. Patient who are severely depressed and respond to ECT. Patients who are severely depressed and respond to an acute course of ECT have extremely high healthcare costs and attendant morbidity and mortality. The risk of relapse in 6 months in these patients is unacceptably high (50-70%) using the conventional strategy of placing the patient on continuation antidepressant medication. The 180 patients who respond to an acute course of ECT or fail the prospective medication trial and then respond to an acute course of ECT and will be randomized to either 6 months of continuation strategies. In the third phase, 160 patients will be followed for an additional year in order to examine the long term benefits of alternative continuation strategies (i.e., ECT vs. medication) on measures of mood stability, neuropsychological function and total healthcare costs. The data from these studies will be used to develop a clinical checklist which can be used in general psychiatric practice to assist clinicians in making clinically effective and cost-efficient treatment decisions.
20
Medicaid
Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CV RISK FACTORS AT AGE 25-64 & LONG-TERM MEDICARE COSTS Principal Investigator & Institution: Daviglus, Martha L.; Professor; Preventive Medicine; Northwestern University Office of Sponsored Programs Chicago, Il 60611 Timing: Fiscal Year 2001; Project Start 20-SEP-2000; Project End 31-JUL-2004 Summary: (Adapted from the Investigator's Abstract) Background: Much recent effort has been directed toward controlling health care costs, but there has been little emphasis or research on prevention as a means of cost containment. This is due largely to lack of data relating to economic impact of prevention. Initial research: New data on two large Chicago cohorts followed for 22 years show that men and women with favorable baseline levels of all major CVD risk factors in middle age are at much lower agespecific risk of death from CVD, non-CVD, and all causes, and have much lower average annual Medicare costs (1984-1994), total and for CVD care, after becoming eligible at age 65 for Medicare. Aims: General - Assess in four large Chicago population cohorts whether young adult and middle-aged risk factor status has an impact not only on average annual Medicare costs, but also on cumulative and lifetime Medicare costs, to ages 70, 75, 80, >80, including to death, and during last one to two years of life. Specific Aims: 1) Assess relationships of CVD risk factors measured in young and middle-aged adult men and women to Medicare utilization and charges, from Medicare enrollment to death or attainment of age 70, 75, 80, >80, including in last one to two years of life. 2) Determine long-term relationship between earlier low-risk status vs. notlow-risk to subsequent Medicare health care charges. Baseline low risk is all six CVD risk factors favorable: systolic/diastolic pressure 120 mmHg/80 mmHg and no antihypertensive treatment, serum cholesterol <200 mg/dl, not currently smoking, no ECG abnormalities, no history of diabetes or heart attack. 3) Determine relationships between baseline habitual eating patterns and subsequent Medicare utilization and charges. 4) Further develop statistical methods for optimal analyses of health care expenditures. To accomplish these aims, the investigators propose to substantially extend their existing database by obtaining additional years of morbidity-mortality experience and of Medicare charge data to the year 2002. Significance: The investigators state that this research is unique and pioneering, with strong implications as to potential for both increasing longevity with health and saving money by shifting population risk factor status downward, to increase the percentage of low risk individuals from current low levels (<10 percent). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: DENTAL AND ORTHODONTIC ACCESS IN CRANIOFACIAL CARE Principal Investigator & Institution: Cunningham, Michael L.; Director; Children's Hospital and Reg Medical Ctr Box 5371, 4800 Sand Point Way Ne, Ms 6D-1 Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): The ability of children with special health care needs to access dental care is an understudied area. Access to dental and orthodontic care for children with craniofacial disorders is of particular importance since these children require dental and orthodontic care as a direct result of their medical condition and as an essential part of their reconstructive treatment. The overall objectives of this study are to develop tools to characterize barriers to accessing dental and orthodontic care for
Studies
21
patients with craniofacial disorders and to identify potential strategies by which access to care may be improved. With that in mind, four specific aims are proposed. In the first project, instruments will be developed, using information obtained from key informant interviews of patients and families, to identify and characterize barriers to accessing timely and appropriate dental and orthodontic care for children with craniofacial disorders. In the second project, Washington state Medicaid claims data will be analyzed to characterize dental and orthodontic care utilization and travel distance for care for low-income children with cleft lip and/or palate. Areas of Washington State where Medicaid beneficiaries with craniofacial disorders have difficulty accessing local dental/orthodontic care will be identified. In the third project, a statewide survey will be developed to assess current level of involvement of community orthodontists in caring for children with craniofacial disorders and to identify factors that could potentially promote or impede increased participation in the future. In the final project, models of patient advocacy programs will be identified and collaborations between the Law School and the Craniofacial Center will be developed with the goal of developing an advocacy program aimed at improving access to dental and orthodontic care for children with craniofacial disorders. At the completion of this planning grant period, we will be prepared to implement a large scale assessment to characterize barriers to accessing dental and orthodontic care and their consequences, as well as intervention projects specifically targeted at the barriers we identify. The overarching goal of the subsequent full-scale project will be to improve access to dental and orthodontic care and thus promote optimal outcomes for all children with craniofacial disorders. This model could potentially be applied to children in other states and to other groups of children with special health care needs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DETROIT DISPARITIES
CENTER
FOR RESEARCH
ON
ORAL
HEALTH
Principal Investigator & Institution: Ismail, Amid I.; Professor; Cariology/Restor Sci/Endod; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2008 Summary: (Provided by the applicant) - The Detroit Center for Research on Oral Health Disparities aims to promote oral health and reduce disparities within the community of low-income African American children (0-5 years) and their main caregivers (14 + years) living in the City of Detroit. The driving theme of the center's research program is to identify determinants and design interventions to answer the following question: why do some low-income African American children and their main caregivers have better oral health than others who live in the same community? The proposed center will focus on studying intra-group disparities in oral health. The community based partners, the City of Detroit Department of Health (DDH) and the Voices of Detroit Initiative (VODI) have strongly supported this theme. The Center will include 3 support cores, 5 research core projects and 1 pilot study. The Center's Methodology Core will select a multistage random sample of African American families living in the poorest 39 Census Tracts in the City of Detroit. A total of 1,529 families will be sampled and interviewed in their homes. It is estimated that 994 families will be examined at community centers in year 2 (2002) funding. Based on extensive data collected by the investigative team (R01 MH58299) in Detroit, the investigators predict that 760 families will be retained by the third examination phase in year 6 (2006). The research teams will investigate the social characteristics of parents, families, and neighborhoods, that are associated with
22
Medicaid
disparities in oral health (dental caries and periodontal diseases) of children and their caregivers; lead levels in saliva of children and saliva and blood (finger prick) of the main caregivers; dietary intake; and genetic, behavioral, social and bacteriologic risk factors of periodontal disease in adults. Using information from 3 core research projects, the investigators propose to develop a tailored multi-media educational intervention (Project #3), based on the transtheoretical model of behavioral change, which will be administered using a randomized controlled design in year 4 of funding, just prior to the second examination phase. Additionally, the center will evaluate the impact on access to dental care of the state-funded experiment on utilization where Medicaid children are managed like privately insured patients (Project #4). The center will support health professionals from the DDH and VODI and the University of Detroit Mercy to receive research training. Doctoral students in three programs targeting minorities in the Schools of Public health and Social Work will be offered stipends to conduct research on health disparities. All families will have access to dental care in a DDH dental clinic (funded by DDH, HRSA, Delta Dental of Michigan and VODI). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DEVELOPING PUBLIC-USE MEDICARE CLAIMS DATA FOR AHEAD Principal Investigator & Institution: Geppert, Jeffrey J.; Unicon Research Corporation 111 University Dr E, Ste 209 College Station, Tx 77840 Timing: Fiscal Year 2002; Project Start 30-SEP-1996; Project End 31-AUG-2004 Summary: Longitudinal Medicare claims files contain information on the majority of particular acute-care medical services used by the elderly, and thus represent a valuable supplement to longitudinal surveys. Because of the complexities of the Medicare files and confidentiality issues, however, Medicare claims data have not been widely used by researchers. This project proposes to produce a CD-ROM containing a public-use version of all Medicare claims information for the AHEAD. The CD-ROM will include "summary" data for use by researchers whose primary interests are not health or utilization of medical care, and "detailed" data suitable for use by investigators with extensive interests in health and medical care. Based on methods developed by project consultants and consultations with AHEAD staff and users, these variables will maximize detail while preserving confidentiality. The CD-ROM will include software for accessing combinations of variables, a textual description of the variables, and information on their construction. Phase I will finalize the "detailed" and "summary" data elements from the Medicare files, test data element creation on at least a portion of the Medicare data for AHEAD respondents, develop draft documentation for the datasets, and determine the structure of the data product. PROPOSED COMMERCIAL APPLICATION: Targeted to researchers in both the academic and nonacademic communities, this project will create "detailed" and "summary" versions of public-use data incorporating all Medicare claims information for linkage to surveys of the elderly. The principal product will be a user-friendly CD-ROM for use with the Survey of Asset and Health Dynamics of the Oldest Old (AHEAD); analogous products could be developed for other longitudinal surveys. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: DO MEDICARE CLAIMS MEASURE CHEMOTHERAPY USE AND OUTCOMES Principal Investigator & Institution: Lamont, Elizabeth B.; Assistant Professor; Medicine; University of Chicago 5801 S Ellis Ave Chicago, Il 60637
Studies
23
Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: (provided by applicant): Although they present more than half of all Americans with cancer, the elderly are under-represented on the clinical trials that seek to determine efficacy and toxicity of chemotherapy. For this reason, results of clinical trials may not be applicable to the general population of elderly cancer patients. Nonetheless, physicians need clinical information regarding tile risks and benefits of chemotherapy in this substantial group of patients. I am a medical oncologist who seeks to develop a career at the crossroads oncology and health services research that is focused on determining the risks and benefits of chemotherapy in the general population of elderly cancer patients. In five years, I want to be able to execute a series of epidemiologic studies examining the possible contribution of medical comorbidity to the chemotherapy utilization and outcomes of elderly Americans with cancer. This longterm research agenda requires additional training on my part and three preliminary studies to determine the ability of a candidate data source, Heath Care Financing Administration's Medicare claims files, to provide inexpensive but reliable clinical information for these studies. Through the three related projects, I seek to determine the reliability of Medicare chemotherapy claims at capturing three critical elements of anticancer therapy 1) chemotherapy administration, 2) chemotherapy-related toxicities, and 3) disease-free survival. To meet these three aims, I will create a new and unique data set by linking Medicare claims to a gold-standard of clinical information regarding chemotherapy administration and outcomes, Cancer and Leukemia Group B (CALGB) clinical trial data. Defining the CALGB data as the gold standard against which to compare the Medicare claims, I will then calculate the sensitivity and specificity of the Medicare claims at capturing 1) chemotherapy administration, and 2) specific chemotherapy-related toxicities, and 3) disease-free survival. In the next phase of my career, I will use Medicare claims, to the extent of their validity, to execute a series of epidemiologic studies examining the chemotherapy utilization and outcomes of elderly Americans with cancer and medical comorbidity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DO REPORTING BIASES MITIGATE DISPARITY ESTIMATES? Principal Investigator & Institution: Fiscella, Kevin; Associate Director; Family Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2005 Summary: Background: Self-report survey data show little difference in crude mammography rates by race. In contrast, Medicare claims and HEDIS mammography data show large disparities. We hypothesize that African Americans over-estimate their use of preventive care more than whites based on stereotype threat. Stereotype threat refers to apprehension by respondents that their behavior will reinforce stereotypes regarding their social group. Aims: 1) To determine whether there are discrepancies between racial/ethnic disparities in preventive care derived from self-report measures and those derived from Medicare claims. 2) To examine potential explanations for possible over-reporting of preventive care by racial and ethnic minorities. 3) To examine potential explanations for possible under-representation of preventive care to minorities in Medicare claims. Methods: We use Medicare Current Beneficiary Survey to examine these aims. We compare estimates of racial disparity in mammography, sigmoidoscopy, and PSA testing based on self-report with estimates from corresponding Medicare claims. We systematically examine other explanations for discrepancy in disparity age, education, income and source of care by sequentially adjusting for these factors. Significance: The National Health Care Disparities Report will rely heavily on self-report
24
Medicaid
to monitor disparities in health care. It is thus critical to determine whether reporting biases associated with race affect the validity of these estimates. Furthermore, erroneous conclusions regarding the absence of racial/ethnic disparities in preventive care may result in missed opportunities to reduce racial/ethnic disparities in health such as racial/ethnic disparities in breast, colon, or prostate cancer mortality. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DRUG ABUSE TREATMENT COSTS OF MEDICAID CLIENTS IN AN HMO Principal Investigator & Institution: Lynch, Frances; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 94612 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2002 Summary: The dramatic growth in health maintenance organizations (HMO) enrollment has heightened concern about the adequacy of treatment available for persons with substance abuse problems. This topic is of particular interest to the growing number of states that are now replacing fee-for- service with capitated health care systems for Medicaid clients, many of whom have severe substance abuse problems. If true, this could disrupt continuity of care and lead to poorer outcomes for Medicaid clients with substance abuse problems. The broad purpose of this study is to provide a better understanding of substance abuse treatment for Medicaid clients in HMOs in order to improve care for Medicaid enrollees. The specific aims are: 1. To describe enrollment duration, service use, and cost care of Medicaid funded enrollees seeking treatment of chemical dependency; 2. To compare enrollment duration, service use, and cost of care of chemically dependent Medicaid clients with hose of non-Medicaid HMO enrollees; and 3. To develop a risk adjustment model designed to improve the prediction of chemical dependency treatment costs for the Medicaid population. Decision makers could use information from this study to set policies to improve the retention of Medicaid clients in HMOs and for setting per member per month payment rates for capitated Medicaid programs. Policy makers especially need cost data on sub-groups of the Medicaid population such as children and youth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: EARLY DISCHARGE AND INFANT MORTALITY Principal Investigator & Institution: Malkin, Jesse D.; Rand Corporation 1700 Main St Santa Monica, Ca 90401 Timing: Fiscal Year 2003; Project Start 20-JAN-2003; Project End 31-DEC-2004 Summary: (provided by applicant): Of the 4 million infants born in the United States each year, about 20,000 (5 out of 1,000) die during the neonatal period and another 10,000 die after the neonatal period but before their first birthday. Some of these deaths are caused by conditions that can be treated successfully if they are diagnosed promptly. One factor that may influence whether such conditions are diagnosed quickly is the length of a well-appearing newborn's postpartum stay, because signs of congenital heart disease, infection, and other health problems may not be evident until two or more days after delivery. Although many studies have examined health effects of early postpartum discharge, few studies have considered mortality as an outcome. The investigators propose to assess the association between early discharge and neonatal mortality using an administrative database from California that captures about three million births between 1991 and 1999. The primary objective of the proposed analysis is to test the hypothesis that newborns discharged early are at increased risk of dying during the
Studies
25
neonatal period relative to newborns with longer stays. The investigators will perform unadjusted analyses, multivariate analyses to control for observed confounders, and instrumental variable estimation to mitigate biases due to unobserved confounders. The investigators will also perform analyses of high-risk sub-populations. The secondary objective of the proposed analysis is to test the hypothesis that newborns discharged early are at increased risk of hospital readmissions during the neonatal period relative to newborns with longer stays. The investigators will also describe time trends in early discharge, neonatal mortality, and hospital readmission rates. An improved understanding of these issues will provide policymakers, health plans, hospitals, providers, and patients with information that can be used to help make more informed decisions about newborn lengths of stay. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EARLY ORTHODONTIC INTERVENTION UNDER MEDICAID Principal Investigator & Institution: King, Gregory J.; Professor and Chairman; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2008 Summary: Orthodontic treatment has become a widely accepted procedure in dentistry. The benefits include improved oral health, function, esthetics and quality of life. Significant disparities exist among income strata regarding access to orthodontic services. The sources of these disparities are complex and may reflect differences in the disease prevalence, gender, cultural biases, perception of problems by this population, economic imperatives and negative perceptions of these patients by orthodontists. The primary objective of this study is to examine the usefulness of early orthodontic intervention as a possible means of increasing access to orthodontic services for children of low-income families. We will examine the effects of early interventions in Medicaid patients using a randomized clinical trial comparing dental, esthetic and psychosocial predictors and outcomes in children who receive early orthodontic treatment and those who do not. This study will also have a follow-up descriptive component, with a matched design, making similar comparisons between Medicaid Founded and privative -pay patients receiving full orthodontic treatment at adolescence. Aim 1 will compare orthodontic outcomes, motivations for treatment, expectations from treatment and satisfaction with results between Medicaid participants who receive early orthodontic treatment and those who do not. A sub- aim of Aim 1 will compare, in the Medicaid group receiving early treatment, the level of understanding and compliance between subjects given informed consent using an interactive CD-ROM and those receiving routine consenting procedures given one-on-one by an orthodontist. Aim 2 will compare parameters similar to those in Aim 1 in Medicaid-funded and private-pay patients who receive full orthodontic treatment at adolescence. Aim 3 will compare these same parameters between Medicaid-funded patients who receive early orthodontic treatment only and Medicaid-funded participants who receive full orthodontic treatment at adolescence. Orthodontic outcomes will be assessed using objective, valid and reliable measures of malocclusion and treatment need (i.e., Peer Assessment Rating and Index of Orthodontic Treatment Need). Patient/parent satisfaction, oral health behaviors and values, body image and quality of life will be assessed using instruments that have also been shown to be valid and reliable. It is expected that significantly greater access to orthodontic services could be provided for Medicaid patients by the more widespread use of simpler, more timely interventions. This study will provide data on the trade-off between simple, timely partial treatments aimed at many patients, versus complete full treatments aimed only at the most severely affected patients.
26
Medicaid
Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ECONOMIC DETERMINANTS OF MORTALITY Principal Investigator & Institution: Dow, William C.; Assistant Professor; Health Policy and Administration; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2004 Summary: This study seeks to better understand the role of economic factors in explaining mortality patterns, particularly in low-income populations. Our focus is on the role of the health insurance system, and more specifically, how large changes in the health insurance coverage of a population might influence mortality. In order to synergistically begin to build a body of empirical regularities, we propose to analyze the causal effects of actual large insurance expansions in different settings. One set of analyses will examine the mortality effects of the implementation of the Medicare and Medicaid programs in the United States during the 1960's, which have received surprisingly little study. A parallel set of analyses will build on previous work examining a large expansion in insurance coverage in Costa Rica during the 1970's. The project also includes a methodological investigation of the effects of the common practice of analyzing regionally aggregated mortality data instead of individual-level micro data. This project is expected to yield important new information in understanding the effect of health insurance on mortality patterns themselves, and on explaining socioeconomic differences in health. This knowledge is important not only for these two countries, but for many other countries as well as they debate large-scale reforms of their health insurance systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: ECONOMIC IMPACT OF STROKE IN THE ELDERLY Principal Investigator & Institution: Hickenbottom, Susan L.; Neurology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): The candidate is a fellowship-trained stroke neurologist dedicated to a career in health services research. This application proposes a comprehensive program to facilitate the candidate's development into an independent investigator in patient-oriented research. The candidate's career goal is to become a leader in stroke health services research by combining expertise in clinical medicine, survey and epidemiological analysis, and health economics, to better understand the social and economic impact of stroke. The University of Michigan has outstanding clinical and health services research resources to support this proposal. The training component of this proposal includes formal graduate education in healthcare economics and survey methodology. The goal of the research proposal is to develop and refine methods for the population-based study of the direct and informal caregiving costs of stroke in the elderly. The Health and Retirement Study (HRS), a nationally representative, NIH-funded longitudinal study of the health and economic implications of aging, will be the main source of data for this proposal. The extensive data collected for the HRS will be used for the following Specific Aims. Aim 1 - To develop methods for determining the annual direct medical costs and informal caregiving costs for elderly individuals in the US. Aim 2 - To determine the relationship between stroke and annual direct medical costs and informal caregiving costs. Aim 3 - To develop longitudinal models to predict time to institutionalization or death following stroke, and for
Studies
27
estimating and predicting lifetime direct medical costs and informal caregiving costs associated with stroke. The proposed analysis will use all waves of the HRS data from 1992 through 2004. Annual direct medical costs will be calculated using HRS-linked Medicare claims data, gross costing, and self-reported medical expenditures. Informal caregiving costs will be calculated using self-reported hours of caregiving. The relationship between stroke and the above costs will be analyzed using a two-part regression model. Longitudinal models for predicting time to institutionalization or death will be developed using regression and proportional hazards analysis, and strokeassociated lifetime costs will be estimated using Markov modeling. The proposal will yield, for the first time, nationally representative estimates of the total economic burden of stroke, which will then be available for use by health policy decision makers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ECONOMICS OF FORMULARY DESIGN AND MENTAL HEALTH POLICY Principal Investigator & Institution: Huskamp, Haiden A.; Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 31-MAY-2007 Summary: (provided by applicant): Prescription drugs have become an increasingly important component of mental health treatment and the costs of psychotropic drugs have increased rapidly in recent years. However, there are major gaps in our knowledge about the economics of psychotropic drug treatment. This Mentored Research Scientist Development Award would allow Dr. Haiden Huskamp, a health economist with expertise in mental health policy and economic institutions, to supplement her economic tools with the knowledge and skills needed to conduct clinically-relevant and policysignificant research on the economics of prescription drugs used in the treatment of mental illnesses. The specific aims of this career development proposal are to: 1) develop a greater understanding of clinical decision-making related to the use of psychotropic drugs; 2) acquire basic knowledge of psychopharmacology; and 3) expand knowledge of the important economic institutions influencing the prescription drug market. In this undertaking, Dr. Huskamp will be guided by her sponsor, Richard Frank, PhD, and cosponsors, Andrew Nierenberg, MD, and Ernst Berndt, PhD. Her career development plan includes guided study with Dr. Nierenberg on clinical issues related to treatment decision-making and Drs. Berndt and Frank on economic institutions of the pharmaceutical market, as well as coursework and participation in psychopharmacological "Grand Rounds," relevant seminar series, and professional meetings. Dr. Huskamp will use the knowledge and skills developed through these career development activities to conduct three research projects. The first project examines the effect of generic entry in the class of selective serotonin reuptake inhibitors (SSRls) on utilization patterns, costs, and market share among antidepressants as well as the competitive response of brand antidepressant manufacturers with respect to drug prices and promotional spending. The second project assesses the economic incentives created by three-tier drug formularies and how these arrangements affect costs, utilization patterns, and adherence to treatment guidelines in a non-elderly population. This project includes an economic welfare analysis of the tradeoffs associated with restrictive formularies. The third project examines the effect of a three-tier formulary on psychotropic drug costs and utilization patterns in a retiree population and explores the impact of formularies on the mental health costs of adding a prescription drug benefit to Medicare and on access to appropriate psychotropic drug treatment under such a benefit. The proposed plan of career development will provide Dr. Huskamp the
28
Medicaid
training, mentoring, time and resources to develop the skills that will put her in a position to lead independent research on the economics of pharmaceutical treatment for mental illnesses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EPIDEMIOLOGIC STUDIES OF LUNG CANCER RISKS IN NSAID USERS Principal Investigator & Institution: Zheng, Wei; Professor; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 28-JUN-2001; Project End 31-DEC-2006 Summary: (provided by applicant): Cumulative evidence from in vitro and animal studies suggests that the enzyme cyclooxygenase-2 (COX-2) is important in the development and progression of lung cancer. Epidemiologic studies evaluating the association between the use of aspirin (an inhibitor of COX-2) and the risk of lung cancer have been conflicting, and no study has been conducted to evaluate non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs). Using pre-recorded drug prescription databases of the Tennessee Medicaid program and North Jutland County of Denmark, we propose to conduct two studies in these populations to examine the effect of NSAID use on the risk of lung cancer. The first is a retrospective cohort study of over 10,000 enrollees of the Tennessee Medicaid Program who were diagnosed with chronic obstructive pulmonary diseases (COPD) during the period of 1980 to 2002. The second is a population-based, retrospective cohort study of over 150,000 users of NSAIDs in the general population of North Jutland County during the period of 1991 to 2002. Within the Danish cohort will be a nested case-control study of 350 cases and 700 controls, in which relevant information will be obtained on over the counter (OTC) analgesic use, as well as cigarette smoking and other potential confounding factors. The two studies proposed here complement each other and provide for an international comparison of NSAIDs as possible lung cancer chemoprevention agents. Because the data on NSAID use have already been collected, the studies will be very cost-efficient. More importantly, the use of pre-recorded pharmacy records minimizes potential errors in exposure assessment and provides a major advantage over existing cohort studies in evaluating the potential chemopreventive effect of NSAIDs. Given the high incidence and mortality of lung cancer and high prevalence of NSAID use, the results from our studies may have important public health implications in lung cancer prevention, and could set the stage for future randomized trials of COX-2 inhibitors in cancer prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: EPIDEMIOLOGY OF DEMENTIA IN AGED NURSING HOME ADMISSIONS Principal Investigator & Institution: Magaziner, Jay S.; Professor; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 15-AUG-1991; Project End 31-MAR-2004 Summary: The long-term care of older persons with dementia is a major concern of providers and policymakers. Approximately 750,000 persons with dementia in the United States reside in nursing homes, and more than 800,000 new cases enter these facilities each year. The cost of caring for persons with dementia who reside in nursing homes has received only limited research attention, despite the fact that the aggregate cost of caring for this group is estimated to be as high as $120 billion annually. The aims
Studies
29
of the proposed continuation study are to: 1) determine the temporal patterns (up to six years) of direct medical care costs and utilization of demented v. non-demented persons admitted to nursing homes for the first time; 2) compare the direct medical care costs and utilization of these demented v. non-demented persons at different levels of functioning and comorbid status; 3) evaluate the variability in costs and utilization for demented v. non-demented new admissions by characteristics of the nursing home; and 4) assess the sensitivity of a diagnosis of dementia using secondary records to determine whether associations observed in Aims 1-2 are robust to alternative definitions of dementia. These aims will be addressed by linking Medicare and Medicaid claims data for up to six years following admission to data from the current study, "The Epidemiology of Dementia in Aged Nursing Home Admissions," (R0l AGOS21 1) in which 2,285 new admissions to a representative sample of 59 nursing homes in Maryland, 1992-1995, were enrolled and evaluated for the presence of dementia by an expert clinical panel of neurologists, psychiatrists, and a geriatrician. These new admissions were similar in demographic, functional, and comorbid status to nursing home admissions elsewhere in the U.S. during the same period. Cost and utilization rates defined by type of service, procedures, sites of care, and payor (Medicare/Medicaid) will be expressed in per person month terms, and longitudinal Poisson regression models will be used to estimate these rates and examine their association with individual (e.g., dementia diagnosis, function, comorbidity) and environmental (e.g., structure and process of care) characteristics. With changes in reimbursement for those in nursing homes and the increasing demand to care for persons with dementia in nursing homes and other settings, policymakers need to have information on cost to optimize care for this growing segment of the long-term care population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FOOD PROGRAMS AND NUTRITIONAL SUPPORT OF THE ELDERLY Principal Investigator & Institution: Lamb, Vicki L.; Center for Demographic Studies; Duke University Durham, Nc 27706 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): The major focus of this exploratory study is on nutritional programs and support, and their effects on risks of institutionalization, hospitalization and mortality. The analyses will use the National Long Term Care Survey (NLTCS), linked Medicare records, and additional data to characterize available nutritional support programs at the local and state level. The NLTCS is a large nationally representative longitudinal survey of health and disability of the US population aged 65 years and older. Questions on nutritional status (participation in Elderly Nutritional Programs, weight and physical activities) were added in 1994. A food frequency questionnaire (FFQ), a series of questions about patterns of food consumption, was added in 1999. This study will focus on the last two waves of the NLTCS, which contain this nutritional information, to pursue the following specific aims: Aim 1. To model participation in Elderly Nutrition Programs (ENPs: home delivered meals, and congregate meals), and the food stamp program among those eligible for such programs. We will estimate probit models that will be used to adjust for the propensity to participate in these programs. Aim 2. To model whether those participating in the ENPs and/or receiving food stamps in 1994, compared with those in other nutritional support arrangements, have reduced risks of institutionalization, hospitalization and mortality between 1994 and 1999. We will use hazard models to
30
Medicaid
estimate the risk of these health outcomes. Aim 3. To model patterns of dietary intake in 1999, using a modified short FFQ, to explore the impact of current receipt of ENP services. Models of dietary intake will be estimated in two ways: k-means clustering, and grade of membership clustering. Regression models will be used to estimate the effects of receipt of nutritional services, health, sociodemographic and location correlates. This study will generate important hypotheses to be examined in future research on the effect of nutritional programs on elderly health outcomes, and the role of nutritional support programs as a significant factor in the provision of community based long-term care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GREATER DENVER LATINO CANCER PREVENTION/CONTROL NETWORK Principal Investigator & Institution: Flores, Estevan T.; None; University of Colorado at Denver Campus Box 129 Denver, Co 802173364 Timing: Fiscal Year 2001; Project Start 04-APR-2000; Project End 31-MAR-2005 Summary: (Applicant's Description) A cancer awareness and training collaboration coordinated by the Latino/a Research & Policy Center (LRPC: Drs. Flores and Espinoza) at the University of Colorado at Denver, will build a network infrastructure among 2025 Latino community based organizations, health clinics, social service agencies, schoolbased clinics, faith-based groups, and employee-based organizations serving Latinos in the greater Denver metro area. The partners include file University of Colorado Health Sciences Center, Cancer Center and the Chancellor's Office of Diversity, the Colorado Department of Health and Environment, Division of Prevention, Colorado ACCESS, the Medicaid HMO with 43,000 clients, the Rocky Mountain Cancer Information Service and the American Cancer Society. During Phase I, the major partners will build the infrastructure for cancer awareness and education projects in the Latino community based on already extant associations and past intervention and education activities. This would include efforts in breast and cervical cancer awareness and prevention, smoking cessation and prostate, colorectal and lung cancer. The project will also target 3 nearby migrant health clinics. The Steering Committee formed will review pilot project proposals for submission to the NCI. During Phase II of the project we will begin the pilot projects with the community groups. The CUHSC and the CDPHE will participate in developing the community education, health promotion and prevention pilot projects. During Phase III of the project the pilot projects will evolve into long-term funded projects benefitting the constituencies of the various members of the Network. Recruitment of Latino/a students to the cancer research and health professions areas will expand. Recruitment of patients to cancer clinical trials will benefit from the professional and lay education programs facilitated by the Network infrastructure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: HEALTH AND CARE TRAJECTORIES OF OLDER DISABLED AMERICANS Principal Investigator & Institution: Freedman, Vicki A.; Polisher Research Institute 1425 Horsham Rd North Wales, Pa 19454 Timing: Fiscal Year 2001; Project Start 01-FEB-1998; Project End 31-JUL-2003 Summary: Currently over 5 million older Americans require care for chronic disability. The cost of providing long-term care to these Americans currently amounts to over one hundred billion dollars per year. In light of impending growth in the number of older
Studies
31
disabled Americans and the current deficit-reduction climate, policy makers now face important questions about how to best restrain growth in public spending for long-term care. Because costs are driven by families decisions about the intensity, structure and balance of arrangements over time, policy makers seeking to control costs require a basic understanding of how families choose care arrangements in response to health declines and improvements of older family members. Yet surprisingly few studies have investigated basic questions about the relationship between health and care trajectories of older disabled Americans over time. The goal of this FIRST award is to understand the dynamic process driving long- term care decisions, particularly the ways in which older persons and their families respond over time to changes in the health of older family members. Using a dynamic, interdisciplinary framework, two overarching research questions will be explored: 1) How do older disabled Americans and their families shift care arrangements in response to various health trajectories and what are the critical junctures in the health progression of older disabled Americans when families shift the intensity and structure of care? And 2) How do various health trajectories affect the balance of informal and formal care over time? That is, under what circumstances do changes in health lead to the displacement of formal care over time? That is, under what circumstances do changes in health lead to the displacement of formal for informal care over time and what is the magnitude of that displacement? To address these issues, the project will use multiple waves from two relatively new nationally representative panel survey: the Study of Asset and Health Dynamics of the Oldest Old (AHEAD) and the Medicare Current Beneficiary Survey (MCBS). Answers to these questions will provide critical information on the underlying process by which older disabled persons and their families cope with disability over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTH CARE ACCESS QUALITY AND INSURANCE FOR CSHCN Principal Investigator & Institution: Swigonski, Nancy L.; Pediatrics; Indiana UnivPurdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-MAR-2003 Summary: Indiana's Children's Health Insurance Program (ICHIP) has enormous potential benefit for Children with Special Health Care Needs (CSHCN) who are uninsured. Indiana opted for a combination of a Medicaid managed care expansion (Phase I) and a separate State Insurance Program (Phase II). Phase I of ICHIP expands Medicaid coverage for children birth to age 18 up to 150 percent FPL. Phase II, effective January 1, 2000, serves children 150-200 percent FPL with a basic plan that includes primary, preventive and acute care. Additional services, not provided under the State Insurance Program, will be accessed through other resources for CSHCN, such as the First Steps Early Intervention (IDEA, Part C) and Children's Special Health Care Services (CSHCS, Title V). Little is known about the impact of differing health care delivery systems on children with special health care needs (CSHCN). We will assess enrollee impact for CSHCN, using a 2 X 2 quasi-experimental design. Indicators of access and quality of care will be compared within and between health care delivery systems: Phase I (comprehensive package of services), Phase II (relying on "wrap around" services from other state programs), Risk-Based Managed Care (RBMC) and Primary Care Case Management(PCCM). Specific Aims are to: 1) Describe the structural, organizational and implementation features of Phase I and Phase II of CHIP that facilitate coordination and collaboration of services for optimal outcomes of CSHCN. 2) Evaluate, within and between, program comparisons of outcomes for CSHCN including: (1) access to care; (2) utilization of services; (3) quality of care; (4) satisfaction
32
Medicaid
with care; (5) expenditures for care, evidence of "crowd out"; (6) health outcomes; and (7) family impact by comparing: pre- and post- enrollment outcomes for CSHCN; CSHCN who receive services through the managed care model of RBMC to those enrolled in PCCM; and CSHCN enrolled in a comprehensive package of benefits under EPSDT (Phase I) to CSHCN with a basic service plan and "wrap-around" services (Phase II). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTH CARE USE /COSTS OF DEMENTIA IN MERDICARE ELDERLY Principal Investigator & Institution: Husaini, Baqar A.; Tennessee State University 3500 Centennial Blvd Nashville, Tn 37203 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2006 Summary: This study will examine four key issues: (1) race and gender differences in the correlates of dementia, particularly focusing on morbidity processes that are associated with dementia in its varied forms; (2) race and gender differences in health care service utilization and health care costs among those suffering from forms of dementia; (3) the influence of socioeconomic contexts and the availability of health services on morbidity processes leading to dementia, and health care costs; (4) the impact of contexts of consumption of alcohol and tobacco on morbidity processes leading to dementia and on health care costs. Data: The study will examine a 2.5% random sample of HCFA beneficiaries from 1996-2000 in the states that make up the census designation of the South (N=275,000). Our contextual level analyses on 1425 counties in the South will examine the impact of socioeconomic conditions, the availability of medical services in the area, and alcohol and tobacco consumption. We will estimate a variety of multi-level hierarchical models for logistic regression models, multinomial logistic regression models, and linear models that incorporate the influence of socioeconomic contexts and other factors into predictions of morbidity, service utilization and health care cost of individual beneficiaries. Significance: The proposed work will generate several important contributions: (1) It will help identify how race and gender differences in heart disease and stroke influence the onset of dementia, and how these processes may differ between vascular/multi-infarct dementia and Alzheimer's disease; (2) It will elucidate how race and gender variations in morbidity processes leading to dementia impact health care service utilization and health care costs. (3) It will allow us to discern if contextual factors such as socioeconomic inequality and health care availability influence the development of dementia and its effect on healthcare outcomes (service utilization and costs); and (4) It will allow a systematic assessment of the influence of contexts of alcohol and tobacco consumption on the development of dementia and its influence on health care service utilization and costs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: EMPLOYMENT
HIGHLY
ACTIVE
ANTIRETROVIRAL
THERAPY
AND
Principal Investigator & Institution: Bernell, Stephanie L.; Public Health; Oregon State University Corvallis, or 973391086 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JAN-2004 Summary: (PROVIDED BY APPLICANT): The objective of this research is to examine the employment consequences of HIV, focusing on the labor market behavior of HIV positive individuals who use and who do not use highly active antiretroviral therapy
Studies
33
(HAART). Like all workers, HIV positive individuals leave the state of employment and unemployment for very different reasons. This study examines the causes of job loss and job acquisition, concentrating primarily on the contribution of HAART and secondarily on the effect of mental health and substance abuse problems. This study uses data from the HIV Cost and Services Utilization Study (HCSUS) and employs discrete choice models of analysis. The specific aims of this research are to (1) examine the effect of HAART on the probability of leaving employment, (2) assess the effect of HAART on the probability of leaving unemployment, and (3) identify whether persons dually diagnosed as HIV positive and having mental health and/or substance abuse problems have differential labor market outcomes than those without mental health or substance abuse problems. Understanding the influence of HAART on the labor market behavior of HIV positive individuals is of fundamental significance to pubic sector policymakers as well as employers in all parts of the economy. On an individual level, it is likely that many people with HIV are still denied opportunities in the workplace due to their HIV status. On a national level, if HAART results in better employment outcomes, it is likely that individuals will remain privately insured for a longer period of time and will be less reliant on federal and state programs (SSI, Medicaid, Medicare, etc,). Furthermore, by having a clearer understanding of the employment outcomes of those who are dually diagnosed with HIV and mental health and/or substance abuse problems, this project will provide new information on the effects of recent policy revisions, including employment-based mental health insurance parity mandates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IDENTIFYING CASES AND COSTS OF DEMENTIA IN THE U.S. Principal Investigator & Institution: Langa, Kenneth M.; Assistant Professor; Internal Medicine; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2006 Summary: (applicant s abstract): Dr. Kenneth Langa is a General Internist and faculty member in the Department of Internal Medicine and the Institute for Social Research at the UM. He gained research experience while earning a Ph.D. in Public Policy at the UC and completing the Robert Wood Johnson Clinical Scholars Program at the UM. During his fellowship training he initiated pilot studies on direct and informal caregiving costs of dementia while working as a Collaborator on the NIA-funded Health and Retirement Study (HRS).His immediate career goal is to obtain new clinical and research skills required for the longitudinal study of cognitive impairment in both clinical and population-based settings; his long-term goal is to lead multidisciplinary research efforts to better understand the social and economic impact of dementia on patients, families, and society. The UM provides a uniquely rich environment to support training in the study of aging and cognitive impairment. Dr. Langa will be mentored by senior faculty in the Institute for Social Research, Medical School, Michigan Alzheimer's Disease Research Center, and School of Public Health. He will benefit from his established collaborations with the principal investigator (Robert J. Willis, Ph.D.) and CoInvestigators of the HRS. The research plan will utilize 6 waves of HRS data (collected between 1993 and 2004) to study the direct and informal caregiving costs of cognitive impairment in a population-based nationally representative sample. The longitudinal design (with up to 11 years of follow-up) and extensive data on socioeconomic status, co-morbidities, and informal caregivers will be used to determine the relationship between severity of cognitive impairment (from mild or pre-clinical to severe disease) and direct and family caregiving costs. Longitudinal models will identify determinants
34
Medicaid
of the incidence and progression of cognitive impairment, as well as nursing home admission and death. Markov models will be developed to estimate the lifetime costs associated with cognitive impairment, and determine the distribution of costs across age, gender, race, socioeconomic status, and public (Medicare and Medicaid) and private payers. This project will better define the economic impact of the growing prevalence of dementia in the United States, as well as the potential benefits of new treatments to prevent or slow the progression of this costly and increasingly common condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMPACT OF AGING ON STROKE CARE: A NATIONAL PERSPECTIVE Principal Investigator & Institution: Brass, Lawrence M.; Professor of Neurology & Epidemiology; Neurology; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by investigator): Our goal is to examine the impact of aging on stroke care in the United States. Our application proposes secondary analysis of data collected as part of the National Stroke Project. The National Stroke Project was part of a Center for Medicare and Medicaid Study (CMS) program (formerly know as the Health Care Financing Administration (HCFA)) to look at quality indicators for stroke care by state. The specific aims and proposed analyses of this R03 application go beyond the analyses proposed, and funding available for, the National Stroke Project. Our application is ideally suited to PA Number: PA-01-082 (Data analysis and Archiving in Demography, Economics, and Behavioral Research on Aging). The R03 Award will permit an analysis of the National Stroke Project database related to measuring and understanding the age-related disparities in stroke care across the United States. Our analyses will yield the first national picture of how age influences the care of elderly patients admitted to the hospital with stroke. In addition, the results of this RO3 will provide new analyses critical to informing the design and content of a planned RO1 linking processes of inpatient care from the elderly patients included in the National Stroke Project with long-term outcomes. The objective of this proposal is to provide insight into how aging influences stroke care both directly and through its association with other factors including demographics, clinical co-morbidities, hospital and physician characteristics, and geography. These results will be critical to enhancing clinical decision-making and performance benchmarking. Accordingly we have set specific aims: 1-to determine the influence of age on the management of acute ischemic stroke; 2-to determine if the impact of age on stroke care is different within the 'Stroke Belt'; and 3-to examine whether hospital and physician characteristics contribute to age related differences in stroke care. Some studies have raised questions about how demographic and clinical factors contribute to the variations seen in the care and outcomes of patients with cerebro-vascular disease, but few data are available regarding how these factors specifically affect the use of specific diagnostic techniques and stroke therapies in older patients with stroke. We hypothesize that variations in care exist by age. Moreover, these differences in care will not be explained by differences clinical features or co-morbid conditions associated with aging. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies
•
35
Project Title: IMPACT OF DEPRESSION & FUNCTION ON HEALTHCARE USE & COST Principal Investigator & Institution: Friedman, Bruce; Community and Prev Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: (provided by applicant): The purpose of this Mentored Research Scientist Career Development Award (KO1) is to become an independent researcher prepared to make a unique and significant contribution to our understanding of the impact of depression and functional impairment on health services use and expenditures among older adults (age 65+). Three themes characterize my background: (a) work-related positions with an exclusive or major focus on the aged; (b) exposure to and involvement with late life mental health; and (c) expertise in crosssectional analysis of healthcare use and expenditures. My past scientific history has focused on innovative intervention studies of elderly patients. I will receive the needed training and conduct mentored research at the University of Rochester, with additional study at the University of Michigan and training and mentored research at Cornell University. Presently little is known about the impact of depression and functional impairment on healthcare use and expenditures among most categories of elderly patients (e.g., primary care patients, home care patients, and community-dwelling high users of medical care). The Training Objectives of my Research Career Development Plan are to: (1) Improve my knowledge base in relation to affective illness, cognitive dysfunction, and chronic illness comorbidity and disability in elderly persons; (2) Increase my knowledge of mental health oriented community-based interventions and public health models; (3) Add to my knowledge and skills in longitudinal data analysis; (4) Become more familiar with the requirements for responsible conduct of research involving human subjects; and (5) Plan, organize, and carrying out a systematic research program adding knowledge of geriatric mental health and function to my expertise and skills in Health Services Research and community-based geriatric interventions. The Specific Aims of the Research Plan are: (Aim 1) To better understand the impact of major and subsyndronml depression on certain specific types of healthcare use and expenditures; (Aim 2) To better understand the effect of functional impairment (deficits in activities of daily living, instrumental activities of daily living, and ambulation/-mobility) on certain specific types of healthcare use and expenditures; and (Aim 3) To study the role of depression as a mediator between functional impairment and use/expenditures, and functional impairment as a mediator between depression and use/expenditures. The Analytic Plan consists of (a) bivariate associations, (b) regression analyses, (c) an examination of direct and indirect effects, and (d) longitudinal analyses applied to data from 3 studies: (1) the Medicare Primary and Consumer-Directed Care Demonstration (2) the Depression Outcome in Primary Care Elderly study, and (3) the Depression in Elderly Medical Homecare Patients study. Given the expected continuing rise in healthcare costs and the high prevalence of depression and functional impairment among the chronically ill aged, understanding the impact of depression and functional impairment on healthcare use and expenditures is of particular public health importance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: IMPACT OF OR. HLTH PLN ON TANF LEAVERS' ABILITY TO CARE Principal Investigator & Institution: Seccombe, Karen; Sociology; Portland State University Box 751 Portland, or 97207 Timing: Fiscal Year 2001; Project Start 05-SEP-2001; Project End 31-AUG-2004
36
Medicaid
Summary: This proposal requests funds to examine the effects of welfare reform on the access to health insurance and use of health services among former welfare recipients and their children in the state of Oregon, a state with a unique health care financing system. Specifically it will aim to determine how families leaving welfare for employment plan for and cope with the expiration of their one-year transitional OHP/Medicaid coverage, and what happens to them after losing their eligibility for the single year of transitional coverage. The research has two main aims, requiring both quantitative and qualitative strategies: (1) An assessment of the ways in which welfare reform has impacted the health and well-being of Temporary Assistance for Needy Families (TANF) leavers, including (a) access and barriers they face in securing health care; (b) ways in which they utilize the health care system; (c) how these patterns vary by urban and rural residence, and race/ethnicity; and (d) how the Oregon Health Plan (OHP) influences these outcomes. (2) An appraisal of the ways in which families leaving welfare for employment plan for and cope with the expiration of their one-year transitional OHP/Medicaid coverage, including (a) respondents' knowledge, expectations, and planning process for securing health insurance; (b) their worries and coping strategies; (c) an elaboration of the ways in which welfare reform has impacted their health and well-being, the access and barriers they face in securing health care, and the ways they utilize the health care system; and (d) the ways that residential location and race/ethnicity may influence their access and use of services. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMPACT OF PUBLICLY FUNDED PROGRAMS ON CHILD SAFETY NETS Principal Investigator & Institution: Budetti, Peter P.; None; Northwestern University 633 Clark St Evanston, Il 60208 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-MAR-2003 Summary: Expansion of Medicaid managed care (MMC), a decline in Medicaid enrollment, and an increase in the number of uninsured children appears to be threatening the stability of pediatric safety net hospitals and Federally Qualified Health Centers (FQHC). Implementation of the State Children's Health Insurance Program (SCHIP) may play a key role in their survival. The impact of these health care-related changes on community safety nets for children has not been studied. SPECIFIC AIMS The study will (1)describe relationship between characteristics of publicly funded programs and survival/financial viability of pediatric safety net providers (PSNP), (2) determine differential effects of MMC and S-CHIP for PSNPs relative to pediatric FQHCs, (3) investigate institutional and organizational factors among PSNPs that are precipitating change as a result of evolving Medicaid and S-CHIP programs, and (4)examine how successes and failures that PSNPs have experienced in confronting changes have affected their communities. STUDY DESIGN The unit of analysis is the individual pediatric safety net institution and the study period is 1996 through 1999. Safety net hospitals will be identified from the American Hospital Association's (AHA) Annual Survey of Hospitals and the Medicare Cost Report. FQHCs will be identified from the Uniform Data System (UDS). All hospitals with a high burden of uncompensated care (UC) and/or a large proportion of Medicaid revenues and all FQHCs will be included. Pediatric safety net hospitals and FQHCs will be selected by service mix (AHA data) and telephone survey to gather pediatric UC and Medicaid revenues for each hospital and by service mix and patient characteristics on the UDS, respectively. Key informant interviews will be conducted in MSAs with significant changes MMC and S-CHIP and in MSAs with significant negative, positive, or no
Studies
37
changes in financial status of pediatric safety nets. Five case studies of MSAs with substantial change in MMC and S-CHIP and financial safety net success or failure will be conducted. ANALYSIS A logistic regression model will estimate the impact of hospital, market, and policy factors on closure. The model will indicate the extent to which baseline factors as well as changes in state Medicaid and S-CHIP policies affected the probability of closure over time. The hospital's cost, revenue, and profit equations will be modeled using a fixed effects regression model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMPACT OF TERMINATING SUBSTANCE ABUSE DISABILITY BENEFIT Principal Investigator & Institution: Orwin, Robert G.; Senior Study Director; Westat, Inc. 1650 Research Blvd Rockville, Md 208503195 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2004 Summary: Effective Jan. 1, 1997, the Contract with America Advancement Act (PL 104121) terminated the Social Security Administration's Disability Insurance (DI) and Supplemental Security Income (SSI) benefits for persons diagnosed with drug or alcohol addiction, also known as DA and A recipients. The law ended Medicaid eligibility as well, leading to many chronic substance abuse patients losing Medicaid reimbursement for addiction treatment and general health care needs. The legislation raised two sets of interrelated concerns. The first was for the well-being of the substance abusers who lost their mandate for treatment, insurance for treatment, insurance for general health care, monthly income, and their relationships with their representative payees. The second was for the larger effects on others in society. Several studies have been conducted or are currently in progress that address the issue of how the benefits termination affected recipients. However, no rigorous evaluation of the net impact of the law using actual resource utilization and labor force participation data has yet been attempted. The proposed study fills that gap with a quasi-experimental evaluation of the economic impact of the policy change in Washington State. Using records extracted and recombined from existing datasets, the analytic methodology combines an enhanced interrupted time series analysis with 1) recent developments in the multilevel random regression modeling of longitudinal outcome data, and 2) contemporary economic valuation methods for resource utilization and productivity. Specific aims are: 1. Estimate the net impact of the law on service utilization and labor force participation among the DA and A population as a whole and its component subgroups. Service utilization data will include mental health services, general medical services, substance abuse services, use of the criminal justice system, and cash benefits. Subgroups will include former benefit classification (SSI, DI, or both), urban v. rural, age, gender, education, ethnicity, criminal justice background, previous employment history, substance abuse diagnosis, substance abuse treatment history, psychiatric comorbidity, medical comorbidity, and SSI/DI requalification status. 2. Based on the findings from Aim 1, estimate the economic impact of the benefits termination on federal, state and local government resources, for the population as a whole and subgroups. This will be accomplished through the use of cost data from Washington State and current economic valuation models that assign unit cost estimates to each of the resource utilization and productivity activities that were modeled in Aim 1. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
38
•
Medicaid
Project Title: INFORMATION SOLUTIONS FOR COMMUNITY LONG TERM CARE Principal Investigator & Institution: Zawadski, Rick T.; Rtz Associates 700 Murmansk St, Ste 4 Oakland, Ca 94607 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-DEC-2002 Summary: California's Multi-Purpose Senior Services Program(MSSP) is one of more than two-hundred Medicaid waiver programs that provide community-based longterm care services to low-income consumers who would otherwise be institutionalized. MSSP serves approximately 10,000 frail elderly individuals in California at 1 sites with a 25% expansion currently budgeted. However, in spite of the program's growing importance in the health care system, there is little information available on its impacts and costs. Current data tracking systems are out-dated, paper-based and cumbersome. MSSP sites and the MSSP Site Association (MSA) have expressed frustration with current systems and a desire to build a standardized information system to collect data that can be used for meeting stricter state and federal reporting requirements, policy planning and development and ongoing program and clinical improvement. This project aims to develop the information base called for by MSSP sites and State agencies responsible for funding them. The project will build a standardized, integrated information system for MSSP based on an existing RTZ associates software system for adult day services and use this system to develop a cross-site database for ongoing analysis. In completing the project's aims, RTZ Associates will collaborate with the MSA and the Partners in Care Foundation. PROPOSED COMMERCIAL APPLICATIONS: The software and the data warehouse follow a financially successful model for the applicant of leasing software to Community Long Term Care Providers. The initial marker will be MSSP sites in California followed by Case Management and Medicaid waiver programs throughout the country. The MSSP Association and its members are participating in the development and the pilot group has committed to lease the system. Future revenues will come from software leases and the sale of data reports. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: INNOVATIVE JOB PLACEMENT MODEL FOR METHADONE PATIENTS Principal Investigator & Institution: Magura, Stephen; Acting Executive Director; National Development & Res Institutes Research Institutes, Inc. New York, Ny 10010 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-AUG-2005 Summary: (Applicant's Abstract) Substance users in treatment programs, including methadone patients, historically have had poor rates of workforce participation. Nationally, 76 percent of methadone patients are unemployed at admission, with virtually the same rate at discharge. Traditionally, addicts in treatment have experienced substantial disincentives to enter employment because of the ready availability of public assistance, disability benefits for addiction disorders and Medicaid. However, policy changes are now creating a new environment. Recent federal and state welfare reform legislation (e.g., federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996; New York State Welfare Reform Act of 1997) requires that drug treatment clients achieve work readiness in specific time frames or lose public benefits and other supports. There is evidence that most methadone patients are potentially capable of and interested in productive activity. However, few methadone programs have offered adequate vocational services. The proposed study will implement and evaluate an innovative vocational rehabilitation model to facilitate
Studies
39
the transition of methadone patients from welfare to competitive employment. The specific aims are: 1) To implement and Individual Placement and Support Model for Substance Users (IPS-SU) among opiate addicts in methadone treatment. The innovative IPS vocational rehabilitation model was originally developed, manualized and favorably evaluated for a seriously mentally-ill (SMI) population. 2) To conduct a randomized field trail of the IPS-SU model's efficacy by voluntarily assigning unemployed methadone patients to either: (a) the innovative IPS-SU model (N=144), or (b) a traditional vocational services program (N=144). The primary outcomes, assessed at 6, 12, and 18 months after admission, are measures of competitive employment; the secondary outcomes are methadone program retention, substance use, and other measures of patient functioning. 3) To determine the static and dynamic patient attributes and intervention process variable which may predict differences in patient outcomes. 4) To conduct benefit-cost and cost-effectiveness analyses of the modified IPS vocational rehabilitation program. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LARGE DATABASE RESEARCH FOR CANCER PREVENTION & CONTROL Principal Investigator & Institution: Cooper, Gregory S.; Associate Professor; Medicine; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2007 Summary: The Candidate, a gastroenterologist/health services researcher has developed a focused research program in cancer prevention and control, primarily through the use of large population-based databases. In addition, he has mentored several trainees and junior faculty at different levels of training. However, because of time and budgetary restraints, his ability to provide data and methodological support to junior researchers is increasingly limited. In addition, he has been unable to expand his research focus to different cancer sites and other content areas, including pharmacoepidemiology. The proposed Established Investigator Award in Cancer Prevention, Control Behavioral and Population Research will assist the Candidate in fulfilling his long-term career goals. These include to evaluate the effectiveness of commonly performed screening, treatment and surveillance procedures in routine clinical practice; determine the accuracy, completeness and appropriateness of alternative methods to measure cancer screening, surveillance, and therapy; and develop a critical mass of cancer prevention and control researchers. The proposal will enable the Candidate to use data sources with which has considerable experience to study other clinically relevant issues. He will investigate the recognition of premalignant conditions of the esophagus and its impact on patient outcome, as well as the frequency of use and clinical impact of endoscopic ultrasonography on the diagnosis and treatment of patients with gastrointestinal cancer. In addition, we will develop expertise in the use of pharmacy databases to study the protective effects of nonsteroidal anti-inflammatory drugs on colorectal cancer incidence. The resources of this award will also enable aim to develop an infrastructure that will provide the necessary data and research support to train junior investigators in the use of large databases to conduct cancer related health services research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: LINKING MOTHER AND CHILD ACCESS TO DENTAL CARE Principal Investigator & Institution: Grembowski, David E.; Professor; Health Services; University of Washington Seattle, Wa 98195
40
Medicaid
Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by investigator): Background. Healthy People 2010 and the U.S. Surgeon General's report, Oral Health in America, indicate that caries is a severe oral health problem among low-income, minority preschool children that is compounded by low access to dental care. Potential solutions to this problem may exist in the linkage between mother and child access to dental care. If low-income mothers have a regular source of dental care (RSDC), oral health benefits may accrue to both mother and child through biological and dental care mechanisms, but little is known about these associations. Aims. Among children aged three-to-six years old and enrolled in Medicaid dental insurance in Washington state (N=115,853), study aims are: 1) to measure the percentage of mothers with a RSDC and identify the determinants of mothers having a RSDC; 2) among mothers, to determine whether having a RSDC is associated with greater dental knowledge, oral health behaviors, dental satisfaction, better self-reported oral health, and less reparative treatment and work loss due to dental care; 3) among children, to determine whether having a mother with a RSDC is associated with greater utilization of dental care and better oral health; and 4) among children, to determine whether children with mothers losing dental coverage have less dental utilization than other children. Methods. Aims will be achieved through a prospective cohort study design composed of a baseline survey of mothers and one-year follow-up of children's dental utilization from Medicaid dental claims. Disproportionate stratified random sampling will select Medicaid households with children aged threeto-six years in four racial/ethnic strata (White non-Hispanic (n=3,050), Hispanic (n=4,511), African-American (n=6,100), and other race/ethnic groups (n=4,518). At least 780 sampled mothers will complete a baseline telephone or mail survey. One year later, Medicaid dental claims for one-year pre/post-survey will be extracted for sampled children. Separate regression analyses will be conducted for each racial/ethnic stratum. Aim 1 analyses will identify factors associated with mothers having a RSDC. Aim 2 analyses of mothers will determine the association between having a RSDC and knowledge and attitudes about dental care, oral health behaviors, and dental utilization. Aim 3 analyses of children will determine whether having a mother with a RSDC is associated with greater dental utilization in the prospective year. Aim 4 analyses of children will determine whether mothers' loss of dental insurance results in fewer children dental utilization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LONGEVITY AND ELDERLY HEALTH CARE EXPENDITURES Principal Investigator & Institution: Norton, Edward C.; Associate Professor; Health Policy & Administration; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 15-APR-2000; Project End 31-MAR-2003 Summary: (Adapted from the Applicant's Abstract): Rapid aging by the United States population over the next several decades is expected to have profound effects on aggregate health care costs. Health care costs are expected to increase because babyboomers will swell the number of elderly, health care expenditures generally increase with age, the elderly are living longer, and technological change will increase the cost of medicine if it continues to increase at historical rates. However, four factors may mitigate the problem. Health care expenditures depend in part on time until death, with higher expenditures prior to death, so increased longevity may merely push expenditures further into the future. A growing percentage of Medicare beneficiaries are enrolling in Medicare managed care, which may slow the growth of expenditures. Male
Studies
41
longevity has increased faster than female longevity, meaning that fewer elderly are widowed, which is a major risk factor for expensive long-term care. Finally, disability rates have been declining over at least the last decade. In the first part of the study the investigators will analyze per person annual health care expenditures as a function of age, time until death, their interaction, insurance (FFS vs. HMO), functional status (ADLs and IADLs), and demographics using seven years of the Medicare Current Beneficiary Survey. The analysis will focus on total health care expenditures by all payers for elderly Medicare beneficiaries, for both standard fee-for-service and HMO beneficiaries. They will also look at three specific types of expenditures: inpatient hospital care, home health, and nursing home. Payer types include Medicare, Medicaid, out-of-pocket, and other payers. In the second part of the study they will simulate future health care expenditures by combining our empirical results with available estimates of changes in the key parameters--mortality, functional status, other demographics, insurance, and technological change. The MCBS panel data will enable them to use their own estimates of the increase in managed care coverage and the decrease in disability rates, as well as other sources. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LONG-TERM CARE INSURANCE: THE PURCHASE DECISION Principal Investigator & Institution: Cramer, Anne T.; None; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2003; Project Start 01-JAN-2004; Project End 31-DEC-2005 Summary: (provided by applicant): The need for long-term medical care has been increasing in recent years and is projected to continue in the years ahead. With this increase, there is much concern about how to pay for the long-term medical care. Because of the potential drain on public funds, there is interest in identifying what circumstances motivate private purchase of long-term care (LTC) insurance and what options individuals have if they choose not to purchase LTC insurance. The goal of the proposed study is to develop, extend, and publish findings about the LTC insurance purchase decision. Specific aims of the proposal include: 1) Expand preliminary findings which suggest that family circumstances are influential in the original purchase decision, while price and income considerations become more important in the renewal decision. 2) Explore the relationship between LTC insurance and other products, such as Medigap, Medicare HMO, and retiree health insurance. 3) Explore the relationship between LTC insurance and care alternatives such as nursing home care and care giving at home. An understanding of the LTC insurance purchase decision is critical in ensuring continued access to long-term medical care for seniors. It will allow us to assess the potential for encouraging private purchase and will allow us to evaluate the appropriateness of public funding. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: MAJOR MENTAL DISORDERS AND HIV--HEALTH SERVICES USE Principal Investigator & Institution: Crystal, Stephen; Research Professor; None; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, Nj 08901 Timing: Fiscal Year 2001; Project Start 20-AUG-2000; Project End 31-JUL-2003 Summary: This study will investigate the provision of health care services to a statewide population of HIV-positive Medicaid participants whose service needs are complicated by major psychiatric comorbidities, particularly schizophrenia and schizoaffective disorder. The overall objective is to generate much-needed knowledge about care of
42
Medicaid
these persons so that policies and programs, which have largely been developed on the basis of findings from inpatient samples, can better address their complex needs. The research will use a unique database created by merging multiple New Jersey Medicaid administrative and claims records with HIV/AIDS Registry data, covering the years 1988-1999 for 8,996 individuals, including (according to preliminary classifications) 577 who received at least one inpatient or two outpatient diagnoses with schizophrenia or schizoaffective disorder, with a mean of 55 encounters with schizophrenia diagnoses. We will also examine, as a secondary focus, individuals diagnosed with mood disorders including bipolar disorder and recurrent major depressive disorder, and will explore the association between combinations of psychiatric and substance abuse comorbidities and use of health care services. The study will examine the types and combinations of psychiatric diagnoses reported by health care providers during health care encounters with HIV+ persons on Medicaid; refine claims-based diagnostic classifications; explore the impact of psychiatric conditions on the types and amounts of health care services used over the course of HIV; analyze receipt of mental health services and the type and consistency over time of psychotropic use; and examine the relationship between comorbid major mental disorders, with and without comorbid substance abuse, and patterns of antiretroviral therapy including type of regimen, incidence of use, consistency of use over time, and dropout from treatment. Results of these analyses will provide an important information base for the development of policies and programs to improve the care of this under-studied group within the population living with HIV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICAID MANAGED CARE & ACCESS TO ALCOHOL TREATMENT Principal Investigator & Institution: Mcfarland, Bentson H.; Associate Professor; Oregon Research Institute 1715 Franklin Blvd Eugene, or 97403 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2005 Summary: (provided by applicant): This project has been completely re-designed to have both descriptive and analytical components addressing treatment utilization by Medicaid clients with alcohol problems. This topic remains significant since Medicaid has undergone substantial change in the last decade as states have replaced fee for service programs with managed care systems such as capitation. Early studies in individual states indicate that these changes may have had considerable impact on Medicaid clients' use of alcohol and drug abuse treatment services. However, there are no published national studies pertaining to these issues. The project will make use of information contained in the Treatment Episode Data Set, Medicaid Eligibility file, Uniform Facility Data System, the Substance and Mental Health Services Administration's Managed Care Tracking System, the National Association of State Alcohol and Drug Abuse Directors annual surveys, and other national data sets. The national data will be combined so as to obtain information on a state by state and year by year basis. Tables and graphs will be produced describing changes in state substance abuse treatment policies for and use of services by Medicaid clients with alcohol problems. In the analytic phase of the project the researchers will generate statistical models of access to alcohol and drug abuse treatment services by Medicaid clients that adjust for state by state and year by year variation in Medicaid enrollment, treatment program availability, and prevalence of alcohol problems in the Medicaid population, among other covariates. Hypotheses pertaining to changes over time in service use, client severity, and treatment modality will be tested. The investigators will explore application of hierarchical models and latent variable growth curves to the national data
Studies
43
sets. The results will be of considerable interest to state Medicaid and alcohol drug abuse program directors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICAID MCO'S AND SUBOPTIMAL PEDIATRIC CARE Principal Investigator & Institution: Cooper, William O.; Pediatrics; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2006 Summary: (provided by the applicant): The candidate is a pediatrician committed to improving equity in childhood healthcare outcomes, especially for low-income children enrolled in Medicaid. Career development activities for the award period arise from three primary goals: 1) become a state-of-the-art child health services researcher; 2) establish a child health services research center; and, 3) increase national visibility for child health services research in high-risk, vulnerable children. The career development plan uses adult learning theory as a basis for designing and implementing specific objectives for each goal. Plans for achieving each objective include formal instruction, interaction with collaborators, practical applications, and self-evaluation and feedback. An advisory group of internal and external senior faculty will meet semi-annually with the candidate to provide feedback and guidance on progress towards stated goals and objectives. The aim of the candidate's research proposal is to examine the effect of Medicaid managed care organizations (MCOs) on access to specific recommended care for children with asthma, as individual MCOs may have conflicting incentives for authorizing care or providing resources for care. The study will compare MCO's with respect to suboptimal use of preventive medications for asthma among approximately 24,000 children with moderate to severe asthma in Washington State and Tennessee. The study will be conducted using a Medicaid research database, linked with vital records and U.S. Census data in Washington State and Tennessee. Additional studies will apply new research methodologies and will be directed at augmenting study findings by addressing recognized limitations of the proposed studies. These evaluations will increase understanding of inequities in care for children and will allow for future interventions to reduce disparities for vulnerable children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: MEDICAID MGD CARE FOR CHILDREN WITH SPEC HLTH CARE NEEDS Principal Investigator & Institution: Mitchell, Jean M.; Professor; None; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: The substantial increase in Medicaid enrollment in capitated plans has raised a number of concerns regarding the delivery of child health care in the U.S. because the financial incentives to control costs inherent in such plans may elicit under-treatment and restrict access to specific treatments, services and specialty providers (Hughes and Luft, 1998). Policymakers also recognize that the shift to Medicaid managed care is likely to have the most profound impact on poor children with chronic or disabling conditions (Fox and McManus, 1998). On the other hand, capitated managed care plans offer several advantages such as care management and coordination of services. Despite the widespread growth of managed care in recent years, little research has examined the effects of managed care arrangements, in particular capitated plans, on utilization of and access to health care services by children with special health care needs (SHCN). We
44
Medicaid
propose to analyze Medicaid eligibility, claims and encounter data for children with SHCN (as determined by eligibility for Supplemental Security Income (SSI)) enrolled in the DC Medicaid program. In addition, we will conduct interviews with parents of children with SHCN to evaluate access to care. Currently, some parents of children with SHCN who qualify for SSI have chosen to voluntarily enroll their child in the capitated managed care plan, while the remainder have opted to remain in the traditional fee-forservice system. As of October 2000, enrollment in capitated managed care will be mandatory for all children with SHCN. Parents will have a choice between two capitated managed care plans. The specific aims of this study are: (1) to prepare detailed case studies for the managed care plans; (2) to analyze factors determining selection of a managed care plan by the parents of children with SHCN; (3) to evaluate the effect of plan choice, child health status, and other characteristics on utilization of services based on several indicators constructed from claims data; (4) to conduct a telephone survey with a random sample of 1,200 parents of children with SHCN to elicit information on why parents have difficulties obtaining access to care for their children; and (5) to conduct a pilot study to obtain information on children's access to care from about 100 parents of children with SHCN who reside in households without telephones. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICAID ALTERNATIVES
VS.
PREMIUM
SUBSIDY:
OREGON'S
CHIP
Principal Investigator & Institution: Mitchell, Janet B.; President; Center for Health Economics Research 411 Waverly Oaks Rd, Ste 330 Waltham, Ma 02452 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-DEC-2003 Summary: Oregon provides a unique laboratory to study how CHIP has improved access to health insurance and medical care for low-income children. Oregon has chosen to offer two very different CHIP health insurance options: (1) a Medicaid "look-alike" program; and (2) a premium subsidy program. Eligibility requirements are identical under both programs (up to 170 percent of FPL). The Medicaid CHIP program is virtually indistinguishable from Oregon's regular Medicaid program. The premium subsidy CHIP program is run by a separate state agency and assists low-income children in buying insurance either through their parent's employer or through the individual market. Unlike the Medicaid CHIP program, however, the premium subsidy program does require some modest cost-sharing. This study will identify the factors leading parents to seek publicly subsidized health insurance, which insurance option they choose, and the cumulative impacts of these decisions on children's access to medical care, with a special emphasis on Hispanic children. The cross-sectional component of this study will consist of a telephone survey of the parents of three groups of children (with an oversample of Hispanic children): children enrolled in the Medicaid look-alike program, children enrolled in the premium subsidy program, and uninsured children. The survey will focus on insurance-seeking behavior, usual source of care, access and utilization, and satisfaction. The longitudinal component will follow children over time using secondary data to examine turn-over in CHIP eligibility. A postcard survey will be conducted of all children who do not re-apply for CHIP coverage when their eligibility period expires. Understanding the perceived benefits and liabilities of the two CHIP options will assist policymakers in making programmatic changes to help increase enrollment. This study will also shed light on whether one of the two CHIP programs is more successful than the other in attracting Hispanic children and securing access to medical care for them. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies
•
45
Project Title: MEDICAL MANAGEMENT OF CHILDREN WITH CHRONIC CONDITIONS Principal Investigator & Institution: Connell, Frederick A.; Associate Dean for Academic Affairs; Health Services; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: Although it is frequently advocated, that children with chronic or complex medical conditions should have a "medical home", there is remarkably little empirical information in the literature about what (or who) constitutes a medical home and the extent to which children with chronic conditions actually have medical homes. The aims of this project are: 1. To develop operational definitions that can be used with claims data to identify a child?s "medical home"; 2. To characterize the kinds of providers that serve as medical homes for children with chronic diseases; 3. To determine whether demographic and medical severity factors are associated with a) having a medical home and b) with having certain kinds of providers serving as medical homes; 4. To determine whether certain kinds of health insurance types a) promote the establishment of a medical home and b) promote certain kinds of providers serving as medical homes. Claims data from Medicaid and from three of Washington States largest private health plans, on approximately 30,000 children with either asthma, diabetes, cerebral palsy, or low birth weight will be used to develop a measure of "medical home" and to study the relationships between demographic factors, disease severity, and plan features and the use of medical homes by children with chronic conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: MEDICARE + CHOICE AND MINORITY ELDERLY Principal Investigator & Institution: Morgan, Robert O.; Associate Professor; Medicine; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Medicare is specifically mandated to provide health care services to elderly and/or disabled United States residents, as well as those with end stage renal disease. Although Medicare has been successful in dramatically improving both the access to care and the overall health of its constituents, studies have shown inequalities in care associated with the race/ethnicity of Medicare beneficiaries. On the surface, Medicare health maintenance organizations (HMOs) appear to address some of the factors associated with these inequalities, however, the Medicare HMO program, now called Medicare+Choice (M+C), is itself undergoing substantial program changes as a result of the Balanced Budget Act (BBA) and subsequent revisions, e.g., the Balanced Budget Revision Act (BBRA) and the Benefits Improvement and Protection Act (BIPA). This study has two broad objectives. First, we will determine individual level characteristics related to M+C plan enrollment among elderly White, Black, and Hispanic Medicare beneficiaries, whether the factors which elderly Black and Hispanic beneficiaries report as influencing their enrollment in HMOs differ from those that influence elderly White Medicare beneficiaries, and whether elderly Black and Hispanic beneficiaries enrolled in HMOs differ from HMO enrolled elderly White beneficiaries in terms of their self-reported health, use of health care, and perceived access to care. Second, we will examine the availability of Medicare HMOs and benefit packages for beneficiaries of differing race/ethnic classifications, how HMO enrollment rates are related to race/ethnic classification and range of plan benefits, and how the availability of HMOs and HMO enrollment by different race/ethnic groups changed subsequent to implementation of BBA provisions. We will use both survey and population-based
46
Medicaid
(using Medicare administrative data and other population-based data) methodologies to examine individual and system level factors affecting access to and use of medical care, the availability of plans and services, and plan selection by enrollees. This study will provide the first comprehensive examination of both individual and system level factors affecting minority use of the Medicare HMOs, and will provide needed information on how the evolving Medicare system is affecting health care for Black and Hispanic Medicare beneficiaries. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MEDICARE EDUCATION AND DECISION SUPPORT TOOLS Principal Investigator & Institution: Mcarthur, Lynne; Johnson, Bassin and Shaw, Inc. 8630 Fenton St, 12Th Floor Silver Spring, Md 20910 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JAN-2004 Summary: (provided by applicant): Who will care for aging baby boomers? They will likely have to do it themselves. The need to educate boomers about the extent of the problems they will face in obtaining affordable health insurance and assisted-living services is abundantly clear. To date, boomers have tended to "turn a blind eye" to these issues, partly out of ignorance and partly out of denial that they will ever need these services. Medicare, Medigap, M+C, Medicaid, and private health insurance eligibility, enrollment, dis-enrollments, coverage, and costs have become a maze of complexity. Government sources of information are inadequate and often not sought until a crisis occurs. Our firm, JBS, runs the Centers for Medicare and Medicaid Services' national resource center in support of all state health insurance and counseling programs We believe that the private sector can develop some informational products that will better enable boomers to plan for and use long-term health insurance options. The proposed products are CD-based interactive software, a "Medicare Game," a Dummies-type book that would make Medicare understandable, a toolkit for retirement planners and human resources professionals, and a Web site. Our SBIR goals are to develop prototype products, assess interest of likely distributors, and evaluate commercial viability. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: MEDICATION USE IN ASSESSING AND IMPROVING ASTHMA CONTROL Principal Investigator & Institution: Hartert, Tina V.; Assistant Professor of Medicine; Medicine; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2004 Summary: Medication and physician prescribing practices have a significant impact on the course of asthma. Several studies have documented that the major factors contributing to asthma morbidity are under-diagnosis and inappropriate treatment (1995 NHLBI/WHO Workshop Report). The objectives of this application are to study the relationship between asthma control and medication utilization. This application proposes to extend a retrospective analysis of the Tennessee Medicaid population to determine risk factors for asthma exacerbations requiring hospital care, to characterize medication utilization patterns that predict such events, and to develop a management scheme based on identification of medication use through a pharmacy-based drug utilization program. We hypothesize that there are timely predictors of asthma exacerbations requiring hospital care in high-risk populations, and that these predictors should be utilized in clinical practice to both identify those at risk and initiate appropriate clinical management. To test this hypothesis we will use an existing
Studies
47
retrospective database to determine patterns of beta-agonist use and prescribing that predict asthma exacerbations requiring hospital care or corticosteroid rescue. We will then test whether these usage patterns predict asthma exacerbations using prospective data, and test a beta-agonist utilization management strategy in clinical practice. The ultimate goal of these analyses will be to (1) develop a computerized pharmacy-based drug utilization review program to identify, in a timely manner, those patients at a high risk of an asthma exacerbation, as well as physicians with high-risk patients and inadequate prescribing practices, and (2) develop a step-wise approach of asthma management based on an objective drug utilization strategy. In specific aim #1 we propose to define medication utilization patterns that predict asthma exacerbations requiring hospital care or systemic corticosteroid rescue. We hypothesize that betaagonist utilization is a predictor of such asthma exacerbations. To test this hypothesis we will utilize the Tennesse Medicaid Database. In specific Aim #2 we will perform a prospective case-crossover study of medication utilization in asthma patients requiring hospitalization. We hypothesize that for high risk asthmatics requiring hospital care, quantification of beta-agonist use, rather than the standard measures of using peak expiratory flows or symptom reporting, is a better means of predicting disease exacerbation. In specific aim #3 we propose to develop a management strategy in high risk asthma patients using medication utilization patients via a computerized pharmacy identification system and a stepwise management modality based on beta-agonist use. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MENTAL MANAGED CARE
HEALTH
SERVICES
RESEARCH
PROGRAM
IN
Principal Investigator & Institution: Mclaughlin, Thomas J.; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, Ma 02481 Timing: Fiscal Year 2001; Project Start 10-APR-1998; Project End 31-MAR-2003 Summary: (Applicant's Abstract): As organized systems of care move towards becoming the predominant form of health delivery system in the U.S., managed care organizations are attempting to measure and improve health outcomes per unit cost ("value"). This agenda, characteristic of today's managed care organization, is due in large part to the demands of the marketplace which expects reorganization of the health care system in order to maximize benefit at the lowest possible cost. Harvard Pilgrim Health Care (HPHC) proposes to develop a research infrastructure building program (RISP) of mental health services and clinical research in the context of managed care which complements and extends an existing and highly developed process of clinical quality management and improvement cycles. The proposed work will accelerate and facilitate a continuously emerging mental health infrastructure within this large health maintenance organization. It is likely that processes of skill-building and formation of multidisciplinary research groups "invented" or developed at HPHC will be applicable to other managed care organizations. Specific aims of the proposed RISP are to develop multidisciplinary groups of mental health researchers that will: (1) study the organization, process and outcomes of care for mental illness in primary care. This group will be represented by core individuals from within the different divisions of HPHC, researchers from academic organizations with a solid track record in mental health research and educational training, and representatives from the public sector who are increasingly important actors in defining and evaluating mental health care for their clients; (2) explore mechanisms to link primary care providers to mental health specialists in order to improve access to and outcomes of care for common and expensive mental illnesses such as depression with or without substance abuse; (3)
48
Medicaid
examine experiments in the re-organization of mental health care delivery within staff and medical groups components of HPHC to improve patient and provider satisfaction and care ("hybrid models"); (4) examine patient factors associated with access and particularly patient-directed interventions aimed at facilitating entry into traditional health and mental health programs, (5) and, finally to study the special needs of publicly-insured members, especially Medicaid populations which are characterized by disproportionately high levels of serious and chronic mental illness such as schizophrenia and major affective disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MENTAL HEALTH SYSTEMS AND JUVENILE JUSTICE OUTCOMES Principal Investigator & Institution: Cuellar, Alison; Biostatistics; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): The program of training and research proposed in this Mentored Research Scientist Development Award application is designed to further both the applicant's near-term and long-term career goals. In this near term it will allow her to develop skills in conducting longitudinal studies dealing with the relationship between mental health and juvenile justice systems using large, secondary datasets. In the long-term it will help her develop theoretical models and empirical tests about the behavior of mental health care and juvenile justice systems, the dynamics of their relationship, and their responses to policy change. The proposed training and research program is designed to address three career development needs: 1) develop a knowledge base of the juvenile justice system as it relates to youth with emotional disorders; 2) develop statistical skills in longitudinal data analysis; and 3) train in the responsible conduct of research and scientific communication. This training will facilitate the applicant's pursuit of innovative, comprehensive, and technologically efficient approaches in research on mental health and juvenile justice systems. The research plan is divided into three separate studies which will complement the proposed sequence of training activities and provide the applicant research experience with dynamic modeling using a variety of datasets. The specific aims of the proposed studies are 1) to estimate the impact of major health policy changes, including Medicaid eligibility and mental health managed care, on juvenile crime outcomes, using two separate approaches; 2) to estimate the effects of major policy changes and key organizational structures on the continuity of mental health service delivery for youth exiting the juvenile justice system; and 3) to estimate the effects of a mental health diversion program for youth in the juvenile justice system on criminal outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: METHADONE BENEFIT ELIMINATION--OREGON HEALTH PLAN Principal Investigator & Institution: Fuller, Bret E.; Public Health and Preventive Medicine; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2003; Project Start 25-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): Significant changes in the Oregon Health Plan (OHP) have created a unique opportunity to investigate impacts on patients enrolled in methadone maintenance services when the Oregon State Legislature eliminated payment for methadone maintenance and outpatient chemical dependency services for those under the Medicaid expansion, Oregon Health Plan-Standard. Approximately 5,000 clients in Oregon were enrolled in methadone services and 3,000 were receiving
Studies
49
OHP Standard prior to these cuts. Thus, beginning March 1, 2003, 3,000 patients were required to self-pay in order to continue receiving methadone services. This study is currently following 151 methadone clients recruited in February and March 2003 and randomly selected to participate in this project. The sample selection was a randomized quasi-experimental study of three groups of clients, (a) those who lost their benefits and were removed from methadone involuntarily, (b) those who attempted to pay out of pocket for methadone, (both received benefits under the OHP Standard) and (c) those who retained their benefits through Medicaid (OHP-Plus). The first wave of data collection began in February 2003; with a second wave in the first weeks of April 2003; and a third data collection point is scheduled for June 2003. Interviews with the Addiction Severity Index, Treatment Services Review and Health Risk Behavior Survey and a chart review of clinical data constitute the first three waves of data collection. This application seeks funding for a one-year follow up interview (Wave 4) as a continuation of earlier work funded by the Robert Wood Johnson Foundation and the Oregon Practice Improvement Collaborative. Data from clients' clinical records one year following the beginning of the study and abstraction of data from four Oregon administrative databases that monitor legal, employment, addiction services and Medicaid reimbursements will round out the data collection for this project. All four completed interviews will provide time series data on the Addiction Severity Index scales (drug use, alcohol use, legal problems, medical problems, family problems, employment problems, and psychiatric problems), participation in mental health, addiction treatment and health care services (Treatment Services Review), and HIV risk behaviors (Risk Behavior Survey). The analysis for these data will present characteristics of methadone clients with respect to differences between the three groups. Means, standard deviations and ranges of the ASI composite scores will be presented examining the levels of addiction behaviors that characterize the sample. Demographic variables including age, gender, length of addiction, dosing levels will also be presented at all four waves. Also, a description of how many OHP-Standard patients were able to successfully self-pay for their methadone treatment on their own will be presented. The main part of the analysis will consist of structural equation models that will be used to isolate slopes and intercepts for addiction behaviors over time, examining any differences between the three client groups and the mediators and moderators of these growth curves. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MINIMALLY INVASIVE GLAUCOMA SURGICAL INSTRUMENT Principal Investigator & Institution: Mirhashemi, Soheila; Neomedix Corporation 29412 Clipper Way Laguna Niguel, Ca 92677 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): Glaucoma remains a major public health problem in America and worldwide. It is estimated that about 3 million Americans and over 67 million people in foreign countries suffer from this debilitating disease. Blindness from glaucoma and treatment of glaucoma impose significant annual costs to the United States Government in Medicare, Medicaid, Social Security, and other healthcare expenditures. Current approaches to glaucoma management include pharmaceuticals, surgical methodologies, and surgical drainage implants. Although each of these treatment approaches provides some positive results among certain subsets of patients, there exists a need for a treatment approach that is more universally efficacious and cost-effective. NeoMedix Corporation is developing an innovative, proprietary Atraumatic Goniectomy System (AGS) technology as a surgical treatment for glaucoma.
50
Medicaid
AGS is the first technology to offer the potential for a cost-effective, user-friendly, ab interno surgical procedure to effectively and permanently reduce IOP in glaucoma patients by atraumatically removing a 90x sector of trabecular meshwork overlaying Schlemm's canal in order to re-establish outflow of aqueous humor through the collective channels. Preliminary studies with an early AGS prototype system have demonstrated that sectors of the trabecular meshwork can be rapidly and readily removed without trauma to the underlying tissues of Schlemm's canal. The specific aims of this proposed research for advancing AGS toward commercialization are as follows: 1) design and build an advanced instrument prototype, 2) perform experimental studies to select and optimize design and operating parameters, and 3) evaluate the basic safety and effectiveness of the AGS technology in the freshly harvested human cornea model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MULTIMEDIA LONG-TERM CARE RESOURCE Principal Investigator & Institution: Lantz, Penelope A.; Health Media Lab, Inc. 2734 Cortland Pl Nw Washington, Dc 20008 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 31-OCT-2003 Summary: (provided by investigator): The long-term goal of this project is to develop and evaluate through focus group discussions and questionnaire survey data, a multimedia resource designed to help individuals and caregivers of individuals navigate through the maze of intricacies associated with long-term care planning, and to help them make informed decisions about long-term care options including, type of care, source of care, and how to pay for care. This resource will include a CD-ROM with tutorials, worksheets, common applications, and legal forms; a toll-free telephone helpline staffed by experienced long-term care counselors; and Website resources from Health Media Lab's long-term care Website section, plus links to other Internet resources. We envision the information provided by each of these media as overlapping, although each has its own advantages. For instance, the telephone helpline will offer personalized, one-on-one help. The Website will have tutorials, printable worksheets, links to other resources, and will be updated frequently. The CD-ROM can have much of the same information and tools as the Website, but may be easier to use for people without high speed Internet access. This multimedia resource will be for use by individuals and couples who want to plan for their long-term care, adult children of elderly parents who are caregivers or who monitor care, and spouses, friends, relatives and others who provide care to elders. It will also be useful for professionals, including employee benefits coordinators, public health, medical and nursing personnel, elder care lawyers and others who provide legal assistance, insurance companies, social workers and other senior service providers, and elder care volunteers who assist in educating caregivers about long-term care options. It will help users understand and utilize (or help others to utilize) health insurance, health care, legal and financial issues, medicare and Medicaid, and other long-term care issues for seniors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: NORTHWEST/ALASKA CENTER TO REDUCE ORAL HEALTH DISPARITY Principal Investigator & Institution: Milgrom, Peter M.; Professor of Dental Public Health Scienc; Dental Public Health Sciences; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2008
Studies
51
Summary: This proposal is in response to RFD DE-99-003 to establish the Northwest and Alaska Center for Oral Health Disparity for research to reduce oral health disparities in the Pacific Northwest and Alaska. It is proposed that the Center develop basic and applied knowledge that addresses the needs of poor, minority, and rural children and their caretakers, utilizing approaches that go beyond the traditional strategies from dental public health that have not found success in these populations. While the research in the proposed center may involve traditional dental personnel, it also stresses the roles of pediatricians, mothers as well as children; and preventive agents beyond fluorides. Participants include Alaska Natives, Native Americans from the Yakima Indian Nation, Hispanics from the agricultural areas of Washington, African Americans and Hispanics from the local military reservations, Hispanics and Pacific Islanders served by urban hospitals as well as rural and low-income Whites. We propose to accomplish this goal through five specific aims: (1) To address the needs of the Pacific Northwest and Alaska by conducting clinical research to evaluate the efficacy of nontraditional interventions to prevent and treat oral disease in children and their caretakers; (2) To develop community-based research that translates existing knowledge and new information regarding children and their caretakers into new technologies and interventions that hold promise for reducing disparities in these high risk populations; (3) To expand health science education and research training opportunities for minority populations in the Pacific Northwest and Alaska by collaborations with key minority educational and health serving institutions in the region; (4) To conduct basic research to further understand the role of host defenses and genetic bases for caries and periodontal disease affect underserved populations as well as to probe the biologic basis for antibacterial that change disease susceptibility; and (5) To increase the impact of the center beyond the projects included in this proposal by recruiting investigators and students from minority institutions in the Pacific Northwest and Alaska and prioritizing and encouraging pilot and center-affiliated studies in which they are involved. The collaborating institutions and partners are Heritage College (Hispanic and Native American-serving institution sited on the Yakima Indian Nation), Alaska Native Tribal Health Consortium/Yukon-Kuskokwim Native Health Corporation, Yakima Valley Farm Workers Clinic, Northwest Portland Area Indian Health Board/Northwest Tribal Epidemiology Center, Washington Dental Service an Foundation (major private dental insurer); and Medical Assistance Administration (Medicaid agency for Washington State). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ORAL HEALTH/OHRQOL AMONG LOW-SES RURAL ADULTS Principal Investigator & Institution: Gilbert, Gregg H.; Professor and Chair; Diagnostic Sciences; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): We propose to investigate the influence that oral health has on oral health-related quality of life (OHRQOL), nutritional status, and lifespace mobility among low socioeconomic status (SES) rural adults. We have a rare opportunity to build upon an ongoing study of predictors of life-space change funded by NIA, called the UAB Study on Aging (SOA). The proposed pilot study will initiate a potentially exciting collaboration between two groups of investigators who until now have conducted independent, but related, lines of research. SOA investigators, who have recently identified links between oral health, nutrition, and life-space change, and School of Dentistry investigators, whose research has investigated links between oral health and OHRQOL, will collaborate to build upon the knowledge gained from both
52
Medicaid
lines of research. This research would provide pilot data for a subsequent R01 application that would test six key hypotheses about oral health, OHRQOL, nutritional status and nutritional risk, and change in life-space mobility, with other key predictors taken into account. The SOA is a prospective, observational cohort study of 1,000 community-dwelling adults 65 years old or older. Recruitment was based on a random sample of Medicare beneficiaries residing in five central Alabama counties, stratified by race, sex, and urban/rural area of residence. In-home assessments of hypothesized predictors of life-space mobility change were conducted in 1999-2001. Follow-up telephone interviews have been conducted every six months since. For the proposed pilot study, clinical oral examinations and oral health interview questions will be added to symbiotically complement a rich set of measures already made or planned. Funding this pilot study would allow us to conduct a preliminary study, confirm the feasibility of adding oral health components to this particular cohort of older adults, to preliminarily test hypotheses, and to estimate sample size requirements. This will provide a sound scientific foundation for an R01 proposal to investigate a potentially causative pathway between oral health, OHRQOL, nutrition, and life-space mobility, with a special interest in a potentially highly vulnerable population: low-SES rural adults. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ORGANIZATION AND FINANCING OF CARE FOR THE SERIOUSLY ME Principal Investigator & Institution: Mechanic, David M.; University Professor and Dean; None; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, Nj 08901 Timing: Fiscal Year 2001; Project Start 01-JUN-1988; Project End 31-AUG-2004 Summary: (Applicant's abstract): The Center for Research on the Organization and Financing of Care for the Severely Mentally Ill provides a well developed infrastructure for research and training in mental health services research and policy of direct relevance to improving systems of care, clinical practice, social policy decisions and the function and quality of life of persons with severe mental illnesses. It does so by recruiting talented researchers, providing mentorship and a supportive research structure for their professional development, building interdisciplinary teams to address complex and important services issues, and translating research findings to policymakers, practitioners, families and consumers of mental health services. Core funding is directed toward pilot and developmental studies that are expected to lead to major externally funded initiatives. (Service Innovations) focuses on strategies that can contribute improved treatment effectiveness and quality of life, such as programs to improve medication adherence. Researchers also track changing patterns of services under deinstitutionalization, increasing privatization, and managed care penetration. (Systems Interaction) examines ways of improving communication and cooperation among service systems, efforts to avoid criminalization of persons with mental illnesses, clients with comorbidities, and improvement of services for persons who depend on more than sector of care. (Care Under Constraints) examines how managed care arrangements and health insurance benefit designs affect access to care, utilization of services, appropriate treatment and outcomes. This core focuses particularly on Medicare and Medicaid programs that are of central importance to persons with severe mental illnesses. (Assessing Needs and Costs) addresses assessment and measurement of need for services, provision of care that is appropriate and accessible to different cultural and age groups, and improved standards and practices of cost effectiveness analysis. The Outreach Care fosters collaboration and communication with key groups to ensure the policy and practice applicability of the Center's research. The Development
Studies
53
Core includes well-developed postdoctoral, doctoral, and undergraduate programs in mental health services research. Skill-building workshops and research seminars promote dialogue on ongoing research results and the use of state-of-the-art research methods. Interdisciplinary teams working in each core area receive technical assistance from Center experts in five key areas: measurement of client outcomes; family burden; cost outcomes; cultural diversity; and policy significance. Well-defined processes have been developed for mentorship, peer review, and the translation of important knowledge to those who can use it. The Center brings together a critical mass of mental health services researchers whose work aims to combine solid social science with practical policy relevance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OUTCOMES FOR PROLONGED MECHANICAL VENTILATION Principal Investigator & Institution: Kitch, Barrett T.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 23-SEP-2002; Project End 31-AUG-2006 Summary: (provided by applicant): The applicant?s long-term interests are to improve the quality and efficiency of care for patients with critical illness by conducting outcomes, health services and health policy research in this field. A specific, current interest is patients with prolonged mechanical ventilation following acute respiratory failure. These patients appear to have a high short-term mortality rate, require intensive technical and personnel support, and are increasingly receiving care in non-ICU settings, such as long-term acute care facilities. Existing data on the incidence, patient and clinical characteristics, and clinical outcomes (e.g. duration of illness and mortality) are limited by such factors as selection bias and small study size. No data exist on the extent to which non-ICU settings are used to care for these patients, and limited information exists on determinants of long-term care hospital utilization or on comparative outcomes for this model of care. This proposal will utilize national Medicare data to define the epidemiology, clinical outcomes and predictors of these outcomes for elderly Medicare patients with prolonged mechanical ventilation. Also using this national database, long-term acute care hospital utilization, associated patient and clinical characteristics, and its impact on clinical outcomes will be explored. Focus group and physician survey work will be employed to determine at a more detailed level factors associated with utilization of long-term care hospitals, including physician attitudes and perceptions of quality of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: PARTNERS IN CARE FOR CHILDREN Principal Investigator & Institution: Zima, Bonnie T.; Associate Professor; None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-JUL-2007 Summary: (provided by applicant): This application is in response to Program Announcement, "Research on Quality of Care for Mental Disorders (PA -95066). It is a second revised ROI application that is being submitted by a new investigator. Partners in Care for Children (PCC) is a quality of care study for children with Attention Deficit Hyperactivity Disorder (ADHD) in public primary care (PC) and carve-out specialty mental health (SMH) sectors enrolled in a managed care Medicaid program. This project addresses a critical need of service delivery systems that care for public-sector children.
54
Medicaid
Namely, it will provide systematically collected longitudinal data on the clinical processes and outcomes among representative samples of children served in and across both major care sectors, and develop an innovative approach to meaningfully evaluate quality of care over time that is adjusted for child outcomes. These distinctions are critical because ADHD is a major public health problem in children that requires chronic care and is often accompanied by severe functional impairment and long-term adverse developmental outcomes. Nevertheless, evidence for ADHD treatment effectiveness is available, and practice parameters for ADHD care in PC and SMH care settings are established. Yet, in light of these advances, recent community-based studies suggest that ADHD is under-treated and inappropriately treated. Thus to inform the development of quality improvement interventions for public sector children with ADHD, PCC?s aims culminate to reach the goal of identifying child, provider and system characteristics that are related to poor care. Further, to translate PCC findings into practice, we have received strong commitment from public agencies and managed care organizations that this study?s findings will be used to develop quality improvement programs. Using a county-wide sample of children, aged 5-11 years, who are enrolled in a large managed care Medicaid program and have had at least one past year contact with public sector outpatient PC or carve-out SNM services, PCC proposes to meet the following aims: 1. To determine the proportion of children who meet ADHD diagnostic criteria or have a history of past year stimulant medication use among those who are identified as having a disruptive behavior problem in public primary care and specialty mental health care settings, adjusting for confounding parent and child sociodemographic factors. Within this aim, the objectives are: a. to examine the level of ADHD diagnostic accuracy in public primary care and specialty mental health care settings. b. to determine the rate of stimulant medication use among children who do not meet ADHD diagnostic criteria in public primary care and specialty mental health care settings. 2. To develop needadjusted indicators of poor quality of care that are applicable to this study population using the RAND/IJCLA appropriateness method, a well-established approach that derives criteria from both outcomes evidence tables and judgments from a multidisciplinary expert panel. 3. To examine the clinical processes, appropriateness of care, and outcomes over time (at 6, 12 months) of children who meet ADHD diagnostic criteria and are treated in public primary care and specialty mental health care settings, adjusting for confounding parent and child factors. Within this aim, the objectives are: a. to describe the clinical processes (diagnosis, assessment, treatment, follow-up), appropriateness of care, and outcomes at the child, family, environment and system levels in public primary care, specialty mental healthcare and co-managed care. b. to identify child, provider and system characteristics that are associated with clinical processes, appropriateness of care and outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PATIENTS, CLINICS, AND SYSTEMS: SCREENING FOR ALCOHOL Principal Investigator & Institution: Chang, Grace; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 24-SEP-1999; Project End 31-AUG-2004 Summary: The majority of patients with alcohol problems present to general medical and other clinical settings, rather than directly to alcohol treatment. The consequences of untreated alcohol problems are well known, and include a whole range of medical and social complications. The identification and treatment of alcohol problems, when patients present for prenatal care, emergency services, or a medical appointment, has been a longstanding clinical research interest. A Midcareer Investigator Award in
Studies
55
Clinical Research would allow the applicant to focus on patient-oriented research interests during a critical professional period. The purpose of the current project, "Alcohol Abuse in Bone Marrow Transplant," is to test the hypothesis that alcohol abuse or dependence has an adverse impact on survival after bone marrow transplant, the second most frequent major organ transplant in the United States and the transplant with the least limited donor organ supply. A prospective cohort study of 124 patients with Chronic Myeloid Leukemia undergoing allogeneic bone marrow transplant is underway. The purpose of the proposed project, "Alcohol Screening in Medicaid Managed Care," is to test the hypothesis that routine alcohol and substance abuse screening of Medicaid members at health plan (HMO) enrollment is less effective than alcohol and substance abuse screening at the HMO primary care site. A sample of 2,000 Medicaid enrollees screened at enrollment will compared with a sample of 715 patients who will be screened for alcohol and substance abuse as they initiate care at primary care HMO sites. Their utilization of alcohol and substance abuse treatment, psychiatric and medical treatment for 12 months subsequent to screening will be compared. A sample of 150 patients with positive primary care screens will be studied more intensively. Both of these studies will focus on patients, but will have important practice and policy implications, as transplant medicine and managed care are increasingly prevalent and underscore the need for alcohol and drug screening of patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: POPULATION MODELS OF FACTORS AFFECTING HEALTH TRENDS Principal Investigator & Institution: Manton, Kenneth G.; Professor; Center for Demographic Studies; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: This Program Project is designed to examine the recent changes in chronic disability and functioning in the U.S. elderly populations, possible sources of those changes including the introduction of the Medicare program and, more recent, biomedical research and therapeutic innovations and the future Medicare service use and cost implications of those changes and the processes underlying them. The work builds upon a significant body of research done at CDS on the analysis and forecasting of chronic disability and health changes in the U.S. elderly population. However, that model needs to be significantly expanded in scope of adding input from economists detailed analyses of Medicare expenditures, and a more in depth analysis of specific omp0onents of health changes (e.g., dementia, stroke). To perform these analysis we have assembled a multi-disciplinary team to carry out a well integrated set of analyses. To conduct those analyses one first defines three core functions. The first (A) is longitudinally linked files but also continuous linked Medicare records which will be kept current as the project is underway (i.e., we should have Medicare data from 1999 in hand with data for 2000 shortly available thereafter; later data will be available to 2001). The third core (C) will make general health forecasts. The four projects involve (1) methodological expansion of the health model to include data from multiple sources; (2) analysis of cohort different in health and Medicare service use; (3) analyses of the natural history of Medicare expenditures; (4) analyses of the recent changes in dementia and stroke and their health cost implications These projects are all designed to take advantage of the three cores and to be integrated so that their results will help resolve the basic questions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
56
•
Medicaid
Project Title: POST-BBA CHANGES IN RURAL HOSPITAL LTC STRATEGIES Principal Investigator & Institution: Fennell, Mary L.; Center for Gerontology and Health Care Research; Brown University Providence, Ri 02912 Timing: Fiscal Year 2002; Project Start 15-AUG-1996; Project End 31-MAY-2005 Summary: (provided by applicant): The ongoing implementation of the 1997 Balanced Budget Act (BBA) and the 1999 Balanced Budget Refinement Act (BBRA) continues to adversely affect reimbursements to hospitals and post-acute/long-term care providers. Reimbursement incentives in each setting may be having the practical effect of limiting access to care for Medicare patients requiring complex and costly services, thus further fragmenting the fee-for-service (FFS) continuum of care for the most vulnerable Medicare beneficiaries. A fragmented continuum of care is especially problematic in rural areas, where disruptions can leave large gaps in access to care if the strategic options of providers are constrained or inter-provider relationships (e.g., hospital to nursing home) are weak. Although the intended effects of the BBA and BBRA were to control costs, there are a wide range of possible unintended effects on rural hospitals, their hospital-based nursing homes and home health agencies, and the relationship between hospitals and external post-acute and long-term care providers. The unintended effects on rural hospitals may involve their adoption and/or abandonment of integration strategies, which in turn may affect the care of rural Medicare beneficiaries as well as the overall financial performance of rural hospitals. The results of our earlier study of rural hospitals and their post-acute and long-term care strategies offer a unique baseline from which to examine the unintended effects of the BBA and BBRA. We plan to address three specific aims: (1) To assess how the BBA and BBRA have affected the organizational strategies of rural hospitals to either diversify into longterm care or link to external providers of long-term care; (2) To assess the impact of BBA and BBRA-related strategic behavior on the timing and placement of discharges among at-risk Medicare patients treated in rural hospitals; and (3) To assess the impact of BBA and BBRA-related strategy changes on the financial performance of rural hospitals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: PRESCRIPTION DRUG COST-SHARING: AFFORDABILITY/SAFETY Principal Investigator & Institution: Hsu, John; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 94612 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: (Provided by applicant) Cost-sharing is a commonly used mechanism to control prescription drug costs; there is, however, a lack of information on how drug cost-sharing affects clinical outcomes and total medical costs, which is particularly concerning given that the most extreme version of cost-sharing (no coverage) is associated with poor health, and that poor drug adherence may lead to higher downstream medical costs. To address these issues, we propose to evaluate the effects of the level of drug cost-sharing on patient clinical outcomes and total direct medical costs between 2000-2005, using a quasi-experimental pre-post design with concurrent controls, within the Kaiser Permanente (KP) integrated health delivery system. In this natural experiment, nearly half of the 330,000 members age 65 years and older experienced a new pharmacy benefit cap on January 1, 2001; and 70% of these same members experiencing a new multi-der drug co-payment during the following year (1/1/2002). The level of cost-sharing will be the main predictor, with co-payment levels in effect until patients exceed their benefit cap if any, and "full costs" applicable after patients exceed their cap. The main outcome measures are emergency department (ED)
Studies
57
visits, hospitalizations, deaths, and total annual direct medical costs, i.e. the sum of all outpatient, inpatient, and pharmacy costs (including patient out-of-pocket drug costs). We will investigate these outcomes by the level of cost-sharing within the Overall Population (age 65 years and older on 1/1/2000), and within select Vulnerable Populations, i.e. patients with low socio-economic status (SES), existing chronic diseases, existing high drug use, or those who are new to the health system. We will use a proportional hazard model to test the hypothesis that higher levels of cost-sharing are related to higher rates of adverse clinical outcomes, and a two-part model to test the hypothesis that higher levels of cost-sharing are related to lower total direct medical costs. We will have the ability to detect even small changes in our outcomes, e.g. 80% power to detect a difference of one death/1,000 person-years. We will make adjustments for relevant patient and organizational factors, such as measures of SES, case-mix, physician, and medical center. These factors may influence drug use independently or modify, the association of cost-sharing level and patients' decisions to use prescription drugs. In short, there is a tremendous need to understand the safety and economic effects of cost-sharing as its use increases, in other words primum non nocere. This study will be the first to address these issues within a broad sample of Medicare beneficiaries. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PRIMARY CARE PROVIDER AND PREVENTIVE ORAL HEALTH Principal Investigator & Institution: Lewis, Charlotte; Route 1, Box 216; Pediatrics; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2006 Summary: This K23 proposal is from a pediatric physician who has a history of a strong interest in oral health in children, and the development of the pediatrician as a positive force in assuring that appropriate attention is paid to oral health in young children. Poor and minority children are disproportionately affected by dental caries and are more likely to have difficulty accessing dental care. Low-income children may have more secure access to regular visits with Primary Care Health Providers (PCHPs). Using the PRECEDE-PROCEED model as a planning framework, this proposal aims to assess the feasibility of a health care model in which PCHPs are substantially involved in oral health. Five interrelated projects seek to determine how PCHPs can successfully expand their scope of practice to include preventive oral health from the provider, practice, and patient-parent perspective. Analysis of Washington State Medicaid claims data will be performed to measure the degree to which PCHPs have unique opportunities to provide preventive oral health counseling and care to their low-income patients who otherwise are not accessing dental care. The final project will be a randomized trial using a pretestposttest design. The PCHP practices will be randomly selected to participate in an expanded oral health preventive package. Control practices will receive limited intervention. The number of claims submitted to Medicaid for fluoride varnish application, as an indicator of expanded PCHP involvement in preventive oral health, will be compared between treatment and control practices. At the completion of these projects, it is expected to have developed a rich model whereby PCHPs may expand their involvement in preventive oral health as a means to improve access to preventive dental care for underserved and other vulnerable groups of children. In addition, this career development award is expected to provide to Dr. Lewis the didactic and experiential training necessary to become an independent clinical investigator focusing on pediatric and dental health services research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
58
•
Medicaid
Project Title: PROSTATE CANCER SCREENING & MORTALITY: SEATTLE VS. CT. Principal Investigator & Institution: Barry, Michael J.; Associate Professor and Director Medical; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-MAR-2005 Summary: This is a resubmission of a previous grant. The investigators propose to assess the outcomes of a "natural experiment" to determine whether aggressive early detection and treatment efforts are effective at reducing prostate cancer mortality for Medicare beneficiaries. In the United States, clinicians in the Seattle SEER area were much more aggressive in trying to detect prostate cancer early (particularly with the prostate-specific antigen or PSA test) and treat it aggressively (particularly "PSA era" (1987-1990). During the pre-PSA era, population-based prostate cancer mortality in these two are and was essentially identical. Their natural experiment focuses primarily on cohorts of about 75,000 men in Seattle and 95,000 men Connecticut who were age 65-74 (with at least a 10-year life expectancy) and who were residents of their respective regions through at least through 1990. During the period 1987-1990, they have already determined that the men in the Seattle cohort were about twice as likely to undergo prostate biopsy, twice as likely to be diagnosed with prostate cancer, and six times as likely to undergo a radical prostatectomy than men in the Connecticut cohort. In fact, the cumulative incidence of radical prostatectomy in the Seattle cohort from 1987- 1997 was over 3% (about the proportion of men in this cohort who would ultimately be expected to die of prostate cancer) compared to less than 1% in the Connecticut cohort. They propose to continue follow-up of these two cohorts through calendar year 2001, or 15 years from inceptions of the cohorts. Over this interval, they would expect to see a reduction in population-based prostate cancer mortality Seattle as compared to Connecticut if early detection and aggressive treatment as actually practiced in the community are indeed an effective strategy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: RCT ON PREVENTING PRESSURE ULCERS WITH SEAT CUSHIONS Principal Investigator & Institution: Brienza, David M.; None; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 25-JUN-2003; Project End 31-MAY-2008 Summary: (provided by applicant): Pressure ulcers (PU) are a significant healthcare problem for the growing number of United States (US) elderly long-term care (LTC) residents. PU diminish quality of life, exact a devastating loss of function, increase the risk of death in geriatric populations and raise healthcare costs. Despite Federal preventive mandates for the long-term care (LTC) setting, widespread non-compliance occurs. The last three Centers for Medicare and Medicaid Services (CMS) LTC surveys showed a cumulative increase of 21% in the number of citations issued for failure to provide proper intervention to prevent or treat pressure ulcers. Costs for the management of PU in the US likely exceed $6.4 billion annually, with a prevalence of approximately 28% in the LTC population. Estimates of the prevalence of sittingacquired PU in the elderly, at-risk population range from 36-50%. Several studies, including our own pilot investigation, support these estimates and have suggested that the use of wheelchair cushions designed to reduce interface pressure will reduce the incidence of sitting-acquired PU. Despite this evidence, elderly wheelchair users are not routinely evaluated for seating and positioning needs because definitive studies have not been completed to justify funding for such seating interventions. Consequently, elderly Medicare beneficiaries are being denied access to medically necessary and
Studies
59
clinically appropriate interventions. Instead, they are most frequently provided with convoluted or segmented-foam cushions that are not designed for pressure ulcer prevention. The primary aim of the proposed multi-center, randomized pressurereducing wheelchair cushion trial (PRWC-II) is to determine the efficacy of pressurereducing cushions in preventing sitting-acquired pressure ulcers in the elderly, LTC population. Positive results of the proposed trial will provide the level of evidence needed to change the standard of care to include the routine evaluation of at-risk residents for seating and positioning needs and the provision of a pressure-reducing cushion as a preventive measure against sitting acquired pressure ulcers. If our hypothesis is correct, such an intervention should result in a decrease in the incidence and prevalence of sitting-acquired pressure ulcers, reduced healthcare costs, and improved quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RELATIONSHIP OF MORBIDITY AND MORTALITY BETWEEN SPOUSES Principal Investigator & Institution: Christakis, Nicholas A.; Professor; Health Care Policy; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-DEC-2006 Summary: (provided by applicant): Employing the perspective and methods of the demography of aging, we propose to examine the relationship between the morbidity and mortality of spouses. We ask questions about how the morbidity and mortality or one spouse, and the timing and nature of that morbidity and mortality, affects the morbidity, mortality, and timing and nature of morbidity and mortality in the other spouse. For example, is the hazard of death in one spouse (the "proband") increased by illness or death in the other spouse? If so, how does the proband's hazard of illness or death change over time after the onset of illness or death in spouse? How do these affects vary according to the type of severity or duration of the spouse's morbidity? Do particular illnesses in spouses place probands at particularly high risk of development illness or dying themselves? What role do socio-demographic factors play in all these effects? To address these questions most effectively, we will create a new panel data set with demographics socioeconomic, and health information about one million elderly married couples followed up to ten years. Using a variety of even history and fixed effects methods, we will conduct four main analyses. First, we will evaluate morbidity in one spouse influences mortality in the other. We hypothesize that individuals married to unhealthy spouses will have worst mortality than those married to healthy spouses, and that the longer the spouses is ill, the greater the effect. We also hypothesize the certain types of spousal morbidity (e.g. those that most compromise activities levels) will be worse for probands. Second, we will reevaluate the widower effect (i.e. the increased tendency of the bereaved to die), but we will; adjust for the health of both spouses prior to widowhood; examine it's temporal shape in detail; and assess its dependence on socioeconomic factors. Third, we will evaluate how morbidity in one spouse influences morbidity in the other. Are healthy spouses better able then unhealthy spouses to provide health benefits in marriage? Four, we will evaluate the impact of widowhood on the morbidity, and not just mortality, of bereaved spouses. Our work advances the demographics of aging by; closely examine how an individual's morbidity and mortality are affected by the presence or absence of spousal support; focusing on cause-of-death specific aspects of demographics phenomena; examine theoretically interesting sub-populations along gender, race, socioeconomic, and health status lines; and shedding light on the mechanisms of inter-spousal health effects. Our work also has
60
Medicaid
policy implications in that it; supports more accurate projections of the health burdens in the elderly; facilitates targeting of support services to the growing numbers to the widowed elderly; and addresses important populations, such as minorities the poor, the oldest old, those with dementia, and caregivers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RESOURCE USE AND PATIENT OUTCOMES IN MEDICARE HOME CARE Principal Investigator & Institution: Fortinsky, Richard H.; Associate Professor; None; University of Connecticut Sch of Med/Dnt Bb20, Mc 2806 Farmington, Ct 060302806 Timing: Fiscal Year 2001; Project Start 01-APR-1999; Project End 31-MAR-2003 Summary: Medicare-certified home care agencies are under increasing pressure to improve both resource efficiency and quality of care for patients who are insured by the Medicare program. Home care agency clinicians and managers, predominantly nurses, are responding by collecting and reviewing standardized data to monitor resource use and patient outcomes. Yet little scientific knowledge has been produced to explain how outcomes in Medicare home care patients are associated with the amount of clinical staff resources allocated for these patients during home care episodes. Therefore, the longterm objective of this study is to improve our understanding of the complex interplay between resource use and health-related outcomes in Medicare home care patients with diverse characteristics who are served by a diverse group of Medicare-certified home care agencies. The primary aim of this study is to determine how home care patient outcomes are associated with specific home care resource use measures, controlling for market, home care agency, and patient variables. The secondary aim is to determine the relative importance of market factors, agency characteristics, patient characteristics, and home care resource use in influencing home care patient outcomes. Hypothesis 1: Patients who end an episode of care due to hospitalization will use the same amount of home care resources as patients who end an episode of care and remain at home, but they will show greater service intensity, controlling for market, agency, and patient variables. Hypothesis 2: Patients who decline in functional status during an episode of home care will use the same amount of home care resources as patients who improve in functional status, controlling for market, agency, and patient variables. Hypothesis 3: Patients whose symptoms worsen during an episode of home care will use the same amount of home care resources as patients whose symptoms improve, controlling for market, agency, and patient variables. Hypothesis 4: The observed relationships (direct and indirect effects) between market factors, agency characteristics, home care resource use, and home care patient outcomes will be adequately represented by a structural equation model. Using a prospective cohort study design, we will enroll 1,500 patients from 30 randomly-selected Ohio home care agencies. Patient data will be collected by trained home care staff, based on assessments at the first and final visits of episodes. Information about resource use at every home visit will also be recorded. Data analyses will determine unadjusted and adjusted relationships between measures of resource use and patient outcomes. A Project Advisory Committee will help translate findings into strategies for planning home care resource allocation based on patient outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: ROCHESTER COLLABORATIVE TO REDUCE ORAL HEALTH DISPARITI* Principal Investigator & Institution: Billings, Ronald J.; Professor; Eastman Dentistry; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627
Studies
61
Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): The partnership of Eastman Dental Center with the City of Rochester and Rochester City Schools to prevent or reduce disparities in oral health began in 1915 with a gift from George Eastman enabling the creation of the Rochester Dental Dispensary. Today, that partnership extends to the University of Rochester Medical Center, including the School of Medicine and Dentistry. However, despite this rich history of collaboration and an extensive network of community-based oral health facilities, fewer than 30% of children from the most impoverished neighborhoods in the city receive regular oral health care. Further, little is known about disparities in oral diseases or dentofacial disorders among Rochester-dwelling Hispanic families from Puerto Rico and Central America. On the basis of regularly scheduled oral health surveys of Rochester school children, a comprehensive database on the distribution of dental caries has been compiled. However, little data on caries prevalence or incidence by race or ethnic group are available. Similarly, while we know that fewer than 30% of Medicaid eligible Rochester children utilize oral health care services, there are no data on barriers to utilization of the abundant and conveniently located neighborhood and school-based oral health care facilities, nor have effective interventions been developed to improve utilization. Little attention has been given to cultural and behavioral characteristics of minorities that may profoundly influence utilization. Given the rich infrastructure and abundant resources available to us, we have formed a community partnership and a multidisciplinary research collaborative to undertake research on preventing or reducing oral health disparities. In this proposal, we describe three specific aims to: 1) organize research teams; 2) link research and community partners; and 3) refine research questions and design studies that will address the following four lines of research: 1) Assess the distribution of oral disease/disorders, with emphasis on dental caries; investigate factors associated with any excess morbidity observed in Rochester-dwelling Hispanic children and contrast findings with matched cohorts of African-American and Caucasian children; 2) Determine the impact of existing oral health care programs on disparities in oral disease morbidity; 3) Identify barriers to effective utilization of the oral health care system; and, 4) Develop intervention strategies that will prevent or reduce disparities in both the levels of oral diseases as well as in access to, and effective utilization of, the oral health care system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SELECTION BIAS BY MEDICARE BENEFICIARIES WITH DIABETES Principal Investigator & Institution: Maciejewski, Matthew L.; Health Services; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-DEC-2002 Summary: The purpose of this study is to examine the effect of Medicare HMO enrollment on the mortality and cost of care for Medicare beneficiaries with diabetes between 1994 and 1998. There are two major public policy concerns regarding individuals with chronic conditions that enroll in Medicare HMOs: Does Medicare contain costs by encouraging people with chronic diseases, such as people with diabetes, to join TEFRA-risk HMOs? and Are the quality of care and health outcomes provided to these enrollees comparable to those in the fee-for-service sector? This study will provide insight into both of these questions using Medicare administrative data from 1992 to 1998. This proposal will extend recent work by Dowd, et al., (1998) and Maciejewski, et al. (2001) looking at biased selection of the general Medicare population into TEFRA-risk HMOs. It will use a unique dataset (the National Medicare Diabetes Cohort), which
62
Medicaid
contains 2.5 million elderly Medicare beneficiaries with diagnosed diabetes mellitus in fee-for-service plans in 1994. The following specific research questions will be addressed: 1) Do healthier beneficiaries with diabetes systematically enroll in Medicare HMOs? 2) Do HMO enrollees with diabetes have different five-year survival rates than Medicare beneficiaries with diabetes who remain in the fee-for-service (FFS) sector? 3) Do unhealthier beneficiaries with diabetes systematically disenroll from Medicare HMOs? 4) Do HMO disenrollees with diabetes have different FFS costs than Medicare beneficiaries who remain in the FFS sector? The careful analysis of enrollment and disenrollment patterns of this chronically ill population, combined with the mortality and cost analyses, will provide insight into the advantages and disadvantages of enrollment in Medicare HMOs. Analyses will be conducted on a cohort of beneficiaries with diabetes in thc fee-for-service sector in 1992-1993, so results are not generalizable to people with diabetes who enrolled in Medicare HMOs prior to 1994. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SURVIVAL
SOCIO-ECONOMIC
DETERMINANTS
OF
KIDNEY
GRAFT
Principal Investigator & Institution: Woodward, Robert S.; Associate Professor; Health Management and Policy; University of New Hampshire Service Building Durham, Nh 038243585 Timing: Fiscal Year 2002; Project Start 05-JUL-2002; Project End 31-MAY-2004 Summary: (provided by applicant): Objective: This study proposes to expand the understanding of how insurance coverage, recipient incomes, immunosuppression prices, Medicaid, and state-specific support programs interact to significantly affect long-term kidney transplantation graft survival. Specific Aims: Elsewhere, we have demonstrated that in the absence of Medicare's immunosuppressive medication coverage, low-income recipients had significantly greater graft loss. Here we ask: 1) whether recipient income and immunosuppression insurance affect graft survival among black recipients differently than white; 2) whether differences in state Medicaid regulations and state programs such as the Missouri Kidney Program have ameliorated the importance of insurance as a determinant of graft survival among low income recipients; and 3) whether the cost of the immunosuppressive regimen correlates with graft survival. Methods: The project merges a) patient-level USRDS-provided data about the patient, transplant, immunosuppressive medications, graft survival, and cost; b) ZIP-code-level Census data socio-economic characteristics (Income, Education, and state-level data with details about Medicaid programs relevant to kidney transplantation and state-kidney-specific support programs. The project will illustrate the importance of each of these variables on graft survival using Kaplan-Meier plots of graft survival. The project will estimate each variable's importance in multivariate Cox Proportional Hazards model. Importance: The results of this project will provide some guidance to both Medicare and state policy-makers responsible for determining the length of immunosuppression coverage. Specifically, it will identify those patient characteristics for which insurance had the greatest historical impact. The results will also guide physicians in selecting among immunosuppressive medications with widely variable prices by identifying those patient groups for whom out-of-pocket price was an important determinant of long-term graft survival. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies
•
63
Project Title: SPECIALIZED THERAPIES BY CHILDREN, CORRELATES OF USE Principal Investigator & Institution: Kuhlthau, Karen A.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 06-AUG-2003; Project End 31-JUL-2004 Summary: (provided by applicant): This project describes patterns and correlates of use of specialized therapies (physical therapy, occupational therapy, speech therapy, language therapy, respiratory therapy, and home health) in children and in children with chronic conditions and injuries. The project has three objectives: 1) to describe patterns of use and expenditures for specialized therapies for children with and without chronic conditions, 2) to determine correlates of specialized therapy use among children including predisposing, enabling, and need characteristics, and, 3) to understand how use of providers affects use. The project will use data from four data sources, the National Health Interview Survey on Disability, the Medical Expenditure Panel Survey, the 5 percent sample of Medi-Cal eligibility and encounter data, California's fee-forservice Medicaid plan, and a cohort of children in Harvard Vanguard Health Associates. Descriptive analyses will include examining patterns of use among chronically and non-chronically ill children and understanding absolute and relative expenditures of therapies. The study will further examine the role of primary and specialty providers as predictors of specialized therapy use. This project will provide the first comprehensive and systematic description of the use, expenditures, and predictors of specialized therapies by children. Understanding the correlates of use and expenditures will provide information about children who have relatively rich versus relatively sparse use of services. This information will help health plans to better predict future use. It will help advocates who may seek to change policies that influence access for subpopulations. This study will provide useful information in discussions regarding care co-ordination and interagency systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: SPORE IN LUNG CANCER Principal Investigator & Institution: Carbone, David P.; Professor of Medicine; Medicine; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 28-JUN-2001; Project End 31-DEC-2006 Summary: (provided by applicant) This Lung Cancer SPORE application is a new application submitted by the Vanderbilt-Ingram Cancer Center and its affiliated institutions. In this proposal, we apply the translational research strengths of the Vanderbilt-Ingram Cancer Center toward reducing the incidence, morbidity, and mortality of lung cancer, by focusing on the discovery and validation of molecular targets for prevention and therapy. In project 1 we are studying the role of specific matrix metalloproteinases and targeted inhibitors in the development and behavior of lung cancer. In Project 2 we are applying sophisticated cDNA microarray and protein mass spectrometry techniques to the identification of molecular fingerprints of lung cancer. These fingerprints could ultimately be used to guide patient care or discover novel molecular targets for therapy. Project 3 studies a new potential molecular target, Notch3, that we identified by mapping a balanced chromosome translocation. This also represents a completely new mechanism for gene activation in lung cancer. Receptor tyrosine kinase inhibitors are an exciting new class of molecularly targeted reagents, and in Project 4 we study their effects on downstream signaling pathways and their use in combination with radiation therapy in anti-angiogenic tumor therapy. In projects 5 and 6 we investigate the role cyclooxygenase 2 (COX2) in the therapy (Project 5) and
64
Medicaid
prevention (Project 6) of lung cancer. We have unique facilities for the analysis of COX2 metabolites and intend to study eicosanoid production by human lung cancer tumors in situ, its association with tumor angiogenesis, and its response to treatment with specific inhibitors in vivo. For Project 6 we propose to use two cohorts with previously collected pharmacy data to study the impact of long term COX2 inhibitors on the incidence of lung cancer. The first is a retrospective cohort study over 10,000 enrollees of the Tennessee Medicaid Program who were diagnosed with chronic obstructive pulmonary diseases (COPD) during the period of 1980 to 2002. The second is a population-based cohort and nested case-control studies of over 150,000 users of NSAIDs in North Jutland County, Denmark during the period of 1991 to 2002. In order to accomplish these research goals, we propose 4 cores: administrative, tissue, clinical, and biostatistical. The proposed career development and developmental research programs are tightly integrated with established institutional initiatives with documented track records of identifying and funding promising projects and individuals. We will use these established mechanisms to fund lung cancer-targeted career development and research projects. We believe that these projects, cores, and pilot and career development awards could lead to major improvements in the prevention, diagnosis, and treatment of lung cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STATE POLICIES AND HOSPITALIZATIONS FROM NURSING HOMES Principal Investigator & Institution: Mor, Vincent M.; Chairman; Ctrs/Gerontol & Hlth Care Res; Brown University Providence, Ri 02912 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2005 Summary: (provided by applicant): Every 6 months, nearly 25 percent of nursing home residents are hospitalized in the U.S. This figure varies considerably within and between states. In spite of the high cost and iatrogenic problems associated with hospitalizing nursing home residents, and observed inter-state variation, there has been little systematic study of the influence of state policy on these rates and whether this influence may be differential for subgroups of vulnerable residents. Preliminary evidence suggests that states with low Medicaid nursing home payment rates tend to have higher hospitalization rates. A more complete analysis of how state policies affect the strategic clinical and management investment choices nursing homes make should inform the development of more coherent and equitable state and federal policies affecting this highly vulnerable population. Using MDS data and matched Medicare hospital claims for all long stay nursing home residents, in all non-hospital based facilities in the 48 contiguous states merged with facility-level Online Survey Certification Automated Records (OSCAR) data, market-level information from the Area Resource File, and data on state policies, we propose examining the effect of state policies on hospitalization as mediated by nursing homes? investments in medical and managerial resources. The specific aims are: (1) To characterize inter and intra state variation in the long-stay nursing home population, particularly the dually eligible population, in terms of patients? clinical conditions and their concentration. (2) To examine the relationship between state Medicaid nursing home policies and facilities? investment in medically relevant clinical and managerial infrastructure to care for longstay Medicaid residents. (3) To model the unique association of facility and state-level factors with hospitalization events among long-stay nursing home residents. (4) Using the model developed in (3), to summarize the moderating effects of state Medicaid payment rates and policies on the relationship between facility context and
Studies
65
hospitalization for specific sub-populations of long-stay residents: (4a) prevalence of cognitively impaired residents and/or availability of special dementia unit among cognitively impaired residents; (4b) prevalence of African Americans; and (4c) prevalence of dually eligible residents. The results of the proposed study should inform extant theories about how long term care providers respond to exogenous policy shocks, the relative competitiveness of the market and local resource constraints. These theoretical insights will help shape the policy implications emerging from the study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STRUCTURE, PROCESS AND OUTCOMES IN THE PACE PROGRAM Principal Investigator & Institution: Mukamel, Dana B.; David Stewart Associate Professor of Hea; Community and Prev Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 31-MAY-2004 Summary: (Applicant's Abstract): The Program of All-Inclusive Care for the Elderly (PACE) is a community-based alternative to nursing home care for frail elderly who have significant functional and/or cognitive impairments. It is a managed care program that integrates primary and long term care services with acute care. Rapid expansion of the PACE program is anticipated as a result of the Balanced Budget Act of 1997. The innovative care approach adopted by the PACE program holds the promise of higher quality care, better health outcomes and lower costs compared to care offered to frail elderly enrolled in traditional Medicare and Medicaid programs, or managed care programs. Past studies demonstrated that PACE compares favorably with Medicare feefor-service care. They have also shown that there is significant variation in health outcomes across sites. This suggests that quality of care in PACE could be improved further. The causes for these variations, and the specific program characteristics associated with them, have not been studied to date. The objective of this study is to identify opportunities for improvements by investigating the links between programs' structure, process and risk-adjusted health outcomes. The study will include 26 PACE sites currently in operation. Individual level data about health outcomes and participants' risks at admission will be used to create risk adjusted outcome measures of quality for each site. Four outcome measures will be developed, based on mortality, changes in functional status, changes in self assessed health status and hospitalizations. These data will be linked to site level data that characterize the structure and process of care in each site. Data about structure and process will be obtained from the National PACE database and from surveys and site visits. Structure and process dimensions will include: Participant characteristics, e.g., health and functional status, ethnicity, family support; Providers' characteristics, e.g., staff turn over, specialty mix, measures of team interactions; Organizational characteristics, e.g., relationship with sponsoring organization, risk sharing, maturity of the site; and External environmental influences, e.g., area practice styles, competition. Statistical regression techniques will be used to test hypotheses about the links between structure, process and outcomes. The knowledge gained from this study would have direct bearing on efforts to improve care in PACE programs, as well as implications for other programs serving frail, noninstitutionalized elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: STUDY OF A NEW PAYMENT SYSTEM FOR MEDICAID Principal Investigator & Institution: Eklund, Stephen A.; Professor; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274
66
Medicaid
Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2005 Summary: (Provided by the applicant): This study will monitor utilization of dental care in Michigan children, in order to evaluate the effectiveness of recent and future SCHIP (State Children?s Health Insurance Program) and Medicaid initiatives in reducing disparities in access to and utilization of dental care. Evidence from many sources demonstrates a wide disparity in utilization of dental care that is associated with the socioeconomic status of children. Disparities exist as measured by both visits for care as well as untreated oral disease. Dental insurance claims data will be used to demonstrate historical patterns of utilization and the disparities between privately insured and Medicaid-eligible children. Future data from both the privately-insured child in Michigan and from the newly-implemented private-insurance based SCHIP and Medicaid programs in Michigan will then be monitored for the next several years to assess the ability of these methods of payment and administration to reduce the historical disparities in dental care utilization. Specific null hypotheses to be tested are: 1) Payment for dental care at market rates will result in no difference in the percent of children with at least one dental visit per year, between children with Medicaid, SCHIP, or private insurance coverage, 2) Payment for dental care at market rates will result in no difference in the mix of services received, between children with Medicaid, SCHIP, or private insurance coverage, and 3) Payment for dental care at market rates will result in no difference in the distance traveled to receive care, between children with Medicaid, SCHIP, or private insurance coverage. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TESTING EBP AND ORGANIZATION EFFECTS IN RURAL APPALACHIA Principal Investigator & Institution: Glisson, Charles A.; Professor and Director; None; University of Tennessee Knoxville Knoxville, Tn 37996 Timing: Fiscal Year 2003; Project Start 03-JUL-2003; Project End 31-MAR-2008 Summary: (provided by applicant): The proposed study examines a two-level strategy for overcoming barriers to the implementation of effective mental health treatments for youth in very rural, deeply impoverished communities. The two-level strategy includes (1) the implementation of an evidence-based practice (EBP) delivered in the homes of referred youth by therapists organized to provide treatment over large, rural, geographical areas and (2) an organizational-community intervention (entitled ARC) that changes the social context in which the service is provided and supports therapists' efforts to serve children in widely-dispersed, isolated communities. The study will be conducted in eight of the poorest, least populated counties in the rural Appalachian Mountains of East Tennessee. The sample will include 720 children referred to juvenile courts in those counties as a result of antisocial behavior. Half of the children selected in each county will receive an EBP, Multisystemic Therapy (MST), and half will receive the usual care provided to children referred to juvenile courts in the eight counties. In addition, an organizational-community intervention (ARC) will be administered in half (four) of the counties by change agents (Ph.D. industrial-organizational psychologists trained in organizational and community development). The change agents will work with treatment teams, judges, school administrators, and other community opinion leaders to address the barriers to mental health care in rural Appalachia and develop community and organizational support for the implementation of the EBP. Multisystemic Therapy (MST) will be provided by Youth Villages, the state's largest private children's mental health service organization. MST services will be funded by the Bureau of TennCare, the state's Medicaid-waiver health insurance program that
Studies
67
covers children eligible for Medicaid as well as the children of the working poor who are ineligible for Medicaid. The services are being structured and funded in a way that will ensure they can be sustained in each county, if successful, after the completion of the study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE AGING OF BLACK VETERANS Principal Investigator & Institution: Costa, Dora L.; National Bureau of Economic Research Cambridge, Ma 02138 Timing: Fiscal Year 2001; Project Start 05-MAR-1992; Project End 31-AUG-2006 Summary: (provided by applicant): The old-age experience of African-Americans and of Whites has historically been different and remains different to this day. AfricanAmericans today face poorer health in old age, are more likely to be retired, and are more likely to live with family members. Although mortality differences between the races at older ages are still a subject of debate, prior to age 85 blacks face higher mortality rates than whites. After age 85 the "cross-over" in black and white mortality rates observed throughout the twentieth century may arise either from selection or from age misreporting. Several factors account for the different old age experiences of blacks and whites. In the case of retirement and living arrangements, these factors include the lower income and social status of African-Americans over their entire life-cycle, cultural norms regarding lifestyle, health differences, and differences in demographic characteristics. In the case of mortality and disability, these factors include differences in income, education, and access to medical care, health habits, environmental stress (including that from disease and poor nutrition) throughout the life-cycle (including early childhood), mortality selection, and genetics. This project will use data on Black Union Army veterans, White Union Army veterans, and recent populations to establish long-run trends in the prevalence of chronic conditions and disability among AfricanAmericans and compare trends with those in the white population; investigate whether differential exposure to infectious disease and differences in occupational status can account for morbidity and mortality differentials between white and black veterans; use army and Pension Bureau reports of age at young ages to establish whether there is a Black-White mortality cross-over at ages 85+; determine whether differences in black and white veterans' retirement rates spring from differences in health, occupation, and local area unemployment; determine whether differences in Black and White veterans' health, marital status, and kin availability account for their differential probabilities of living in extended families; and establish the impact of pensions (a pure income transfer) on black veterans' propensity to retire and to live in extended families, comparing the responsiveness of Black veterans to income transfers with that of White veterans. The findings will help illuminate the role of the greater life-long poverty of African-Americans in explaining differences in Black-White retirement patterns, elderly living arrangements, morbidity, and mortality. The findings will also help forecast future retirement, mortality, and disability trends that will aid in the development of health and pension policies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
•
Project Title: THE EPIDEMIOLOGY OF DIABETES IN THE U.S. ELDERLY Principal Investigator & Institution: Mcbean, Alexander M.; Health Services Research and Policy; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070
68
Medicaid
Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): The reported prevalence of diabetes is increasing in the United States and in many other countries. It is not known how much of this increase is due to an increased incidence or increased survival. The majority of the cases of diabetes occur in the elderly population. This study will measure the incidence and prevalence of diabetes, as well as the mortality rates for the years 1997 through 2003 among Medicare beneficiaries 67 years of age and older. In addition, cardiovascular, kidney, eye and neurological complications are a major part of the natural history and burden of diabetes in the elderly. This study will measure the frequency and time to the onset of these complications in people who have diabetes at the time the study begins (prevalent cases) as well as in the new cases (incident cases) that develop during the study. All of these analyses will provide information on different age groups of the elderly, men and women, as well as the five race groups: white, black, Asian, Hispanic and North American Native. This study will be one of the few, and the most current, to provide nationally representative information on this population, particularly among members of minority race groups. Thus, the information will be useful to the Healthy People 2010 initiative and the President's Initiative to Eliminate Racial and Ethnic Disparities in Health by providing information for the tracking of the Healthy People 2010 Objectives for diabetes and the President's Initiative. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE ILLINOIS FAMILIES STUDY: CHILD WELL-BEING Principal Investigator & Institution: Holl, Jane L.; Assistant Professor; None; Northwestern University 633 Clark St Evanston, Il 60208 Timing: Fiscal Year 2001; Project Start 13-SEP-2000; Project End 31-MAR-2004 Summary: This study focuses on the etiology of two specific forms of child neglect: physical neglect and supervisory neglect. Welfare reform requires parents to spend more time in formal employment, subject them to time limits and sanctions on the receipt of income assistance, and may result in unstable health care coverage for their families. Assessing whether such changes results in a differential rate of child maltreatment in general, and different types of child neglect in particular, is the focus of this study. The specific aims of the project are to assess the relationship between child and (1) employment, (2) income (dynamics), and (3) health care coverage. We will also identify the factors that mediate or moderate such relationships and expand the knowledge about causal pathways leading to specific forms of child neglect. We will also include baseline assessments of child development so that future studies may assess the developmental impacts of these forms of child neglect. This study builds upon the Illinois Families Study (IFS). The IFS will follow 1,500 families over six-years to study the effects of welfare and work by conducting annual surveys to gather information about demographics, employment, income, parenting, child care, health, and domestic violence and will gather, quarterly administrative data about use of welfare, Medicaid, unemployment, and social services. Nine Illinois counties have been selected for the study representing over 75% of the Illinois TANF caseload. This study will involve a sub-sample of children the IFS (500 children <2 years at the first interview). A parent will be interviewed, in-person, 6 months after the first IFS interview and then annually. The interview will focus on child development and temperament, parenting beliefs, household accident risks, adequacy of basic needs, and health care. Medical chart reviews will be conducted to assess access and adequacy of health care and to identify additional risks for neglect. Quarterly administrative data from the Illinois Department of Employment's Insurance database, the New-Hire registry, and all social agency
Studies
69
registries (Food Stamps, Medicaid, Child Abuse) will be linked for each subject. Data from a continuously integrated database of children's services in Illinois that depicts a full network of relationships linking individual children and public services (e.g. child protection, juvenile justice, Medicaid, special education, and mental health services) will also be linked. The more likely statistical power levels for each neglect outcome range from.72 to.94 for a two-tailed test, and from.82 to.97 for a one-tailed test. This study will not rely solely on formal indicators of neglect, but will investigate other "informal" indicators based on operationalized definitions of environmental, physical, and supervisory neglect. Independent measures will include demographics, parental characteristics, parent-child interaction, parent and child physical and mental health, and child development. The means, standard deviations, and ranges associated with each indicators will be reported, and for repeated measured, the average change from one interview to the next will be provided. The primary goal of the multivariate analyses is to determine which factors or combinations of factors place children at greater risk for child neglect and CPS intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: USE OF RADIATION IN STAGE IV NON-SMALL CELL LUNG CANCER Principal Investigator & Institution: Hayman, James A.; Assistant Professor; Radiation Oncology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 31-MAR-2004 Summary: (provided by applicant): The primary objective of this project is to examine factors associated with the utilization of radiation therapy in a sample of patients with Stage IV (i.e., metastatic) non-small cell lung cancer diagnosed in selected regions of the U.S. during a period ranging from 1991 to 1996. Anecdotal reports suggest that the use of radiation therapy to palliate symptoms associated with metastatic cancer is common and that there may be substantial variation in the intensity of treatment (i.e., number of treatments). This has important cost and quality implications because studies published over the last decade suggest that shorter courses of radiation treatment may be as effective as longer courses. Although this remains controversial in the U.S., as early as 1994 clinical guidelines in the U.S. began to endorse shorter courses of therapy. We propose to use the population-based linked SEER-Medicare data set to examine patterns and determinants of the utilization of palliative radiation therapy in patients age 65 or greater diagnosed with metastatic non-small cell lung cancer between 1991 and 1996. Created by researchers at the National Cancer Institute, this data set contains clinical data on almost all patients aged 65 and older diagnosed with cancer in the eleven SEER regions that have been linked to their respective Medicare claims data. Specifically, we plan to use SEER data to identify incident cases of metastatic non-small cell lung cancer and then use the Medicare claims data to identify those patients who received radiation therapy and quantify the intensity with which they were treated. We then propose to use this information to identify factors associated with the use and intensity of treatment with radiation including patient predisposing/enabling factors, clinical factors, organizational factors and physician factors. Lastly, we plan to examine whether the frequency and intensity of the administration of treatment with palliative radiation in this patient population has changed over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
70
•
Medicaid
Project Title: VALIDATION QUESTIONNAIRE
OF
FAMILY
HISTORY
OF
CANCER
Principal Investigator & Institution: Dunn, Marsha; Westat, Inc. 1650 Research Blvd Rockville, Md 208503195 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-MAY-2002 Summary: This methodologic study will provide estimates of the accuracy of family history of cancer reports in a general population setting, which will help to evaluate the feasibility of future surveillance studies of genetic risk factors for cancer. A family history of cancer questionnaire will be developed and administered to a probability sample of approximately 1600 residents in the state of Connecticut. The questionnaire will ascertain the occurrence of cancer in the respondents' first and second degree relatives. Positive and negative reports of major cancers, including breast, prostate, lung, colorectal, and ovarian cancers, will be validated by searching state tumor registry records and other data sources (i.e., Medicare records, National Death Index files or death certificates, and physician reports)in order to determine the sensitivity and specificity of family history reports. Some additional epidemiologic and psychosocial variables will be collected to examine possible predictors of reporting accuracy and completeness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: WHY IS CARDIAC RISK INCREASED IN RHEUMATIOD ARTHRITIS Principal Investigator & Institution: Solomon, Daniel H.; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 06-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): While rheumatoid arthritis is primarily considered a condition affecting the joints and impairing function, past data suggest that cardiac disease represents the number one cause of mortality in rheumatoid arthritis. However, the adjusted rates of cardiovascular death and myocardial infarction in rheumatoid arthritis are poorly characterized. Additionally, whether the increased cardiovascular risk is because of the medications used for rheumatoid arthritis or the underlying disease severity is unknown. The proposed research has two major aims: 1) to quantify the rates of cardiovascular death and myocardial infarction in patients with rheumatoid arthritis after controlling for known cardiovascular risk factors and 2) to determine the contribution of rheumatoid arthritis medication exposure and disease severity to cardiovascular disease rates. Prior work on this issue has largely been conducted in referral populations and attempts to control for known cardiovascular risk factors have been poor. We propose to study this issue in a large Medicare/Medicaid database that we have extensive experience working with. This database contains information on over 2 million patients followed for 10 years and includes diagnoses and procedures for all physician and inpatient visits. As well, prescription data from a large pharmacy benefits program has been integrated into this database allowing for a complete characterization of an individual patients medication exposure. While any one diagnosis of rheumatoid arthritis may not be accurate in such a database, the project entails a validation substudy to develop an algorithm for selecting patients with a high probability of having rheumatoid arthritis. The proposed project will be an important advance in this area because of the large number of patients with rheumatoid arthritis to be included (over 5,000), the community-based nature of their care, the ability to control for known cardiovascular risk factors, the extensive medication information allowing for us to
Studies
71
explore key hypotheses regarding corticosteroid exposure, and the attempt to simultaneously control for disease severity Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: YOUTHS' ACCESS TO MENTAL HEALTH SERVICES: A CAREER AWARD Principal Investigator & Institution: Stiffman, Arlene R.; Professor; None; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 04-AUG-2000; Project End 31-JUL-2005 Summary: (Applicant's abstract): Knowledge of youths' access to mental health services is an underdeveloped, but nationally important, issue that will impact the way youths' services are funded and provided. This research career proposal addresses youths' entry into and pathways through mental health services provided by both specialty and nonspecialty sectors (mental health, public health, child welfare, juvenile justice, education, and drug and alcohol). To date, services research has neglected the role of social workers and nonspecialty mental health professionals in the provision of mental health services. A K02 Award will allow Dr. Stiffman the time to build upon her previous work, adding breadth to its significant contributions in this area. The research will test hypotheses with data from ongoing studies and address knowledge needed to provide better access to mental health services in multiple service sectors. The hypotheses relate to service access; the role of the gateway provider, and Medicaid/managed care: 1. Youths' use of services for their mental heath problems is determined by: their need, their predisposing characteristics, and service enabling characteristics; 2. Youths' access to services for their mental health problems is determined by: their need as perceived by gateway providers; and those gateway providers' resources, service connections, and service knowledge; 3. The use of specialty mental health services is positively associated with the availability and accessibility of Medicaid and managed care reimbursed services. This study will also explore service access questions about which too little is yet known to frame specific hypotheses, but which are important to improving access and delivery of services. During the K02, exploratory analyses will help frame these as hypotheses for new studies: 1.) What are the multisector configurations of services and their complementary or supplementary relationships?; 2.) What is the relationship of problem persistence to service configuration change over time? and; 3.) What is the relationship of barriers (which will change over time) to changes in service configurations? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to 3
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
72
Medicaid
sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Medicaid, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Medicaid” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Medicaid (hyperlinks lead to article summaries): •
A Congress on Nursing and Health Care Economics Report. Going to the source: Medicaid. Author(s): Mondoux L. Source: Mich Nurse. 2003 June-July; 76(6): 15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836428&dopt=Abstract
•
A disease-specific Medicaid expansion for women. The Breast and Cervical Cancer Prevention and Treatment Act of 2000. Author(s): Lantz PM, Weisman CS, Itani Z. Source: Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health. 2003 May-June; 13(3): 79-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867087&dopt=Abstract
•
A functioning profile of Medicaid Waiver participants in Michigan: does the program admit the high functioning? Author(s): Li L, Zullo R. Source: Care Manag J. 2003 Spring; 4(1): 31-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14502876&dopt=Abstract
•
A Medicaid population's use of physicians' offices for dental problems. Author(s): Cohen LA, Manski RJ, Magder LS, Mullins CD. Source: American Journal of Public Health. 2003 August; 93(8): 1297-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893618&dopt=Abstract
•
A preliminary investigation of the effects of restrictions on Medicaid funding for abortions on female STD rates. Author(s): Sen B. Source: Health Economics. 2003 June; 12(6): 453-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759915&dopt=Abstract
•
A profile of Hawaiians in the Medicaid Fee-For-Service program. Author(s): Loke M, Kang-Kaulupali KT, Honbo L. Source: Pac Health Dialog. 2001 September; 8(2): 322-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12180511&dopt=Abstract
Studies
73
•
A study to assess patient satisfaction of transitioning from Medicaid to managed care by sickle cell patients in Hampton Roads, Virginia. Author(s): Anderson J, Miller SD. Source: Journal of Health & Social Policy. 2002; 16(1-2): 5-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809374&dopt=Abstract
•
Ability of Medicaid claims data to identify incident cases of breast cancer in the Ohio Medicaid population. Author(s): Koroukian SM, Cooper GS, Rimm AA. Source: Health Services Research. 2003 June; 38(3): 947-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822920&dopt=Abstract
•
Access and use of health care vary by type of Medicaid managed care program. Author(s): Fleisher L. Source: Find Brief. 2003 June; 6(3): 1-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812191&dopt=Abstract
•
Access of target groups to 1915(c) Medicaid home and community based waiver services. Author(s): Harrington C, Carrillo H, Wellin V, Norwood F, Miller N. Source: Home Health Care Services Quarterly. 2001; 20(2): 61-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987655&dopt=Abstract
•
Access to care among disabled adults on Medicaid. Author(s): Long SK, Coughlin TA, Kendall SJ. Source: Health Care Financing Review. 2002 Summer; 23(4): 159-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500477&dopt=Abstract
•
Access to community-based long-term care: Medicaid's role. Author(s): Miller NA, Harrington C, Goldstein E. Source: Journal of Aging and Health. 2002 February; 14(1): 138-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11892757&dopt=Abstract
•
Access to dental care services for Medicaid children: variations by urban/rural categories in Illinois. Author(s): Byck GR, Walton SM, Cooksey JA. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2002 Fall; 18(4): 512-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380894&dopt=Abstract
74
Medicaid
•
Access to drug therapy and substitution between alternative antidepressants following an expansion of the California Medicaid formulary. Author(s): McCombs JS, Shi L, Croghan TW, Stimmel GL. Source: Health Policy (Amsterdam, Netherlands). 2003 September; 65(3): 301-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12941496&dopt=Abstract
•
Access to health care for youth leaving foster care: Medicaid and SCHIP. Author(s): English A, Morreale MC, Larsen J. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 2003 June; 32(6 Suppl): 53-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782444&dopt=Abstract
•
Access to spacers and peak flow meters among Medicaid patients with asthma. Author(s): Magee JS, Jones SM, Ayers ME, Golden W, Vargas PA. Source: The Journal of Asthma : Official Journal of the Association for the Care of Asthma. 2002 December; 39(8): 687-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12507188&dopt=Abstract
•
Achieving optimal maternal and infant health outcomes for Medicaid patients, with application for commercial populations. Author(s): Foust RF, Carey B. Source: Manag Care Interface. 2002 June; 15(6): 45-50, 53-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12087607&dopt=Abstract
•
ADAP and Medicaid financial emergencies growing. Author(s): James JS. Source: Aids Treat News. 2002 December 27; (387): 2-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635624&dopt=Abstract
•
Adjusted clinical groups: predictive accuracy for Medicaid enrollees in three states. Author(s): Adams EK, Bronstein JM, Raskind-Hood C. Source: Health Care Financing Review. 2002 Fall; 24(1): 43-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545598&dopt=Abstract
•
Adult health care access and use under Medicaid: does it vary by state? Author(s): Coughlin TA, Long SK. Source: Journal of Health Care for the Poor and Underserved. 2003 May; 14(2): 208-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739301&dopt=Abstract
Studies
75
•
Air pollution and emergency department visits for asthma among Ohio Medicaid recipients, 1991-1996. Author(s): Jaffe DH, Singer ME, Rimm AA. Source: Environmental Research. 2003 January; 91(1): 21-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12550084&dopt=Abstract
•
Alcohol and juvenile justice contacts: a comparison of fee-for-service and capitated Medicaid mental health services. Author(s): Scott MA, Snowden LR, Libby AM. Source: J Stud Alcohol. 2002 January; 63(1): 44-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11925057&dopt=Abstract
•
An overview of Medicaid managed care litigation. Author(s): Rosenbaum S, Teitelbaum J, Kirby C, Priebe L, Klement T. Source: Issue Brief George Wash Univ Cent Health Serv Res Policy. 1998 November; (2): 1-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12425332&dopt=Abstract
•
Ante- and postpartum substance abuse treatment and antiretroviral therapy among HIV-infected women on Medicaid. Author(s): Warner LA, Wei W, McSpiritt E, Sambamoorthi U, Crystal S. Source: J Am Med Womens Assoc. 2003 Summer; 58(3): 143-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12948105&dopt=Abstract
•
Antibiotic prescriptions associated with outpatient visits for acute upper respiratory tract infections among adult Medicaid recipients in North Carolina. Author(s): Brown DW, Taylor R, Rogers A, Weiser R, Kelley M. Source: N C Med J. 2003 July-August; 64(4): 148-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12971239&dopt=Abstract
•
Antipsychotic dosing and concurrent psychotropic treatments for Medicaid-insured individuals with schizophrenia. Author(s): dosReis S, Zito JM, Buchanan RW, Lehman AF. Source: Schizophrenia Bulletin. 2002; 28(4): 607-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12795494&dopt=Abstract
•
Approaches to asthma care. Medicaid health plans pilot programs to combat a complex health issue. Author(s): Barta PJ, Brodsky KL. Source: Healthplan. 2002 March-April; 43(2): 42-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11961923&dopt=Abstract
76
Medicaid
•
Assessing Medicaid patients' perceptions of the OB/GYN-patient relationship. Author(s): Crutchfield TN, Eveland VB, Eveland AP. Source: Health Marketing Quarterly. 2002; 19(4): 21-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557987&dopt=Abstract
•
Assessing the effectiveness of Medicaid in breast and cervical cancer prevention. Author(s): Koroukian SM. Source: Journal of Public Health Management and Practice : Jphmp. 2003 July-August; 9(4): 306-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836513&dopt=Abstract
•
Assessing the extent of medical home coverage among Medicaid-enrolled children. Author(s): Petersen DJ, Bronstein J, Pass MA. Source: Maternal and Child Health Journal. 2002 March; 6(1): 59-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926256&dopt=Abstract
•
Association between interruptions in Medicaid coverage and use of inpatient psychiatric services. Author(s): Harman JS, Manning WG, Lurie N, Christianson JB. Source: Psychiatric Services (Washington, D.C.). 2003 July; 54(7): 999-1005. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851437&dopt=Abstract
•
Asthma prevalence among Alaska Native and nonnative residents younger than 20 years enrolled in Medicaid. Author(s): Gessner BD. Source: Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology. 2003 June; 90(6): 616-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839319&dopt=Abstract
•
Beneficiary profiles and service consumption patterns in an urban Medicaid home and community-based waiver program. Author(s): Davitt JK, Kaye LW, Bagati D, Graub P. Source: Care Manag J. 2001-2002 Winter; 3(2): 84-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12455219&dopt=Abstract
•
Big changes ahead for Medicaid and Medicare. Author(s): McHenry KF. Source: Iowa Med. 2003 July-August; 93(4): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12971235&dopt=Abstract
Studies
77
•
Bush's Medicaid proposal puts states between a rock and a hard place. Author(s): Swartz K. Source: Inquiry. 2003 Spring; 40(1): 3-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836904&dopt=Abstract
•
Caring for patients under Medicaid mandatory managed care: perspectives of primary care physicians. Author(s): Chaudry RV, Brandon WP, Thompson CR, Clayton RS, Schoeps NB. Source: Qualitative Health Research. 2003 January; 13(1): 37-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12564262&dopt=Abstract
•
Case study: improving pregnancy outcomes for Medicaid patients. Author(s): Blackburn G, Burke M, Hamilton W, Wang Y, Yoder E. Source: Healthplan. 2003 July-August; 44(4): 39-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12920870&dopt=Abstract
•
Changing patterns of initial drug therapy for the treatment of hypertension in a Medicaid population, 1997-2000. Author(s): Weiss R, Buckley K, Clifford T. Source: Clinical Therapeutics. 2002 September; 24(9): 1451-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380636&dopt=Abstract
•
Child & adolescent psychiatry: Accessing Medicaid's child mental health services: the experience of parents in two states. Author(s): Semansky RM, Koyanagi C. Source: Psychiatric Services (Washington, D.C.). 2003 April; 54(4): 475-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663834&dopt=Abstract
•
Child participation in WIC: Medicaid costs and use of health care services. Author(s): Buescher PA, Horton SJ, Devaney BL, Roholt SJ, Lenihan AJ, Whitmire JT, Kotch JB. Source: American Journal of Public Health. 2003 January; 93(1): 145-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12511404&dopt=Abstract
•
Childhood injuries in Connecticut's Medicaid managed care program. Author(s): Lee MA, Learned A. Source: Journal of Health Care for the Poor and Underserved. 2003 August; 14(3): 43650. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955921&dopt=Abstract
78
Medicaid
•
Children's use of mental health services in different Medicaid insurance plans. Author(s): Mandell DS, Boothroyd RA, Stiles PG. Source: The Journal of Behavioral Health Services & Research. 2003 April-June; 30(2): 228-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710375&dopt=Abstract
•
Comment: Medicaid prescriber compliance with Joint National Committee VI hypertension treatment guidelines. Author(s): Manley HJ, Mangum S, Dugan DJ. Source: The Annals of Pharmacotherapy. 2002 December; 36(12): 1975-6; Author Reply 1976. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452768&dopt=Abstract
•
Community-acquired pneumonia: compliance with centers for Medicare and Medicaid services, national guidelines, and factors associated with outcome. Author(s): Ziss DR, Stowers A, Feild C. Source: Southern Medical Journal. 2003 October; 96(10): 949-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570338&dopt=Abstract
•
Comorbidity-based payment methodology for Medicaid enrollees with HIV/AIDS. Author(s): Fakhraei SH, Kaelin JJ, Conviser R. Source: Health Care Financing Review. 2001 Winter; 23(2): 53-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500338&dopt=Abstract
•
Comparing asthma care provided to Medicaid-enrolled children in a Primary Care Case Manager plan and a staff model HMO. Author(s): Shields AE, Comstock C, Finkelstein JA, Weiss KB. Source: Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association. 2003 September-October; 3(5): 253-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974661&dopt=Abstract
•
Comparing the medical expenses of adults with Medicaid and commercial insurance in a health maintenance organization. Author(s): Ray GT, Lieu TA. Source: Journal of Health Care for the Poor and Underserved. 2003 August; 14(3): 42035. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955920&dopt=Abstract
Studies
79
•
Comparison of urea reduction ratio and hematocrit data reported in different data systems: results from the Centers for Medicare & Medicaid Services and the Renal Network Inc. Author(s): Frankenfield DL, Brier ME, Bedinger MR, Milam RA, Eggers PW, Cain JA, Aronoff GR, Frederick PR. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2003 February; 41(2): 433-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12552507&dopt=Abstract
•
Co-occurrence of HIV and serious mental illness among Medicaid recipients. Author(s): Blank MB, Mandell DS, Aiken L, Hadley TR. Source: Psychiatric Services (Washington, D.C.). 2002 July; 53(7): 868-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12096171&dopt=Abstract
•
Correlates of family burden under Medicaid managed mental health care. Author(s): Stroup TS, Morrissey JP, Ellis AR, Blank M. Source: Administration and Policy in Mental Health. 2001 November; 29(2): 117-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11939747&dopt=Abstract
•
Correlates of late stage breast cancer and death in a Medicaid-insured population. Author(s): Bradley CJ, Given CW, Roberts C. Source: Journal of Health Care for the Poor and Underserved. 2003 November; 14(4): 503-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14619552&dopt=Abstract
•
Cost impact of botulinum toxin use in Medicaid-enrolled children with cerebral palsy. Author(s): Balkrishnan R, Camacho FT, Smith BP, Shilt JS, Jacks LK, Koman LA, Rascati KL, Mooney JF 3rd. Source: J South Orthop Assoc. 2002 Summer; 11(2): 71-9. Erratum In: J South Orthop Assoc. 2002 Fall; 11(3): 166. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12741586&dopt=Abstract
•
Cost of treating bipolar disorder in the California Medicaid (Medi-Cal) program. Author(s): Li J, McCombs JS, Stimmel GL. Source: Journal of Affective Disorders. 2002 September; 71(1-3): 131-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12167509&dopt=Abstract
•
Court strikes down department of Medicaid's refusal to pay for consultation services. Author(s): Thomas JP. Source: J Ky Med Assoc. 2002 October; 100(10): 433-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12395744&dopt=Abstract
80
Medicaid
•
Coverage decision-making in Medicaid managed care: key issues in developing managed care contracts. Author(s): Rosenbaum S, Teitelbaum JB. Source: Issue Brief George Wash Univ Cent Health Serv Res Policy. 1998 May; (1): 1-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12425331&dopt=Abstract
•
Coverage gaps for Medicaid-eligible children in the wake of federal welfare reform. Author(s): Haley J, Kenney G. Source: Inquiry. 2003 Summer; 40(2): 158-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13677563&dopt=Abstract
•
Covering uninsured adults through Medicaid: lessons from the Oregon health plan. Author(s): Haber SG, Khatutsky G, Mitchell JB. Source: Health Care Financing Review. 2000 Winter; 22(2): 119-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500324&dopt=Abstract
•
Cultural competence in Medicaid managed care purchasing: general and behavioral health services for persons with mental and addiction-related illnesses and disorders. Author(s): Rosenbaum S, Teitelbaum J. Source: Issue Brief George Wash Univ Cent Health Serv Res Policy. 1999 May; (4): 1-22. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12426707&dopt=Abstract
•
Datapoints: use of multiple psychotropic drugs by Medicaid-insured and privately insured children. Author(s): Martin A, Sherwin T, Stubbe D, Van Hoof T, Scahill L, Leslie D. Source: Psychiatric Services (Washington, D.C.). 2002 December; 53(12): 1508. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12461205&dopt=Abstract
•
Datapoints: use of nonpsychiatric inpatient care by Medicaid mental health service users. Author(s): Buck JA, Miller K. Source: Psychiatric Services (Washington, D.C.). 2003 March; 54(3): 300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610235&dopt=Abstract
•
Dental visits to hospital emergency departments by adults receiving Medicaid: assessing their use. Author(s): Cohen LA, Manski RJ, Magder LS, Mullins CD. Source: The Journal of the American Dental Association. 2002 June; 133(6): 715-24; Quiz 768. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12083647&dopt=Abstract
Studies
81
•
Depression in Medicaid-covered youth: differences by race and ethnicity. Author(s): Richardson LP, DiGiuseppe D, Garrison M, Christakis DA. Source: Archives of Pediatrics & Adolescent Medicine. 2003 October; 157(10): 984-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14557159&dopt=Abstract
•
Descriptive analyses of the integrity of a US Medicaid claims database. Author(s): Hennessy S, Bilker WB, Weber A, Strom BL. Source: Pharmacoepidemiology and Drug Safety. 2003 March; 12(2): 103-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12647699&dopt=Abstract
•
Designing a complaint and grievance system and other member assistance services under Medicaid managed care. Author(s): Rosenbaum S, Teitelbaum J. Source: Issue Brief George Wash Univ Cent Health Serv Res Policy. 2000 February; (7): 1-14. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12426708&dopt=Abstract
•
Diabetes preventive care in Oregon's Medicaid population. Author(s): Kemple AM, Ngo DL, Clarke NG, Marshall LM, Kohn MA, Hedberg K. Source: Journal of Public Health Management and Practice : Jphmp. 2003 July-August; 9(4): 299-305. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836512&dopt=Abstract
•
Diabetic patient experiences in a Medicaid managed care system. Author(s): Womeodu RJ, Graney MJ, Gibson DV, Bailey JE. Source: Tenn Med. 2003 October; 96(10): 465-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14574722&dopt=Abstract
•
Differences in use of health services between White and African American children enrolled in Medicaid in North Carolina. Author(s): Buescher PA, Horton SJ, Devaney BL, Roholt SJ, Lenihan AJ, Whitmire JT, Kotch JB. Source: Maternal and Child Health Journal. 2003 March; 7(1): 45-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710799&dopt=Abstract
•
Disasters and the public health safety net: Hurricane Floyd hits the North Carolina Medicaid program. Author(s): Domino ME, Fried B, Moon Y, Olinick J, Yoon J. Source: American Journal of Public Health. 2003 July; 93(7): 1122-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835196&dopt=Abstract
82
Medicaid
•
Disease management for Medicaid's kidney failure patients: the Florida initiative. Author(s): Bozikis JP. Source: Nephrol News Issues. 2001 April; 15(5): 31-2, 38-40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12108961&dopt=Abstract
•
Disparities in dental service utilization among Alabama Medicaid children. Author(s): Dasanayake AP, Li Y, Wadhawan S, Kirk K, Bronstein J, Childers NK. Source: Community Dentistry and Oral Epidemiology. 2002 October; 30(5): 369-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12236828&dopt=Abstract
•
Do adjusted clinical groups eliminate incentives for HMOs to avoid substance abusers? Evidence from the Maryland Medicaid HealthChoice program. Author(s): Ettner SL, Johnson S. Source: The Journal of Behavioral Health Services & Research. 2003 January-February; 30(1): 63-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633004&dopt=Abstract
•
Do clinicians screen Medicaid patients for syphilis or HIV when they diagnose other sexually transmitted diseases? Author(s): Rust G, Minor P, Jordan N, Mayberry R, Satcher D. Source: Sexually Transmitted Diseases. 2003 September; 30(9): 723-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972797&dopt=Abstract
•
Do commercial managed care members rate their health plans differently than Medicaid managed care members? Author(s): Roohan PJ, Franko SJ, Anarella JP, Dellehunt LK, Gesten FC. Source: Health Services Research. 2003 August; 38(4): 1121-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12968820&dopt=Abstract
•
Do enrollees in 'look-alike' Medicaid and SCHIP programs really look alike? State Children's Health Insurance Program. Author(s): Edwards JN, Bronstein J, Rein DB. Source: Health Aff (Millwood). 2002 May-June; 21(3): 240-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12025990&dopt=Abstract
•
Do welfare caseload declines make the Medicaid risk pool sicker? Author(s): Garrett B, Holahan J. Source: Inquiry. 2002 Spring; 39(1): 12-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12067071&dopt=Abstract
Studies
83
•
Drug companies crying foul over Medicaid's formulary push. Author(s): Carroll J. Source: Manag Care. 2002 November; 11(11): 12-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12491852&dopt=Abstract
•
Drug 'ediction'. This pilot program could mean massive Medicaid dollar savings for LTC facilities. Author(s): Clark T. Source: Contemporary Longterm Care. 2003 April; 26(4): 34-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698897&dopt=Abstract
•
Dually eligible for Medicare and Medicaid: two for one or double jeopardy? Author(s): Ryan J, Super N. Source: Issue Brief Natl Health Policy Forum. 2003 September 30; (794): 1-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14524355&dopt=Abstract
•
Economic consequences of underuse of generic drugs: evidence from Medicaid and implications for prescription drug benefit plans. Author(s): Fischer MA, Avorn J. Source: Health Services Research. 2003 August; 38(4): 1051-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12968816&dopt=Abstract
•
Economic grand rounds: medical expenditures among children with psychiatric disorders in a Medicaid population. Author(s): Mandell DS, Guevara JP, Rostain AL, Hadley TR. Source: Psychiatric Services (Washington, D.C.). 2003 April; 54(4): 465-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663833&dopt=Abstract
•
Effect of CAHPS performance information on health plan choices by Iowa Medicaid beneficiaries. Author(s): Farley DO, Elliott MN, Short PF, Damiano P, Kanouse DE, Hays RD. Source: Medical Care Research and Review : Mcrr. 2002 September; 59(3): 319-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12205831&dopt=Abstract
•
Effects of CAHPS health plan performance information on plan choices by New Jersey Medicaid beneficiaries. Author(s): Farley DO, Short PF, Elliott MN, Kanouse DE, Brown JA, Hays RD. Source: Health Services Research. 2002 August; 37(4): 985-1007. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12236394&dopt=Abstract
84
Medicaid
•
Effects of Medicaid managed care programs on health services access and use. Author(s): Garrett B, Davidoff AJ, Yemane A. Source: Health Services Research. 2003 April; 38(2): 575-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785562&dopt=Abstract
•
Eligibility and enrollment of adolescents in Medicaid and SCHIP: recent progress, current challenges. Author(s): Morreale MC, English A. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 2003 June; 32(6 Suppl): 25-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782442&dopt=Abstract
•
Enrollee satisfaction with three Florida Medicaid managed care programs. Author(s): Hu HM, Duncan RP, Porter CK. Source: Manag Care Interface. 2003 May; 16(5): 22-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789861&dopt=Abstract
•
Ethnic differences in use of antipsychotic medication among Texas Medicaid clients with schizophrenia. Author(s): Opolka JL, Rascati KL, Brown CM, Barner JC, Johnsrud MT, Gibson PJ. Source: The Journal of Clinical Psychiatry. 2003 June; 64(6): 635-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823076&dopt=Abstract
•
Evaluating behavioral health services in Minnesota's Medicaid population using the Experience of Care and Health Outcomes (ECHO) Survey. Author(s): Beebe TJ, Harrison PA, McRae JA Jr, Asche SE. Source: Journal of Health Care for the Poor and Underserved. 2003 November; 14(4): 608-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14619558&dopt=Abstract
•
Evaluating Medicaid HMOs when encounter data are missing: case of developmentally delayed children. Author(s): Alemi F, Maddox PJ, Prudius V, Doyon V. Source: Health Care Management Science. 2003 February; 6(1): 37-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638925&dopt=Abstract
•
Evaluating selection out of health plans for Medicaid beneficiaries with substance abuse. Author(s): Normand SL, Belanger AJ, Frank RG. Source: The Journal of Behavioral Health Services & Research. 2003 January-February; 30(1): 78-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633005&dopt=Abstract
Studies
85
•
Evolution of Medicaid managed care systems and eligibility expansions. Author(s): Ku L, Ellwood M, Hoag S, Ormond B, Wooldridge J. Source: Health Care Financing Review. 2000 Winter; 22(2): 7-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500318&dopt=Abstract
•
Examining costs of chronic conditions in a Medicaid population. Author(s): Garis RI, Farmer KC. Source: Manag Care. 2002 August; 11(8): 43-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12232928&dopt=Abstract
•
Expanding public health insurance to parents: effects on children's coverage under Medicaid. Author(s): Dubay L, Kenney G. Source: Health Services Research. 2003 October; 38(5): 1283-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14596391&dopt=Abstract
•
Extent of services provided by pharmacists in the Iowa Medicaid Pharmaceutical Case Management program. Author(s): Carter BL, Chrischilles EA, Scholz D, Hayase N, Bell N. Source: Journal of the American Pharmaceutical Association (Washington,D.C. : 1996). 2003 January-February; 43(1): 24-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585748&dopt=Abstract
•
Factors affecting physician provision of preventive care to Medicaid children. Author(s): Adams EK. Source: Health Care Financing Review. 2001 Summer; 22(4): 9-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378784&dopt=Abstract
•
Factors associated with Medicaid enrollment for low-income children in the United States. Author(s): Lin CJ, Lave JR, Chang CC, Marsh GM, LaVallee CP, Jovanovic Z. Source: Journal of Health & Social Policy. 2003; 16(3): 35-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877247&dopt=Abstract
•
Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients. Author(s): Berman S, Dolins J, Tang SF, Yudkowsky B. Source: Pediatrics. 2002 August; 110(2 Pt 1): 239-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12165573&dopt=Abstract
86
Medicaid
•
Federally qualified health centers: surviving Medicaid managed care, but not thriving. Author(s): Hoag SD, Norton SA, Rajan S. Source: Health Care Financing Review. 2000 Winter; 22(2): 103-17. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500323&dopt=Abstract
•
Financial performance and participation in Medicaid and Medi-Cal managed care. Author(s): McCue MJ, McCall N, Hurley RE, Wyttenbach M, White M. Source: Health Care Financing Review. 2001 Winter; 23(2): 69-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500339&dopt=Abstract
•
Financial risk reduction for people with disabilities in Medicaid programs. Author(s): Palsbo SE, Post R. Source: Managed Care Quarterly. 2003 Spring; 11(2): 1-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12968436&dopt=Abstract
•
Fiscal year 2001 Medicaid Home and Community-Based Services expenditures exceed those of ICFs/MR. Author(s): Lakin KC, Prouty R, Smith J, Polister B, Smith G. Source: Mental Retardation. 2002 August; 40(4): 336-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12180416&dopt=Abstract
•
For the patient. The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension. Author(s): Fedder DO, Chang RJ, Curry S, Nichols G. Source: Ethn Dis. 2003 Winter; 13(1): 146. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723023&dopt=Abstract
•
Formation of trusts and spend down to Medicaid. Author(s): Taylor DH Jr, Sloan FA, Norton EC. Source: The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences. 1999 July; 54(4): S194-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12382597&dopt=Abstract
•
Foster care and Medicaid managed care. Author(s): Leslie LK, Kelleher KJ, Burns BJ, Landsverk J, Rolls JA. Source: Child Welfare. 2003 May-June; 82(3): 367-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12769396&dopt=Abstract
Studies
87
•
Grim outlook. Increased Medicaid spending may force states to cut costs, scale back benefits. Author(s): Tieman J. Source: Modern Healthcare. 2002 December 16; 32(50): 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545614&dopt=Abstract
•
Has Medicaid managed care affected beneficiary access and use? Author(s): Zuckerman S, Brennan N, Yemane A. Source: Inquiry. 2002 Fall; 39(3): 221-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479536&dopt=Abstract
•
Has the increase in HMO enrollment within the Medicaid population changed the pattern of health service use and expenditures? Author(s): Kirby JB, Machlin SR, Cohen JW. Source: Medical Care. 2003 July; 41(7 Suppl): Iii24-Iii34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865724&dopt=Abstract
•
Health care access, use, and satisfaction among disabled Medicaid beneficiaries. Author(s): Coughlin TA, Long SK, Kendall S. Source: Health Care Financing Review. 2002 Winter; 24(2): 115-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690698&dopt=Abstract
•
Health hazard. Medicaid cuts could endanger patients. Author(s): Benko LB. Source: Modern Healthcare. 2003 January 20; 33(3): 26-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12577866&dopt=Abstract
•
Health outcomes and Medicaid costs for frail older individuals: a case study of a MCO versus fee-for-service care. Author(s): Burton LC, Weiner JP, Stevens GD, Kasper J. Source: Journal of the American Geriatrics Society. 2002 February; 50(2): 382-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12028225&dopt=Abstract
•
High-risk teen compliance with prescription contraception: an analysis of Ohio Medicaid claims. Author(s): Zink TM, Shireman TI, Ho M, Buchanan T. Source: Journal of Pediatric and Adolescent Gynecology. 2002 February; 15(1): 15-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11888805&dopt=Abstract
88
Medicaid
•
Home-based treatment, rates of ambulatory follow-up, and psychiatric rehospitalization in a Medicaid managed care population. Author(s): Frederick S, Caldwell K, Rubio DM. Source: The Journal of Behavioral Health Services & Research. 2002 November; 29(4): 466-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404940&dopt=Abstract
•
Honesty as good policy: evaluating Maryland's Medicaid managed care program. Author(s): Chang DI, Burton A, O'Brien J, Hurley RE. Source: The Milbank Quarterly. 2003; 81(3): 389-414. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12941001&dopt=Abstract
•
How do they manage? Disabled elderly persons in the community who are not receiving Medicaid long-term care services. Author(s): O'Keeffe J, Long SK, Liu K, Kerr M. Source: Home Health Care Services Quarterly. 2001; 20(4): 73-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12068967&dopt=Abstract
•
Huge Medicaid cuts weighed in Washington. Author(s): James JS. Source: Aids Treat News. 2003 April 4; (390): 7-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739476&dopt=Abstract
•
If we prescribe it, will it come? Access to asthma equipment for Medicaid-insured children and adults in the Bronx, NY. Author(s): Warman KL, Jacobs AM, Silver EJ. Source: Archives of Pediatrics & Adolescent Medicine. 2002 July; 156(7): 673-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090834&dopt=Abstract
•
Impact and cost-effectiveness of respiratory syncytial virus prophylaxis for Kansas Medicaid's high-risk children. Author(s): Shireman TI, Braman KS. Source: Archives of Pediatrics & Adolescent Medicine. 2002 December; 156(12): 1251-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444839&dopt=Abstract
•
Impact of economic policies on reducing tobacco use among Medicaid clients in New York. Author(s): Murphy JM, Shelley D, Repetto PM, Cummings KM, Mahoney MC. Source: Preventive Medicine. 2003 July; 37(1): 68-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799131&dopt=Abstract
Studies
89
•
Impact of Medicaid managed care on utilization of obstetric care: evidence from TennCare's early years. Author(s): Sloan FA, Conover CJ, Mah ML, Rankin PJ. Source: Southern Medical Journal. 2002 August; 95(8): 811-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190214&dopt=Abstract
•
Improvements in access to care for HIV and AIDS in a statewide Medicaid managed care system. Author(s): Bailey JE, Van Brunt DL, Raffanti SP, Long WJ, Jenkins PH. Source: Am J Manag Care. 2003 September; 9(9): 595-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14527105&dopt=Abstract
•
Improving utilization of preventive dental services by Medicaids-enrolled children: focus on the parents. Author(s): Nagahama SI, McNabb K, Vanderlinde M, Cobb K, Moore CS, Milgrom P, Coldwell SE. Source: Asdc J Dent Child. 2002 September-December; 69(3): 325-31, 236. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12613321&dopt=Abstract
•
Increases in fees for New York State Medicaid Dentistry. Will there be an increase in care? Author(s): Waldman HB. Source: The New York State Dental Journal. 2002 November; 68(9): 28-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442731&dopt=Abstract
•
Initiation and continuation of newer antiretroviral treatments among Medicaid recipients with AIDS. Author(s): Crystal S, Sambamoorthi U, Moynihan PJ, McSpiritt E. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2001 December; 16(12): 850-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903765&dopt=Abstract
•
Interactions between Medicare and Medicaid home care in Connecticut: responses to the 1997 BBA. Author(s): Liu K, Long SK, Kapustka H. Source: Home Health Care Services Quarterly. 2001; 20(3): 75-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12018687&dopt=Abstract
•
Interest groups and state Medicaid drug programs. Author(s): Pracht EE, Moore WJ. Source: Journal of Health Politics, Policy and Law. 2003 February; 28(1): 9-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705416&dopt=Abstract
90
Medicaid
•
Is Medicaid, the largest insurer of children with special health care needs, in danger? Author(s): Berman S. Source: Pediatrics. 2003 September; 112(3 Pt 1): 668-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12949298&dopt=Abstract
•
Language proficiency and the enrollment of Medicaid-eligible children in publicly funded health insurance programs. Author(s): Feinberg E, Swartz K, Zaslavsky AM, Gardner J, Walker DK. Source: Maternal and Child Health Journal. 2002 March; 6(1): 5-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926255&dopt=Abstract
•
Late stage cancers in a Medicaid-insured population. Author(s): Bradley CJ, Given CW, Roberts C. Source: Medical Care. 2003 June; 41(6): 722-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773838&dopt=Abstract
•
Managed Medicaid's last stand. Author(s): Carroll J. Source: Manag Care. 2003 March; 12(3): 46A-46B, 46F, 46H. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685376&dopt=Abstract
•
Managing behavioral health in Medicaid. Author(s): Mechanic D. Source: The New England Journal of Medicine. 2003 May 8; 348(19): 1914-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12736285&dopt=Abstract
•
Managing Medicaid in tough times. Author(s): Tomsic TD. Source: State Legislatures. 2002 June; 28(6): 12-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051251&dopt=Abstract
•
Maui Medicaid clinic. Author(s): Arakaki LS. Source: Hawaii Dent J. 1994 April; 25(4): 8, 11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910927&dopt=Abstract
•
Medicaid and children: a national disgrace. Author(s): Edwards S. Source: Health Aff (Millwood). 2003 March-April; 22(2): 281; Author Reply 281-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674432&dopt=Abstract
Studies
91
•
Medicaid and indigent care issue brief: Medicaid: access to health services: year end report-2002. Author(s): Johnson P. Source: Issue Brief Health Policy Track Serv. 2002 December 31; : 1-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877156&dopt=Abstract
•
Medicaid and indigent care issue brief: Medicaid: provider reimbursement: year end report-2002. Author(s): Johnson P. Source: Issue Brief Health Policy Track Serv. 2002 December 31; : 1-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877157&dopt=Abstract
•
Medicaid and indigent care issue brief: Medicaid: services covered: year end report2002. Author(s): Johnson P. Source: Issue Brief Health Policy Track Serv. 2002 December 31; : 1-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877158&dopt=Abstract
•
Medicaid and managed care: a lasting relationship? Author(s): Hurley RE, Somers SA. Source: Health Aff (Millwood). 2003 January-February; 22(1): 77-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528840&dopt=Abstract
•
Medicaid and mental health. Author(s): Giliberti M, Semansky R. Source: Health Aff (Millwood). 2003 May-June; 22(3): 251. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757294&dopt=Abstract
•
Medicaid and mental health: be careful what you ask for. Author(s): Frank RG, Goldman HH, Hogan M. Source: Health Aff (Millwood). 2003 January-February; 22(1): 101-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528842&dopt=Abstract
•
Medicaid and rural health care. Author(s): Hurley RE, Crawford H, Praeger S. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2002; 18 Suppl: 164-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12061511&dopt=Abstract
92
Medicaid
•
Medicaid and the disabled. Author(s): Tanzman MR. Source: Health Aff (Millwood). 2003 May-June; 22(3): 250; Author Reply 250-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757293&dopt=Abstract
•
Medicaid and the unconstitutional dimensions of prior authorization. Author(s): Ranjan JN. Source: Michigan Law Review. 2002 November; 101(2): 602-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12632592&dopt=Abstract
•
Medicaid can push for quality. Author(s): Somers SA. Source: Health Aff (Millwood). 2003 July-August; 22(4): 260. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12889776&dopt=Abstract
•
Medicaid confronts a changing managed care marketplace. Author(s): Hurley RE, Draper DA. Source: Health Care Financing Review. 2002 Fall; 24(1): 11-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545597&dopt=Abstract
•
Medicaid cuts. Author(s): Borges W. Source: Tex Med. 2003 June; 99(6): 24-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836572&dopt=Abstract
•
Medicaid expenditures on behavioral health care. Author(s): Mark TL, Buck JA, Dilonardo JD, Coffey RM, Chalk M. Source: Psychiatric Services (Washington, D.C.). 2003 February; 54(2): 188-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556599&dopt=Abstract
•
Medicaid funding cuts affect people with AIDS across the U.S. Author(s): Krauss K. Source: Aids Treat News. 2002 May 31; (380): 4-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085845&dopt=Abstract
•
Medicaid HCBS Waivers and supported employment pre- and post-Balanced Budget Act of 1997. Author(s): West M, Hill JW, Revell G, Smith G, Kregel J, Campbell L. Source: Mental Retardation. 2002 April; 40(2): 142-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11925268&dopt=Abstract
Studies
93
•
Medicaid hits home and states struggle. Author(s): Scott JS. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2003 July; 57(7): 30-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866152&dopt=Abstract
•
Medicaid managed behavioral health in rural areas. Author(s): Lambert D, Gale J, Bird D, Hartley D. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2003 Winter; 19(1): 22-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585771&dopt=Abstract
•
Medicaid managed care and coverage of prescription medications. Author(s): Buchanan RJ. Source: American Journal of Public Health. 2002 August; 92(8): 1238-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12144975&dopt=Abstract
•
Medicaid managed care and racial differences in satisfaction and access. Author(s): Greenberg G, Brandon WP, Schoeps N, Tingle LR, Shull LD. Source: Journal of Health Care for the Poor and Underserved. 2003 August; 14(3): 35171. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955916&dopt=Abstract
•
Medicaid managed care and STDs: missed opportunities to control the epidemic. Author(s): Pourat N, Brown ER, Razack N, Kassler W. Source: Health Aff (Millwood). 2002 May-June; 21(3): 228-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12025989&dopt=Abstract
•
Medicaid managed care and working-age beneficiaries with disabilities and chronic illnesses. Author(s): Ireys HT, Thornton C, McKay H. Source: Health Care Financing Review. 2002 Fall; 24(1): 27-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12553296&dopt=Abstract
•
Medicaid managed care meets developmental disabilities: proceed with caution. Author(s): Goel NL, Keefe RH. Source: Journal of Health & Social Policy. 2003; 16(3): 75-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12877249&dopt=Abstract
94
Medicaid
•
Medicaid managed care payment methods and capitation rates in 2001. Author(s): Holahan J, Suzuki S. Source: Health Aff (Millwood). 2003 January-February; 22(1): 204-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528853&dopt=Abstract
•
Medicaid managed care prescription use and cost savings. Author(s): Shireman TI, Hornung RW, Ho M, Moomaw CJ, Jang R. Source: Journal of the American Pharmaceutical Association (Washington,D.C. : 1996). 2002 July-August; 42(4): 587-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12150357&dopt=Abstract
•
Medicaid managed care: are academic medical centers penalized by attracting patients with high-cost conditions? Author(s): Heisler M, DeMonner SM, Billi JE, Hayward RA. Source: Am J Manag Care. 2003 January; 9(1): 19-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12549812&dopt=Abstract
•
Medicaid matters: children's health and Medicaid eligibility expansions. Author(s): Lykens KA, Jargowsky PA. Source: Journal of Policy Analysis and Management : [the Journal of the Association for Public Policy Analysis and Management]. 2002 Spring; 21(2): 219-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12722747&dopt=Abstract
•
Medicaid mess. Author(s): Ortolon K. Source: Tex Med. 2002 July; 98(7): 24-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12134747&dopt=Abstract
•
Medicaid not required to fund medically necessary abortions. Author(s): Annas GJ. Source: Nurs Law Ethics. 1980 October; 1(8): 3+. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085918&dopt=Abstract
•
Medicaid participation by private and safety net pediatricians, 1993 and 2000. Author(s): Tang SF, Yudkowsky BK, Davis JC. Source: Pediatrics. 2003 August; 112(2): 368-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897289&dopt=Abstract
•
Medicaid prescription drug coverage: state efforts to control costs. Author(s): Gencarelli DM. Source: Nhpf Issue Brief. 2003 May 10; (790): 1-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12751504&dopt=Abstract
Studies
95
•
Medicaid program information. Author(s): Mitchell L. Source: J Okla State Med Assoc. 2003 January; 96(1): 42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12632854&dopt=Abstract
•
Medicaid program information. Author(s): Mitchell L. Source: J Okla State Med Assoc. 2002 December; 95(12): 778. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596437&dopt=Abstract
•
Medicaid program information. Author(s): Mitchell L. Source: J Okla State Med Assoc. 2003 March; 96(3): 158-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12688232&dopt=Abstract
•
Medicaid program; external quality review of Medicaid managed care organizations. Final rule. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 January 24; 68(16): 3585-638. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545997&dopt=Abstract
•
Medicaid program; Medicaid managed care. Withdrawal of final rule with comment period. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2002 June 14; 67(115): 40987-40989. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12068900&dopt=Abstract
•
Medicaid program; Medicaid managed care: new provisions. Final rule. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2002 June 14; 67(115): 40989-1116. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12068901&dopt=Abstract
•
Medicaid program; time limitation on price recalculations and recordkeeping requirements under the drug rebate program. Final rule with comment period. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 August 29; 68(168): 51912-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962118&dopt=Abstract
96
Medicaid
•
Medicaid recipients' rights. Author(s): Manne J. Source: Health Aff (Millwood). 2003 May-June; 22(3): 251-2; Author Reply 252. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757295&dopt=Abstract
•
Medicaid reforms to save $46.4 million. Author(s): McHenry KF. Source: Iowa Med. 2003 May-June; 93(3): 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12827850&dopt=Abstract
•
Medicaid reimbursement for APRNs. Author(s): McKeon E. Source: The American Journal of Nursing. 2002 March; 102(3): 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11976521&dopt=Abstract
•
Medicaid reimbursement for light therapy. Author(s): Kanofsky JD, Aspengren KL, Watts GR. Source: The American Journal of Psychiatry. 2003 April; 160(4): 796-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12668375&dopt=Abstract
•
Medicaid reimbursement. Author(s): Rucker TD. Source: The Journal of the American Dental Association. 2003 April; 134(4): 412; Discussion 412. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12733766&dopt=Abstract
•
Medicaid underfunding crisis threatens patient access. Author(s): Natinsky P. Source: Mich Med. 2002 May-June; 101(3): 10-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12058654&dopt=Abstract
•
Medicaid woes returning. Author(s): Tomsic TD. Source: State Legislatures. 2002 January; 28(1): 26-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11936166&dopt=Abstract
•
Medicaid, health care financing trends, and the future of state-based public mental health services. Author(s): Buck JA. Source: Psychiatric Services (Washington, D.C.). 2003 July; 54(7): 969-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851432&dopt=Abstract
Studies
97
•
Medicaid: focusing on state innovation. Author(s): Cubanski J, Kline J. Source: Issue Brief (Commonw Fund). 2003 April; (617): 1-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12693393&dopt=Abstract
•
Medicaid: for want of an ostomy pouch. Author(s): Turnbull GB. Source: Ostomy Wound Manage. 2003 May; 49(5): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732753&dopt=Abstract
•
Medicaid: lessons from a decade. Author(s): Rowland D, Tallon JR Jr. Source: Health Aff (Millwood). 2003 January-February; 22(1): 138-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528845&dopt=Abstract
•
Medicaid: past successes and future challenges. Author(s): Perkins J. Source: Health Matrix (Cleveland, Ohio : 1991). 2002 Winter; 12(1): 7-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12013702&dopt=Abstract
•
Medicare and Medicaid programs; fire safety requirements for certain health care facilities. Final rule. Author(s): Centers for Medicare& Medicaid Services (CMS), HHS. Source: Federal Register. 2003 January 10; 68(7): 1374-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12523353&dopt=Abstract
•
Medicare and Medicaid programs; hospital conditions of participation: quality assessment and performance improvement. Final rule. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 January 24; 68(16): 3435-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545996&dopt=Abstract
•
Medicare and Medicaid programs; requirements for paid feeding assistants in long term care facilities. Final rule. Author(s): Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 September 26; 68(187): 55528-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14513822&dopt=Abstract
98
Medicaid
•
Medicare maximization by state Medicaid programs: effects on Medicare home care utilization. Author(s): Anderson WL, Norton EC, Dow WH. Source: Medical Care Research and Review : Mcrr. 2003 June; 60(2): 201-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800684&dopt=Abstract
•
Medicare, Medicaid, and CLIA programs; laboratory requirements relating to quality systems and certain personnel qualifications. Final rule. Author(s): Centers for Disease Control and Prevention (CDC) (2) Centers for Medicare & Medicaid Services (CMS), HHS. Source: Federal Register. 2003 January 24; 68(16): 3639-714. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545998&dopt=Abstract
•
Mounting pressures: physicians serving Medicaid patients and the uninsured, 19972001. Author(s): Cunningham PJ. Source: Track Rep. 2002 December; (6): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12532973&dopt=Abstract
•
New report clarifies the extent of the Medicaid shortfall. Author(s): Natinsky P. Source: Mich Med. 2003 September-October; 102(5): 10-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520909&dopt=Abstract
•
NJDA fights to save dental benefits for adults on Medicaid. Author(s): Schulz JJ, Elmore ER. Source: J N J Dent Assoc. 2003 Spring; 74(2): 34-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861653&dopt=Abstract
•
No permission needed. Bush proposes lift of federal Medicaid requirement. Author(s): Fong T. Source: Modern Healthcare. 2003 February 3; 33(5): 7, 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602296&dopt=Abstract
•
Nurse-evaluator uncovers Medicaid fraud scheme. Case on point: Goubran v. Dir. State Dept. of Health Srvcs., 2002 WL 31256887 P.2d -CA. Author(s): Tammelleo AD. Source: Nurs Law Regan Rep. 2002 October; 43(5): 4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12436818&dopt=Abstract
Studies
99
•
Olanzapine versus risperidone in the treatment of schizophrenia : a comparison of costs among Texas Medicaid recipients. Author(s): Rascati KL, Johnsrud MT, Crismon ML, Lage MJ, Barber BL. Source: Pharmacoeconomics. 2003; 21(10): 683-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828491&dopt=Abstract
•
Olmstead v. L.C.: implications for Medicaid and other publicly funded health services. Author(s): Rosenbaum S, Teitelbaum J, Stewart A. Source: Health Matrix (Cleveland, Ohio : 1991). 2002 Winter; 12(1): 93-138. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12013703&dopt=Abstract
•
Options for prenatal care under Medicaid and SCHIP. Author(s): Oliver L. Source: Ncsl Legisbrief. 2003 February; 11(10): 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585315&dopt=Abstract
•
Oregon's transition to a managed care model for Medicaid-funded substance abuse treatment: steamrolling the glass menagerie. Author(s): D'Ambrosio R, Mondeaux F, Gabriel RM, Laws KE. Source: Health & Social Work. 2003 May; 28(2): 126-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12774534&dopt=Abstract
•
Outcome assessment of the Medicaid managed care program in Harris County (Houston). Author(s): Averill PM, Ruiz P, Small DR, Guynn RW, Tcheremissine O. Source: The Psychiatric Quarterly. 2003 Summer; 74(2): 103-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602828&dopt=Abstract
•
Outpatient encounter data for risk adjustment: strategic issues for Medicare and Medicaid. Author(s): Welch WP. Source: The Journal of Ambulatory Care Management. 2002 July; 25(3): 1-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12141013&dopt=Abstract
•
Overview of the Medicare and Medicaid programs. Author(s): Hoffman ED Jr, Klees BS, Curtis CA. Source: Health Care Financ Rev Stat Suppl. 2001; : 1-376. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12820295&dopt=Abstract
100
Medicaid
•
Parent caregiver-related predictors of health care service utilization by children with cerebral palsy enrolled in Medicaid. Author(s): Balkrishnan R, Naughton M, Smith BP, Manuel J, Koman LA. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2002 March-April; 16(2): 73-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11904641&dopt=Abstract
•
Participation of plans and providers in Medicaid and SCHIP managed care. State Children's Health Insurance Program. Author(s): Gold M, Mittler J, Draper D, Rousseau D. Source: Health Aff (Millwood). 2003 January-February; 22(1): 230-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528855&dopt=Abstract
•
Patterns of ACE inhibitor use in elderly Medicaid patients with heart failure. Author(s): Howard PA, Shireman TI, Dhingra A, Ellerbeck EF, Fincham JE. Source: The American Journal of Geriatric Cardiology. 2002 September-October; 11(5): 287-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214166&dopt=Abstract
•
Pediatric emergency department utilization within a statewide Medicaid managed care system. Author(s): Brousseau DC, Dansereau LM, Linakis JG, Leddy T, Vivier PM. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2002 April; 9(4): 296-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11927453&dopt=Abstract
•
Perils of pioneering: monitoring Medicaid managed care. Author(s): Wooldridge J, Hoag SD. Source: Health Care Financing Review. 2000 Winter; 22(2): 61-83. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500321&dopt=Abstract
•
Pharmaceutical case management helps Iowa Medicaid patients. Author(s): Young D. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 March 1; 60(5): 414, 416. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635443&dopt=Abstract
•
Pharmaceuticals: Medicaid drug cost containment: year end report-2002. Author(s): Floridi T, Kammer C. Source: Issue Brief Health Policy Track Serv. 2002 December 31; : 1-13. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856684&dopt=Abstract
Studies
101
•
Pharmaceuticals: rebate program limited to individuals covered by Medicaid. Author(s): Zendran M. Source: The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics. 2001 Fall-Winter; 29(3-4): 409-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12056380&dopt=Abstract
•
Playing the lottery: HCBS lawsuits and other Medicaid litigation on behalf of the developmentally disabled. Author(s): Feltz MK. Source: Health Matrix (Cleveland, Ohio : 1991). 2002 Winter; 12(1): 181-238. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12013699&dopt=Abstract
•
Policing Medicaid and Medicare managed care: the role of courts and administrative agencies. Author(s): Mello MM. Source: Journal of Health Politics, Policy and Law. 2002 June; 27(3): 465-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12092677&dopt=Abstract
•
Politically incorrect observations on how to help the Medicaid budget crisis. Author(s): South DS. Source: J Miss State Med Assoc. 2002 April; 43(4): 127-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11989201&dopt=Abstract
•
Poor program's progress: the unanticipated politics of Medicaid policy. Author(s): Brown LD, Sparer MS. Source: Health Aff (Millwood). 2003 January-February; 22(1): 31-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528837&dopt=Abstract
•
Predictors of warfarin use among Ohio Medicaid patients with new-onset nonvalvular atrial fibrillation. Author(s): Johnston JA, Cluxton RJ Jr, Heaton PC, Guo JJ, Moomaw CJ, Eckman MH. Source: Archives of Internal Medicine. 2003 July 28; 163(14): 1705-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885686&dopt=Abstract
•
Preferred drug lists for Medicaid. Author(s): Kozma CM. Source: Manag Care Interface. 2003 June; 16(6): 47-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841075&dopt=Abstract
102
Medicaid
•
Prenatal care and infant birth outcomes among Medicaid recipients. Author(s): Guillory VJ, Samuels ME, Probst JC, Sharp G. Source: Journal of Health Care for the Poor and Underserved. 2003 May; 14(2): 272-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739305&dopt=Abstract
•
Prescription drug costs for dually eligible people in a Medicaid home- and community-based services program. Author(s): Phillips VL, Atherly A. Source: Journal of the American Geriatrics Society. 2002 July; 50(7): 1283-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133026&dopt=Abstract
•
Process of care for Medicaid-enrolled children with asthma: served by community health centers and other providers. Author(s): Shields AE, Finkelstein JA, Comstock C, Weiss KB. Source: Medical Care. 2002 April; 40(4): 303-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12021686&dopt=Abstract
•
Promising practices: how leading safety-net plans are managing the care of Medicaid clients. Author(s): Sparer MS, Brown LD, Gusmano MK, Rowe C, Gray BH. Source: Health Aff (Millwood). 2002 September-October; 21(5): 284-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12224894&dopt=Abstract
•
Provider risk sharing in Medicaid managed care plans. Author(s): Draper DA, Gold MR. Source: Health Aff (Millwood). 2003 May-June; 22(3): 159-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757280&dopt=Abstract
•
Provision of sexual health services to adolescent enrollees in Medicaid managed care. Author(s): Lafferty WE, Downey L, Holan CM, Lind A, Kassler W, Tao G, Irwin KL. Source: American Journal of Public Health. 2002 November; 92(11): 1779-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12406808&dopt=Abstract
•
Psychiatric hospital length of stay for Medicaid clients before and after managed care. Author(s): McFarland BH, Khorramzadeh S, Millius R, Mahler J. Source: Administration and Policy in Mental Health. 2002 January; 29(3): 191-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12033665&dopt=Abstract
Studies
103
•
Psychotropic drug use and expenditures among Medicaid beneficiaries with and without other mental health or substance abuse services. Author(s): Hennessy KD, Green-Hennessy S, Buck JA, Miller K. Source: The Journal of Nervous and Mental Disease. 2003 July; 191(7): 476-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891096&dopt=Abstract
•
Putting Medicaid at risk. Author(s): Weil A. Source: The Hastings Center Report. 2003 May-June; 33(3): Inside Back Cover. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854455&dopt=Abstract
•
Quality of care for children in commercial and Medicaid managed care. Author(s): Thompson JW, Ryan KW, Pinidiya SD, Bost JE. Source: Jama : the Journal of the American Medical Association. 2003 September 17; 290(11): 1486-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13129989&dopt=Abstract
•
Quality of Medicaid managed care plans' care of children consistently lags behind commercial plans' care. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2003 October 17; 14(20): 1-2, 6-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14584492&dopt=Abstract
•
Race differences in the age at diagnosis among Medicaid-eligible children with autism. Author(s): Mandell DS, Listerud J, Levy SE, Pinto-Martin JA. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2002 December; 41(12): 1447-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12447031&dopt=Abstract
•
Race/ethnicity, language, and patients' assessments of care in Medicaid managed care. Author(s): Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Source: Health Services Research. 2003 June; 38(3): 789-808. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822913&dopt=Abstract
•
Racial/ethnic variation in asthma status and management practices among children in managed Medicaid. Author(s): Lieu TA, Lozano P, Finkelstein JA, Chi FW, Jensvold NG, Capra AM, Quesenberry CP, Selby JV, Farber HJ. Source: Pediatrics. 2002 May; 109(5): 857-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986447&dopt=Abstract
104
Medicaid
•
Radical simplification: Disaster Relief Medicaid in New York City. Author(s): Haslanger K. Source: Health Aff (Millwood). 2003 January-February; 22(1): 252-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528857&dopt=Abstract
•
Readiness for Medicaid managed care reform initiatives: a profile of rural family physicians. Author(s): James PA, Cowan TM, Bliss MK, Graham RP, Rosenthal TC. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 1999 Summer; 15(3): 27784. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11942560&dopt=Abstract
•
Reforming the Medicaid disproportionate share hospital program. Author(s): Coughlin TA, Ku L, Kim J. Source: Health Care Financing Review. 2000 Winter; 22(2): 137-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500325&dopt=Abstract
•
Relationship between early primary care and emergency department use in early infancy by the Medicaid population. Author(s): Kotagal UR, Schoettker PJ, Atherton HD, Hornung RW, Bush D, Pomerantz WJ, Schubert CJ. Source: Archives of Pediatrics & Adolescent Medicine. 2002 July; 156(7): 710-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090840&dopt=Abstract
•
Relationship between health insurance and medical care for patients hospitalized with human immunodeficiency virus-related Pneumocystis carinii pneumonia, 19951997: Medicaid, bronchoscopy, and survival. Author(s): Parada JP, Deloria-Knoll M, Chmiel JS, Arozullah AM, Phan L, Ali SN, Goetz MB, Weinstein RA, Campo R, Jacobson J, Dehovitz J, Berland D, Bennett CL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 December 1; 37(11): 1549-55. Epub 2003 November 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14614679&dopt=Abstract
•
Risk of death for Medicaid recipients undergoing congenital heart surgery. Author(s): DeMone JA, Gonzalez PC, Gauvreau K, Piercey GE, Jenkins KJ. Source: Pediatric Cardiology. 2003 March-April; 24(2): 97-102. Epub 2002 September 25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12360394&dopt=Abstract
Studies
105
•
Rural-urban differences in health risks, resource use and expenditures within three state Medicaid programs: implications for Medicaid managed care. Author(s): Bronstein JM, Adams EK. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2002 Winter; 18(1): 38-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12043754&dopt=Abstract
•
Rx for Medicaid: with Medicaid costs rising and revenues declining, states are looking at what to do. Author(s): Tobler L, Folkemer D. Source: State Legislatures. 2003 April; 29(4): 16-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12678012&dopt=Abstract
•
Safety-net institutions buffer the impact of Medicaid managed care: a multi-method assessment in a rural state. Author(s): Waitzkin H, Williams RL, Bock JA, McCloskey J, Willging C, Wagner W. Source: American Journal of Public Health. 2002 April; 92(4): 598-610. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11919059&dopt=Abstract
•
Scattering of primary care: doctor switching and utilization of health care by children on fee-for-service Medicaid. Author(s): Joffe GP, Rodewald LE, Herbert T, Barth R, Szilagyi PG. Source: Journal of Urban Health : Bulletin of the New York Academy of Medicine. 1999 September; 76(3): 322-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607899&dopt=Abstract
•
SCHIP, Medicaid expansions lead to shifts in children's coverage. Author(s): Cunningham PJ, Reschovsky JD, Hadley J. Source: Issue Brief Cent Stud Health Syst Change. 2002 December; (59): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12512518&dopt=Abstract
•
Service use of rural and urban Medicaid beneficiaries suffering from depression: the role of supply. Author(s): Lambert D, Agger M, Hartley D. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 1999 Summer; 15(3): 34455. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11942567&dopt=Abstract
•
Some thoughts on troubled ADAPs and Medicaid. Author(s): Pietrandoni G. Source: Posit Aware. 2003 July-August; 14(4): 42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12951952&dopt=Abstract
106
Medicaid
•
Specialists' and primary care physicians' participation in Medicaid managed care. Author(s): Backus L, Osmond D, Grumbach K, Vranizan K, Phuong L, Bindman AB. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2001 December; 16(12): 815-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903760&dopt=Abstract
•
State budget attempts to leverage federal dollars for Medicaid. Other ideas would help contain costs. Author(s): Natinsky P. Source: Mich Med. 2003 May-June; 102(3): 14-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822274&dopt=Abstract
•
State budget cuts affect Medicaid adult dental program. Author(s): Carlson-Easley N. Source: Todays Fda. 2002 July; 14(7): 14-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12174678&dopt=Abstract
•
State Medicaid prescription drug expenditures for Medicare-Medicaid dual eligibles: estimates of Medicaid savings and federal expenditures resulting from expanded Medicare prescription coverage. Author(s): Dale SB, Verdier JM. Source: Issue Brief (Commonw Fund). 2003 April; (627): 1-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685428&dopt=Abstract
•
State Medicaid programs offering personal care services. Author(s): LeBlanc AJ, Tonner MC, Harrington C. Source: Health Care Financing Review. 2001 Summer; 22(4): 155-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12378764&dopt=Abstract
•
State Mental Health Policy: New Mexico's Medicaid managed care waiver: organizing input from mental health consumers and advocates. Author(s): Willging CE, Semansky RM, Waitzkin H. Source: Psychiatric Services (Washington, D.C.). 2003 March; 54(3): 289-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610233&dopt=Abstract
•
State policy and practice regarding substance abuse treatment services for Medicaid recipients with disabilities. Author(s): Bachman SS, Drainoni ML, Tobias C. Source: The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions. 2003 March-April; 12(2): 166-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746092&dopt=Abstract
Studies
107
•
States cut Medicaid benefits amid recession, revenue declines. Author(s): Hefner D. Source: Journal of the National Medical Association. 2002 April; 94(4): A9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11991349&dopt=Abstract
•
States examine ways to improve disease management in Medicaid. Author(s): Carroll J. Source: Manag Care. 2003 March; 12(3): 15-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685370&dopt=Abstract
•
Strategies for integrating Medicare and Medicaid: design features and incentives. Author(s): Miller EA, Weissert WG. Source: Medical Care Research and Review : Mcrr. 2003 June; 60(2): 123-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800681&dopt=Abstract
•
Strategies for surveying families of Medicaid-insured children by telephone. Author(s): Jensvold NG, Lieu TA, Chi FW, Capra AM, Sisk CA. Source: Journal of Health Care for the Poor and Underserved. 2003 February; 14(1): 1722. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12613065&dopt=Abstract
•
Stratifying medical and pharmaceutical administrative claims as a method to identify pediatric asthma patients in a Medicaid managed care organization. Author(s): Twiggs JE, Fifield J, Apter AJ, Jackson EA, Cushman RA. Source: Journal of Clinical Epidemiology. 2002 September; 55(9): 938-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12393083&dopt=Abstract
•
Substitution in a Medicaid mental health carve-out: services and costs. Author(s): Libby AM, Cuellar A, Snowden LR, Orton HD. Source: Journal of Health Care Finance. 2002 Summer; 28(4): 11-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12148661&dopt=Abstract
•
TEFRA Medicaid option for children with mental illness. Author(s): Keely J. Source: Ncsl Legisbrief. 2003 March; 11(13): 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12617087&dopt=Abstract
•
The ABCs of children's health care: how the Medicaid expansions affected access, burdens, and coverage between 1987 and 1996. Author(s): Banthin JS, Selden TM. Source: Inquiry. 2003 Summer; 40(2): 133-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13677561&dopt=Abstract
108
Medicaid
•
The burden of injury in preschool children in an urban Medicaid managed care organization. Author(s): Bishai D, McCauley J, Trifiletti LB, McDonald EM, Reeb B, Ashman R, Gielen AC. Source: Ambulatory Pediatrics : the Official Journal of the Ambulatory Pediatric Association. 2002 July-August; 2(4): 279-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135402&dopt=Abstract
•
The bursting state fiscal bubble and state Medicaid budgets. Author(s): Boyd DJ. Source: Health Aff (Millwood). 2003 January-February; 22(1): 46-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528838&dopt=Abstract
•
The challenges of providing case management in a Medicaid environment. Author(s): Crosby M, Gambrill L, Trembly L, Smith H. Source: The Case Manager. 2000 May-June; 11(3): 69-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11935644&dopt=Abstract
•
The data page. Medicaid cuts threaten kids coverage. Author(s): Runy LA. Source: Hospitals & Health Networks / Aha. 2003 September; 77(9): 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14528794&dopt=Abstract
•
The economic burden of Barrett's esophagus in a Medicaid population. Author(s): Amonkar MM, Kalsekar ID, Boyer JG. Source: The Annals of Pharmacotherapy. 2002 April; 36(4): 605-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11918506&dopt=Abstract
•
The economic implications of case-mix Medicaid reimbursement for nursing home care. Author(s): Grabowski DC. Source: Inquiry. 2002 Fall; 39(3): 258-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479538&dopt=Abstract
•
The effect of Medicaid managed care on mental health care for children: a review of the literature. Author(s): Hutchinson AB, Foster EM. Source: Mental Health Services Research. 2003 March; 5(1): 39-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602645&dopt=Abstract
Studies
109
•
The effect of Medicaid participation by private and safety net pediatricians on incremental expansion of coverage for children. Author(s): Bucciarelli RL. Source: Pediatrics. 2003 August; 112(2): 416. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897298&dopt=Abstract
•
The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension. Author(s): Fedder DO, Chang RJ, Curry S, Nichols G. Source: Ethn Dis. 2003 Winter; 13(1): 22-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723008&dopt=Abstract
•
The effects of CON repeal on Medicaid nursing home and long-term care expenditures. Author(s): Grabowski DC, Ohsfeldt RL, Morrisey MA. Source: Inquiry. 2003 Summer; 40(2): 146-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13677562&dopt=Abstract
•
The evolving role and care management approaches of safety-net Medicaid managed care plans. Author(s): Gusmano MK, Sparer MS, Brown LD, Rowe C, Gray B. Source: Journal of Urban Health : Bulletin of the New York Academy of Medicine. 2002 December; 79(4): 600-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468679&dopt=Abstract
•
The extent of potential antihypertensive drug interactions in a Medicaid population. Author(s): Carter BL, Lund BC, Hayase N, Chrischilles E. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 2002 November; 15(11): 953-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12441214&dopt=Abstract
•
The impact of legislation and secular trends on newborn length of stay for Medicaid infants in Ohio. Author(s): Kotagal UR, Schoettker PJ, Atherton HD, Bush D, Hornung RW. Source: The Journal of Pediatrics. 2002 September; 141(3): 392-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12219061&dopt=Abstract
110
Medicaid
•
The impact of managed care on the substance abuse treatment patterns and outcomes of Medicaid beneficiaries: Maryland's HealthChoice program. Author(s): Ettner SL, Denmead G, Dilonardo J, Cao H, Belanger AJ. Source: The Journal of Behavioral Health Services & Research. 2003 January-February; 30(1): 41-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633003&dopt=Abstract
•
The Iowa Managed Substance Abuse Care Plan: access, utilization, and expenditures for Medicaid recipients. Author(s): McCarty D, Argeriou M. Source: The Journal of Behavioral Health Services & Research. 2003 January-February; 30(1): 18-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633002&dopt=Abstract
•
The Medicaid bind. Fiscally burdened states need short-term help, long-term fix for program. Author(s): Engler J. Source: Modern Healthcare. 2002 July 29; 32(30): 35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195667&dopt=Abstract
•
The Medicaid managed care grievance process: new protections for beneficiaries. Author(s): Brady TS, Hutchison S. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2002 April; 56(4): 46-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11963598&dopt=Abstract
•
The Medicaid mess. Author(s): Besaw L. Source: Tex Med. 2003 June; 99(6): 7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836569&dopt=Abstract
•
The Medicaid outlook for Michigan and beyond. Author(s): Ellis ER. Source: Mich Health Hosp. 2003 March-April; 39(2): 8-11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12685355&dopt=Abstract
•
The National Health Service Corps and Medicaid inpatient care: experience in a southern state. Author(s): Probst JC, Samuels ME, Shaw TV, Hart GL, Daly C. Source: Southern Medical Journal. 2003 August; 96(8): 775-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14515918&dopt=Abstract
Studies
111
•
The Nebraska Medicaid managed behavioral health care initiative: impacts on utilization, expenditures, and quality of care for mental health. Author(s): Bouchery E, Harwood H. Source: The Journal of Behavioral Health Services & Research. 2003 January-February; 30(1): 93-108. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12633006&dopt=Abstract
•
The politics of discretionary Medicaid spending, 1980-1993. Author(s): Kousser T. Source: Journal of Health Politics, Policy and Law. 2002 August; 27(4): 639-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12374292&dopt=Abstract
•
The relationship of post-acute home care use to Medicaid utilization and expenditures. Author(s): Payne SM, DiGiuseppe DL, Tilahun N. Source: Health Services Research. 2002 June; 37(3): 683-710. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132601&dopt=Abstract
•
The role of Medicaid HMO enrollment in the longitudinal utilization of medical care services in a cohort of injecting drug users in Baltimore, Maryland. Author(s): Juday TR, Wu A, Celentano DD, Frick KD, Wang MC, Vlahov D. Source: Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse. 2003 March; 24(1): 27-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12652093&dopt=Abstract
•
The tenuous nature of the Medicaid entitlement. Author(s): Jost TS. Source: Health Aff (Millwood). 2003 January-February; 22(1): 145-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528846&dopt=Abstract
•
The uninsured and Medicaid. Author(s): Searing A. Source: N C Med J. 2002 January-February; 63(1): 52-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11989312&dopt=Abstract
•
The Utah solution. HHS sees state's Medicaid solution as blueprint. Author(s): Taylor M. Source: Modern Healthcare. 2003 February 17; 33(7): 7, 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12688080&dopt=Abstract
112
Medicaid
•
There's something about Medicaid. Author(s): Weil A. Source: Health Aff (Millwood). 2003 January-February; 22(1): 13-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528836&dopt=Abstract
•
Thomas A. Scully and the Centers for Medicare and Medicaid Services. Interview by Kevin C. Park and Wanda Bishop. Author(s): Scully TA. Source: J Healthc Qual. 2003 January-February; 25(1): 23-5, 35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879627&dopt=Abstract
•
Timeliness of immunizations of children in a Medicaid primary care case management managed care program. Author(s): Cotter JJ, Bramble JD, Bovbjerg VE, Pugh CB, McClish DK, Tipton G, Smith WR. Source: Journal of the National Medical Association. 2002 September; 94(9): 833-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392047&dopt=Abstract
•
Treatment access emergency: ADAP and Medicaid. Author(s): James JS. Source: Aids Treat News. 2002 May 31; (380): 2-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085842&dopt=Abstract
•
Trends in antipsychotic use in a Texas Medicaid population of children and adolescents: 1996 to 2000. Author(s): Patel NC, Sanchez RJ, Johnsrud MT, Crismon ML. Source: Journal of Child and Adolescent Psychopharmacology. 2002 Fall; 12(3): 221-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427295&dopt=Abstract
•
Twenty years of growth in Medicaid Home and Community Based Services, recipients, and costs: June 1982 to June 2002. Author(s): Lakin KC, Prouty R, Polister B, Coucouvanis K. Source: Mental Retardation. 2003 October; 41(5): 394-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12964896&dopt=Abstract
•
Two-year outcomes of fee-for-service and capitated Medicaid programs for people with severe mental illness. Author(s): Cuffel BJ, Bloom JR, Wallace N, Hausman JW, Hu TW. Source: Health Services Research. 2002 April; 37(2): 341-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035997&dopt=Abstract
Studies
113
•
Underuse of controller medications among Medicaid-insured children with asthma. Author(s): Finkelstein JA, Lozano P, Farber HJ, Miroshnik I, Lieu TA. Source: Archives of Pediatrics & Adolescent Medicine. 2002 June; 156(6): 562-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12038888&dopt=Abstract
•
Unmet need among rural Medicaid beneficiaries in Minnesota. Author(s): Long SK, Coughlin TA, Kendall SJ. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2002 Summer; 18(3): 43746. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12186318&dopt=Abstract
•
US: Medicaid pays for half of nursing home bills, but better off do not qualify. Author(s): Charatan F. Source: Bmj (Clinical Research Ed.). 2002 June 29; 324(7353): 1543. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12092600&dopt=Abstract
•
Use of psychotropic drugs by mentally ill Medicaid beneficiaries. Author(s): Hennessy KD, Green-Hennessy S, Buck JA, Miller K. Source: Psychiatric Services (Washington, D.C.). 2002 September; 53(9): 1070. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221302&dopt=Abstract
•
Using Medicaid/SCHIP to insure working families: the Massachusetts experience. Author(s): Mitchell JB, Osber DS. Source: Health Care Financing Review. 2002 Spring; 23(3): 35-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12500348&dopt=Abstract
•
Welfare leavers' use of Medicaid transitional medical assistance in California, 19931997. Author(s): Mauldon J, Nayeri K, Dobkin C. Source: Inquiry. 2002-2003 Winter; 39(4): 372-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12638712&dopt=Abstract
•
Well-baby care in Connecticut's Medicaid managed-care program. Author(s): Lee MA, Learned A. Source: Conn Med. 2002 September; 66(9): 515-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12369545&dopt=Abstract
114
Medicaid
•
Westside Mothers and Medicaid: will this mean the end of private enforcement of federal funding conditions using section 1983? Author(s): Platt MA. Source: Am Univ Law Rev. 2001 December; 51(2): 273-308. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11963954&dopt=Abstract
•
Where the action really is: Medicaid and the disabled. Author(s): Vladeck BC. Source: Health Aff (Millwood). 2003 January-February; 22(1): 90-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528841&dopt=Abstract
•
Why dentists shun Medicaid: impact on children, especially children with special needs. Author(s): Waldman HB, Perlman SP. Source: J Dent Child (Chic). 2003 January-April; 70(1): 5-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762600&dopt=Abstract
•
Women's health and Medicaid reform. Author(s): Freund KM. Source: Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health. 2003 March-April; 13(2): 45-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732438&dopt=Abstract
•
Zidovudine use during pregnancy among HIV-infected women on Medicaid. Author(s): Sambamoorthi U, Akincigil A, McSpiritt E, Crystal S. Source: Journal of Acquired Immune Deficiency Syndromes (1999). 2002 August 1; 30(4): 429-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12138350&dopt=Abstract
115
CHAPTER 2. NUTRITION AND MEDICAID Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and Medicaid.
Finding Nutrition Studies on Medicaid The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Medicaid” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
4
Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
116
Medicaid
The following information is typical of that found when using the “Full IBIDS Database” to search for “Medicaid” (or a synonym): •
Antenatal corticosteroids for the prevention of neonatal respiratory distress in a predominantly rural state Medicaid population. Author(s): Division of General Internal Medicine, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
[email protected] Source: Golden, W E Hopkins, R H Sanchez, N P Obstet-Gynecol. 1998 November; 92(5): 837-41 0029-7844
•
Empiric investigation on direct costs-of-illness and healthcare utilization of Medicaid patients with diabetes mellitus. Author(s): US Pharmacopeia, Rockville, MD 20852, USA.
[email protected] Source: Guo, J J Gibson, J T Gropper, D M Oswald, S L Barker, K N Am-J-Manag-Care. 1998 October; 4(10): 1433-46 1096-1860
•
Health risk factor surveys of commercial plan- and Medicaid-enrolled members of health-maintenance organizations--Michigan, 1995. Source: Anonymous MMWR-Morb-Mortal-Wkly-Repage 1997 October 3; 46(39): 923-6 0149-2195
•
Impact of a mandatory Medicaid case management program on prenatal care and birth outcomes. A retrospective analysis. Author(s): Wharton Doctoral Program in Health Care System, University of Pennsylvania, Philadelphia. Source: Goldfarb, N I Hillman, A L Eisenberg, J M Kelley, M A Cohen, A V Dellheim, M Med-Care. 1991 January; 29(1): 64-71 0025-7079
•
Medicaid regulations for long-term care. Source: Anonymous J-Am-Diet-Assoc. 1990 August; 90(8): 1062-3 0002-8223
•
Medicaid reimbursement for alternative therapies. Source: Steyer, T E Freed, G L Lantz, P M Altern-Ther-Health-Med. 2002 Nov-December; 8(6): 84-8 1078-6791
•
Outcomes and cost benefits associated with the introduction of inhaled corticosteroid therapy in a Medicaid population of asthmatic patients. Author(s): Division of Pharmaceutical Policy and Evaluative Sciences, School of Pharmacy, University of North Carolina at Chapel Hill, USA. Source: Balkrishnan, R Norwood, G J Anderson, A Clin-Ther. 1998 May-June; 20(3): 56780 0149-2918
•
Patterns of use of a free nicotine patch program for Medicaid and uninsured patients. Author(s): Center for Urban Research in Primary Care, State University of New York at Buffalo, USA. Source: Jaen, C R Cummings, K M Shah, D Aungst, W J-Natl-Med-Assoc. 1997 May; 89(5): 325-8 0027-9684
•
Prenatal exposure to prescribed drugs in Tennessee Medicaid, 1983-1988. Author(s): Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2637. Source: Piper, J M Mitchel, E F Paediatr-Perinat-Epidemiol. 1991 October; 5(4): 402-9 0269-5022
•
Prenatal participation in WIC related to Medicaid costs for Missouri newborns: 1982 update. Source: Schramm, W.F. Public-Health-Rep. Washington, D.C. : Public Health Service. Nov/December 1986. volume 101 (6) page 607-615. charts. 0090-2818
Nutrition
117
•
Prescription drug use before and during pregnancy in a Medicaid population. Source: Piper, J M Baum, C Kennedy, D L Am-J-Obstet-Gynecol. 1987 July; 157(1): 148-56 0002-9378
•
Procedures provided to Medicaid recipients by pediatric, general and public health dentists in the commonwealth of Virginia: fiscal years 1994 and 1995. Author(s): Medical College of Virginia, Virginia Commonwealth University (VCU), Schools of Medicine and Dentistry, USA. Source: Cooke, M R Farrington, F H Huie, M Meadows, S L Pediatr-Dent. 2001 SepOctober; 23(5): 390-3 0164-1263
•
Relational database for drug-use review of Tennessee Medicaid claims. Author(s): Department of Clinical Pharmacy, University of Tennessee, Memphis, USA. Source: Chyka, P A Holimon, T D Tepedino, J T Petersen, H Am-J-Health-Syst-Pharm. 1996 January 15; 53(2): 164-6 1079-2082
•
The Medicaid eligibility expansions for pregnant women: evaluating the strength of state implementation efforts. Source: Gold, R.B. Singh, S. Frost, J. Fam-plann-perspect. [New York : Alan Guttmacher Institute,. Sept/October 1993. volume 25 (5) page 196-207. 0014-7354
•
The Nebraska Medicaid Drug Utilization Review Program. Source: LeGrady, D Nebr-Med-J. 1992 January; 77(1): 3-6 0091-6730
•
Therapeutic drug monitoring of mood stabilizers in Medicaid patients with bipolar disorder. Author(s): Office of Research, American Psychiatric Association, Washington, D.C., USA. Source: Marcus, S C Olfson, M Pincus, H A Zarin, D A Kupfer, D J Am-J-Psychiatry. 1999 July; 156(7): 1014-8 0002-953X
•
Treatment of Medicaid patients with asthma: comparison with treatment guidelines using disease-based drug utilization review methodology. Author(s): College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA. Source: Laumann, J M Bjornson, D C Ann-Pharmacother. 1998 December; 32(12): 1290-4 1060-0280
•
Variations in the use of medication for the treatment of childhood asthma in the Michigan Medicaid population, 1980 to 1986. Author(s): US Department of Health and Human Services, Public Health Service, Rockville, Md. Source: Bosco, L A Gerstman, B B Tomita, D K Chest. 1993 December; 104(6): 1727-32 0012-3692
•
Weighing costs and benefits of adequate prenatal care for 12,023 births in Missouri's Medicaid program, 1988. Source: Schramm, W.F. Public-Health-Rep. Rockville, Md. : U.S. Department of Health & Human Services, Public Health Service. Nov/December 1992. volume 107 (6) page 647-652. 0033-3549
•
WIC decreases Medicaid costs, USDA study shows. Source: Nutr-Week. Washington, D.C. : Community Nutrition Institute. October 19, 1990. volume 20 (41) page 6-7. 0736-0096
118
Medicaid
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
•
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
•
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
•
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
•
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
•
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
•
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
•
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
•
Google: http://directory.google.com/Top/Health/Nutrition/
•
Healthnotes: http://www.healthnotes.com/
•
Open Directory Project: http://dmoz.org/Health/Nutrition/
•
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
•
WebMDHealth: http://my.webmd.com/nutrition
•
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
119
CHAPTER 3. ALTERNATIVE MEDICINE AND MEDICAID Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to Medicaid. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to Medicaid and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “Medicaid” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to Medicaid: •
1984 Presidential election: issues of relevance to child and adolescent health. Author(s): Mondale WF, Reagan RW. Source: The Journal of School Health. 1984 October; 54(9): 366-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6568361&dopt=Abstract
•
2002: something old, something new. Author(s): Puckett RP. Source: Health Care Food & Nutrition Focus. 2002 January; 18(5): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11794905&dopt=Abstract
•
A dramatic approach to healthcare ethics committee education. Author(s): Jacobson JA, Foubert PJ.
120
Medicaid
Source: Hec Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues. 1994 November; 6(6): 329-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10140912&dopt=Abstract •
A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers. Author(s): Berliner E, Ozbilgin B, Zarin DA. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 March; 37(3): 539-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12618689&dopt=Abstract
•
A vision for ambulatory care in the 21st century. Author(s): Zuckerman AM. Source: Ambul Outreach. 1998 Winter; : 5-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10346023&dopt=Abstract
•
Access to health care and the undocumented alien. Author(s): Loue S. Source: The Journal of Legal Medicine. 1992 September; 13(3): 271-332. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1402383&dopt=Abstract
•
Advance directives for the critically ill: the federal legislative initiative. Author(s): Mishkin B. Source: Healthspan. 1990 March; 7(3): 8-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10106561&dopt=Abstract
•
Advanced practice nurses in nephrology. Author(s): Easom A, Allbritton G. Source: Adv Ren Replace Ther. 2000 July; 7(3): 247-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10926113&dopt=Abstract
•
Assessing the quality of asthma care provided to Medicaid patients enrolled in managed care organizations in Connecticut. Author(s): Apter AJ, Van Hoof TJ, Sherwin TE, Casey BA, Petrillo MK, Meehan TP. Source: Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology. 2001 February; 86(2): 211-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11258692&dopt=Abstract
•
Assuring professional pastoral care for every nursing home resident. Author(s): Knight B.
Alternative Medicine 121
Source: Journal of Health Care Chaplaincy. 1999; 8(1-2): 89-107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10387595&dopt=Abstract •
Chiropractic and Public Law 92-603. Author(s): Ballantine HT. Source: J Iowa Med Soc. 1974 January; 64(1): 7-11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4590831&dopt=Abstract
•
Chiropractic services in a staff model HMO: utilization and satisfaction. Author(s): Hansen JP, Futch DB. Source: Hmo Pract. 1997 March; 11(1): 39-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10165554&dopt=Abstract
•
Chronomodulated chemotherapy: clinical value and possibilities for dissemination in the United States. Author(s): Block KI. Source: Chronobiology International. 2002 January; 19(1): 275-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11962681&dopt=Abstract
•
Complementary roles for formal and informal support groups: a study of nursing homes and mortality rates. Author(s): Litwak E. Source: J Appl Behav Sci. 1985; 21(4): 407-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10300658&dopt=Abstract
•
Developing a nutritional surveillance system. Author(s): Nichaman MZ. Source: Journal of the American Dietetic Association. 1974 July; 65(1): 15-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4600588&dopt=Abstract
•
Dossey's odyssey: a conversation with Larry Dossey. Interview by Joe Flower. Author(s): Dossey L. Source: The Healthcare Forum Journal. 1998 November-December; 41(6): 20-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10346613&dopt=Abstract
•
Editorial: Onward with chiropractic. Author(s): Radovsky SS. Source: The New England Journal of Medicine. 1975 September 25; 293(13): 662-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1097918&dopt=Abstract
122
Medicaid
•
Effect of medical care review on the use of injections: a study of the New Mexico Experimental Medical Care Review Organization. Author(s): Brook RH, Williams KN. Source: Annals of Internal Medicine. 1976 October; 85(4): 509-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=989709&dopt=Abstract
•
Effect on physical functioning of care in adult foster homes and nursing homes. Author(s): Stark AJ, Kane RL, Kane RA, Finch M. Source: The Gerontologist. 1995 October; 35(5): 648-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8543222&dopt=Abstract
•
Effects of psychosocial risk factors and prenatal interventions on birth weight: evidence from New Jersey's HealthStart program. Author(s): Reichman NE, Teitler JO. Source: Perspectives on Sexual and Reproductive Health. 2003 May-June; 35(3): 130-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866786&dopt=Abstract
•
Entering the 21st century: moving incontinence treatment options to the forefront. Author(s): Newman DK. Source: Ostomy Wound Manage. 1999 December; 45(12): 5-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10687660&dopt=Abstract
•
Establishing a PNP faculty practice clinic for Medicaid EPSDT screening. Author(s): Jordan C. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1994 May-June; 8(3): 140-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7799183&dopt=Abstract
•
Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. Author(s): Solomon LJ, Scharoun GM, Flynn BS, Secker-Walker RH, Sepinwall D. Source: Preventive Medicine. 2000 July; 31(1): 68-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10896845&dopt=Abstract
•
Governmental regulation of heart transplantation and the right to privacy. Author(s): Merriken K, Overcast TD. Source: J Contemp Law. 1985; 11(2): 481-514. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11656659&dopt=Abstract
•
Hemochromatosis and dietary iron supplementation: implications from US mortality, morbidity, and health survey data. Author(s): Gable CB.
Alternative Medicine 123
Source: Journal of the American Dietetic Association. 1992 February; 92(2): 208-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1737903&dopt=Abstract •
Ice massage for the reduction of labor pain. Author(s): Waters BL, Raisler J. Source: Journal of Midwifery & Women's Health. 2003 September-October; 48(5): 317-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14526344&dopt=Abstract
•
Impact of Oregon's priority list on Medicaid beneficiaries. Author(s): Mitchell JB, Bentley F. Source: Medical Care Research and Review : Mcrr. 2000 June; 57(2): 216-34; Discussion 235-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10868074&dopt=Abstract
•
Incorporating Yup'ik and Cup'ik Eskimo traditions into behavioral health treatment. Author(s): Mills PA. Source: J Psychoactive Drugs. 2003 January-March; 35(1): 85-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12733763&dopt=Abstract
•
Intolerant tolerance. Author(s): Khushf G. Source: The Journal of Medicine and Philosophy. 1994 April; 19(2): 161-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8051515&dopt=Abstract
•
L-carnitine use in dialysis patients: is national coverage for supplementation justified? What were CMS regulators thinking--or were they? Author(s): Steinman TI, Nissenson AR, Glassock RJ, Dickmeyer J, Mattern WD, Parker TF 3rd, Hull AR. Source: Nephrol News Issues. 2003 April; 17(5): 28-30, 32-4, 36 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715624&dopt=Abstract
•
Legal abortion: the continuing battle. Author(s): Curran WJ. Source: The New England Journal of Medicine. 1974 June 6; 290(23): 1301-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4827628&dopt=Abstract
•
Managed care: Public-sector managed behavioral health care: VI. The Iowa approach to profit and community reinvestment. Author(s): Sabin JE, Daniels N.
124
Medicaid
Source: Psychiatric Services (Washington, D.C.). 2000 October; 51(10): 1239-40, 1247. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11013319&dopt=Abstract •
Managed care: Strengthening the consumer voice in managed care: VII. The Georgia peer specialist program. Author(s): Sabin JE, Daniels N. Source: Psychiatric Services (Washington, D.C.). 2003 April; 54(4): 497-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663836&dopt=Abstract
•
Medicaid reform: an opportunity for the osteopathic medical profession. Author(s): Ross-Lee B, Weiser MA. Source: J Am Osteopath Assoc. 1994 March; 94(3): 233-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8200827&dopt=Abstract
•
Medicaid reimbursement for alternative therapies. Author(s): Steyer TE, Freed GL, Lantz PM. Source: Alternative Therapies in Health and Medicine. 2002 November-December; 8(6): 84-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12440844&dopt=Abstract
•
Medical ethics and economics of organ transplantation. Author(s): Benjamin M. Source: Health Progress (Saint Louis, Mo.). 1988 March; 69(2): 47-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10302248&dopt=Abstract
•
MR angiography, the Health Care Financing Administration, and Laetrile. Author(s): Yucel EK. Source: Ajr. American Journal of Roentgenology. 1996 August; 167(2): 311-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8686592&dopt=Abstract
•
Our annual tribute to people who make a difference. Author(s): Trotto NE. Source: Contemporary Longterm Care. 2001 June; 24(6): 30-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11417098&dopt=Abstract
•
Paranoia or reality? Author(s): Kaiser GC. Source: The Annals of Thoracic Surgery. 1998 May; 65(5): 1201-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9594838&dopt=Abstract
Alternative Medicine 125
•
Persons receiving care from selected health care practitioners: United States, 1980. Author(s): Mugge RH. Source: Natl Med Care Util Expend Surv B. 1984 September; (6): 1-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10296631&dopt=Abstract
•
Pharmaceuticals issue brief: medical marijuana: year end report-2002. Author(s): Herstek J, Watson A, Kammer C. Source: Issue Brief Health Policy Track Serv. 2002 December 31; : 1-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856685&dopt=Abstract
•
Pharmacists' reactions to the Wisconsin Medicaid drug-use review program. Author(s): Brown CM, Lipowski EE. Source: Am J Hosp Pharm. 1993 September; 50(9): 1898-902. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7907839&dopt=Abstract
•
Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong women in California. Author(s): Tuttle CR, Dewey KG. Source: Journal of the American Dietetic Association. 1996 September; 96(9): 885-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8784333&dopt=Abstract
•
Power to heal. Funding cuts for pastoral education opposed. Author(s): Reilly P. Source: Modern Healthcare. 2003 June 30; 33(26): 10, 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12858635&dopt=Abstract
•
Practice patterns of massage therapists. Author(s): Lee AC, Kemper KJ. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 2000 December; 6(6): 527-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11152057&dopt=Abstract
•
Pregnant, alcohol-abusing women. Author(s): Hankin J, McCaul ME, Heussner J. Source: Alcoholism, Clinical and Experimental Research. 2000 August; 24(8): 1276-86. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10968668&dopt=Abstract
•
Providers issue brief: alternative providers. Author(s): Rothouse M.
126
Medicaid
Source: Issue Brief Health Policy Track Serv. 1999 June 29; : 1-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11073386&dopt=Abstract •
Psychosocial thriving during late pregnancy: relationship to ethnicity, gestational weight gain, and birth weight. Author(s): Walker LO, Kim M. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2002 May-June; 31(3): 263-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12033539&dopt=Abstract
•
The administration of chiropractic in the New York City Medicaid program. Author(s): Dintenfass J. Source: Medical Care. 1973 January-February; 11(1): 40-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4631408&dopt=Abstract
•
Who cares for Missouri's Medicaid nursing home residents? Characteristics of attending physicians. Author(s): Lawhorne LW, Walker G, Zweig SC, Snyder J. Source: Journal of the American Geriatrics Society. 1993 April; 41(4): 454-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8463535&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
•
AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
•
Chinese Medicine: http://www.newcenturynutrition.com/
•
drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html
•
Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
•
Google: http://directory.google.com/Top/Health/Alternative/
•
Healthnotes: http://www.healthnotes.com/
•
MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
•
Open Directory Project: http://dmoz.org/Health/Alternative/
•
HealthGate: http://www.tnp.com/
•
WebMDHealth: http://my.webmd.com/drugs_and_herbs
•
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
•
Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
Alternative Medicine 127
The following is a specific Web list relating to Medicaid; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Alternative Therapy Chiropractic Source: Integrative Medicine Communications; www.drkoop.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
129
CHAPTER 4. DISSERTATIONS ON MEDICAID Overview In this chapter, we will give you a bibliography on recent dissertations relating to Medicaid. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “Medicaid” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on Medicaid, we have not necessarily excluded non-medical dissertations in this bibliography.
Dissertations on Medicaid ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to Medicaid. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •
The Effects on Seven Community Mental Health Centers in Dade County, Florida As a Result of Regulatory Changes Allowing Direct Reimbursement from Medicaid Insurance for Services Given to Mentally Ill Patients by Milano, Cecelia Manchor, DPA from Nova University, 1991, 124 pages http://wwwlib.umi.com/dissertations/fullcit/9132944
•
The Equity and Impact of Medicare and Medicaid with Respect to Mexican Americans in Texas. by Hunt, Thomas Lynn, PhD from The University of Texas at Austin, 1978, 209 pages http://wwwlib.umi.com/dissertations/fullcit/7817654
•
The Factors Affecting the Utilization of Inpatient Care Facilities by New York State Medicaid Clients by Johnson, Steven C., PhD from State University of New York at Albany, 1983, 173 pages http://wwwlib.umi.com/dissertations/fullcit/8314820
130
Medicaid
•
The Fertility Effects of Medicaid-Funded Family Planning Services by Mellor, Jennifer Marie, PhD from University of Maryland College Park, 1996, 202 pages http://wwwlib.umi.com/dissertations/fullcit/9707644
•
The Fit between Low-Income Elders and Consumer-directed Personal Assistance Services: Informing the Development of More Adequate Substitutes for Medicaidfunded Institutional Care by Acree, Michelle Wolf; PhD from Virginia Commonwealth University, 2002, 241 pages http://wwwlib.umi.com/dissertations/fullcit/3045101
•
The Impact of a Finite Prescription Limit on Medicaid Recipients: an Economic Assessment by Martin, Bradley C., PhD from University of Georgia, 1993, 135 pages http://wwwlib.umi.com/dissertations/fullcit/9329810
•
The Impact of Financial Resources on the Recovery from Crisis Situations As Measured by Symptomology (insurance Coverage, Medicaid) by Cluse-tolar, Theresa, PhD from The Ohio State University, 1994, 151 pages http://wwwlib.umi.com/dissertations/fullcit/9505178
•
The Impact of Managed Care upon Women and Newborns Enrolled in Medicaid by Kruzikas, Denise Teresa; PhD from The University of Rochester, 2002, 194 pages http://wwwlib.umi.com/dissertations/fullcit/3050838
•
The Impact of Medicaid Expansions on Pregnancy Resolution and Out-of-wedlock Births in New York City by Li, Wenhui, PhD from City University of New York, 1996, 87 pages http://wwwlib.umi.com/dissertations/fullcit/9707123
•
The Impact of Medicaid Managed Care on Community Health Centers by Shin, Peter Wonsik; PhD from The George Washington University, 2002, 174 pages http://wwwlib.umi.com/dissertations/fullcit/3032766
•
The Impact of Medicare and Medicaid on the Supply and Demand Conditions of Nursing Homes by Henry, Louis Hayes, PhD from University of Notre Dame, 1970, 220 pages http://wwwlib.umi.com/dissertations/fullcit/7105538
•
The Impact of Prenatal Medicaid Programs on the Health of Newborns by Trenholm, Christopher Allen, PhD from The University of North Carolina at Chapel Hill, 1997, 134 pages http://wwwlib.umi.com/dissertations/fullcit/9803661
•
The Impact of the Introduction of Clozapine on the Utilization of Health Care Services for Schizophrenic Medicaid Enrollees by Brown, Jeffrey Stuart; PhD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 2002, 157 pages http://wwwlib.umi.com/dissertations/fullcit/3052309
•
The Incentive Effects of Medicaid on Women's Labor Supply (Labor Supply) by Winkler, Anne Elizabeth, PhD from University of Illinois at Urbana-champaign, 1989, 178 pages http://wwwlib.umi.com/dissertations/fullcit/8924970
•
The Incentive Effects of the Earned Income Tax Credit and the Medicaid Program on the Behavior of Low-Income Individuals by Cappellari, Lisa Marie; PhD from University of California, Davis, 2000, 128 pages http://wwwlib.umi.com/dissertations/fullcit/9980480
Dissertations 131
•
The Influence of Counseling and Education on Behavior and Pregnancy Outcome in African American Medicaid-Eligible Women by Spivey, Crystal Bridget Brown; DrPH from University of Alabama at Birmingham School of Public Health, 2002, 96 pages http://wwwlib.umi.com/dissertations/fullcit/3082023
•
The Influence of Diagnoses, Race, and Medicaid Enrollment on Health Services among the Seriously Mentally Disabled Population by Chipps, Esther M.; PhD from The Ohio State University, 2003, 338 pages http://wwwlib.umi.com/dissertations/fullcit/3093634
•
The Interstate Variation in Long-Term Care for the Elderly Financed by Medicaid by Krause, Mark Allen, PhD from West Virginia University, 1990, 141 pages http://wwwlib.umi.com/dissertations/fullcit/9106541
•
The Medicaid Best Price Law and Its Effect on Pharmaceutical Manufacturers' Pricing Policies and Behavior for Name Brand, Outpatient Pharmaceutical Products by Betz, Robert Bruce; PhD from The George Washington University, 2000, 367 pages http://wwwlib.umi.com/dissertations/fullcit/9969806
•
The Medicaid Reimbursement Program and Reported Nursing Care in the Massachusetts Long-Term Care Industry by Mishol, David Nicholas, PhD from Boston College, 1998, 139 pages http://wwwlib.umi.com/dissertations/fullcit/9915566
•
The Organizational Determinants of HMO Participation in Medicaid Managed Care by Gurule, David; DrPH from University of Michigan, School of Public Health, 2002, 126 pages http://wwwlib.umi.com/dissertations/fullcit/3048319
•
The Political Economy of Medicaid (Health Care, State Policy) by Barrilleaux, Charles Joseph, PhD from State University of New York at Binghamton, 1984, 266 pages http://wwwlib.umi.com/dissertations/fullcit/8506870
•
The Political Economy of Medicaid at the County Level (New York) by Takada, Hitomi Adrianna, PhD from State University of New York at Binghamton, 1992, 295 pages http://wwwlib.umi.com/dissertations/fullcit/9206405
•
The Politics of Medicaid Eligibility: An Analysis of Changes for the AFDC Population by Mazumdar, Siddhartha, PhD from University of Pittsburgh, 1992, 156 pages http://wwwlib.umi.com/dissertations/fullcit/9304242
•
The Politics of States' Medicaid Managed Care: 1981--1998 by Bernick, Ethan Michael; PhD from The Florida State University, 2002, 178 pages http://wwwlib.umi.com/dissertations/fullcit/3065474
•
The Politics of the New York State Medicaid Law of 1966: An Analysis by Bernstein, Betty Jean, PhD from New York University, 1969, 382 pages http://wwwlib.umi.com/dissertations/fullcit/6921237
•
The Process of Detecting, Prosecuting, and Sentencing Health Care Malfeasance: An In-depth Analysis of Fraud Reports (Malfeasance, Medicaid) by Payne, Brian Kieth, PhD from Indiana University of Pennsylvania, 1993, 217 pages http://wwwlib.umi.com/dissertations/fullcit/9329512
•
The Relationship of Selected Characteristics of Skilled Nursing Facilities to Compliance with the Medicare and Medicaid Conditions of Participation: A Case
132
Medicaid
Study of Four Southeastern States (Policy Compliance) by Haire, John Hagerman, Dpa from University of Georgia, 1985, 179 pages http://wwwlib.umi.com/dissertations/fullcit/8514008 •
The Role of Medicaid in Pregnancy Outcomes (Abortion) by Nagatoshi, Charles Takeo, PhD from The University of Wisconsin - Madison, 1987, 189 pages http://wwwlib.umi.com/dissertations/fullcit/8800372
•
A Comparative Analysis of State Discretionary Medicaid Policies by Clauser, Steven Boyd, PhD from University of Minnesota, 1983, 344 pages http://wwwlib.umi.com/dissertations/fullcit/8329503
•
A Comparison of Medicaid Case-managed and Noncase-managed Birth Outcomes by Shepard, William Earl, DPA from The University of Alabama, 1993, 119 pages http://wwwlib.umi.com/dissertations/fullcit/9403313
•
A General Equilibrium Analysis of Medicaid and Medicare by Gecan, Ronald William, PhD from University of Minnesota, 1997, 107 pages http://wwwlib.umi.com/dissertations/fullcit/9804719
•
A History of the Arizona Health Care Cost Containment System Policy: Ahcccs As a Medicaid Alternative, 1981 to 1987 by Preisler, Dennis George, PhD from Arizona State University, 1998, 250 pages http://wwwlib.umi.com/dissertations/fullcit/9910283
•
A Medicaid Resident Assessment-Based Statewide Analysis of Intermediate Care Nursing Homes by Glass, Anne Howard Pyles, PhD from Virginia Polytechnic Institute and State University, 1989, 195 pages http://wwwlib.umi.com/dissertations/fullcit/9003591
•
A Model of Nursing Home Provider Response to Medicaid Incentive Reimbursement by Mulaney, Eileen, DBA from The George Washington University, 1989, 165 pages http://wwwlib.umi.com/dissertations/fullcit/9005715
•
A Political Theory to Explain the Variation in State Medicaid Policies (State Policies, Welfare) by Grogan, Colleen Mary, PhD from University of Minnesota, 1991, 284 pages http://wwwlib.umi.com/dissertations/fullcit/9205443
•
A Proposal for Reforming Nursing Home Reimbursement under Medicaid by Karpoff, Peter, PhD from The University of Wisconsin - Madison, 1971, 148 pages http://wwwlib.umi.com/dissertations/fullcit/7125478
•
A Public Choice Analysis of Selected Transfer Programs: AFDC, Medicaid and Food Stamps by Colburn, Christopher Bingham, PhD from Texas A&m University, 1988, 173 pages http://wwwlib.umi.com/dissertations/fullcit/8913340
•
A Study of Process and Content of Public Policy in American States: with Reference to the Medicaid Program by Cha, Marn Jai, PhD from University of Southern California, 1970, 250 pages http://wwwlib.umi.com/dissertations/fullcit/7107705
•
A Study of the Effectiveness of Publicly Funded Case Management Services for Persons with Severe Mental Illness (Medicaid) by Becker, Marion Ann, PhD from The University of Wisconsin - Madison, 1992, 252 pages http://wwwlib.umi.com/dissertations/fullcit/9230154
Dissertations 133
•
A Study of the Impact of Medicare and Medicaid on Financial Performances of St. Louis Area Hospitals (Missouri) by Schmitz, Homer Harold, PhD from Saint Louis University, 1983, 171 pages http://wwwlib.umi.com/dissertations/fullcit/8325428
•
Access to Care among Elderly Medicare Beneficiaries: The Influence of Medicaid Coverage by Lyons, Barbara Suzanne, PhD from The Johns Hopkins University, 1997, 406 pages http://wwwlib.umi.com/dissertations/fullcit/9730749
•
Access to Medicaid-Covered Prenatal Care: A Normative Implementation Environment Evaluation by Neuwirth, Carolyn Rachel, PhD from Texas Woman's University, 1993, 255 pages http://wwwlib.umi.com/dissertations/fullcit/9417373
•
Access to Medical Care Services: A Study of Utilization and Satisfaction of Medical Care Services Financed Through the New Mexico Medicaid Program by Gonzales, Arturo Nicholas, PhD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1983, 167 pages http://wwwlib.umi.com/dissertations/fullcit/8313208
•
Adult Day Care: Fluidity of Models, Fragmentation of Funding (Medicaid, Reimbursement, Care Access) by Stuart, Margaret Heflin, PhD from University of California, San Francisco, 1994, 249 pages http://wwwlib.umi.com/dissertations/fullcit/9523560
•
Advocacy Strategies and Medicaid Reform: A Descriptive Look at the Characteristics of Agencies That Engage in Advocacy Strategies to Positively Affect Medicaid Reform Policies for Persons with HIV/AIDS by Sapp, Carlton Maurice; PhD from The Ohio State University, 1999, 139 pages http://wwwlib.umi.com/dissertations/fullcit/9951719
•
Alcoholism Treatment and Its Effect on Subsequent Health Care Costs: A Medicaid Study of Cost Differences by Treatment Setting by Kemp, Edmund Paul, DPA from Western Michigan University, 1987, 123 pages http://wwwlib.umi.com/dissertations/fullcit/8721473
•
Allocating Services with Heterogeneous Consumers: An Application to the Medicaid Prenatal Care Market (Service Allocation) by Travis, Karen Marie, PhD from University of Washington, 1995, 136 pages http://wwwlib.umi.com/dissertations/fullcit/9609797
•
American Attitudes toward the Dependent Poor: Impediments to an Equitable National Health Care System (Attitudes toward Poor, AFDC Eligibility, Medicaid, Poor) by Jakobi, Patricia Lynne, PhD from The University of Texas Graduate Sch. of Biomedical Sci. at Galveston, 1992, 297 pages http://wwwlib.umi.com/dissertations/fullcit/9310434
•
American Indian Elderly and Long-Term Care: Interorganizational Barriers to the Use of Oregon's Home and Community-Based Medicaid Waiver by Isgrigg, Jo Lynn, PhD from Portland State University, 1999, 179 pages http://wwwlib.umi.com/dissertations/fullcit/9933284
•
An Action Research Approach to Reforming Rural Health and Human Services Through Medicaid Managed Care: Implications for the Policy Sciences by Boser, Susan R.; PhD from Cornell University, 2001, 248 pages http://wwwlib.umi.com/dissertations/fullcit/3011234
134
Medicaid
•
An Analysis of a Proposed Change in the Hospital Reimbursement Policy of Florida's Medicaid Program by Freedman, Stephen Alan, PhD from The Florida State University, 1983, 145 pages http://wwwlib.umi.com/dissertations/fullcit/8311424
•
An Analysis of Michigan Medicaid Payment Policies for Maternity Services Including Provider Supply and Client Access, Utilization, Level of Care, and Health Outcomes by Anthony, Molly Anne, PhD from Michigan State University, 1992, 276 pages http://wwwlib.umi.com/dissertations/fullcit/9302968
•
An Analysis of Reimbursement Methodologies and Cost Containment Policies in Medicaid Inpatient Hospital and Pharmaceuticals by Pracht, Etienne Elmer, PhD from The Louisiana State University and Agricultural and Mechanical Col., 1998, 128 pages http://wwwlib.umi.com/dissertations/fullcit/9836902
•
An Analysis of the Effects of the Medicare and Medicaid Programs on the Cost of Hospital Services: A Case Study. by Gulley, Charles Douglas, PhD from The Louisiana State University and Agricultural and Mechanical Col., 1976, 204 pages http://wwwlib.umi.com/dissertations/fullcit/7710371
•
An Econometric Analysis of the Regional Differences in Medicaid Benefit Levels by Kao, Kai, PhD from Kansas State University, 1988, 114 pages http://wwwlib.umi.com/dissertations/fullcit/8819233
•
An Econometric Model of Medicaid (Health Care Policy) by Miller, Mark Edwin, PhD from State University of New York at Binghamton, 1987, 519 pages http://wwwlib.umi.com/dissertations/fullcit/8626728
•
An Evaluation of Medicaid As a Scheme for Redistributing Physician Services towards the Medically Indigent and Socially Disadvantaged. by Anderson, Charles Edward, PhD from Stanford University, 1975, 139 pages http://wwwlib.umi.com/dissertations/fullcit/7513477
•
An Evaluation of the Impact of an Intensive Case Management Program on Medical Cost and Service Utilization for a Medicaid Population with Rare and Expensive Medical Conditions in the State of Maryland by Huang, Judy Yin Shih; PhD from University of Maryland Baltimore County, 2002, 359 pages http://wwwlib.umi.com/dissertations/fullcit/3038708
•
An Examination of Firms Charged with Medicare and Medicaid Fraud: Does Corporate Governance Matter? by Cammack, Susan Estelle; PhD from University of Missouri - Columbia, 2002, 79 pages http://wwwlib.umi.com/dissertations/fullcit/3060090
•
An Implementation Analysis of the Home and Community-Based Services Waiver of Title XIX, Social Security Act (Medical Assistance) (Medicaid) by Zetick, Bonnie Harper, PhD from Bryn Mawr College, the Grad. Sch. of Social Work and Social Research, 1989, 283 pages http://wwwlib.umi.com/dissertations/fullcit/8924652
•
An Investigation into the Perceptions of Children's Mental Health Treatment Center Leadership in a Managed Medicaid Environment: Organizational Readiness for the New York State Medicaid Special Needs Plans by Miller, Joseph Anthony, PhD from New York University, 1999, 191 pages http://wwwlib.umi.com/dissertations/fullcit/9925003
Dissertations 135
•
Assessing the Impact of a Medicaid Managed Care Program on Health Care Utilization: a Two-Stage Hurdle Regression Approach by Reed, Donald Edward; PhD from Georgia State University, 2001, 251 pages http://wwwlib.umi.com/dissertations/fullcit/3029794
•
Birth Outcomes for High-Risk Pregnant Medicaid Women Case Managed by Registered Nurses by Mcdonough Catto, Jo-Ellen Margaret; PhD from University of South Carolina, 2003, 188 pages http://wwwlib.umi.com/dissertations/fullcit/3084803
•
Can Counties Become Smart Buyers in Medicaid Behavioral Managed Care Contracting? Policy Implementation and Management Issues by Palasani-Minassians, Henrik; PhD from State University of New York at Albany, 2002, 401 pages http://wwwlib.umi.com/dissertations/fullcit/3070686
•
Can Migration Lead to the De Facto Merging of Rich and Poor Communities: A Special Application to the Provision of Medicaid by Jones, Robert Thomas; PhD from Clark University, 2001, 93 pages http://wwwlib.umi.com/dissertations/fullcit/3028942
•
Child Health Status in the United States and Medicaid Expansions, 1986-1990 by Lykens, Kristine Ann; PhD from The University of Texas at Dallas, 1999, 222 pages http://wwwlib.umi.com/dissertations/fullcit/9939579
•
Consequences of Medicaid Expansions on Three Outcomes: Demand for Private Insurance, Infant and Child Health, and Labor Supply by Yazici, Esel Yildiz, PhD from City University of New York, 1997, 144 pages http://wwwlib.umi.com/dissertations/fullcit/9808027
•
Crime between Organizations: A Case Study of Medicaid Provider Fraud. by Vaughan, Diane Caskey, PhD from The Ohio State University, 1979, 223 pages http://wwwlib.umi.com/dissertations/fullcit/7922574
•
Dallas Area Health Care Use: Study of Insured, Uninsured, and Medicaid Enrolled Children (Texas) by Roy, Lonnie C.; PhD from University of North Texas, 2000, 227 pages http://wwwlib.umi.com/dissertations/fullcit/3041923
•
Demographic Factors Predictive of Medicaid Enrollment in Michigan Counties by Howe, Dale Kennedy; PhD from Western Michigan University, 2002, 392 pages http://wwwlib.umi.com/dissertations/fullcit/3057699
•
Differential Impact of Copayment on Drug Utilization in the South Carolina Medicaid Program by Reeder, Claiborne Eugene, PhD from University of South Carolina, 1983, 328 pages http://wwwlib.umi.com/dissertations/fullcit/8319279
•
Discrimination against Medicaid Patients in Nursing Home Admissions Policies. by Greenlees, John Shearer, PhD from University of California, Los Angeles, 1977, 128 pages http://wwwlib.umi.com/dissertations/fullcit/7716167
•
Does Substitution for Informal Care to the Elderly Occur When Medicaid Provides Community-Based Long-Term Care Services? by Belardi, Gregory Joseph, PhD from State University of New York at Albany, 1992, 189 pages http://wwwlib.umi.com/dissertations/fullcit/9228970
136
Medicaid
•
Early Intervention Service Utilization in North Carolina: Differences between Children with and without Medicaid by Bernier, Kathleen Yonce, PhD from The University of North Carolina at Chapel Hill, 1994, 208 pages http://wwwlib.umi.com/dissertations/fullcit/9523027
•
Effects of a Medicare, Medicaid and Private Health Insurance Program on Knowledge, Attitudes, and Practices of Elderly Citizens by Williams, Deloris Green, PhD from University of Illinois at Urbana-Champaign, 1986, 325 pages http://wwwlib.umi.com/dissertations/fullcit/8623440
•
Effects of State Medicaid Policies on the Likelihood of Nursing Home Admission and Length of Stay: an Application of the Competing-Risks Model by Noguchi, Haruko, PhD from City University of New York, 1997, 314 pages http://wwwlib.umi.com/dissertations/fullcit/9720123
•
Entitlement to Empowerment: Use of the Medicaid Home and Community-Based Waiver Program to Fund Work Supports by Gardner, Marie Shania; PhD from Virginia Commonwealth University, 2000, 169 pages http://wwwlib.umi.com/dissertations/fullcit/9968267
•
Equity in Financing and Access to Long Term Care (Medicaid, Nursing Homes) by Hug, Richard William, PhD from Syracuse University, 1984, 333 pages http://wwwlib.umi.com/dissertations/fullcit/8508222
•
Essays on Medicaid and Its Populations by Bednarek, Heather L.; PhD from Michigan State University, 1999, 127 pages http://wwwlib.umi.com/dissertations/fullcit/9948067
•
Estimation of the Demand for Long-Term Care Insurance and Its Impact on Medicaid Expenditures: The Indiana Case (Health Care Costs) by Pevas, Mary Ann T., PhD from University of Notre Dame, 1990, 223 pages http://wwwlib.umi.com/dissertations/fullcit/9105714
•
Evaluating Infant Utilization and Retention under Medicaid Managed Care by Shulman, Shanna Rachel Mara; PhD from Harvard University, 2003, 77 pages http://wwwlib.umi.com/dissertations/fullcit/3091686
•
Evaluating the Effect of Medicaid and State Children's Health Insurance Program Expansions by Davis, Jason R.; PhD from Michigan State University, 2002, 117 pages http://wwwlib.umi.com/dissertations/fullcit/3064218
•
Exits, Recidivism, and Caseload Growth: The Effect of Private Health Insurance Markets on the Demand for Medicaid by Perreira, Krista Marlyn; PhD from University of California, Berkeley, 1999, 173 pages http://wwwlib.umi.com/dissertations/fullcit/9966520
•
Experiences of Middle-Aged Adults with Physical Disabilities in Medicaid Managed Care by Hiranandani, Vanmala Sunder; PhD from University of Pennsylvania, 2002, 288 pages http://wwwlib.umi.com/dissertations/fullcit/3054949
•
Facilitating Access to Medicaid (Elderly Women, Long Term Care) by Mushkin, Rebecca L., DSW from City University of New York, 1995, 261 pages http://wwwlib.umi.com/dissertations/fullcit/9605638
•
Factors Affecting Declines in Texas Medicaid Enrollment by Leventhal, Emily Anne; PhD from The University of Texas at Austin, 2001, 187 pages http://wwwlib.umi.com/dissertations/fullcit/3034929
Dissertations 137
•
Gender, Race, and Access to Health Care: Florida Medicaid and AIDS (Immune Deficiency) by Han, Lein Fang, PhD from The Florida State University, 1994, 165 pages http://wwwlib.umi.com/dissertations/fullcit/9434107
•
Health Politics and American Federalism: A Comparison of the Medicaid Programs in New York and California by Sparer, Michael Steven, PhD from Brandeis University, 1992, 339 pages http://wwwlib.umi.com/dissertations/fullcit/9311879
•
Health Services to Children: Medicaid's Original Early and Periodic Screening Diagnosis and Treatment Program (EPSDT) vs. Medicaid's Mandated Expansion in Healthy Child and Youth Program (HCY) by Brooks-Scott, Sandra Celeste, EDD from Saint Louis University, 1998, 174 pages http://wwwlib.umi.com/dissertations/fullcit/9911923
•
Home Care Option for Older Adults with Chronic Limitations: An Evaluation of Passport (Long-Term Care, Medicaid Waiver, Nursing Home, Ohio) by Cheung, KamFong Monit, PhD from The Ohio State University, 1986, 360 pages http://wwwlib.umi.com/dissertations/fullcit/8625195
•
Hospital Responses to Prospective Payment System: New York State Medicaid Program by Hwang, Woopill; PhD from State University of New York at Albany, 2001, 182 pages http://wwwlib.umi.com/dissertations/fullcit/3039628
•
Hospital-sponsored Community Health Center: a Study of Hospital Utilization Patterns for Continuously Covered Medicaid Beneficiaries (Primary Care, Urban Initiative) by Werthman, Linda Jean, PhD from Case Western Reserve University, 1985, 120 pages http://wwwlib.umi.com/dissertations/fullcit/8525264
•
Impact of Welfare Reform on Substance Abusers' Medicaid Eligibility and Subsequent Effect on Access to and Utilization of Behavioral Health Services in Philadelphia, 1994--1999 (Pennsylvania) by Blitz, Cynthia Leigh; PhD from University of Pennsylvania, 2001, 108 pages http://wwwlib.umi.com/dissertations/fullcit/3003597
•
Implementation of Computerized Management Information Systems in Public Agencies: An Analysis of the Implementation Process of the Welfare Management System and the Medicaid Management System in New York by Altmeyer, Ann S., PhD from Syracuse University, 1982, 271 pages http://wwwlib.umi.com/dissertations/fullcit/8310443
•
Improving Pregnancy Outcomes: an Evaluation of the Steps Ahead Medicaid Maternity Waiver Program (Steps Ahead Medicaid Maternity Waiver Program, Infant Mortality) by Nason, Carroll Stiles, DPA from The University of Alabama, 1994, 163 pages http://wwwlib.umi.com/dissertations/fullcit/9508502
•
Institutional Form and the Nursing Home Industry: Ownership Effects on Costs and Quality (Medical Costs, Medicaid) by Holmes, Julia Shaw, PhD from The University of Michigan, 1992, 175 pages http://wwwlib.umi.com/dissertations/fullcit/9308335
•
Inter-Vivos Transfers by Elderly at Risk for Nursing Home Placement: Implications for Federal Medicaid Policy by Gilchrist, Barbara J.; PhD from Saint Louis University, 1999, 120 pages http://wwwlib.umi.com/dissertations/fullcit/9942771
138
Medicaid
•
Intra-State Inequalities in the Financing and Delivery of Noneducational Social Services to Children and Youth: An Assessment of the State of Nebraska (Welfare, Medicaid, AFDC, Outreach Programs, Food Stamps) by Petersen, Carol Dawn, PhD from The University of Texas at Austin, 1986, 225 pages http://wwwlib.umi.com/dissertations/fullcit/8618566
•
Long-Term Care Insurance: Factors Affecting Demand and Coverage Purchased. Understanding the Impact of Medicaid Features on Individual Decision-Making (Insurance) by Kumar, A. K. Nanda, PhD from Boston University, 1994, 343 pages http://wwwlib.umi.com/dissertations/fullcit/9415016
•
Managed Care Medicaid in Texas: Was It on Target? by Dunglinson, Teng-man Pauline; MBA from University of Houston-clear Lake, 2002, 103 pages http://wwwlib.umi.com/dissertations/fullcit/1409087
•
Medicaid Access to Nursing Home Services When Private-Pay Demand Is Uncertain: an Application to Massachusetts (Queueing, Stochastic) by Menzin, Joseph Henry, PhD from Boston University, 1987, 184 pages http://wwwlib.umi.com/dissertations/fullcit/8702132
•
Medicaid and Health Insurance for Children: Essays in Empirical Economics by Shore-Sheppard, Lara Dawn, PhD from Princeton University, 1996, 158 pages http://wwwlib.umi.com/dissertations/fullcit/9701249
•
Medicaid and Managed Care: an Implementation Study of the Tennessee Primary Care Network by Harrington, John Jay, PhD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1995, 328 pages http://wwwlib.umi.com/dissertations/fullcit/9629772
•
Medicaid and the Costs of Federalism: 1984-1992 by Gilman, Jean Marie, PhD from University of Virginia, 1996, 237 pages http://wwwlib.umi.com/dissertations/fullcit/9708569
•
Medicaid and the Politics of State Health Care Reform by Satterthwaite, Shad Brent, PhD from The University of Oklahoma, 1998, 222 pages http://wwwlib.umi.com/dissertations/fullcit/9828778
•
Medicaid Drug Rebates, Pharmaceutical Prices, and Unintended Consequences of Health Policy Reform by Mullins, C. Daniel, PhD from Duke University, 1994, 145 pages http://wwwlib.umi.com/dissertations/fullcit/9510847
•
Medicaid Incentive Reimbursement Programs in Long-Term Care: An Evaluation of the Florida Medicaid AIDS Nursing Home Admission Program (Immune Deficiency) by Cruise, Peter L., PhD from Florida Atlantic University, 1995, 210 pages http://wwwlib.umi.com/dissertations/fullcit/9525294
•
Medicaid Managed Care and Family Planning Services: An Analysis of Recipient Utilization and Choice of Type of Provider by Amey, Annette Lynn; PhD from The Johns Hopkins University, 2003, 269 pages http://wwwlib.umi.com/dissertations/fullcit/3080622
•
Medicaid Managed Care Models: Variations in Performance by Johnston, Jocelyn M., PhD from Syracuse University, 1994, 194 pages http://wwwlib.umi.com/dissertations/fullcit/9516433
•
Medicaid Policy and Infant Survivability (Prenatal Care) by Poertner, Grace C. Schwane, PhD from Washington University, 1991, 213 pages http://wwwlib.umi.com/dissertations/fullcit/9220082
Dissertations 139
•
Medicaid Politics: Policymaking Contexts and the Politics of Group Differences in the American States by Kronebusch, Karl, PhD from Harvard University, 1993, 232 pages http://wwwlib.umi.com/dissertations/fullcit/9412417
•
Medicaid Reimbursement and the Quality of Nursing Home Care by Grabowski, David Charles; PhD from The University of Chicago, 1999, 184 pages http://wwwlib.umi.com/dissertations/fullcit/9951790
•
Medicaid Reimbursement: The Impact on the Cost and Utilization of Long-Term Care by Buchanan, Robert John, PhD from University of Virginia, 1980, 284 pages http://wwwlib.umi.com/dissertations/fullcit/8022688
•
Medicaid, Financial Transfers, and Expectations of the Elderly by Bassett, William Francis, Iii, PhD from Brown University, 1999, 216 pages http://wwwlib.umi.com/dissertations/fullcit/9932370
•
Medicaid: A Case Study in Societal Guidance. by Doty, Pamela Jane, PhD from Columbia University, 1977, 441 pages http://wwwlib.umi.com/dissertations/fullcit/7724325
•
Michigan Medicaid Managed Care: An Evaluation of the Physician Sponsor Plan by Cain, Monica; PhD from Wayne State University, 2002, 106 pages http://wwwlib.umi.com/dissertations/fullcit/3047542
•
Modeling the Health Care Utilization of Children in Medicaid by Rein, David Bruce; PhD from Georgia State University, 2003, 262 pages http://wwwlib.umi.com/dissertations/fullcit/3082883
•
On the Assessment of Excessive Hospitalization: A Study of a Medicaid Population. by Cotton, Mary Frances, PhD from University of Pennsylvania, 1978, 199 pages http://wwwlib.umi.com/dissertations/fullcit/7824709
•
On the Epidemiology of Posttraumatic Stress Disorder: Period Prevalence Rates and Acute Service Utilization Rates among Massachusetts Medicaid Program Enrollees: 1993--1996 by Macy, Robert Donnelly; PhD from Union Institute and University, 2002, 133 pages http://wwwlib.umi.com/dissertations/fullcit/3057835
•
Patterns of Physician Participation in a Changing Health Care Market: Implications for Medicare and Medicaid by Worzala, Chantal Louise; PhD from The Johns Hopkins University, 2000, 222 pages http://wwwlib.umi.com/dissertations/fullcit/9950615
•
Prediction of Immediate and Delayed Nursing Home Entry in Community Applicants to Medicaid Long-Term Care in South Carolina by Huang, Chiu-Chin; PhD from University of South Carolina, 2000, 194 pages http://wwwlib.umi.com/dissertations/fullcit/9981264
•
Prevalence and Treatment of Substance Abuse among Adults in a Medicaid Population Pre and Post Managed Care by Leonard, Deanie Myers; PhD from The Johns Hopkins University, 2002, 212 pages http://wwwlib.umi.com/dissertations/fullcit/3028300
•
Previous Health Care Utilization As a Predictor of Enrollment in Managed Care by Families Eligible for Medicaid by Kallich, Joel David, PhD from Boston University, 1990, 327 pages http://wwwlib.umi.com/dissertations/fullcit/9023751
140
Medicaid
•
Quality of Care Assessment: State Medicaid Administrators' Use of Quality Information by Fickel, Jacqueline Jean; PhD from The University of Texas at Austin, 2002, 272 pages http://wwwlib.umi.com/dissertations/fullcit/3077639
•
Quality of Care under Medicaid: An Exploratory Analysis by Jack, John William, DPA from State University of New York at Albany, 1980, 138 pages http://wwwlib.umi.com/dissertations/fullcit/8107661
•
Rate of Ambulatory Follow-Up after Discharge from a Mental Health Inpatient Setting among Missouri Medicaid Managed Care Recipients by Frederick, Scott Gordon; PhD from Saint Louis University, 2000, 94 pages http://wwwlib.umi.com/dissertations/fullcit/9973346
•
Satisfaction with Health Maintenance Organizations: Exploring Axes of Differentiation among Medicaid Beneficiaries in Utah by Paita, Luis Manuel C., PhD from Utah State University, 1998, 294 pages http://wwwlib.umi.com/dissertations/fullcit/9901416
•
Stability and Change in Health Care Politics (Policy Change, Reform, Medicare, Medicaid) by Gusmano, Michael Kelley, PhD from University of Maryland College Park, 1995, 355 pages http://wwwlib.umi.com/dissertations/fullcit/9607767
•
State Medicaid Coverage for Tobacco Dependence Treatments: Implications for a Federal Mandate by Ibrahim, Jennifer Kathleen; PhD from University of California, Berkeley, 2002, 262 pages http://wwwlib.umi.com/dissertations/fullcit/3082238
•
State Medicaid Policies and Provision: an Examination of the Four Programs Contained within Medicaid by Sakowski, Julie Ann, PhD from University of Houston, 1996, 96 pages http://wwwlib.umi.com/dissertations/fullcit/9724408
•
State Medicaid Program Policy Decisions and Medical Service Expenditures for Elderly Cash Grant Eligibles: An Empirical Analysis (Finance, Utilization) by Reutzel, Thomas J., PhD from The Pennsylvania State University, 1984, 167 pages http://wwwlib.umi.com/dissertations/fullcit/8506672
•
State Variation in Medicaid Spending on Nursing Facility Care and the Impact of OBRA 1987 by Exline, Joan Lynn, PhD from Wayne State University, 1996, 69 pages http://wwwlib.umi.com/dissertations/fullcit/9715834
•
Stimulating the Use of Preventive Health Services: Pricing and Promotion (Medicaid, Health Maintenance Organizations (HMO's), Community Health Centers, Health Care Utilization, Preventive) by Ball, Judy Kay, PhD from Syracuse University, 1985, 178 pages http://wwwlib.umi.com/dissertations/fullcit/8603747
•
Subjective Expectations of Nursing Home Use, Medicaid, and Economic Behavior by Older Americans by Merrill, Angela Roe; PhD from University of California, Berkeley, 2000, 201 pages http://wwwlib.umi.com/dissertations/fullcit/9979732
•
The Application of Behavioral Principles of Education to the Development of a Medicaid Program Integrity Investigator Training Curriculum. by Cogan, Rose Martinez, Edd from University of Maryland College Park, 1978, 123 pages http://wwwlib.umi.com/dissertations/fullcit/7917120
Dissertations 141
•
The Behavior of For-Profit and Nonprofit Nursing Homes under Different Medicaid Payment Incentives: A Three State Analysis by Visconti, Michele Therese; PhD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 2001, 250 pages http://wwwlib.umi.com/dissertations/fullcit/3015039
•
The Demand for Medicaid and AFDC by Berendt, Emil Bohdan, PhD from City University of New York, 1985, 80 pages http://wwwlib.umi.com/dissertations/fullcit/8515608
•
The Effect of Facility Type on Quality in Medicaid's Intermediate Care Facility Program for the Mentally Retarded by Brown, Samuel Lee, PhD from University of Maryland Baltimore County, 1998, 199 pages http://wwwlib.umi.com/dissertations/fullcit/9820402
•
The Effect of Medicaid Expansions on the Behavior of the Poor (Welfare) by Yelowitz, Aaron S., PhD from Massachusetts Institute of Technology, 1994 http://wwwlib.umi.com/dissertations/fullcit/f1506339
•
The Effect of Medicaid on Access to Health Care and Welfare Participation by Decker, Sandra Lynn, PhD from Harvard University, 1993, 158 pages http://wwwlib.umi.com/dissertations/fullcit/9412327
•
The Effect of Medicaid Prescription Drug Copayment Policy on Health Outcomes and Expenditures in a Dually Enrolled Dialysis Population by Jordan, Neil; PhD from University of Minnesota, 2002, 107 pages http://wwwlib.umi.com/dissertations/fullcit/3047639
•
The Effect of the Implementation of Prospective Payment on the Health Care Industry; an Empirical Analysis (DRG, Medicare, Medicaid) by Love, Dianne Burgess, PhD from University of Arkansas, 1984, 109 pages http://wwwlib.umi.com/dissertations/fullcit/8528928
•
The Effects of Medicaid and Maternal Depression on Prenatal Care and Infant Health by Defelice, Lisa C.; PhD from University of New Hampshire, 1999, 227 pages http://wwwlib.umi.com/dissertations/fullcit/9943995
•
The Effects of Medicaid Mental Health Capitation on Youth Involvement in the Juvenile Justice System in the State of Colorado by Scott, Michelle Ann-Rish; PhD from University of California, Berkeley, 1999, 147 pages http://wwwlib.umi.com/dissertations/fullcit/9966563
•
The Effects of Medicaid Reimbursement Policy and Information Costs on the Quality of Nursing Home Care under Excess Demand Conditions by Nyman, John Arthur, PhD from The University of Wisconsin - Madison, 1984, 192 pages http://wwwlib.umi.com/dissertations/fullcit/8410789
•
The Effects of Medicaid Reimbursement, Medicaid Demand, Market Competition and Hospital Quality on Nonprofit and For-Profit Hospital Medicaid Share by Eisert, Sheri Lynn, PhD from University of Washington, 1995, 149 pages http://wwwlib.umi.com/dissertations/fullcit/9537318
•
The Effects of the Medicaid Spend Down Process upon the Subjective Well-being of Nursing Home Residents (Welfare, Self-Esteem, Life Satisfaction, Depression) by Hermann, John Alvin, PhD from University of Maryland at Baltimore, 1985, 244 pages http://wwwlib.umi.com/dissertations/fullcit/8603202
142
Medicaid
•
The Effects of WIC on Dental Medicaid Use and Related Expenditures by Preschool Children by Lee, Jessica Yuna; PhD from The University of North Carolina at Chapel Hill, 2002, 86 pages http://wwwlib.umi.com/dissertations/fullcit/3061701
•
The Use of Physicians' Services by Low-Income Children: the Role of Medicaid and Other Factors (Health Insurance) by Rosenbach, Margo L., PhD from Brandeis U., the F. Heller Grad. Sch. for Adv. Stud. in Soc. Wel., 1985, 290 pages http://wwwlib.umi.com/dissertations/fullcit/8518900
•
Three Essays in the Economics of the Physician Firm (Medicaid) by Bradford, William David, Iii, PhD from The Louisiana State University and Agricultural and Mechanical Col., 1991, 219 pages http://wwwlib.umi.com/dissertations/fullcit/9219522
•
Through the Eyes of Patients: a Phenomenological Study of Medicaid by Smith, Nancy Lynn, PhD from University of Colorado at Denver Graduate School of Public Affairs, 1997, 218 pages http://wwwlib.umi.com/dissertations/fullcit/9810984
•
To Bill or Not to Bill: Medicaid Billing for Special Education-related Services in Arkansas Public Schools by Davis-smith, Myra Kay, EDD from Virginia Polytechnic Institute and State University, 1997, 94 pages http://wwwlib.umi.com/dissertations/fullcit/9812503
•
To Lift a Heavy Burden: the Story of the Medicare and Medicaid Law by David, Sheri Iris, PhD from City University of New York, 1982, 320 pages http://wwwlib.umi.com/dissertations/fullcit/8222938
•
Toward a Comprehensive Model of Welfare Exits: Aid to Families with Dependent Children, Food Stamps and Medicaid by Piskulich, Cheryl Michelle, PhD from State University of New York at Binghamton, 1992, 248 pages http://wwwlib.umi.com/dissertations/fullcit/9300991
•
Toward a Theory of Physicians' Participation in the Kansas Medicaid Managed Care (PCN) Network (Kansas Medicaid Primary Care Network, Missouri) by Ubokudom, Sunday Effiong, PhD from University of Kansas, 1994, 322 pages http://wwwlib.umi.com/dissertations/fullcit/9504066
•
Two Essays on Medicaid: Acute and Long-Term Care Usage (Acute Care) by Lo Sasso, Anthony Thomas, PhD from Indiana University, 1996, 110 pages http://wwwlib.umi.com/dissertations/fullcit/9627038
•
When Practitioners Assist Elders in Accessing Medicaid for Long-Term Care: Implications of Eligibility, Transfer of Assets, and Estate Recovery by Goggins, Laurie Dircks, PhD from Virginia Commonwealth University, 1997, 146 pages http://wwwlib.umi.com/dissertations/fullcit/9817702
•
Who Cares for Poor People? Physicians, Medicaid, and Marginality by Hynes, Margaret M., PhD from Columbia University, 1995, 168 pages http://wwwlib.umi.com/dissertations/fullcit/9606899
Dissertations 143
Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
145
CHAPTER 5. CLINICAL TRIALS AND MEDICAID Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning Medicaid.
Recent Trials on Medicaid The following is a list of recent trials dedicated to Medicaid.5 Further information on a trial is available at the Web site indicated. •
Early Orthodontic Intervention Under Medicaid Condition(s): Malocclusion Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR); Northwest and Alaska Center on Oral Health Disparities; Washington State Department of Social and Health Services; Children's Hospital and Medical Center - Seattle Purpose - Excerpt: Orthodontic treatment has become a widely accepted procedure in dentistry. The benefits include improved oral health, function, esthetics and quality of life. Significant disparities exist among income strata regarding access to orthodontic services. The sources of these disparities are complex and may reflect differences in the disease prevalence, gender, cultural biases, perception of problems by this population, economic imperatives and negative perceptions of these patients by orthodontists. The primary objective of this study is to examine the usefulness of early orthodontic intervention as a means of increasing access to orthodontic services for children of lowincome families. We will examine the range of early orthodontic interventions in Medicaid patients using a randomized clinical trial comparing dental, esthetic and psychosocial predictors and outcomes in the children who receive early orthodontic treatment and those who do not. This study will also have a follow-up descriptive component with a matched design, making similar comparisons between Medicaidfunded and private-pay patients receiving full orthodontic treatment at adolescence. Phase(s): Phase III
5
These are listed at www.ClinicalTrials.gov.
146
Medicaid
Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00067379
Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “Medicaid” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
•
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
•
For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
•
For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm
•
For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
•
For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm
•
For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp
•
For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm
•
For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
•
For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
•
For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm
Clinical Trials 147
•
For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
•
For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm
•
For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm
•
For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials
149
CHAPTER 6. BOOKS ON MEDICAID Overview This chapter provides bibliographic book references relating to Medicaid. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Medicaid include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “Medicaid” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on Medicaid: •
Head Start, Medicaid, and CHIP: Partners for healthy children: A guide for Head Start programs Source: Washington, DC; U.S. Administration for Children and Families and U.S. Health Care Financing Administration. 1999. 139 pp. Contact: Available from U.S. Administration for Children and Families, 370 L'Enfant Promenade, S.W., Seventh Floor, Washington, DC 20447. Telephone: (202) 401-9215 / fax: (202) 205-9688 / Web site: http://www.acf.dhhs.gov. Contact for cost information. Summary: The purpose of this guide is to bridge the gap between Head Start, Medicaid, and State Children's Health Insurance Programs (SCHIP) to support the healthy development and well being of low-income children. Chapters include an introduction to federal partnerships and programs, working with partners, reaching out to families, and partnerships in action. The appendices include the following: highlights of the Head Start, Early Head Start, Head Start Health Services, Medicaid and SCHIP programs; the
150
Medicaid
text of an intraagency agreement between the Health Care Financing Administration and the Administration for Children and Families; lists of state, regional and agency contacts; and examples of confidentiality waivers. •
Toward a healthy future: Medicaid early and periodic screening, diagnosis and treatment for poor children Source: Los Angeles, CA: National Health Law Program. 2003. 196 pp. Contact: Available from National Health Law Program, Texas Rural Legal Aid, 2639 South La Cienega Boulevard, Los Angeles, CA 90034. Telephone: (310) 204-6010 / fax: (310) 204-0891 / e-mail:
[email protected] / Web site: http://www.healthlaw.org. $55.00. Summary: This book discusses public third party coverage of preventive health services for poor children and adolescents, primarily Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. It also reviews managed care and nonMedicaid programs for poor children. The first part of the book looks at the current crisis in child health care and the need for screening. Part 2 reviews the background of Medicaid. Part 3, which provides the bulk of the book, outlines the legal requirements for EPSDT including outreach, informing, screening, periodicity, diagnosis and treatment, provider participation, coordination, and reporting. Part 4 looks at the problems of managed care and suggested solutions. Accompanying appendices provide a legislative history to EPSDT, age-appropriate screening forms, a comparison of American Academy of Pediatrics recommendations versus states' periodicity schedules (FY 1999), and an outline of the scope of Medicaid benefits.
•
Medicaid and managed care: Lessons from the literature Source: Washington, DC: Kaiser Commission on the Future of Medicaid. 1995. 90 pp. Contact: Available from Kaiser Commission on the Future of Medicaid, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347- 5270 / fax: (202) 347-5274. Available at no charge. Summary: This book is based upon a literature review on Medicaid and managed care from the past 20 years. The authors provide an overview, discuss four lessons derived from the analysis of the literature, consider the risks of and challenges to Medicaid managed care, and include an annotated bibliography. The lessons learned relate to access to care, the impact on health care costs, quality of care and patient satisfaction, and the impact of managed care on special populations.
•
Alzheimer's Day Care, Nursing Homes and Medicaid: (From Alzheimer's Caregiving to the Getting of Medicaid Help) Source: Gardner, MA: Robert V. Rowe. 1999. 46 p. Contact: Available from Robert V. Rowe. 47 Lake Street, Suite A608, Gardner, MA 01440. PRICE: $18.95, plus $2.00 shipping. ISBN: 0966984625. Summary: This book is the personal account of an 81-year-old man who cared for his wife who had Alzheimer's disease (AD). The author relates his experience over the five years since his wife was diagnosed with AD. He describes his efforts to care for her at home as the sole caregiver, finding community day-care assistance, enrolling in a State sponsored prescription assistance program, emergency hopitalization, finding a nursing home, and applying for Medicaid. The author discusses each step and explains how to
Books
151
enlist community help, and how to find the best nursing home in your area. He also provides copies of letters showing how he responded to each of Medicaid's requests for verification. •
Serving Medicaid eligible adolescents through managed care Source: Portland, ME: National Academy for State Health Policy. 1994. 39 pp. Contact: Available from National Academy for State Health Policy, 50 Monument Square, Suite 502, Portland, ME 04101. Telephone: (207) 874- 6524 / fax: (207) 874-6527. $15.00 includes shipping and handling. Summary: This document reports on results of three focus groups. Two asked adolescents for their desires and needs for health care and one convened experts on Medicaid managed care for adolescents. Topics include: how adolescents qualify for Medicaid, what types of state Medicaid managed care exist, what are the main health problems, what are the adolescents' needs and how do they utilize health care services, problems, attempts at solution, and suggestions.
•
Health needs and Medicaid financing: State facts Source: Washington, DC: Kaiser Commission on the Future of Medicaid. 1995. 121 pp. Contact: Available from Kaiser Commission on the Future of Medicaid, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347- 5270 / fax: (202) 347-5274. Summary: This fact book contains data for each state and the District of Columbia on selected indicators of health needs, insurance coverage, and Medicaid finances. It includes a brief overview of Medicaid, the individual state fact sheets, summary tables for each indicator, and a glossary. The health needs indicators include figures for infant mortality, low-income populations, and elderly and disabled populations. The insurance coverage data include the uninsured, those insured by Medicaid, and low-income populations covered by Medicaid. The financial figures cover spending by enrollment group, type of service, disproportionate share hospital (DSH) payments, average annual growth, federal funding, federal funding as a percentage of state expenditures, and information on Section 1115 waivers.
•
Making Medicaid work to fund intensive community services for children with serious emotional disturbance: An advocacy guide to financing key components of a comprehensive state system of care Source: Washington, DC: Judge David L. Bazelon Center for Mental Health Law. 1994. 100 pp. Contact: Available from Judge David L. Bazelon Center for Mental Health Law, 1101 15th Street, N.W., Suite 1212, Washington, DC 20005-5002. Telephone: (202) 467-5730 or (202) 467-4232 TDD / fax: (202) 223-0409 / e-mail:
[email protected] / Web site: http://www.bazelon.org/. $9.50 plus $4.00 shipping and handling; prepayment required. Summary: This report discusses how states use Medicaid to fund services for children with serious emotional disturbances, and how Medicaid can cover components of a community based system of care. It provides an overview of Medicaid and a summary of states' use of Medicaid to fund Early and Periodic Screening, Diagnosis and Treatment (EPSDT); examples of services under a rehabilitation option, and a targeted
152
Medicaid
case management option; and examples of waiver programs and other options. It ends with a glossary describing intensive community mental health services. •
State interagency collaboration: Assuring quality care for mothers and children in Medicaid risk-based managed care Source: Portland, ME: National Academy for State Health Policy. 1995. 53 pp. Contact: Available from National Academy for State Health Policy, 50 Monument Square, Suite 502, Portland, ME 04101. Telephone: (207) 874- 6524 / fax: (207) 874-6527. $15.00 includes shipping and handling; prepayment required; make checks payable to Center for Health Policy Development. Summary: This report discusses how the states can coordinate health care, eliminate duplication, reduce administrative costs, and improve quality of care for women and children enrolled in Medicaid managed care. It considers state regulatory oversight agencies for Medicaid and commercial health insurance, standards and quality, the potential for collaboration between agencies, and how the MCH agency can contribute. It mentions incremental changes to private insurance and the possible convergence of private and Medicaid regulatory standards.
•
Constructing the middle ground: Cultural competence in Medicaid managed care Source: Seattle, WA: Cross Cultural Health Care Program. 2000. 383 pp. Contact: Available from Cross Cultural Health Care Program, 270 South Hanford St., Suite 100, Seattle, WA 98134. Telephone: 206-860-0329 or or 206-860-0331 / fax: 206-8600334 / Web site: http://www.xculture.org. $45.00 for print, $25.00 for CD-ROM, plus shipping and handling. Summary: This report discusses the gap in knowledge of culturally competent care and service of the Medicare managed-care population, that is, the insured poor, particularly ethnic minorities, linguistic minorities, and newly immigrant and refugee populations. Chapter topics include cultural competence in Medicaid managed care, defining organizational cultural competence, and a summary of findings and principles. Extensive appendices focus on cultural competence in the Medicaid managed care marketplace; constructing a culturally competent organization; capturing resources and underwriting cultural competence; attaching the organization to the community; creating and maintaining access to needed services; bridging the communications gaps; and advancing cultural competence through customer service. Additional appendices discuss seeing and educating the minority patient; provider perspectives; building clinical cultural competence; and building a culturally competent work force. References and research methods conclude the report.
•
The lay of the land: What program managers need to know to serve people with HIV/AIDS in Medicaid managed care Source: Portland, ME: National Academy for State Health Policy. 1997. 110 pp. Contact: Available from National Academy for State Health Policy, 50 Monument Square, Suite 502, Portland, ME 04101. Telephone: (207) 874- 6524 / fax: (207) 874-6527. $20.00 includes shipping and handling. Summary: Written for state policymakers, people with HIV/AIDS, and AIDS advocates, this two-part report is aimed at helping Medicaid managed care programs meet the health care needs of people with HIV/AIDS in cost-effective ways. The first part
Books
153
identifies issues of treatment in managed care environments and describes the practices of 35 states enrolling people with HIV/AIDS in managed care as of June 30, 1996. Part two summarizes federally funded programs for people with HIV/AIDS, focusing on 27 federal programs. The reported was prepared with the financial support of The Henry J. Kaiser Family Foundation.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “Medicaid” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “Medicaid” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “Medicaid” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
1999 Medicaid managed behavioral care sourcebook : strategies and opportunities for providers and purchasers; ISBN: 1579870473; http://www.amazon.com/exec/obidos/ASIN/1579870473/icongroupinterna
•
1999 Medicare & Medicaid Benefits by Cch Editorial (1999); ISBN: 0808003089; http://www.amazon.com/exec/obidos/ASIN/0808003089/icongroupinterna
•
21st Century Complete Guide to Medicare, Medicaid, and Nursing Homes Publications, Notices, Claims, and Appeals, Program Memos and Transmittals, Technical Information for Providers, Congressional and Agency Documents (Two CD-ROM Set) by U.S. Government; ISBN: 1592481426; http://www.amazon.com/exec/obidos/ASIN/1592481426/icongroupinterna
•
A Guide to Medicaid's Excess Income Program: A Step by Step Guide to the Excess Income Prostam by Diane Wenzler (1997); ISBN: 088156205X; http://www.amazon.com/exec/obidos/ASIN/088156205X/icongroupinterna
•
Advocate's Guide to Medicaid Case Management Programs (1988); ISBN: 0941077209; http://www.amazon.com/exec/obidos/ASIN/0941077209/icongroupinterna
•
Advocates Guide to the Medicaid Program by Roger Schwartz (1985); ISBN: 9998293332; http://www.amazon.com/exec/obidos/ASIN/9998293332/icongroupinterna
•
Affording Access to Quality Care: Strategies for State Medicaid Cost Management by Richard Curtis, Ian Hill (1986); ISBN: 9997689828; http://www.amazon.com/exec/obidos/ASIN/9997689828/icongroupinterna
•
AIDS Specific Home and Community Based Waivers for the Medicaid Population by Peter D. Jacobson, et al (1989); ISBN: 0833010131; http://www.amazon.com/exec/obidos/ASIN/0833010131/icongroupinterna
•
Alzheimer's, Day Care, Nursing Homes and Medicaid by Robert V. Rowe; ISBN: 0966984625; http://www.amazon.com/exec/obidos/ASIN/0966984625/icongroupinterna
154
Medicaid
•
An Ounce of Prevention : Child Health Politics under Medicaid by Anne-Marie Foltz (Author) (1982); ISBN: 0262060825; http://www.amazon.com/exec/obidos/ASIN/0262060825/icongroupinterna
•
And Access for All: Medicaid and Hispanics (1990); ISBN: 9994591010; http://www.amazon.com/exec/obidos/ASIN/9994591010/icongroupinterna
•
Avoiding the Medicaid Trap: How to Beat the Catastrophic Costs of Nursing-Home Care by Armond D. Budish; ISBN: 0805034269; http://www.amazon.com/exec/obidos/ASIN/0805034269/icongroupinterna
•
Characteristics of Medicaid Home and Community Based Waiver Program Applications by M. Kreiger (1982); ISBN: 9991465405; http://www.amazon.com/exec/obidos/ASIN/9991465405/icongroupinterna
•
Children's Health Under Medicaid: A National Review of Early Periodic Screening, Diagnosis and Treatment [DOWNLOAD: PDF] by National Health Law Program (Author); ISBN: B00005R94Y; http://www.amazon.com/exec/obidos/ASIN/B00005R94Y/icongroupinterna
•
Civil Fines and Penalties Debt: Review of Cmsª (Centers for Medicare and Medicaid Services) Management and Collection Processes by Gary T. Engel (2003); ISBN: 0756725771; http://www.amazon.com/exec/obidos/ASIN/0756725771/icongroupinterna
•
Controlling Medicaid Costs, Federalism, Competition and Choice by Thomas W. Grannemann; ISBN: 0844735159; http://www.amazon.com/exec/obidos/ASIN/0844735159/icongroupinterna
•
Costs of Treating AIDS Under Medicaid 1986-1991 by Pascal (1987); ISBN: 999890756X; http://www.amazon.com/exec/obidos/ASIN/999890756X/icongroupinterna
•
Dually Eligible Beneficiaries: Characteristics, Delivery Systems, Costs, and the Role of Medicare and Medicaid by Linda F. Wolf (Editor) (1998); ISBN: 0788186582; http://www.amazon.com/exec/obidos/ASIN/0788186582/icongroupinterna
•
Entitlement Politics: Medicare and Medicaid, 1995-2001 (Social Institutions and Social Change) by David G. Smith; ISBN: 0202307190; http://www.amazon.com/exec/obidos/ASIN/0202307190/icongroupinterna
•
Essential Community Provider Issues in Medicaid Managed Care by Maureen A. Milligan; ISBN: 0899409040; http://www.amazon.com/exec/obidos/ASIN/0899409040/icongroupinterna
•
Estimating Medicaid Eligible Pregnant Women and Children Living Be Low 185 Percent of Poverty: Strategies for Improving State Perinatal Prog by Paul W. Newacheck, Gerry R. Feinstein (Editor) (1988); ISBN: 1558770100; http://www.amazon.com/exec/obidos/ASIN/1558770100/icongroupinterna
•
Evaluation of a Medicaid-Eligibility Expansion in Florida: Developing the Database by Ellen R. Harrison, et al (1996); ISBN: 0833024620; http://www.amazon.com/exec/obidos/ASIN/0833024620/icongroupinterna
•
Excluding Fraudulent Providers from Medicaid: Hearing Before the Subcommittee on Human Resources and Intergovernmental Relations of the Committee on G by United States (1997); ISBN: 0160559251; http://www.amazon.com/exec/obidos/ASIN/0160559251/icongroupinterna
Books
155
•
Expanding the Medicaid Program in Texas: Funding Issues and Alternatives by Anne Dunkelberg (1988); ISBN: 0899408613; http://www.amazon.com/exec/obidos/ASIN/0899408613/icongroupinterna
•
Financing Health Care for the Poor: The Medicaid Experience by John F. Holahan; ISBN: 0669976342; http://www.amazon.com/exec/obidos/ASIN/0669976342/icongroupinterna
•
Fraud Control Game: State Responses to Fraud and Abuse in Afdc and Medicaid Programs by John A. Gardiner; ISBN: 025332470X; http://www.amazon.com/exec/obidos/ASIN/025332470X/icongroupinterna
•
Growth in Medicaid spending : hearing before the Committee on the Budget, House of Representatives, One Hundred Fourth Congress, first session, hearing held in Washington, DC, April 4, 1995 (SuDoc Y 4.B 85/3:104-13); ISBN: 0160475066; http://www.amazon.com/exec/obidos/ASIN/0160475066/icongroupinterna
•
Guide to State Medicaid Managed Care Laws by Jane M. Anderson (1995); ISBN: 1569251010; http://www.amazon.com/exec/obidos/ASIN/1569251010/icongroupinterna
•
Intensive Care: We Must Save Medicare and Medicaid Now by H. Ross Perot, Ross, Jr. Perot (1995); ISBN: 0060951729; http://www.amazon.com/exec/obidos/ASIN/0060951729/icongroupinterna
•
Knowledge Gap: What Medicaid Beneficiaries Understand -and What They Don'tAbout Managed Care : A Survey of Medicaid Recipients in the South Bronx and Harlem. by Christine, M.S. Molnar (1996); ISBN: 0881562009; http://www.amazon.com/exec/obidos/ASIN/0881562009/icongroupinterna
•
Making the Consumer's Voice Heard in Medicaid Managed Care: Increasing Participation, Protection and Satisfaction [DOWNLOAD: PDF] by National Health Law Program (Author); ISBN: B00005R950; http://www.amazon.com/exec/obidos/ASIN/B00005R950/icongroupinterna
•
Managed Care in Medicaid: Lessons for Policy and Program Design by Robert E. Hurley, et al; ISBN: 0910701954; http://www.amazon.com/exec/obidos/ASIN/0910701954/icongroupinterna
•
Managed Care Manual: Medicaid & State Health Reform by Larry S. Gage (1995); ISBN: 0614062705; http://www.amazon.com/exec/obidos/ASIN/0614062705/icongroupinterna
•
Managed Medicare and Medicaid: Facts, Trends and Data by Christopher J. Gearon (1997); ISBN: 092915620X; http://www.amazon.com/exec/obidos/ASIN/092915620X/icongroupinterna
•
Managing Medicaid Managed Care by James W. Fossett (Editor) (2004); ISBN: 0914341944; http://www.amazon.com/exec/obidos/ASIN/0914341944/icongroupinterna
•
Medicaid : lessons for national health insurance; ISBN: 0912862106; http://www.amazon.com/exec/obidos/ASIN/0912862106/icongroupinterna
•
Medicaid and Childhood Immunizations: A National Study (1992); ISBN: 9993999342; http://www.amazon.com/exec/obidos/ASIN/9993999342/icongroupinterna
•
Medicaid and Devolution: A View from the States by John J. Dilulio (Editor), et al (1998); ISBN: 0815784511; http://www.amazon.com/exec/obidos/ASIN/0815784511/icongroupinterna
156
Medicaid
•
Medicaid and Schip: Recent Hhs Approvals of Demonstration Waiver Projects Raise Concerns by Kathryn G. Allen, Katherine Iritani (2003); ISBN: 075672919X; http://www.amazon.com/exec/obidos/ASIN/075672919X/icongroupinterna
•
Medicaid and Supplemental Security Income Options and Strategies: Options and Strategies for Child Welfare Agencies by Madelyn Dewoody; ISBN: 0878684506; http://www.amazon.com/exec/obidos/ASIN/0878684506/icongroupinterna
•
Medicaid and the Costs of Federalism, 1984-1992 by Jean Donovan Gilman (1998); ISBN: 0815332785; http://www.amazon.com/exec/obidos/ASIN/0815332785/icongroupinterna
•
Medicaid and the Limits of State Health Reform by Michael S. Sparer (1996); ISBN: 1566394341; http://www.amazon.com/exec/obidos/ASIN/1566394341/icongroupinterna
•
Medicaid at the Crossroads: A Report of the Kaiser Commission on the Future of Medicaid by Diane Rowland, et al (1992); ISBN: 0944525105; http://www.amazon.com/exec/obidos/ASIN/0944525105/icongroupinterna
•
Medicaid Case Management: Kentucky's Patient Access and Care Program (Rm, 786) by Kevin M. Devlin (1989); ISBN: 9991942920; http://www.amazon.com/exec/obidos/ASIN/9991942920/icongroupinterna
•
Medicaid Claims Examiner (Career Examination Series: C-2691) by Jack Kerdman (1999); ISBN: 0837326915; http://www.amazon.com/exec/obidos/ASIN/0837326915/icongroupinterna
•
Medicaid Cost Containment Through Third Party Liability Programs (R M, 741) (1984); ISBN: 9994150413; http://www.amazon.com/exec/obidos/ASIN/9994150413/icongroupinterna
•
Medicaid Decisions: A Systematic Analysis of the Cost Problem by Stephen M Davidson; ISBN: 0884101428; http://www.amazon.com/exec/obidos/ASIN/0884101428/icongroupinterna
•
Medicaid Experience by Allen D. Spiegel (1979); ISBN: 0894430882; http://www.amazon.com/exec/obidos/ASIN/0894430882/icongroupinterna
•
Medicaid Ez: A Guide to Get Those Nursing Home Bills Paid by Beverly Huber Albanese, Heidi L. Macomber (2000); ISBN: 0595010970; http://www.amazon.com/exec/obidos/ASIN/0595010970/icongroupinterna
•
Medicaid Financing Crisis: Balancing Responsibilities, Priorities, and Dollars by Diane Rowland, et al (1993); ISBN: 0871685140; http://www.amazon.com/exec/obidos/ASIN/0871685140/icongroupinterna
•
Medicaid for Long Term Nursing Home Care by Richard Moran Enders; ISBN: 0962796492; http://www.amazon.com/exec/obidos/ASIN/0962796492/icongroupinterna
•
Medicaid Fraud and Abuse: Assessing State and Federal Responses: Hearing Before the Committee on Commerce, U.S. House of Representatives by Fred Upton (Editor) (1999); ISBN: 0756711606; http://www.amazon.com/exec/obidos/ASIN/0756711606/icongroupinterna
•
Medicaid fraud--prescription drug diversion : hearing before the Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations, House of Representatives, One Hundred Third Congress, first session,
Books
157
August 2, 1993 (SuDoc Y 4.G 74/7:M 46/11); ISBN: 0160467519; http://www.amazon.com/exec/obidos/ASIN/0160467519/icongroupinterna •
Medicaid Funded Home and Community Based Services for People With Developmental Disabilities (1993); ISBN: 9993717568; http://www.amazon.com/exec/obidos/ASIN/9993717568/icongroupinterna
•
Medicaid Hmo's and Maternal and Child Health by Kevin Brazner, Catherine L. Gaylord (1986); ISBN: 9998485843; http://www.amazon.com/exec/obidos/ASIN/9998485843/icongroupinterna
•
Medicaid Home Care Options for Disabled Children by Linda Hall (1990); ISBN: 9991136347; http://www.amazon.com/exec/obidos/ASIN/9991136347/icongroupinterna
•
Medicaid in the Reagan Era: Federal Policy and State Choices by Rand Bovbjerg, John Holahan; ISBN: 087766319X; http://www.amazon.com/exec/obidos/ASIN/087766319X/icongroupinterna
•
Medicaid issues under health care reform : hearing before the Committee on Finance, United States Senate, One Hundred Third Congress, second session, March 24, 1994 (SuDoc Y 4.F 49:S.HRG.103-937); ISBN: 0160466768; http://www.amazon.com/exec/obidos/ASIN/0160466768/icongroupinterna
•
Medicaid Managed Care and Service Delivery Reform in New York: A Work in Progress (Special Report (United Hospital Fund of New York).) by Kathryn Haslanger (2003); ISBN: 1881277712; http://www.amazon.com/exec/obidos/ASIN/1881277712/icongroupinterna
•
Medicaid Managed Care Mmc: Statesª Safeguards for Children With Special Needs Vary Significantly by Walter Ochinko, Karen Doran (2000); ISBN: 0756717582; http://www.amazon.com/exec/obidos/ASIN/0756717582/icongroupinterna
•
Medicaid Managed Care: How Do We Get There from Here? by Ira Mothner (1991); ISBN: 0934459932; http://www.amazon.com/exec/obidos/ASIN/0934459932/icongroupinterna
•
Medicaid Personal Care Spending in New York City: Implications and Recommendations for Long-Term Care Policy by Alene Hokenstad (Editor) (2001); ISBN: 1881277607; http://www.amazon.com/exec/obidos/ASIN/1881277607/icongroupinterna
•
Medicaid Prenatal Care: States Improve Access and Enhance Services, But Face New Challenges by BPI Information Services (1994); ISBN: 1579791204; http://www.amazon.com/exec/obidos/ASIN/1579791204/icongroupinterna
•
Medicaid Reform and the American States: Case Studies on the Politics of Managed Care by Mark R. Daniels (Author) (1998); ISBN: 0865692637; http://www.amazon.com/exec/obidos/ASIN/0865692637/icongroupinterna
•
Medicaid Reimbursement of Nursing Home Care by Grimaldi; ISBN: 0844734578; http://www.amazon.com/exec/obidos/ASIN/0844734578/icongroupinterna
•
Medicaid Research and Demonstration Programs by Laura Tobler, Patricia A. Butler (1995); ISBN: 1555163440; http://www.amazon.com/exec/obidos/ASIN/1555163440/icongroupinterna
•
Medicaid Since 1980: Costs, Coverage, and the Shifting Alliance Between the Federal Government and the States by Teresa A. Coughlin, et al; ISBN: 0877666180; http://www.amazon.com/exec/obidos/ASIN/0877666180/icongroupinterna
158
Medicaid
•
Medicaid Survival Kit: Update by Martha P. King, et al (1996); ISBN: 1555166555; http://www.amazon.com/exec/obidos/ASIN/1555166555/icongroupinterna
•
Medicaid, HMOs, & Maternal & Child Health by Catherine L. Gaylord, Kevin Brazner (1986); ISBN: 0685198642; http://www.amazon.com/exec/obidos/ASIN/0685198642/icongroupinterna
•
Medicaid: Eligibility for the Aged and Disabled by Julie Lynn Stone (2003); ISBN: 1590338189; http://www.amazon.com/exec/obidos/ASIN/1590338189/icongroupinterna
•
Medicaid: States Turn to Managed Care to Improve Access and Control Costs (1993); ISBN: 1568065884; http://www.amazon.com/exec/obidos/ASIN/1568065884/icongroupinterna
•
Medicaid: The Trade-Off Between Cost Containment and Access to Care (Changing Domestic Priorities Series) by John F. Holahan, Joel W. Cohen; ISBN: 0877664064; http://www.amazon.com/exec/obidos/ASIN/0877664064/icongroupinterna
•
Medicare and Medicaid by Margaret Greenfield (Author) (1983); ISBN: 0313238413; http://www.amazon.com/exec/obidos/ASIN/0313238413/icongroupinterna
•
Medicare and Medicaid Patient and Program Protection Act of 1987: A Legislative History of Pub Law No 98-507 (Legislative Histories Series) by Bernard D., Jr. Reams (Editor) (1990); ISBN: 0899416950; http://www.amazon.com/exec/obidos/ASIN/0899416950/icongroupinterna
•
Medicare and Medicaid: Past, Present and Future by Kathleen N. Lohr, M. Susan Marquis (1984); ISBN: 9995858541; http://www.amazon.com/exec/obidos/ASIN/9995858541/icongroupinterna
•
Monitoring Medicaid Managed Care: Developing an Assessment and Evaluation Program (A Special Report) by Melvin I. Krasner (1995); ISBN: 1881277259; http://www.amazon.com/exec/obidos/ASIN/1881277259/icongroupinterna
•
Monitoring Medicaid Provider Participation & Access to Care by Karen Glass (Editor), Deborah Lewis-Idema (1992); ISBN: 1558771662; http://www.amazon.com/exec/obidos/ASIN/1558771662/icongroupinterna
•
New approaches to the Medicaid crisis : proceedings of the 1981 Commonwealth Fund Forum; ISBN: 0866210075; http://www.amazon.com/exec/obidos/ASIN/0866210075/icongroupinterna
•
Ombudsprograms and Member Advocates: Consumer-Oriented Approaches to Problem-Solving in Medicaid Managed Care [DOWNLOAD: PDF] by National Health Law Program (Author); ISBN: B00005R952; http://www.amazon.com/exec/obidos/ASIN/B00005R952/icongroupinterna
•
Options for Reforming the Medicaid Matching Formula by Blumberg (1993); ISBN: 9994785826; http://www.amazon.com/exec/obidos/ASIN/9994785826/icongroupinterna
•
Outstanding Medicaid Eligibility Workers at Community and Migrant Health Centers by Tim M. Henderson, Karen Glass (Editor) (1992); ISBN: 1558771514; http://www.amazon.com/exec/obidos/ASIN/1558771514/icongroupinterna
•
Participation of Federally Qualified Health Centers in Medicaid Case Management Programs by L. Carl Volpe, Tim M. Henderson (1992); ISBN: 1558771611; http://www.amazon.com/exec/obidos/ASIN/1558771611/icongroupinterna
Books
159
•
Poor Health Care for Poor Americans: A Ranking of State Medicaid Programs by Karen Erdman, Sidney M. Wolfe (1987); ISBN: 9999414427; http://www.amazon.com/exec/obidos/ASIN/9999414427/icongroupinterna
•
Prescription for Profit: How Doctors Defraud Medicaid by Paul Jesilow, et al (1993); ISBN: 0520076141; http://www.amazon.com/exec/obidos/ASIN/0520076141/icongroupinterna
•
Recommendations for Making the Consumers' Voice Heard in Medicaid Managed Care: A Guide to Effective Consumer Involvement [DOWNLOAD: PDF] by National Health Law Program (Author); ISBN: B00005R94W; http://www.amazon.com/exec/obidos/ASIN/B00005R94W/icongroupinterna
•
Remaking Medicaid: Managed Care for the Public Good by Stephen Davidson (Author), Stephen A. Somers (Author); ISBN: 0787940429; http://www.amazon.com/exec/obidos/ASIN/0787940429/icongroupinterna
•
Running in Place: How the Medicaid Model Falls Short, and What to Do About It (The Devolution Revolution) by Eliot Fishman (2002); ISBN: 0870784773; http://www.amazon.com/exec/obidos/ASIN/0870784773/icongroupinterna
•
Section 1115 Medicaid Waivers: An Advocate's Primer [DOWNLOAD: PDF] by National Health Law Program (Author); ISBN: B00005R951; http://www.amazon.com/exec/obidos/ASIN/B00005R951/icongroupinterna
•
St. Anthony's Medicaid Managed Care and Capitation Manual (Mref) by Michael Grambo (Editor) (1998); ISBN: 1563294931; http://www.amazon.com/exec/obidos/ASIN/1563294931/icongroupinterna
•
St. Anthony's Roadmap for Medicaid Managed Care: A Clinical and Financial Tour of Unmanaged, Managed and Highly Managed Markets by Michael Grambo (Editor), Sean Hopkins (1996); ISBN: 1563293730; http://www.amazon.com/exec/obidos/ASIN/1563293730/icongroupinterna
•
State Medicaid drug formularies : cost saving measure or second-class medicine? : hearing before the Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations, House of Representatives, One Hundred Third Congress, first session, June 9, 1993 (SuDoc Y 4.G 74/7:ST 2/17); ISBN: 0160465400; http://www.amazon.com/exec/obidos/ASIN/0160465400/icongroupinterna
•
States Response to Medicaid Financing Crisis: Case Studies Report by Holahan (1992); ISBN: 999444753X; http://www.amazon.com/exec/obidos/ASIN/999444753X/icongroupinterna
•
Testing CAHPS Health Plan Performance Reports in the Florida Medicaid Program by Donna O. Farley, et al (2000); ISBN: 0833029045; http://www.amazon.com/exec/obidos/ASIN/0833029045/icongroupinterna
•
The AIDS Benefits Handbook: Everything You Need to Know to Get Social Security, Welfare, Medicaid, Medicare, Food Stamps, Housing, Drugs, and Other by Thomas P. McCormack (1990); ISBN: 0300047363; http://www.amazon.com/exec/obidos/ASIN/0300047363/icongroupinterna
•
The Effects of the AIDS Epidemic on Traditional Medicaid Populations/R-4148-Hcfa by Anthony H. Pascal, et al (1992); ISBN: 0833012274; http://www.amazon.com/exec/obidos/ASIN/0833012274/icongroupinterna
160
Medicaid
•
The Medicaid Cost Explosion: Causes and Consequences: Report of the Kaiser Commission on the Future of Medicaid by Judith Feder, et al (1993); ISBN: 0944525121; http://www.amazon.com/exec/obidos/ASIN/0944525121/icongroupinterna
•
The Medicaid Planning Handbook by Jr. Alexander A. Bove (Author) (1996); ISBN: 0316103748; http://www.amazon.com/exec/obidos/ASIN/0316103748/icongroupinterna
•
Welfare Medicine in America: A Case Study of Medicaid by Rosemary Stevens, Robert Bocking Stevens (2003); ISBN: 0765809575; http://www.amazon.com/exec/obidos/ASIN/0765809575/icongroupinterna
•
Who Cares for Poor People?: Physicians, Medicaid, and Marginality (Health Care Policy in the United States) by Margaret M. Hynes; ISBN: 0815330456; http://www.amazon.com/exec/obidos/ASIN/0815330456/icongroupinterna
•
With Dignity : The Search for Medicare and Medicaid by Sheri I. David (Author) (1985); ISBN: 031324720X; http://www.amazon.com/exec/obidos/ASIN/031324720X/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “Medicaid” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:6 •
Evaluation of the costs of medical care provided to D. C. Medicaid enrollees in a prepaid group practice: a final report Author: Westat Research, inc.; Year: 1975; Rockville, Md.: Westat, 1975
•
Family planning, Medicaid, and the private physician; report. Author: Rosoff, Jeannie I.; Year: 1969; New York, [1969]
•
Financing mental health care under Medicare and Medicaid. Author: United States. Social Security Administration. Office of Research and Statistics.; Year: 1971; [Washington, For sale by the Supt. of Docs., U. S. Govt. Print. Off., 1971]
•
Medicaid; payment of reasonable charges for prescribed drugs, guidelines. Author: United States. Medical Services Administration.; Year: 1971; [Washington, 1971]
•
Medicare and Medicaid amendments, material related to H. R. 1. Prepared by the staff and printed for the use of the Committee on Finance. Author: United States. Congress. Senate. Committee on Finance.; Year: 1971; Washington, U. S. Govt. Print. Off., 1971
•
Medicare and Medicaid guide. Author: Commerce Clearing House.; Year: 9999; New York, Commerce Clearing House, 1970-
6
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
Books
161
•
Medicare and Medicaid. Hearings before the Subcommittee on Medicare-Medicaid of the Committee on Finance, United States Senate, Ninety-first Congress, second session. Author: United States. Congress. Senate. Committee on Finance. Subcommittee on Medicare-Medicaid.; Year: 1970; Washington, U. S. Govt. Print. Off., 1970
•
Medicare and Medicaid: the 1965 and 1967 social security amendments. Author: Greenfield, Margaret.; Year: 1968; Berkeley, Univ. of California, Institute of Governmental Studies, 1968
•
Medicare-Medicaid anti-fraud act: hearing before the Subcommittee on Health and the Environment of the Committee on Interstate and Foreign Commerce, House of Representatives, Ninety-fourth Congress, second session. September 22, 1976. Author: United States. Congress. House. Committee on Interstate and Foreign Commerce. Subcommittee on Health and the Environment.; Year: 1976; Washington: U. S. Govt. Print. Off., 1976
•
Medicare-Medicaid reimbursement policies: social security studies final report Author: Institute of Medicine (U.S.); Year: 1976; Washington: For sale by the Supt. of Docs., U. S. Govt. Print. Off., 1976
•
Mental health benefits of Medicare and Medicaid. Author: National Institute of Mental Health (U.S.); Year: 1970; Washington, For sale by Supt. of Docs., U. S. Govt. Print. Off., 1970]
•
More needs to be done to assure that physicians' services - paid for by Medicare and Medicaid - are necessary, B-164031(4), Department of Health, Education, and Welfare. Report to the Congress by the Comptroller General of the United States, Aug. 2, 1972. Author: United States. General Accounting Office.; Year: 1972; [Washington] 1972
•
Public assistance social services related to Medicaid. Author: Butts, Sarah A.; Year: 1973; [Washington] U. S. Community Services Administration, 1972, reprinted 1973
•
Report on a study of Medicaid utilization of services in a prepaid group practice health plan Author: Fuller, Norman A.; Year: 1976; [West Hyattsville, Md.]: Dept. of Health, Education, and Welfare, Public Health Service, Health Services Administration, Bureau of Medical Services, 1976
•
The impact of Medicaid on interstate income differentials. Author: Stuart, Bruce C.; Year: 1971; [Lansing] Michigan Dept. of Social Services, Research and Program Analysis Division, 1971
•
Welfare medicine in America; a case study of Medicaid [by] Robert Stevens & Rosemary Stevens. Author: Stevens, Robert Bocking.; Year: 1974; New York, Free Press [c1974]; ISBN: 0029315204 http://www.amazon.com/exec/obidos/ASIN/0029315204/icongroupinterna
Chapters on Medicaid In order to find chapters that specifically relate to Medicaid, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Medicaid using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “Medicaid” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on Medicaid:
162
•
Medicaid
Taking Care of Yourself Financially: An Overview Source: in Everson, G.T.; Weinberg, H. Living with Hepatitis B: A Survivor's Guide. Long Island, NY: Hatherleigh Press. 2002. p.118-138. Contact: Available from Hatherleigh Press. 5-22 46th Avenue Suite 200, Long Island City, NY 11101. (800) 528-2550. E-mail:
[email protected]. Website: http://store.yahoo.com/hatherleighpress/index.html. PRICE: $15.95 plus shipping and handling. ISBN: 1578260841. Summary: Chronic hepatitis B can lead to cirrhosis (liver scarring), liver cancer, and the need for liver transplantation. This chapter on the financial challenges of chronic illness is from a book that helps readers diagnosed with hepatitis B virus (HBV) infection educate themselves about the disease and its treatment. The authors present a general overview of financial issues and include resources to help patients find their own solutions. Topics include costs of treatment, such as ongoing medical care, antiviral treatment, and liver transplantation; private health insurance, including selecting health insurance and the different types of private insurance; government health insurance, including Medicare, Medicaid, and Veterans Administration programs; applying for disability; and disability insurance, including Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Throughout the chapter the authors include quotes from real people who are living with hepatitis. The authors also include resource organizations that may offer additional support and information for readers.
•
Financing Health Care Source: in Weinstein, B.E. Geriatric Audiology. New York, NY: Thieme. 2000. p. 313-323. Contact: Available from Thieme. 333 Seventh Avenue, New York, NY 10001. (800) 7823488. Fax (212) 947-0108. E-mail:
[email protected]. PRICE: $59.00 plus shipping and handling. ISBN: 0865777012. Summary: The purpose of this chapter is to provide audiologists with a brief perspective on the financing of health care, which is a very complicated, changing phenomenon. The chapter is from a textbook that is designed to incorporate issues of aging and geriatrics into the delivery of health care by audiologists and other hearing care professionals. In this chapter, the author discusses Medicare and Medicaid, particularly their long term care benefits; managed care and Medicare managed care structures; and the funding of audiologic services. The author stresses that audiologists must have an appreciation for the amount of money spent on health care, for what the money buys, and how the money is paid out. The typical payment for audiologic services in managed care plans is limited, usually to diagnostic services or to illness or accident related hearing disorders. Some benefit packages include hearing aids and more and more Medicare plans are including a small hearing aid benefit. 2 figures. 7 tables. 42 references.
•
Financing Health Care for Children with Chronic Conditions Source: in Jackson, P.L., and Vessey, J.A., eds. Primary Care of the Child with a Chronic Condition. St. Louis, MO: Mosby-Year Book, Inc. 1996. p. 100-117. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545. PRICE: $49.95. ISBN: 0815148518. Summary: This book chapter outlines financing options for the health care needs of children with chronic conditions. The author considers four financing methods: private health insurance, including prepayment arrangements; public programs, such as
Books
163
Medicaid, the Title V Program for Children with Special Health Care Needs, and other Federal and State categorical programs; private, philanthropic sources; and the family's own funds. The source of financial coverage depends on a number of factors, including the medical condition, family income, parents' employment, State and county of residence, availability of a voluntary organization for the specific condition, and the availability of people in the health care and legal systems who can advocate for the child's rights to specific sources of financial assistance. 5 tables. 40 references. •
Specific Factor: Alzheimer's Source: in O'Brien, R.C.; Flannery, M.T. Long Term Care: Federal, State, and Private Options for the Future. New York, NY: The Haworth Press. 1997. p. 29-38. Contact: Haworth Press. 10 Alice Street, Binghamton, NY 13904-1580. (800) HAWORTH, (607) 722-5857; FAX: (800) 895-0582, (607) 722-6362. Internet: http://www.haworthpressinc.com. PRICE: $54.95 (hardcover), $24.95 (softcover). ISBN: 0789002612. Summary: This book section examines issues in financing long-term care for people with Alzheimer's disease (AD). Although the largest population of people requiring longterm care are those with some form of dementia, two of the largest provisional health care programs, Medicare and Medicaid, are not readily available for the care of these patients. Medicare generally does not cover custodial care except for hospitalization, and Medicaid is not available until the family has exhausted its own financial resources. No government program will pay for long-term care at home. Thus, families caring for dementia patients at home must rely on private insurance. Presently, however, more than 30 million Americans have no health insurance. Some studies show that proper treatment may be not unaffordable and inaccessible to those who are uninsured. Even those with health insurance are at risk for inadequate care because most insurance plans will not cover AD. In recent years, employer sponsored group long-term care programs have grown in popularity. Although these plans are not available to everyone, most include coverage for custodial nursing home care and home health care, and specifically cover impairments caused by AD.
•
Solving Discrimination and Insurance Problems Source: in Touchette, N. Diabetes Problem Solver. Alexandria, VA: American Diabetes Association. 1999. p. 441-459. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $19.95 for members; plus shipping and handling. ISBN: 1570400091. Summary: This chapter deals with solving discrimination and insurance problems in people who have diabetes. Prior to the passage of the American with Disabilities Act of 1990, people who had diabetes commonly faced outright discrimination in the workplace. This law protects all civilian employees who work for companies that employ more than 15 people from discrimination. Two federal laws guarantee all students with disabilities a free and appropriate public education without discrimination. Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against individuals with disabilities in any federally funded program. The Individuals with Disability Education Act guarantees free appropriate public education for all children with disabilities. Although people who have diabetes are not allowed to enlist in the military, they may or may not be allowed to continue to serve if they are
164
Medicaid
diagnosed while serving. The chapter presents guidelines for determining whether a person is being discriminated against in the workplace, in schools and day care facilities, and in the military and offers suggestions for resolving a situation involving discrimination in these settings. In addition, the chapter offers guidelines for choosing either fee-for-service and managed care health care and discusses the coverage provided by Medicare and Medicaid. •
Ambulatory Medical Care for Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 541-552. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail:
[email protected]. PRICE: Full-text available online at no charge. Also available at http://www.niddk.nih.gov/. Summary: This chapter on ambulatory medical care for diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Based on the 1989 National Health Interview Survey (NHIS), persons with diabetes in the United States had 96.1 million outpatient medical care contacts in 1990, including 53.4 million visits to physician's offices, 13.9 million visits to outpatient clinics, 1.6 million visits to emergency rooms, 10.7 million telephone contacts, and 16.4 million visits to other ambulatory care settings, including company, industry, and public health clinics and home visits. There was an average of 15.5 contacts with physicians for ambulatory care per person with diabetes, compared with 5.5 contacts per person in the general U.S. population. Based on the 1990 National Ambulatory Medical Care Survey (NAMCS), the estimated rate of office-based physician visits with a primary or secondary diagnosis of diabetes per person with diabetes was two to three fold higher than the rate of visits for all other diagnoses for persons without diabetes. Diabetes was the second most frequently cited chronic disease accounting for office-based physician visits in the 1990 NAMCS, after hypertension. In 1989, greater than 90 percent of persons with diabetes had one physician whom they saw for treatment of their diabetes and, of these, 65 percent had seen this physician four or more times in the past year. The mean duration of a visit for diabetes in 1990 was 17.4 minutes. Blood pressure was measured in 77 percent and cholesterol in 10 percent of the visits, and urinalysis was performed in 25 percent. Medicare was the source of payment for 46 percent of office visits, Medicaid for 10 percent, commercial insurance for 25 percent, and in 30 percent the patient had outof-pocket expenses. 2 appendices. 6 figures. 13 tables. 12 references. (AA-M).
•
Diabetes and Long Term Care Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 571-590. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail:
[email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text available online at no charge. Summary: This chapter on diabetes and longterm care is from a compilation and assessment of data on diabetes and its complications in the United States. Longterm care (LTC), which includes nursing facilities and home health care, provides care to an
Books
165
increasing population of disabled, elderly persons with diabetes. In 1987, 389,000 residents of nursing facilities, age greater than 55 years, had diagnosed diabetes. About 18.3 percent of all nursing home residents older than 55 years had been diagnosed with diabetes, compared with 12.6 percent of the general population. Persons with diabetes in this age group were twice as likely as nondiabetic persons to reside in a nursing facility. Residents with diabetes were more likely to be younger and nonwhite, compared with nondiabetic residents, but are similar in gender, marital status, and geographic location of the nursing facility. More than 80 percent have cardiovascular disease, 56 percent have hypertension, 39 percent have senile dementia, and 69 percent have two or more chronic conditions in addition to their diabetes. Almost all are limited in their ability to perform the activities of daily living. Residents with diabetes and nondiabetic residents were in nursing facilities in 1987 for a similar length of time and had similar total expenditures for care. However, Medicaid contributed an average of $1,226 more per resident with diabetes in 1987 than per nondiabetic resident. Residents with diabetes have higher rates of acute and chronic complications of diabetes, resulting in higher rates of expensive hospitalizations and mortality compared with nondiabetic residents. Providing quality care for residents with diabetes in nursing facilities is hampered by staff shortages, frequent staff turnover, poor pay, and lack of education and educational materials on diabetes in the nursing home environment. Home health care agencies serve as an increasingly important source of formal longterm care for patients with diabetes. However, little information is currently available about the demographics, use, expenditures, and quality of home health care. 4 appendices. 6 figures. 11 tables. 68 references. (AA-M). •
Money Problems Source: in Rezen, S.V. and Hausman, C. Coping with Hearing Loss: Plain Talk for Adults About Losing Your Hearing. New York, NY: Barricade Books. 2000. p. 257-263. Contact: Available from Barricade Books, Inc. 185 Bridge Plaza North, Suite 308 A, Ft. Lee, NJ 07024. (800) 592-6657. Website: www.barricadebooks.com. PRICE: $19.95 plus shipping and handling. ISBN: 1569801657. Summary: This chapter on financial considerations is from a book designed to help adults and their families cope with hearing loss. Written in nontechnical language, the chapters are filled with examples and specific strategies that real people have used in settings from the workplace to home to social and recreational situations. In this chapter, the authors remind readers that the seemingly high cost of hearing aids includes costs for research and development, an average of five hours of service and counseling by the dispenser within the first year, and the warranty as well as the hearing instrument itself. Medicare will pay for a hearing test if it is used in the diagnosis of a medical problem, but not for any testing done that is connected with a hearing aid, nor for the aid itself. Medicaid may be available for some costs associated with hearing aids; coverage varies by state. The authors provide other suggestions for obtaining financial assistance in paying for hearing aids, including state vocational rehabilitation programs, private health insurance, local service groups, and groups that provide reconditioned hearing aids at minimal costs. The authors then explore strategies for saving money on services related to hearing aids, such as using a university sponsored clinic. The chapter concludes with a brief section of answers to commonly asked questions about financial aid and hearing aids.
166
•
Medicaid
Health Insurance and Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 591-600. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail:
[email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on health insurance and diabetes is from a compilation and assessment of data on diabetes and its complications in the United States. Among all adults with diabetes, 92 percent have some form of health insurance. However, about 640,000 people with diabetes do not have any form of health care coverage. Among individuals with diabetes, age 18 to 64 years, 10.3 percent are covered by Medicare, 69.3 percent by private health insurance, 5.5 percent through military benefits, and 14.1 percent through Medicaid or other public assistance programs. Among those 65 years of age and older, 94.7 percent are covered by Medicare, 69.2 percent by private health insurance, 4.9 percent through military benefits, and 15.4 percent through Medicaid or other public assistance programs. Government-funded programs are responsible for health care coverage for 57.4 percent of adults with diabetes, including 26.4 percent of those age 18 to 64 years and 96 percent of those age 65 or older. There is little difference by type of diabetes (IDDM or NIDDM) in the proportion of individuals covered by each health insurance mechanism. At age 18 to 64 years, males compared with females have higher rates of coverage for each insurance type except Medicaid and other public programs; a higher proportion of blacks and Hispanics compared with all whites are covered by Medicare and Medicaid; and whites are more frequently covered by private health insurance. Virtually all persons with diabetes covered by Medicare or private health insurance have coverage for hospital care and physician or surgeon bills. Coverage for prescription medicines occurs for 62.9 percent of adults with diabetes. There are only small differences between people with diabetes and those without diabetes in the proportion covered and the types of health care coverage. 10 figures. 5 tables. 14 references. (AA-M).
•
Insurance and Disability Advocacy Issues in Inflammatory Bowel Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 555-559. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email:
[email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on insurance and disability advocacy issues is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). The author stresses that physicians can be good advocates for their patients with IBD. The key to being a good advocate is to be knowledgeable about the issues and to be able to offer facts and guidance to patients with their many insurance and disability related issues. The author discusses the vulnerable age peak for obtaining insurance; changing employment; benefits programs including Medicare, Medicaid, high risk insurance pools, and Family and Medical
Books
167
Leave; and disability programs, including Social Security disability benefits, the Americans with Disabilities Act (ADA), and education issues for children with IBD. The chapter offers a list of tips for patients. Do not let current health insurance coverage lapse. If the patient does not have health insurance, look into the options available to obtain it. Have regular visits with the doctor, as insurers look favorably on patients who have regular visits, and this will also help the patient to stay well. Take medication as prescribed, because the condition likely will not improve on its own, even if the use of medication temporarily disallows eligibility to an insurance plan. If possible, choose a job with group insurance and portable benefits. For parents of children with IBD, anticipate their need for modified coverage prior to their eighteenth birthday. Determine with the insurance agent or benefits representative what the best options are for the teenager prior to turning 18 so that no lapse in coverage occurs. •
Rehabilitation Funding Source: in Wallace, G.L., ed. Adult Aphasia Rehabilitation. Woburn, MA: ButterworthHeinemann. 1996. p. 21-38. Contact: Available from Butterworth-Heinemann. 255 Wildwood Avenue, P.O. Box 4500, Woburn, MA 01801-2041. (617) 928-2500; Fax (617) 933-6333. PRICE: $47.50 plus shipping and handling. ISBN: 0750695358. Summary: This chapter on rehabilitation funding is from a text on adult aphasia rehabilitation. After an introductory section on six criteria for a reformed health care system, the authors consider funding sources, including traditional private insurance plans, managed care organizations, legal decisions, private payment, Medicare, and other public insurance systems (Medicaid, worker's compensation); ways to maximize the likelihood of reimbursement for speech-language pathology services, including adequate documentation and working with case managers; and the future of reimbursement for speech-language pathology services. The authors conclude that speech-language pathologists must keep abreast of the continual changes in health care funding and financing and should continually develop strategies that provide for the most efficacious rehabilitation at the lowest cost. 2 tables. 10 references.
•
Appendix C: The Laws Source: in Cutler, B.C. You, Your Child, and 'Special Education': A Guide to Making the System Work. Baltimore: Paul H. Brookes Publishing Company. 1993. p. 237-241. Contact: Available from Paul H. Brookes Publishing Company. P.O. Box 10624, Baltimore, MD 21285-0624. (800) 638-3775. Fax (410) 337-8539. E-mail:
[email protected]. Website: www.brookespublishing.com. PRICE: $22.00 plus shipping and handling. ISBN: 1557661154. Summary: This chapter, from a parents' guide to the special education system in the U.S., presents an overview of the Federal laws concerning the rights of people with disabilities. For each law, the public law (PL) number, title of the act, and year passed are given. This information is followed by a simple description of the law's purpose and content. Education laws included are PL 94-142, Education for All Handicapped Children Act; PL 98-199, Education of the Handicapped Act Amendments; PL 99-372, Handicapped Children's Protection Act; PL 99-457, Education of the Handicapped Act Amendments (Early Intervention Amendments to PL 94-142); PL 100-407, TechnologyRelated Assistance for Individuals with Disabilities Act (the 'Tech Act'); PL 101-392, The Carl D. Perkins Vocational and Applied Technology Education Act; and PL 101-476, Individuals with Disabilities Education Act (IDEA). Rehabilitation and civil rights laws
168
Medicaid
included are PL 93-112, Rehabilitation Act; PL 101-336, Americans with Disabilities Act; and PL 102-569, Rehabilitation Act Amendments of 1992. Medicaid laws included are PL 97-35, Title XIX of the Social Security Act; PL 100-360, Catastrophic Coverage Act; PL 101-239, Medicaid Amendments; and PL 101-508, Child Care and Development Block Grant. Also included is PL 101-496, The Developmental Disabilities Assistance and Bill of Rights Act.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to Medicaid have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:7 •
Directory of Dental Services in Residential Facilities for the Mentally Retarded and Mentally Ill Source: Chicago, IL: Academy of Dentistry for People with Disabilities. 1993. 89 p. Contact: Available from Academy of Dentistry for People with Disabilities. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2660. PRICE: $25.00 for members of the Academy and members of Special Care Dentistry; $45.00 for nonmembers, plus shipping and handling. Summary: Deinstitutionalization has had a profound impact over the past decade on dental services provided to persons with mental retardation and mental illness (MH/MR) who still reside in institutions. In order to assess the extent of this change, and to help plan for dental services for those persons who will continue to be deinstitutionalized, this Directory of Dental Services was compiled. For each state, the following information is listed: state dental director, dental director for MH/MR programs, contact person for dental program directory, additional information and comments, a list of MH/MR facilities, Medicaid coverage for dentistry, and a summary of dental staff/client information. A brief glossary of terms is also included.
•
Did you know: Help is available with the costs of health care for pregnant women and children with special health needs: A guide to the funding sources that will pay for medical services Source: Charleston, WV: Office of Maternal and Child Health, West Virginia Department of Health and Human Resources. n.d. 73 pp. Contact: Available from West Virginia Department of Health and Human Resources, Office of Maternal and Child Health, 1411 Virginia Street, East, Charleston, WV 25301. Telephone: (304) 558-0030 / fax: (304) 558-2183. Single copies available at no charge. Summary: This directory identifies programs administered by the West Virginia state government that provide financial support for pregnant women and children with special health needs; it is for the use of intermediaries that assist families find financial
7
You will need to limit your search to “Directory” and “Medicaid” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “Medicaid” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.
Books
169
assistance. The entries are arranged topically under the administering agency; each provides an overview of the types of services provided and contact information. Services described include: EPSDT, pediatric health services, the early intervention project, the Right from the Start Project, Medicaid, and Supplemental Security Income for Children with Disabilities, among others. Other chapters address common questions about billing and support services for families of children with special needs. •
National Transplant Resource Directory Source: Pittsburgh, PA: Stadtlanders Pharmacy. 1998. 12 p. Contact: Available from Stadtlanders Pharmacy. Social Services Department, 600 Penn Center Boulevard, Pittsburgh, PA 15235-9931. (800) 238-7828. PRICE: Single copy free. Summary: This directory was created to assist transplant recipients, their families, and health care professionals with locating national transplant resources. The first section of the directory lists resources for coverage for health care and medications, including COBRA; high risk insurance pools; Medicaid coverages, including SSI, Medicaid, and QMB; Medicare; Medicare HMOs; Medicare Supplemental Insurance (Medigap policy); state kidney programs; state pharmaceutical assistance programs; and the Veterans Administration. The second section lists resources for educational information, financial grants, fundraising, and medication grants. Each entry notes the organization name, address, and telephone number, along with a brief description of the types of activities and resources offered.
•
Directory of Aging Resources. 2nd Ed Source: Silver Spring, MD: Business Publishers, Inc. 1994. 458 p. Contact: Available from Business Publishers, Inc. 951 Pershing Drive, Silver Spring, MD 20910-4464. (301) 587-6300; FAX (301) 587-1081. PRICE: $97.00. ISBN: 0916742121. Summary: This directory, intended for use by professionals in the field of aging, and by senior citizens and their families, including persons with Alzheimer's disease, is a guidebook to the aging network in the United States. The book lists Federal and state government programs; congressional committees, national organizations; state and local organizations; research programs affiliated with universities, colleges, corporations, and businesses; and international organizations based in the United States. Each listing includes a contact name, address, and telephone numbers; and information about the mission or purpose of the organization, its key activities and services in the aging field, and, where applicable, funding sources and publications. State listings provide contact addresses and telephone numbers for assistance programs in various areas such as energy, housing, meals, Medicaid, Social Security, and transportation. Area agencies on aging are also listed for each state. Three indexes are included: A personnel index, listing contact names for all organizations; an index of 30 subject categories, including Alzheimer's Disease; and a master index to the names of all organizations and programs listed in the directory.
•
Reimbursement Primer Source: Chicago, IL: American Association of Diabetes Educators. 2000. 139 p. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, Suite 400, Chicago, IL 60603. (312) 424-2426. Fax (312) 424-2427. E-mail:
[email protected]. Website: www.aadenet.org. PRICE: $40.00 for nonmembers; $20.00 for members.
170
Medicaid
Summary: This primer, written for diabetes educators, helps them understand how the reimbursement industry works and how they can make the system work for them. The primer begins by introducing the payors who reimburse claims for health care expenses, including Medicare and Medicaid, private insurance companies, and self funded employers. Topics include the factors that payors consider in determining who is eligible, what will be covered, and how much they will reimburse. In addition, the primer describes major payors' coverage policies for diabetes education, equipment, and supplies. This is followed by a review of the ways that diabetes educators come to be recognized by payors as suitable providers of diabetes self management education (DSME) services. The next section details the process of reimbursement, focusing on filing claims, verifying patient eligibility and coverage, obtaining precertification if necessary, determining payors' claims processes, filling out claim forms, assigning appropriate codes, being aware of legal issues, processing a claim, appealing a denied claim, and helping patients access equipment and supplies. 15 appendices. 7 figures. 18 tables. •
Georgia Senior Resource Guide Source: Atlanta, GA: Care Solutions, Inc. 1995. 258 p. Contact: Available from Care Solutions, Inc. 8302 Dunwoody Place, Suite 352, Atlanta, GA 30350. (404) 642-6722; (800) 227-3410; FAX (404) 640-6073. PRICE: $24.95 plus $3.00 shipping and handling. ISBN: 0963193996. Summary: This resource guide is designed to help older adults, caregivers, and professionals make informed decisions about finding and using elder care services in Georgia. The first chapter discusses options available to older adults who want to remain at home and describes organizations that serve as gateways to the service delivery system. Subsequent chapters discuss housing options, legal and financial issues, health insurance, and health care and caregiving. Included are discussions about retirement communities, nursing homes, retirement benefits, financial assistance, employment opportunities, wills and other legal documentation, Medicare and Medicaid coverage, major health problems, and coping issues. A resource section lists by county, service, and provider over 2,100 resource centers and the services they offer.
•
Indiana Directory: Dental Care for People with Disabilities Source: Indianapolis, IN: Indiana State Board of Health. 199x. 30 p. Contact: Available from Indiana State Board of Health. Division of Dental Health, 1330 West Michigan Street, Indianapolis, IN 46206-1964. (317) 633-8417; FAX, (317) 633-0776. PRICE: Single copy free. Reproducible with permission and credit noted. Summary: To help promote the oral health of people with disabilities in Indiana, information regarding physical access to dental facilities and dentists' willingness to accept Medicaid coverage has been compiled in this directory. Dentists listed in the directory are divided by County of practice with codes assigned to specify information regarding the physical facilities of the office, whether Medicaid is accepted, and to indicate whether each dentist is a general practitioner or dental specialist. Specialities covered include general practice; oral and maxillofacial surgery; endodontics; orthodontics; pediatric dentistry; periodontics; prosthodontics; and oral pathology.
171
CHAPTER 7. MULTIMEDIA ON MEDICAID Overview In this chapter, we show you how to keep current on multimedia sources of information on Medicaid. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on Medicaid is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “Medicaid” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “Medicaid” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on Medicaid: •
Medicaid waivers update Source: [Baltimore, MD?]: Health Care Financing Administration, U.S. Department of Health and Human Services. 1995. 1 videotape (37 minutes, VHS 1/2 inch). Contact: Available from U.S. Health Care Financing Administration, 7500 Security Boulevard, C2-26-12, Baltimore, MD 21244 / Web site: http://www.hcfa.gov. Summary: In this videotape, the author first describes how the Health Care Financing Administration (HCFA) can approve changes to Medicaid programs by waiving certain provisions of the Social Security Act. He describes Section 1115 waivers (also called demonstration or health care reform waivers) and differentiates them from program waivers. He explains the difference between the two types of program waivers, 1915(b) and 1915(c) waivers. After explaining what provisions can and cannot be waived under Section 1115, the author provides an overview of the growth of 1115 programs and outlines common approaches and unique features of these programs. He lists states with active 1115 programs and states with pending proposals; describes the stages of HCFA's
172
Medicaid
review process; and provides some detail on how these programs affect vulnerable populations, especially children with special health needs (CSHN). •
Use your power: The key to the highway of health with Medicaid managed care Source: Washington, DC: District of Columbia Office of Maternal and Child Health. [1996]. 1 videotape (30 minutes, VHS1/2 inch). Contact: Available from District of Columbia Healthy Start Resource Center, 3720 Martin Luther King Jr. Avenue, S.E., 3rd Floor, Washington, DC 20032. Telephone: (202) 645-0386. $20.00 for individuals and non-profit organizations; $50.00 for institutions and for profit organizations; plus $5.00 shipping and handling in D.C. Metropolitan Area; otherwise add $10.00 for shipping and handling. Prepayment required; make checks payable to D.C. Office of Maternal and Child Health. Summary: This videotape shows a simulated talk show with stories and advice from parents who have had experience with Medicaid managed care and questions from an in-studio audience. It discusses five aspects of Medicaid managed care: enrollment, primary care, referrals, emergency care, and rights and responsibilities. It is intended for use in waiting rooms, on public TV and at community meetings, and as a training tool for community-based organizations. [Funded in part by the Maternal and Child Health Bureau].
•
Medicaid dental program Source: Lincoln, NE: Nebraska Health and Human Services System. 2001. 1 videotape (7 minutes, VHS 1/2 inch), 1 card. Contact: Available from Kimberly McFarland, Nebraska Department of Health and Human Services, Dental Health Division, 301 Centennial Mall South, Third Floor, P.O. Box 95007, Lincoln, NE 68509-5007. Telephone: (402) 471-0166 / fax: (402) 471-0383 / email:
[email protected] / Web site: http://www.hhs.ne.us. Single copies available at no charge. Summary: This videotape, designed for program enrollees, describes important features of the Nebraska Medicaid Dental Program and Kids Connection and explains which dental services the programs cover entirely or partially. The videotape is narrated by a mother with a young child, a doctor, a dental office staff person, and a dentist, each describing different aspects of how people can work effectively with a dentist and what they can expect during a dental visit. The videotape emphasizes making clients feel comfortable about going to the dentist and clarifying how they can take responsibility for their dental health (e.g., by brushing and flossing; by following the dentist's instructions, or calling to cancel appointments if necessary). The videotape also provides statistics about percentages of people who do not receive dental care nationally and in the state of Nebraska. A companion promotional card in the shape of a baby bottle gives tips on infant oral health care.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option
Multimedia 173
“Sound Recordings.” Type “Medicaid” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on Medicaid: •
Medicaid data systems: Whats new - Whats working! Source: Portland, ME: National Academy for State Health Policy. 1997. 4 audiocassettes. Summary: These audiocassettes of the National Academy for State Health Policy preconference on whats new and whats working with Medicaid data systems discuss what professionals want Medicaid data systems to do and the data systems in Maine, Tennessee, and Minnesota.
•
Understanding Medicaid: A crash course for policymakers Source: Washington, DC: Forum for State Health Policy Leadership, National Conference of State Legislatures. 1998. 1 booklet (11 pp.), 1 audiotape (44 minutes). Contact: Available from Forum for State Health Policy Leadership, National Conference of State Legislatures, 444 North Capitol Street, N.W., Suite 515, Washington, DC 20001. Telephone: (202) 624-5400 / fax: (202) 737-1069 / e-mail:
[email protected]. $20.00. Summary: This audiotape and accompanying guidebook are a basic introduction to the Medicaid program and to Medicaid managed care. The primary intended audience is legislators, legislative health staff, foundations, members of the Forum for State Health Policy Leadership, and health organizations. The booklet provides the text for the frames of the software used for this presentation.
Bibliography: Multimedia on Medicaid The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in Medicaid (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on Medicaid: •
Can Medicaid work for low-income working families? [electronic resource] Source: prepared by Kathleen A. Maloy. [et al.]; Year: 2002; Format: Electronic resource; [Washington, D.C.]: Kaiser Commission on Medicaid and the Uninsured, [2002]
•
Emerging practices in Medicaid primary care case management programs [electronic resource] Source: Joanne Rawlings-Sekunda, Deborah Curtis, Neva Kaye; produced for the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning; Year: 2001; Format: Electronic resource; [Washington, D.C.]: The Office, [2001]
•
Ensuring special needs populations' access to providers in managed care networks [electronic resource]: a technical assistance and self-assessment tool for state Medicaid agencies: toolkit Source: by Suzanne Felt-Lisk, Jessica Mittler, and Amanada Cassidy; Year: 2001; Format: Electronic resource; [Princeton, N.J.]: Center for Health Care Strategies, c2001
•
Medicaid [sound recording]: challenges, changes, and opportunities in a era of health care reform: September 22-23, 1994, Baltimore, MD. Year: 1994; Format: Sound recording; [Washington, D.C.]: Group Health Association of America, [1994]
174
Medicaid
•
Medicaid managed care: a guide for states Source: Neva Kaye; Year: 2001; Portland, ME: National Academy for State Health Policy, c2001
•
Medicaid managed care data collection and reporting [electronic resource]: final report Source: National Committee on Vital and Health Statistics, Subcommittee on Population Specific Issues; prepared with the assistance of George Washington University Medical; Year: 1999; Format: Electronic resource; [Washington, D.C.?: The Committee?, 1999]
•
Medicaid managed care enrollment report [electronic resource]: summary statistics as of June 30. Year: 9999; Format: Electronic resource; [United States]: U.S. Dept. of Health and Human Services, Health Care Financing Administration, Office of Managed Care,
•
Medicaid policy in pediatric care delivery [videorecording] Source: [presented by] the University of Texas Medical School at Houston; produced by UT/TV-Houston, the University of Texas Health Science Center at Houston; Year: 1989; Format: Videorecording; [United States: s.n.], c1989
•
Medicare & Medicaid program manuals, transmittals & program memos [electronic resource]. Year: 9999; Format: Electronic resource; [Washington, D.C.?]: Health Care Financing Administration, [1999?]-
•
State Medicaid cutbacks and the federal role in providing fiscal relief to states [electronic resource] Source: by Leighton Ku, Donna Cohen Ross, and Melanie Nathanson; Year: 2002; Format: Electronic resource; Washington, D.C.: Center on Budget and Policy Priorities, [2002]
•
State Medicaid initiatives involving EDI and telecommunications [videorecording] Source: HITN, Healthcare Informatics Telecom Network; Year: 1995; Format: Videorecording; [Cold Spring, NY]: HITN, c1995
•
Welfare leavers and Medicaid dynamics [electronic resource]: five states in 1995 Source: Marilyn Ellwood & Carol Irvin; Year: 2000; Format: Electronic resource; [Washington, DC?]: Office of the Assistant Secretary for Planning and Evaluation. Office of Health Policy, [2000]
175
CHAPTER 8. PERIODICALS AND NEWS ON MEDICAID Overview In this chapter, we suggest a number of news sources and present various periodicals that cover Medicaid.
News Services and Press Releases One of the simplest ways of tracking press releases on Medicaid is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “Medicaid” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to Medicaid. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “Medicaid” (or synonyms). The following was recently listed in this archive for Medicaid: •
Nevada probes Pediatrix on Medicaid billings Source: Reuters Industry Breifing Date: November 20, 2003
•
Lawmakers spar over disease management for Medicaid Source: Reuters Health eLine Date: October 15, 2003
176
Medicaid
•
Lawmakers say Medicaid next healthcare challenge Source: Reuters Health eLine Date: October 08, 2003
•
Cash-strapped states curbing Medicaid drug lists Source: Reuters Health eLine Date: September 22, 2003
•
Tenet under investigation by Florida Medicaid Source: Reuters Health eLine Date: August 08, 2003
•
Government report criticizes Medicaid alternatives Source: Reuters Health eLine Date: July 08, 2003
•
House panel seeks drug price data for Medicaid Source: Reuters Health eLine Date: June 27, 2003
•
U.S. attorney probes Pediatrix Medicaid billing Source: Reuters Industry Breifing Date: June 24, 2003
•
Governors at odds over Medicaid plan Source: Reuters Health eLine Date: June 13, 2003
•
U.S. House committee launches Medicaid probe Source: Reuters Industry Breifing Date: June 12, 2003 The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to
Periodicals and News
177
Market Wire’s home page at http://www.marketwire.com/mw/home, type “Medicaid” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “Medicaid” (or synonyms). If you know the name of a company that is relevant to Medicaid, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Medicaid” (or synonyms).
Newsletters on Medicaid Find newsletters on Medicaid using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “Medicaid.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “Medicaid” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •
How the new welfare reform law affects Medicaid Source: Washington, DC: Urban Institute. 1997. 6 pp. Contact: Available from Publications Department, Urban Institute, 2100 M Street, N.W., Washington, DC 20037. Telephone: (202) 261-5709 / fax: (202) 429-0687 / e-mail:
[email protected] / Web site: http://www.urban.org. Summary: This newsletter briefly discusses the four principal changes made to Medicaid eligibility by the welfare reform legislation: 1) decoupling welfare and Medicaid eligibility, 2) narrowing Medicaid eligibility for disabled children in the Supplemental Security Income (SSI) program, 3) terminating access to Medicaid for some legal immigrants because they lose SSI, and 4) barring most future legal immigrants from Medicaid. It also reviews how the new provisions may potentially affect key parties-states and local governments, health care providers, and beneficiaries.
•
Variations in Medicaid spending among states Source: Washington, DC: Urban Institute. 1997. 8 pp.
178
Medicaid
Contact: Available from Publications Department, Urban Institute, 2100 M Street, N.W., Washington, DC 20037. Telephone: (202) 261-5709 / fax: (202) 429-0687 / e-mail:
[email protected] / Web site: http://www.urban.org. Summary: This newsletter explores the variations of Medicaid programs across the states based on: 1) total Medicaid spending expenditures per low-income individual, 2) Medicaid coverage of the low-income population, 3) Medicaid spending per beneficiary, and 4) state Medicaid spending per low-income individual. The newsletter shows the variations in textual and tabular format and the implications for policy. •
Medicaid managed care currents Source: New York, NY: United Hospital Fund. 1996-. quarterly. Contact: Available from United Hospital Fund, Empire State Building, 23rd Floor, 350 Fifth Avenue, New York, NY 10118-2399. Telephone: (212) 494-0700. Single copies available at no charge. Summary: This newsletter features articles which focus on trends in implementing Medicaid managed care in New York state. Articles to date have covered the history of Medicaid managed care in New York City with an assessment of future trends and experiences in 1996 as the city implemented direct enrollment procedures to reach Medicaid participants.
•
Medicaid managed mental health care: Is it a solution? Source: Spotlight. 1(1): 1-16. April 1993. Contact: Available from Center for Vulnerable Populations, National Academy for State Health Policy, 50 Monument Square, Suite 302, Portland, ME 04101. Telephone: (207) 874-6524. Available at no charge. Summary: This special issue of 'Spotlight' examines Medicaid managed care and its implications for access to mental health services for populations with special health needs. A background on managed care is provided, pros and cons are considered, and questions are considered as to whether it can control costs and provide better health services. The newsletter reviews the significance of managed care to various stockholders such as state administrators, legislators, consumers, and providers. It then examines the program elements that affect mental health services and examines programs that have been established in Utah, South Carolina, Massachusetts, and Florida.
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “Medicaid” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on Medicaid:
Periodicals and News
•
179
Keep Yourself Covered: What Everyone Should Know About Health Insurance and Transplantation Source: Transplant Chronicles. 4(4): 5. 1997. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Summary: No matter when a transplant is performed and regardless of the patient's income or type of insurance, most transplant patients require ongoing care and antirejection medications. This brief newsletter article reminds readers about the terminology that can be involved in health coverage options. Seven terms are defined and discussed: employer insurance, Medicare (Parts A and B), Medigap, high-risk insurance, Medicaid (medical assistance), drug programs, and the Transplant Foundation. For each organization mentioned, the author provides a toll-free telephone number for readers needing more information. The author reminds readers that social workers may also be aware of other local, state, or national programs that are available. The author also emphasizes that one should never have to compromise health care because of a lack of coverage.
•
Spousal Impoverishment and Alzheimer's Source: ADRDA of Eastern Massachusetts Newsletter. 6(1): 5. Winter 1988. Contact: Available from Alzheimer's Association, Eastern Massachusetts Chapter. One Kendall Square, Building 600, Cambridge, MA 02139. (617) 494-5150. Summary: This article discusses the problem of spousal impoverishment in Alzheimer's disease. It describes new legislation in Massachusetts aimed to allow the at-home spouse to keep half of the combined annual income of both spouses (up to $12,000) and still be eligible for Medicaid and other public services. A telephone number for further information is included.
•
Assisted Living: The Merger of Housing and Long Term Care Services Source: Long Term Care Advances: Topics in Research, Training, Service and Policy (Newsletter of Duke University Center for the Study of Aging and Human Development). 1(4): 1-8. 1990. Contact: Available from Duke Family Support Program. Box 3600, Duke University Medical Center, Durham, NC 27710. (919) 660-7510 or (800) 672-4213 (in North Carolina). Summary: This article provides a brief history of assisted living housing in Oregon for the elderly (including those who are victims of Alzheimer's disease.) The article discusses: trends that led to the concept of assisted living as a new option for elder consumers' need for services and preference of remaining in an 'at home' environment; the implementation of assisted living housing; the underlying principles of assisted living (creating small private apartments for personal space while expanding the usual amount of common space for resident use); the argument of shared responsibility in which residents are viewed in terms of their abilities, not disabilities; and the changing of State policies to accommodate and institutionalize the concept of assisted living facilities. The State of Oregon is projecting placement of 1400 Title XIX clients in assisted living over the next 5-10 years; if assisted living attracts the same ratio of private to Medicaid residents as currently exists, some 11,000 additional units will be needed to meet the demand.
180
•
Medicaid
Dental Insurance is Essential, But Not Enough Source: Closing the Gap. p. 4-5. July 1999. Contact: Available from Office of Minority Health Resource Center. P.O. Box 37337, Washington, DC 20013-7337. (800) 444-6472. Summary: This article reviews the lack of dental insurance and some additional strategies to address the problem of lack of access to dental services in the U.S., particularly among lower income persons. Topics include the amount of money spent on dental services, dental Medicaid, the lack of services for low income children (despite apparent coverage by dental Medicaid), the reasons that dentists do not participate in Medicaid services, the Children's Health Insurance Program (CHIP), dental services in CHIP, other public health initiatives, barriers to dental care for some cultural and linguistic minorities. The author concludes with recommendations for addressing these issues, including: make oral health a much higher priority on the local, state, and national levels; upgrade and expand the dental components of Medicaid and CHIP programs; promote and implement special initiatives for vulnerable and high risk populations to improve access to dental care; and fluoridate all community water supplies. 2 tables.
•
Final Actions of 101st Congress Include Major Gains for Alzheimer Patients and Families Source: Alzheimer's Association Baltimore-Central Maryland Chapter Newsletter. January-February 1991. Contact: Available from Alzheimer's Association Baltimore-Central Maryland Chapter. 540 East Belvedere Avenue, Suite 202, Baltimore, MD 21212. (410) 435-4933. PRICE: Call for information. Summary: This article summarizes major legislation of the 101st Congress that directly affects Alzheimer patients and families. Congress appropriated $247 million for Alzheimer's research, an increase of 67 percent. Most of the funding went to the National Institute on Aging. Congress enacted three essential parts of the Comprehensive Alzheimer Research and Education bill. As part of the Budget Reconciliation bill, Congress approved a modest but very significant expansion of the Medicaid program to allow states to provide home and community-based services to the elderly. Congress also passed a number of technical amendments to nursing home reform and rejected amendments that would have seriously undermined nursing home reform.
•
SSI Perspective: Overcoming Barriers to Employment Source: Renal Rehabilitation Report. 5(5): 4-5. September-October 1997. Contact: Available from Life Options Rehabilitation Program. Medical Education Institute, Inc, 414 D'Onofrid Drive., Suite 200, Madison, WI 53719. (608) 833-8033. Email:
[email protected]. Summary: This article, from a special issue on vocational rehabilitation and employment for dialysis patients, discusses overcoming barriers to employment. Many dialysis patients fear the potential loss of financial benefits they receive, either through Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). The article provides a case study that illustrates how the SSI system works and how patients can best work within the SSI framework. The case study emphasizes the importance of
Periodicals and News
181
working closely with the Social Security Administration (SSA) to learn about all the possibilities that are available for people with end-stage renal disease. The article then provides an interview that discusses common questions about SSI. The interview is with Wayne Nix, educational consultant for the National Kidney Foundation of Michigan and director of the OUTREACH: Renal Rehabilitation and Empowerment Program. Topics covered include SSI work incentives, Medicaid coverage, handling overpayment problems, the appeal process, where to get assistance with problems involving the SSI, vocational counseling, training and education issues, the role of part time work, and the indicators that are essential to health and rehabilitation (adequate dialysis, good hematocrit readings, acceptable serum albumin levels, properly controlled blood pressure, and a regular exercise program). •
Planning Your Financial Security Around Alzheimer's Disease Source: Alzheimer's Disease and Related Disorders Association, Inc., Cleveland Chapter. [Newsletter] p. 5-6. June 1988. Contact: Available from Alzheimer's Association, Cleveland Chapter. 1801 Chestnut Hills Drive, Cleveland Heights, OH 44106. (216) 721-8457. Summary: This comprehensive article for caregivers of Alzheimer's patients discusses financial planning in depth. It explains how to take stock of assets and determine whether lawyers, financial planners, and insurance agents really have their client's best interests at heart. It defines power of attorney, living trust, and joint tenancy, and gives advice on insurance plans, Medicare, and Medicaid.
•
Good News for Alzheimer's Patients Source: Issues in Focus. [Newsletter] p. 11-13. April 1991. Contact: Available from Alzheimer's Association, Cleveland Area Chapter. 12200 Fairhill Road, Cleveland, OH 44120. (216) 721-8457. PRICE: Single copy free. Summary: This newsletter article describes the provisions of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) which affect nursing home care. As a result of OBRA '87, nursing homes will be held to much higher standards of care, which could vastly improve the lives of patients with Alzheimer's disease in long-term care facilities. Changes in nursing home practices became effective October 1, 1990. The Health Care Financing Administration sets standards of care for every nursing home that receives Medicare or Medicaid funds and also contracts with state governments to inspect the quality of care provided in these facilities once a year. Under OBRA '87, nursing homes must make every effort to create an environment that maintains or enhances quality of life.
•
Estate Planning for the Aging or Incapacitated Client Source: Mount Sinai Medical Center Alzheimer's Disease Research Center. [Newsletter] 2(1): 4-6. Spring 1991. Contact: Available from Mount Sinai Medical Center Alzheimer's Disease Research Center. Box 1230, One Gustave L. Levy Place, New York, NY 10029-6574. (212) 241-8329. PRICE: Free subscription. Summary: This newsletter article discusses estate planning for the aging or incapacitated client. A major uncertainty in estate planning for the older client is whether and when the client or client's spouse will require long-term care in a nursing
182
Medicaid
home or residential care facility, or will need care at home. Private insurance and Medicare play a role in paying for long-term care. The Medicare Catastrophic Coverage Act provisions help ameliorate 'spousal impoverishment', in which the institutionalization of the husband leaves the wife nearly or entirely without income and assets. Medicaid is the major payor for long-term care. Whether or not an application for public benefits is contemplated, the possibility that a person is or may become mentally incapacitated must be considered. An estate plan should include provisions for taking care of the person if incapacitation occurs. Possible devices include the durable power of attorney, trusts, and appointment of a guardian or conservator. Many state statutes permit a healthy person to name someone to serve in either capacity in case of future need. •
What Can You Do? Source: Public Policy Update. [Newsletter] Number 25: 5. June 1989. Contact: Alzheimer's Disease and Related Disorders Association. 919 North Michigan Avenue, Suite 1000, Chicago, IL 60611-1676. (800) 272-3900; (312) 335-8882 (TDD); (312) 335-1110 (Fax). Summary: This newsletter article for advocates contains suggestions from the Alzheimer's Association for protecting families of people with Alzheimer's disease from the effects of new Medicaid eligibility laws. The article provides an example of a legislative attempt in Michigan to allow the state to place a lien against the house of Medicaid recipients in nursing homes. The article recommends that advocates monitor state implementation of the law, particularly in the areas of asset limits and income. Five objectives to be achieved in the implementation of Medicaid benefits by state legislatures are also listed.
•
Frail Elderly Amendments Passed Source: Alzheimer's Association Public Policy Update. [Newsletter] Number 29: 4-5. November-December 1990. Contact: Alzheimer's Association. 919 North Michigan Avenue, Suite 1000, Chicago, IL 60611-1676. (800) 272-3900; (312) 335-8700; (312) 335-8882 (TDD); FAX (312) 335-1110. PRICE: Call for price information. Summary: This newsletter article reviews the Medicaid Frail Elderly Amendments enacted by Congress as part of its budget reconciliation bill. States will be allowed to provide, as part of their basic Medicaid program, home and community-based services to poor elderly beneficiaries who are functionally disabled. This federal law defines functional disability in a way that specifically recognizes the needs of patients with Alzheimer's disease. Frail elderly persons with Alzheimer's disease will be eligible for services if supervision is needed for at least 2 out of 5 daily living tasks or if the patient's behavior poses health or safety risks to the patient or others.
•
Panel Recommends Training Incentives for Alzheimer's and Dementia Care Source: Senior Care Professional. Number 91-9: 3. September 10, 1991. Contact: Available from CD Publications. 8204 Fenton Street, Silver Spring, MD 20910. (800) 666-6380 or (301) 588-6380. PRICE: Call for price information. Summary: This newsletter article summarizes the second report of the Advisory Panel on Alzheimer's Disease, made in 1990. The Advisory Panel on Alzheimer's Disease
Periodicals and News
183
recommended that at least 25 percent of long term care staff training mandated by the Omnibus Budget Reconciliation Act of 1987 should be dedicated specifically to caring for Alzheimer's disease and dementia patients. In a report to the U.S. Health and Human Services Department and to Congress, the panel noted that health care workers capable of working with Alzheimer's and dementia patients are in short supply. The panel also cited the need for incentives to seek training and employment in these fields, including tuition reimbursement and loan forgiveness. The panel urged the expansion of noninstitutional services, including broadening Medicare and Medicaid benefits for home care of Alzheimer's and dementia patients. It also recommended that eligibility for treatment programs be altered to include Alzheimer's and dementia patients.
Academic Periodicals covering Medicaid Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to Medicaid. In addition to these sources, you can search for articles covering Medicaid that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
185
APPENDICES
187
APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute8: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
•
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
•
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
•
National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
•
National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
•
National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
•
National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
•
National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
8
These publications are typically written by one or more of the various NIH Institutes.
188
Medicaid
•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
•
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
•
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
•
National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
•
National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
•
National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
•
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
•
National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
•
National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
•
National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
•
National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
•
National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
•
National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
•
Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
•
National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
•
National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
•
Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
•
Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
Physician Resources
189
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:10 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
•
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
•
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
•
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
•
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
•
Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
•
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
•
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
•
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
•
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
•
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
9
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 10 See http://www.nlm.nih.gov/databases/databases.html.
190
Medicaid
•
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
•
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database
A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “Medicaid” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “Medicaid” (or synonyms) into the “For these words:” box. The following is a sample result: •
Financial Planning for Nursing Home Care: Medicaid Eligibility Considerations. 7th Rev. Ed Source: Cleveland Heights, OH: Alzheimer's Disease and Related Disorders Association, Inc., Cleveland Chapter. 1987. 17 p. Contact: Available from Alzheimer's Association, Cleveland Chapter. 1801 Chestnut Hills Drive, Cleveland Heights, OH 44106. (216) 721-8457. Summary: Financial planning for an individual who will be placed in a nursing home can be of critical importance. Insurance currently in force rarely covers room charges at nursing homes, although skilled care may be covered by some policies. At a cost of about $24,000 per year at a nursing home, the average couple's lifetime savings can be quickly depleted without adequate planning. A new type of insurance commonly known as long-term care insurance is becoming more widely available in Ohio. If insurance is not available, understanding the rules of the Medicaid system can provide solutions to the problem of nursing home care.
•
Housing Works Medicaid Managed Care Telephone Survey Contact: Housing Works, 594 Broadway Ste 700, New York, NY, 10012, (212) 966-0466, http://www.housingworks.org. Summary: Part One of this survey was conducted to determine whether Medicaid managed care plans operating in New York City are prepared to serve women and children Medicaid consumers living with HIV/AIDS. Of the twenty plans polled (all of the plans in New York City approved to provide Medicaid services), 95 percent were unable to answer the survey question and provide the name of a primary care physician who has experience treating HIV/AIDS. Seventy-five percent of the plans could not provide the names of any HIV-experienced providers. Detailed accounts of each call are given in the survey. The second part of the study, surveyed individual providers within managed care plans to inquire about their experience treating HIV/AIDS. Of the nine managed care programs surveyed, there were only five appropriate providers. Only eight of the sixty-nine doctors surveyed had HIV/AIDS experience, were accepting new patients, and could provide an initial appointment within 3-4 weeks. This study
Physician Resources
191
concludes that New York City's Medicaid managed care plans are not ready to serve women and children living with HIV/AIDS. •
Modeling the Impact of AIDS/HIV Epidemic on State Medicaid Programs; Preview Copy Contact: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Center for Health Information and Dissemination, 2101 E Jefferson St Ste 501, Rockville, MD, 20852, (301) 594-1360. Summary: The differential effects of HIV on State Medicaid programs are projected in this paper, which uses a computer model based on a case study of California. An overview of Medicaid cost estimates emphasizes the limited amount of data available. Critical factors that affect State Medicaid AIDS costs include: HIV morbidity, risk group distribution, private health insurance coverage, and Medicaid eligibility and coverage policies. A simple, cost model study projects distribution of Persons with AIDS (PWA's) and their Medicaid service use in California. Rather than stating absolute cost figures, the study demonstrates the relative impacts of changing epidemiology and policy assumptions on service utilization and reimbursement.
•
Medicaid Source Book: Background Data and Analysis Contact: US Congress, House of Representatives, Committee on Energy and Commerce, Subcommittee on Health and the Environment, 2415 Rayburn Bldg, Washington, DC, 20515, (202) 224-3121. Summary: The potential impact of Human immunodeficiency virus (HIV) on the Medicaid program and Medicaid coverage of services for beneficiaries with Acquired immunodeficiency syndrome (AIDS) are outlined in this report. This includes current estimates of the epidemic such as its scope and Medicaid's share of health care costs, Medicaid eligibility for persons with AIDS and future trends, and home and community care which includes hospice care, nursing home care, drugs and other experimental therapies, and special problems with children.
•
The Medicaid Program: Title XIX of the Social Security Act; 42 CFR Contact: US Department of Health and Human Services, Centers for Medicare & Medicaid Services, 7500 Security Blvd, Baltimore, MD, 21244-1850, (410) 786-7860, http://www.cms.hhs.gov. Summary: This article describes the guidelines for state Medicaid plans. The description includes Federal requirements, eligible groups, and types and ranges of services. Mandatory and optional services are listed. In addition, the article explains the three main types of waivers to the Federal mandates including: 1) home and communitybased; 2) freedom of choice; and 3) demonstration grant waivers.
•
Advocating for Quality in Medicaid Managed Care: Ideas for Families and Youth Affected by HIV and AIDS Contact: AIDS Alliance for Children Youth and Families, 918 16th St NW Ste 201, Washington, DC, 20006, (202) 785-3564, http://www.aidspolicycenter.org. Summary: This booklet explains Medicaid and managed care in detail for families living with HIV or AIDS. It has been developed for youth, families, Title IV projects, and health care providers who wish to work with Medicaid officials and managed care organizations so that Medicaid managed care plans meet the needs of young people and
192
Medicaid
families. The booklet describes the Medicaid waiver process, answers key questions to consider for serving children, youth, and families, and presents Medicaid managed care advocacy tips. •
Understanding Medicaid Long Term Care: A Primer for Alzheimer Advocates Source: Washington, DC: Alzheimer's Association. 1997. 30 p. Contact: Alzheimer's Association. Washington Public Policy Office. 1319 F Street, NW, Suite 710, Washington, DC 20004. (202) 393-7737; FAX (202) 393-2109. PRICE: Single copy free. Summary: This booklet is intended to help Alzheimer's disease (AD) advocates understand Medicaid as a potential source of funding for long term care. An introductory section provides background information about the Medicaid program, who it is designed to help, and the types of services it covers. The next three sections discuss key issues that affect the availability of Medicaid long term care services for people with AD. The first section, on financial eligibility, defines the categories of needy people covered by Medicaid and summarizes the rules concerning income and assets, spousal impoverishment, transfers of assets, and recovery of improperly paid benefits. The next section discusses other eligibility factors such as the need for care, age, disability, residency, and citizenship. The third section, on long term care services, explains Medicaid coverage for nursing home care and home and community care. The booklet includes a checklist for AD advocates and tables showing selected data for the 50 States.
•
Working with Medicaid plans to build best clinical and administrative practices Source: Lawrenceville, NJ: Center for Health Care Strategies. 2001. 6 pp. Contact: Available from Center for Health Care Strategies, 1009 Lenox Drive, Suite 204, Lawrenceville, NJ 08648. Telephone: (609) 895-8101 / fax: (609) 895-9648 / e-mail:
[email protected] / Web site: http://www.chcs.org. Available at no charge; also available from the Web site at no charge. Summary: This brief reports on the activities of Medicaid plans to collaboratively develop, refine, and pilot practices to improve birth outcomes under the Best Clinical and Administrative Practices (BCAP) initiative, a program to enhance the ability of plans to bring quality care to enrollees. Topics include: creating a common language for process involvement; applying the BCAP model toward improving birth outcomes; each of the steps of the model -- identification, stratification, outreach, intervention; and measurement for evaluation.
•
Medicaid managed care and due process: A guide for states and health plans Source: Princeton, NJ: Center for Health Care Strategies. 2000. 29 pp. Contact: Available from Center for Health Care Strategies, 1009 Lenox Drive, Suite 204, Lawrenceville, NJ 08648. Telephone: (609) 895-8101 / fax: (609) 895-9648 / e-mail:
[email protected] / Web site: http://www.chcs.org. Single copies available at no charge. Summary: This guide accompanies the comprehensive report: Medicaid Managed Care and Due Process: The Law, Its Implementation, and Recommendations. The guide provides state Medicaid agencies, managed care entities, and their risk managers with access to statements of the legal requirements, examples of real world problems that have occurred in practice, and recommendations for achieving efficiency and complying
Physician Resources
193
with the law. Topics covered include: education and information; the adverse action; the notice; continued benefits; the request for review; the time frames for final administrative action; expedited review; the in-plan grievance; the fair hearing; disposition and corrective action; and the availability and use of complaint data. •
Medicaid Managed Care and HIV/AIDS: A Guide for Community-Based Organizations Contact: AIDS Action, 1906 Sunderland Pl NW, Washington, DC, 20036, (202) 530-8030, http://www.aidsaction.org. Summary: This guide provides information on the challenges and opportunities of health care access and quality for people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) who depend or will depend on Medicaid managed care programs. It highlights the importance of Medicaid programs as the health care safety net for low-income, vulnerable Americans, including those living with AIDS; it discusses state efforts to enroll and serve people with HIV in Medicaid managed care; it outlines recent federal legislative and administrative actions related to Medicaid and Medicaid managed care; and it explores challenges and solutions to health care access and quality under Medicaid managed care for people living with HIV, including the expansion of Medicaid to people with HIV infection who are poor enough, but not sick enough to qualify. The appendices include resources and materials of interest to Ryan White CARE Act grantees and other community-based providers.
•
The AIDS Benefits Handbook: Everything You Need to Know to Get Social Security, Welfare, Medicaid, Medicare, Food Stamps, Housing, Drugs, and Other Benefits Contact: Yale University Press, PO Box 209040, New Haven, CT, 06520-9040, (203) 4320940. Summary: This manual introduces the welfare programs that may provide benefits to persons infected with Human immunodeficiency virus (HIV) or those with Acquired immunodeficiency syndrome (AIDS). While stressing that the welfare system is difficult and frustrating, the monograph outlines individual programs in terms of their eligibility requirements, places and terms of application, benefits, and appeal rights. The central programs for Persons with AIDS (PWA's) are Social Security Disability Insurance (SSDI), Supplementary Security Income (SSI), AZT Assistance, and Medicaid. Other important programs administered by the States are General Assistance, Aid to Families with Dependent Children, Emergency Assistance, and Food Stamp programs. Some veterans with AIDS can qualify for assistance from the Department of Veterans Affairs income and health programs. Medicare, Emergency Assistance, housing, and mental health programs may benefit some PWA's, while lesser-known programs with a high potential for assistance include the Hill-Burton, State, or local indigent medical assistance and private hospital charity programs; State Supplementary Payment (SSP) programs to finance tuition in "board and care homes," and State-run drug and health insurance subsidy programs. The manual introduces practical topics, including dealing with the welfare office, making a case, differentiating between social workers and eligibility workers, and counting assets for welfare programs.
194
•
Medicaid
Medicaid Survival Kit Contact: National Conference of State Legislatures, Intergovernmental Health Policy Project, 444 N Capitol St NW Ste 515, Washington, DC, 20001, (202) 624-5400, http://www.ncsl.org. Summary: This manual provides state policymakers with an overview of the existing Medicaid program and the population it serves; information about options available to states, even without a major overhaul at the federal level; and a discussion of what some states are doing to contain costs and increase efficiency of health care delivery under Medicaid. The manual is divided into twelve sections: Medicaid overview; federal issues; mothers and children; the elderly; people with disabilities/chronic conditions; health centers and other community-based providers; managed care; pharmaceuticals; other cost containment strategies; state activities; private insurance reform; and additional resources.
•
Medicaid Managed Care: Defining the Issues for Women With HIV/AIDS Contact: Center for Women Policy Studies, National Resource Center on Women and AIDS Policy, 1211 Connecticut Ave NW Ste 312, Washington, DC, 20036, (202) 872-1770, http://www.centerwomenpolicy.org. Summary: This paper identifies the needs, issues, perspectives, and concerns of women with HIV to ensure that their expertise and that of their advocates and care providers are considered in state and federal Medicaid policy debates. Medicaid is the only source of health insurance coverage for 8 percent of all women in the United States, providing a wide range of services vital to women, including ob/gyn care. Medicaid reform initiatives are summarized and issues regarding managed care programs are discussed. The potential problems associated with the cost-conscious Medicaid managed care initiatives are outlined.
•
Why aren't more uninsured children enrolled in Medicaid or SCHIP? Source: Washington, DC: Urban Institute. 2001. 7 pp. Contact: Available from Urban Institute, 2100 M Street, N.W, Washington, DC 20037. Telephone: (202) 261-5709 / fax: (202) 429-0687 / e-mail:
[email protected] / Web site: http://www.urban.org. Available from the Web site at no charge. Summary: This policy brief uses new questions in the 1999 National Survey of America's Families to assess the reasons why low-income uninsured children do not enroll in Medicaid or State Children's Health Insurance Programs (SCHIP). Parents were asked whether they had heard of the SCHIP or Medicaid programs in their state; whether their child had participated in Medicaid or SCHIP at any time in the preceding year; whether those who had heard of the programs had inquired about coverage; for those who had inquired about coverage, whether they had applied for either program in the past year; and the main reason why they did not inquire about or apply for coverage. The survey findings are presented followed by a discussion of the policy implications. Tables and charts of the respondents' answers are included throughout the brief. Endnotes and references are provided.
•
Dental care for Medicaid-enrolled children Source: Washington, DC: American Public Human Services Association. 2000. 15 pp.
Physician Resources
195
Contact: Available from American Public Human Services Association, 810 First Street, N.E., Suite 500, Washington, DC 20002. Telephone: (202) 682-0100 / fax: (202) 289-6555 / e-mail:
[email protected]. Available at no charge. Summary: This report analyzes the findings of a 1999 study of access to dental care for children covered by Medicaid or the State Childrens Health Insurance Program (SCHIP). Findings are reported as an aggregate, not state by state. The report includes sections on (1) background and methodology, (2) access barriers, (3) reimbursement policy, (4) managed dental care, (5) working to change behavior, (6) the role of safety net providers, (7) outreach to children and families, (8) outreach to providers, and (9)SCHIP. •
Evaluation of the Missouri Medicaid dental program: Final report to the Missouri Department of Health, Bureau of Dental Health Source: Kansas City, MO: School of Dentistry, University of Missouri, and Public Policy Center, University of Iowa. 1999. 219 pp. Contact: Available from University of Iowa, Public Policy Center, 227 South Quad, Iowa City, IA 52242. Summary: This report contains the findings of a survey of Missouri dentists designed to assist the Missouri Department of Social Services in providing improved access to dental care for Medicaid recipients, to evaluate aspects of the Medicaid dental program in Missouri, and to develop a series of policy options for improving the program. The questionnaire contained sections regarding utilization of dental services by Medicaid enrolled children, attitudes and participation of Missouri dentists in the Medicaid program, and factors affecting dentist participation in the program.
•
Building healthier kids through successful partnerships: SCHIP/Medicaid outreach and enrollment Source: Washington, DC: Association of Maternal and Child Health Programs. 2000. 10 pp. Contact: Available from Association of Maternal and Child Health Programs, 1220 19th Street, N.W., Suite 801, Washington, DC 20036. Telephone: (202) 775-0436 / fax: (202) 775-0061 / e-mail:
[email protected] / Web site: http://www.amchp.org. Available at no charge. Summary: This report describes partnerships between state Title V Maternal and Child Health Service Block Grant agencies and the State Childrens Health Insurance Programs(SCHIP) and Medicaid, focusing on outreach and enrollment. [Funded by the Maternal and Child Health Bureau].
•
The Michigan Healthy Kids Dental Medicaid Program: Background, program design, and baseline assessment Source: Chicago, IL: Illinois Center for Health Workforce Studies. 2000. 18 pp. Contact: Available from Illinois Regional Health Workforce Center, University of Illinois at Chicago, 850 West Jackson Boulevard, Suite 400, Chicago, IL 60607-3025. Telephone: (312) 996-0703 / fax: (312) 996- 0065 / e-mail:
[email protected] / Web site: http://www.uic.edu/sph/ichws. Available from the Web site at no charge. Summary: This report describes the design and initial implementation stages of Michigan's Healthy Kids Dental program, covering the history of Michigan's approach to dental access problems. Additional topics include a discussion of baseline county data
196
Medicaid
to allow comparison of the selected demonstration counties, dental utilization rates, limited dental participation, and overall program effectiveness. References are provided. •
Dental care counts: Medicaid dental services in decay: A crisis for St. Louis children Source: St. Louis, MO: Citizens for Missouri's Children. 2000. 34 pp. Contact: Available from Citizens for Missouri's Children, 2717 Sutton Avenue, St. Louis, MO 63143. Telephone: (314) 647-2003 / fax: (314) 644-5437 / e-mail:
[email protected] / Web site: http://www.mokids.org. Available from the Web site at no charge. Summary: This report describes the oral health care crisis for children in Missouri, with specific information about the St. Louis area. Topics include public policy issues and children's oral health, the Medicaid managed care program in Missouri, emergency room use and preventable hospitalization for dental-related illness, and factors in the Missouri dental care crisis. The report includes recommendations for action by all in Missouri. The report contains one appendix: St. Louis Dental Care Access for MC+/Medicaid Consumers Survey. Data are presented in charts and tables throughout the report. The report concludes with a list of endnotes.
•
Medicaid spending growth: Results from a 2002 survey Source: Washington, DC: Henry J. Kaiser Family Foundation. 2002. 53 pp. Contact: Available from Henry J. Kaiser Family Foundation, Washington Office, 1330 G Street, NW, Washington, DC 20005. Telephone: (202) 347- 5270 / fax: (202) 347-5274 / email:
[email protected] / Web site: http://www.kff.org. Available at no charge; also available from the Web site at no charge. Summary: This report describes the results of a 2002 survey of all states and the District of Columbia to identify state Medicaid spending trends, how states are responding to these trends, and their overall fiscal conditions. Chapter topics include an introduction and background in recent Medicaid spending trends; the survey methodology; survey results in these categories: by year, state children's health insurance program, administrative budgets, treatment option and state Olmstead Plan implementations, and outlook. Cost containment efforts by Iowa, Oklahoma, Missouri, and Mississippi are profiled. The report also includes five appendices: (1) survey instrument; (2) 2002 state legislative regular and special session calendar; (3) factors contributing to Medicaid expenditure growth in 2002: state survey; (4) cost containment actions taken in 50 states and the District of Columbia in FY 2002; and (5) cost containment actions taken in 50 states and the District of Columbia in FY 2003.
•
Making it simple: Medicaid for children and CHIP income eligibility guidelines and enrollment procedures: Findings from a 50- state survey Source: Washington, DC; Kaiser Commission on Medicaid and the Uninsured. 2000. 34 pp. Contact: Available from Kaiser Commission on Medicaid and the Uninsured, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347-5270 / fax: (202) 347-5274 / e-mail:
[email protected] / Web site: http://www.kff.org. Available at no charge; also available from the Web site at no charge. Summary: This report describes the strategies states were using as of July 2000 to increase health insurance coverage for children through Medicaid and SCHIP-financed
Physician Resources
197
separate programs. This report includes state-by- state tables presenting information on selected child health coverage program features for every state and the District of Columbia. The tables include income eligibility guidelines and selected simplification and redetermination strategies, adopted as of July 2000. Additional sections discuss why simplification matters; why program alignment matters; policy implications; notes; and explanation of terms. •
Medicaid and SCHIP: States' enrollment and payment policies can affect children's access to care Source: Washington, DC: U. S. General Accounting Office. 2001. 54 pp. Contact: Available from U.S. General Accounting Office, 441 G Street, N.W., Room 5A14, Washington, DC 20548. Telephone: (202) 512-6000 distribution or (202) 512-2537 TDD / fax: (202) 512-2837 / e-mail:
[email protected] / Web site: http://www.gao.gov. Available at no charge; also available from the Web site at no charge. Summary: This report discusses the differences in Medicaid and SCHIP enrollment requirements, particularly application requirements and eligibility determination practices, and how they can affect beneficiaries' ability to obtain and keep coverage. Topics include differences in eligibility requirements; health plan and provider participation; differences in payments; and differences in plan choices between programs. The appendices cover the report objectives, scope, and methodology; state's design choices under SCHIP; comments from the U.S. Department of Health and Human Services; and General Accounting Office acknowledgments. The report includes numerous tables and figures.
•
Understanding the Connecticut dental Medicaid reform proposal: State options in contracting dental care in Medicaid Source: Farmington, CT: Connecticut Health Foundation. 2003. 14 pp. Contact: Available from Connecticut Health Foundation, 270 Farmington Avenue, Suite 357, Farmington, CT 06032. Telephone: (860) 409-7773 / fax: (860) 409-7763 / Web site: http://www.cthealth.org. Available from the Web site at no charge. Summary: This report discusses the options available to states in arranging dental services in their Medicaid program, and describes Connecticut's experience and current proposal. Topics include a description of the various program options and related decisions facing states as they determine how to obtain dental care for their beneficiaries; arguments, both for and against, each decision; and comment on the lessons to be derived from various states' efforts.
•
Why is rural important? Enrolling rural children in CHIP and Medicaid Source: [Rockville, MD: Rural Wrok Group, U.S. Interagency Task Force on Children's Health Insurance Outreach. 1999. 7 pp. Contact: Available from U.S. Office of Rural Health Policy, Parklawn Building, Room 905, 5600 Fishers Lane, Rockville, MD 20857. Telephone: (301) 443-0835 or (800) 633-7701 or (301) 656-3100 / fax: (301) 443- 2803 / Web site: http://www.nal.usda.gov. Available from the Web site at no charge. Summary: This report discusses the special outreach efforts needed to enroll rural children in the Children's Health Insurance Program (CHIP) and Medicaid and the
198
Medicaid
special concern in rural areas with linking outreach, enrollment, and access to care. Two case studies of successful programs are included. •
Medicare and Medicaid Costs for People With Alzheimer's Disease Source: Chicago, IL: Alzheimer's Association. April 3, 2001. 24 p. Contact: Available from Alzheimer's Association. 919 North Michagan Avenue, Suite 1100, Chicago, IL 60611-1676. (800) 272-3900 or (312) 335-8700. FAX: (312) 335-1110. Website: www.alz.org/media/news/current/040301alzreport.pdf. PRICE: Free online access. Summary: This report estimates Medicare spending and Medicaid nursing facility spending State by State in the United States for people with Alzheimer's disease (AD). The analysis is based on national prevalence rates for AD and Health Care Financing Administration data for Medicare and Medicaid. In 2000, estimated Medicare and Medicaid expenditures for beneficiaries with AD were $31.9 billion and $18.2 billion, respectively. By 2010, Medicare costs for beneficiaries with AD are projected to increase by 54.5 percent to $49.3 billion, and Medicaid nursing facility costs for AD patients are projected to increase by more than 80 percent to $33 billion. In the year 2000, expenditures for persons with AD made up approximately 14.4 percent of total Medicare spending, even though they represent less than 10 percent of Medicare beneficiaries. The share of Medicare spending devoted to beneficiaries with AD is expected to increase to 15.7 percent by 2010. The States with the greatest total spending in 2000 were New York, California, Florida, Pennsylvania, and Texas; these are also the most populous States. 8 references.
•
Medicaid and SCHIP: States use varying approaches to monitor children's access to care Source: Washington, DC: U. S. General Accounting Office. 2003. 66 pp. Contact: Available from U.S. General Accounting Office, 441 G Street, N.W., Room 5A14, Washington, DC 20548. Telephone: (202) 512-6000 distribution or (202) 512-2537 TDD / fax: (202) 512-2837 / e-mail:
[email protected] / Web site: http://www.gao.gov. Available at no charge; also available from the Web site at no charge. Summary: This report examines the ability of enrollees in Medicaid and the State Children's Health Insurance Program (SCHIP) to obtain needed services. The report analysis 16 states' approaches to monitoring access to primary and preventive health care services in their Medicaid and SCHIP programs. Topics focus on three key areas: (1) specific requirements for participating managed care plans and physicians to help ensure sufficient physician capacity and accessibility for eligible beneficiaries; (2) actions to independently verify or otherwise monitor provider participation; and (3) routine data collection and analysis of information on beneficiaries' actual service utilization, including patient satisfaction surveys. The appendices include measures related to service utilization, managed care plan withdrawals in four states, an analysis of Medicaid payment rates in selected states; and comments and acknowledgments from the Department of Health and Human Services and the General Accounting Office. Statistics are provided in table format throughout the report.
Physician Resources
•
199
Covering parents through Medicaid and SCHIP: Potential benefits to low-income parents and children Source: Washington, DC: Kaiser Commission on Medicaid and the Uninsured. 2001. 41 pp. Contact: Available from Kaiser Commission on Medicaid and the Uninsured, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347-5270 / fax: (202) 347-5274 / e-mail:
[email protected] / Web site: http://www.kff.org. Available at no charge; also available from the Web site at no charge. Summary: This report examines the extent to which expanding coverage to parents through Medicaid and State Children's Health Insurance Program (SCHIP) programs could help low-income families by (a) reducing uninsurance among parents; (b) improving access and use by enrolling more parents in these programs; and (c) reducing uninsurance rates among children. Section one of the report provides information on policies governing public coverage of low-income families. Section two describes the data used in the report analysis. The third section present the methods and findings. The final section discusses the policy implications of the report findings. Statistics are presented in text, graph, chart, and table formats throughout the report. A reference section is provided. The first appendix provides model specifications and equations. Appendix two compares changes in insurance distribution of eligible children in Massachusetts and the rest of the nation.
•
The waiting game: Children's Defense Fund focus group report on the Children's Health Insurance Program and Medicaid Source: Washington, DC: Children's Defense Fund. 1999. 13 pp. Contact: Available from Children's Defense Fund, 25 E Street, N.W, Washington, DC 20001. Telephone: (202) 628-8787 / fax: (202) 662-3510 / e-mail:
[email protected] / Web site: http://www.childrensdefense.org. Available at no charge. Summary: This report examines the findings of a series of six focus groups with low income mothers who lack health insurance for their children. Topics discussed at the meetings include the challenges of parenting, coping without health insurance, barriers the mothers perceive in the health care system, and test messages to educate and inform mothers about the State Childrens Health Insurance Program (CHIP) and Medicaid. Copies of the test messages are included at the end of the report.
•
Meeting the Needs of Children, Youth, and Families Affected by HIV and AIDS Through Medicaid Managed Care Contact: AIDS Alliance for Children Youth and Families, 918 16th St NW Ste 201, Washington, DC, 20006, (202) 785-3564, http://www.aidspolicycenter.org. Summary: This report explains Medicaid and managed care in detail for families living with HIV or AIDS. It has been developed for youth, families, Title IV projects, and other health care providers who wish to work with Medicaid officials and managed care organizations so that Medicaid managed care plans meet the needs of young people and families. The report presents an overview of the Medicaid program including funding, eligibility, and delivery of care; basic information about managed care, including a glossary of terms; a summary of how managed care is increasingly being used to deliver and finance health care for Medicaid beneficiaries; some fundamental challenges to health care access under Medicaid managed care; and, ways youth and families affected
200
Medicaid
by HIV and AIDS can get involved in the development of Medicaid managed care systems. •
Promising practices issue brief: Increasing dentists' participation in Medicaid and SCHIP Source: [Denver, CO]: Forum for Sate Health Policy Leadership, National Conference of State Legislatures. 2001. 20 pp. Contact: Available from National Conference of State Legislatures, 1560 Broadway, Suite 700, Denver, CO 80202. Telephone: (303) 830-2200 or (303) 830-2054 book order line / fax: (303) 863-8003 / e-mail:
[email protected] / Web site: http://www.ncsl.org. $15.00; Available from the Web site at no charge. Summary: This report focuses on the issue of access to dental care by low- income children and families. Topics include dentists' participation in Medicaid, the supply of providers, barriers to dentists' participation, reimbursement rates, administrative simplification, outreach for dental providers, and expanding the use of dental hygienists. Oral health questionnaires from Medicaid and SCHIP programs are provided, as are reference notes.
•
Medicaid: Stronger efforts needed to ensure children's access to health screening services Source: Washington, DC: U.S. General Accounting Office. 2001. 35 pp. Contact: Available from U.S. General Accounting Office, 441 G Street, N.W., Room 5A14, Washington, DC 20548. Telephone: (202) 512-6000 distribution or (202) 512-2537 TDD / fax: (202) 512-2837 / e-mail:
[email protected] / Web site: http://www.gao.gov. Available from the Web site at no charge. Summary: This report for Congressional requesters examines the extent to which children enrolled in Medicaid are receiving Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services; efforts states have taken to improve delivery of EPSDT services, particularly within managed care; and federal efforts to ensure that state Medicaid programs provide covered EPSDT services. Topics also include cooperation between the federal Medicaid agencies and state agencies to develop criteria and a timetable for assessing and improving the reporting and provision of EPSDT services as well as developing mechanisms for identifying and highlighting practices that could be used as models for other states. The report includes many charts and tables.
•
States' approaches to increasing Medicaid beneficiaries' access to dental services Source: Princeton, NJ: Center for Health Care Strategies. 2000. 25 pp. Contact: Available from Center for Health Care Strategies, 353 Nassau Street, Princeton, NJ 08540. Telephone: (609) 279-0700 / fax: (609) 279-0956 / e-mail:
[email protected] / Web site: http://www.chcs.org. Available at no charge; also available from the Web site at no charge. Summary: This report gives the results of a study that assesses states' efforts to increase access to dental care for Medicaid-eligible children. The report covers issues affecting access, states' approaches to increasing access, and states' supply of dentists. States' efforts to increase access to dental care are summarized in a table. Statistics describing dentists' participation in Medicaid programs are provided.
Physician Resources
•
201
Access to health care and provider participation in the Alaska Medicaid program Source: [Juneau, AK]: Division of Medical Assistance, [Alaska] Department of Health and Social Services. 2001. 25 pp. Contact: Available from Alaska Department of Health and Social Services, Division of Medical Assistance, Alaska Office Building, P.O. Box 110600, Juneau, AK 99811. Telephone: (907) 465-3090 or (800) 811-7470 / fax: (907) 465-2204 / Web site: http://www.hss.state.ak.us/dma. Available from the Web site at no charge. Summary: This report identifies policy options for improving access to medical and dental care for persons enrolled in the Alaska Medicaid program, including children in the Denali KidCare program. Topics include barriers to access, coverage of services, eligibility, and transportation. Additional topics include audits of medical and dental providers, billing issues and the business relationship with the fiscal agent, and patient responsibility and education. Information is also provided on the study's methodology. [Funded by the Maternal and Child Health Bureau].
•
Medicaid coverage of family planning services: Results of a national survey Source: Washington, DC: Henry J. Kaiser Family Foundation. [2001]. 94 pp. Contact: Available from Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025. Telephone: (650) 854-9400 or (800) 656-4533 / fax: (650) 854-4800 / e-mail:
[email protected] / Web site: http://www.kff.org. Available at no charge; also available from the Web site at no charge. Summary: This report outlines the results of a national study to gather information on the coverage and delivery of family planning services in Medicaid programs, and to identify the critical policy and program issues that affect access to these services. Topics include a definition of family planning, family planning and Medicaid managed care, family planning waivers, systems issues, and respondents' perspectives. Numerous tables provided survey data on state Medicaid programs and services provided for family planning. Additional summary tables on public health coverages by state and references are included in the appendices.
•
Dentists' participation in Medicaid Source: Chicago, IL: American Dental Association. 2000. 20 pp. Contact: Available from American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Telephone: (312) 440-2568 / fax: (312) 440- 7461 / e-mail:
[email protected] / Web site: http://www.ada.org. $10.00 for ADA members; $30.00 for general public, plus shipping and handling. Summary: This report presents responses to survey questions pertaining to dentists' participation in dental Medicaid programs. This issues covered include whether or not dentists currently treat Medicaid patients; ten reasons why they do not participate in dental Medicaid programs; the impact of fees on willingness to participate; what changes in the program would make them participate; annual gross receipts from Medicaid programs; and percentage of 'no shows' by various dental plans. Statistical information is provided in graph and table format throughout the report. The appendices include information on the survey methodology, response frequencies, and a copy of the survey instrument.
202
•
Medicaid
National Medical Expenditure Survey: Use of Services and Expenses for the Noninstitutionalized Population Under Medicaid: Research Findings 20 Source: Rockville, MD: Agency for Health Care Policy and Research, United States Department of Health and Human Services. 1994. 26 p. Contact: Agency for Health Care Policy and Research. United States Department of Health and Human Services, Executive Office Center, Suite 501, 2101 East Jefferson Street, Rockville, MD 20852. (301) 443-2403; (800) 358-9295 (for publications only). PRICE: Free. Summary: This report presents selected estimates of coverage, use of services, and health care expenses for people under the Medicaid program during 1987. Data from the 1987 National Medical Expenditure Survey indicate that about 22 million Americans in the noninstitutionalized population, or 9.3 percent of this population, had Medicaid coverage for all or part of the year. Poor and disabled people, people in families with no employed adult, and people in single-parent households were the most likely to have Medicaid coverage. Average total expenses per full-year Medicaid enrollee were $2,408, of which $1,297 went toward hospital expenses. Physician ambulatory visits were the second largest component of total expense ($474) and dental visits the smallest ($37). Nonphysician visits accounted for $132, prescribed medicines for $139, and other expenses for $323. Expenditures for all types of services increased with age and were higher for the disabled. Those with Medicaid coverage for only part of the year were less likely than those with coverage all year to have any expenses. For part-year enrollees with expenses, a lower proportion of the expenses was covered by Medicaid and a much higher proportion was paid by private insurance and out-of-pocket money. Data may be useful for government policy makers deciding on long-term health care legislation for patients with Alzheimer's disease or other dementias. 12 tables, 15 references. (AA-M).
•
Survey of State Medicaid Coverage of AIDS - Related Drugs Contact: National Conference of State Legislatures, Intergovernmental Health Policy Project, 444 N Capitol St NW Ste 515, Washington, DC, 20001, (202) 624-5400, http://www.ncsl.org. Summary: This report presents the findings of a survey of State Medicaid agencies to determine which drugs, related to the treatment of Acquired immunodeficiency syndrome (AIDS), caused by Human immunodeficiency virus (HIV), are covered. States were asked in the survey whether they include therapeutic drugs in the State formulary and whether there are any restrictions applied to payments for drugs; they were also asked about the approval process for drugs in their formulary and how "off-label" drugs are treated. The survey also inquired into the coverage of experimental and investigational new drugs (IND's) and experimental treatments. The survey findings show that almost all States do pay for all ten AIDS-related drugs listed in the survey. The most common restriction placed on payment is prior authorization. Most States have open formularies; however, several States accept drugs without any review, while others have more rigorous approval processes for drugs. Most State claims processing systems had no way to distinguish between drugs that were "off-label" and those that conformed to Food and Drug Administration (FDA) labeling requirements. Only two States that responded to the survey pay for any experimental or investigational new drug or experimental treatments. There was a mixed response to the question of whether States would pay for medical services associated with the administration of experimental or investigational treatments.
Physician Resources
•
203
Medicaid managed care and due process: The law, its implementation, and recommendation Source: Princeton, NJ: Center for Health Care Strategies. 2000. 119 pp. Contact: Available from Center for Health Care Strategies, 1009 Lenox Drive, Suite 204, Lawrenceville, NJ 08648. Telephone: (609) 895-8101 / fax: (609) 895-9648 / e-mail:
[email protected] / Web site: http://www.chcs.org. Single copies available at no charge. Summary: This report presents the results of a project, the Medicaid Managed Care Complaint Project of the National Health Law Program, to understand why clearly defined Medicaid managed care complaint processes do not transfer well in practice. The goals of the project are: to provide education about federal fair hearing requirements and how they are being applied to Medicaid managed care enrollees; to identify exemplary or promising practices in the operation of complaint processes and offer specific recommendations; and to offer recommendations for involving beneficiaries in the design, implementation, and monitoring of complaint processes. Five states, Arizona, California, Delaware, North Carolina, and Tennessee, were chosen for in-depth study. References are provided. An appendix provides an overview of the legal requirements and terminology.
•
Pediatric dental care in CHIP and Medicaid: Paying for what kids need, getting value for state payments Source: New York, NY: Milbank Memorial Fund. 1999. 23 pp. Contact: Available from Milbank Memorial Fund, 645 Madison Avenue, 15th Floor, New York, NY 10022. Telephone: (212) 355-8400. Available at no charge; available from Web site at no charge. Summary: This report proposes a new approach to policy for state financing of dental care for the 20 million children who lack access to preventive and reparative services. It explores the opportunity that the Children's Health Insurance Program (CHIP) presents to legislators and state policymakers to develop effective new pediatric oral health programs, reform ineffective pediatric dental Medicaid programs, and maximize the impact of public health approaches to improve the oral health of children who suffer the most dental disease.
•
Issues in children's access to dental care under Medicaid Source: Chicago, IL: American Dental Association. 2000. 33 pp. Contact: Available from Survey Center, (312) 440-2568, American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Telephone: (312) 440-2500 / fax: (312) 4402800 / Web site: http://www.ada.org. $15.00. Summary: This report provides a summary of barriers to dental care access by needy children. Discussion includes factors relating to dental needs, insurance and Medicaid availability, participation in Head Start programs, and economic considerations. Some tables are categorized by age, ethnicity, income, and geographic region. Expert interviews and a copy of the protocol are provided along with information extracted from recent literature. A bibliography is included.
•
Voices for children's health in New York State: Community roundtables on increasing Medicaid and Child Health Plus enrollment Source: New York, NY: New York Academy of Medicine. 1999. 44 pp.
204
Medicaid
Contact: Available from New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029-5293 / e-mail:
[email protected] / Web site: http://www.nyam.org. Summary: This report provides an overview of the roundtables' work on increasing Medicaid and Child Health Plus enrollment. Results are presented in four sections: overall impressions; why children eligible for Medicaid and Child Health Plus remain uninsured; recommendations for increasing enrollment statewide; and regional barriers and solutions. •
Reaching uninsured children through Medicaid: If you build it right, they will come Source: Washington, DC: Kaiser Commission on Medicaid and the Uninsured. 2002. 29 pp. Contact: Available from Kaiser Commission on Medicaid and the Uninsured, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347-5270 / fax: (202) 347-5274 / e-mail:
[email protected] / Web site: http://www.kff.org. Available at no charge; also available from the Web site at no charge. Summary: This report provides information about changes that have been and can be made to encourage eligible but unenrolled children to enroll in Medicaid and state children's health insurance programs (SCHIP). Five sections discuss the following topics: an overview of the Medicaid and SCHIP programs and barriers to enrollment; modernizing Medicaid; enrollment trends; and ways to maintain and increase enrollment in Medicaid and SCHIP. Statistical data is presented in chart, graph and table formats throughout the report and in the concluding appendix.
•
Track, monitor, and respond: Three keys to better lead screening for children in Medicaid Source: [Washington, DC]: Alliance to End Childhood Lead Poisoning. [2001]. 7 pp. Contact: Available from Alliance to End Childhood Lead Poisoning, 227 Massachusetts Avenue, N.E., Suite 200, Washington, DC 20002. Telephone: (202) 543-1147 / fax: (202) 543-4466 / e-mail:
[email protected] / Web site: http://www.aeclp.org/. Available from the Web site at no charge. Summary: This report provides information on tracking, monitoring, and responding to lead screening efforts of managed care plans and health care providers. The primary audience is people in regional, state, and local Medicaid offices with responsibility for carrying out policy of the Centers for Medicare and Medicaid Services (CMS) on lead screening and follow-up care for young Medicaid beneficiaries. The report is divided into three sections: the tracking section has recommendations on collecting essential information on lead screening; the monitoring section suggests strategies for utilizing this information; and the responding section is a case-study of a response to health care providers based on tracking and performance monitoring.
•
Medicaid enrollment in 50 states: December 2001 data update Source: Washington, DC: Kaiser Commission on Medicaid and the Uninsured. 2002. 88 pp. Contact: Available from Kaiser Commission on Medicaid and the Uninsured, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347-5270 / fax: (202)
Physician Resources
205
347-5274 / e-mail:
[email protected] / Web site: http://www.kff.org. Available at no charge; also available from the Web site at no charge. Summary: This report provides total Medicaid enrollment statistics for the 50 states and the District of Columbia, and identifies national trends from the data. Enrollment statistics are categorized in table and graph formats under the following topics: (1) families, children, and pregnant women; (2) TANF cash assistance enrollees; (3) transitional medical assistance; (4) poverty-related Medicaid enrollees; and (5) aged and disabled enrollees. Comparisons between categories and a summary table highlighting trends in enrollment and coverage for special groups are also provided. The appendices include information on the impact of Medicaid expansion on enrollment trends; the impact of limited coverage and waivers on overall enrollment; the report methodology; data issues; and eligibility categories. •
Partnering with parents to promote the healthy development of young children enrolled in Medicaid: Results from a survey assessing the quality of preventive and developmental services for young children Source: New York, NY: Commonwealth Fund. 2002. 53 pp. Contact: Available from Commonwealth Fund, One East 75th Street, New York, NY 10021-2692. Telephone: (888) 777-2744 or (212) 606-3800 / fax: (212) 606-3500 / e-mail:
[email protected] / Web site: http://www.cmwf.org. Available at no charge. Summary: This report summarizes findings from the Promoting Healthy Development Survey-PLUS (PHDS-PLUS), of parents of children under age four about the provision and quality of preventive and developmental services to low-income children who were covered by Medicaid. The survey also examines issues surrounding the health of young children and their parents and family health behaviors and routines. Additional report topics include children's access to and utilization of health care services; provision of anticipatory guidance and parent education; assessment of parental well-being and safety within the family; and parents' experiences with pediatric clinicians. The final section includes conclusions and implications, survey methodology, and notes. Extensive statistical data are listed in charts and tables throughout the report. A one page briefing report summarizing the report, facts, and figures is also provided.
•
Making Medicaid Managed Care Work: An Action Plan for People Living With HIV Contact: National Association of People With AIDS, 1413 K St NW Ste 700, Washington, DC, 20005-3442, (202) 898-0414, http://www.napwa.org. Kaiser Family Foundation, AIDS Public Information Project, 1450 G Street NW Ste 250, Washington, DC, 20005, (800) 656-4533, http://www.kff.org. Summary: This report summarizes the discussions and presentations from a meeting convened to discuss the ramifications of Medicaid managed care for people living with HIV. A goal of the meeting was to devise an action plan that encourages HIV/AIDS patients to learn about and actively influence the development of managed care systems that can effectively serve them. The nine consensus points reached at the meeting are outlined. Recommendations on how to translate consensus recommendations into programs and services for people living with HIV/AIDS are presented.
206
•
Medicaid
Medicaid and children: Overcoming barriers to enrollment: Findings from a national survey Source: Washington, DC: Kaiser Commission on Medicaid and the Uninsured. 2000. 31 pp. Contact: Available from Kaiser Commission on Medicaid and the Uninsured, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347-5270 / fax: (202) 347-5274 / e-mail:
[email protected]. Available from the Web site at no charge. Summary: This report summarizes the results of a nationwide telephone survey of 1, 335 low income parents and six focus groups to identify barriers to Medicaid enrollment and find strategies to overcome them. Topics discussed are a profile of Medicaid-eligible children, Medicaid knowledge and perceptions, barriers to Medicaid enrollment, strategies for improving Medicaid enrollment, and policy implications. Survey respondent demographics and an explanation of survey methodology are included in appendices.
•
Medicaid and SCHIP: Recent HHS approvals of demonstration waiver projects raise concerns Source: Washington, DC: U. S. General Accounting Office. 2002. 67 pp. Contact: Available from U.S. General Accounting Office, 441 G Street, N.W., Room 5A14, Washington, DC 20548. Telephone: (202) 512-6000 distribution or (202) 512-2537 TDD / fax: (202) 512-2837 / e-mail:
[email protected] / Web site: http://www.gao.gov. Available at no charge; also available from the Web site at no charge. Summary: This report to the U.S. Senate Committee on Finance discusses a review of Social Security Act section 1115 waiver requests by states to modify Medicaid and the State Childrens Health Insurance Program (SCHIP). Topics of the review were (1) types of waiver proposals that have been submitted and approved; (2) whether the U.S. Department of Health and Human Services (HHS) has ensured that the approved waivers are consistent with the goals and fiscal integrity of Medicaid and SCHIP; and (3) the extent to which there has been opportunity for public input into the expedited process. The report offers recommendations for Congressional and executive action, agency and state comments about the review, and the General Accounting Office's (GAO)evaluation. The appendices include descriptions of four recent Section 1115 waiver approvals; waiver applications under review; the response of the HHS General Counsel's Office and HHS; comments from the states of Arizona, Illinois, and Utah, along with GAO contact and staff information.
•
Medicaid coverage of perinatal services: Results of a national survey Source: Menlo Park, CA: Henry J. Kaiser Family Foundation. [2001]. 61 pp. Contact: Available from Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025. Telephone: (650) 854-9400 or (800) 656-4533 / fax: (650) 854-4800 / e-mail:
[email protected] / Web site: http://www.kff.org. Available at no charge; also available from the Web site at no charge. Summary: This report, based on a national survey of state Medicaid programs, documents state policies on coverage of perinatal care. Topics include Medicaid services and eligibility, perinatal services and Medicaid managed care, payment and financial issues, and monitoring access and availability. It also summarizes the respondents'
Physician Resources
207
perspectives. Tables presenting data on individual states' Medicaid policies and statistics on perinatal services are included throughout the report. A list of references is provided. •
Access to oral health care for Medicaid children in Illinois: A focus on rural Illinois Source: Chicago, IL: Illinois Center for Health Workforce Studies, University of Illinois at Chicago. 2001. 24 pp. Contact: Available from Illinois Regional Health Workforce Center, University of Illinois at Chicago, 850 West Jackson Boulevard, Suite 400, Chicago, IL 60607-3025. Telephone: (312) 996-0703 / fax: (312) 996- 0065 / e-mail:
[email protected] / Web site: http://www.uic.edu/sph/ichws. Available from the Web site at no charge. Summary: This report, prepared for the Illinois Rural Health Association, presents findings from a study on the dental utilization rates of children enrolled in Illinois Medicaid/KidCare. The authors examine utilization rates in both rural and non-rural areas, and examine how the overall supply of dentists, the level of dentist's participation in Medicaid, and county-level sociodemographic factors affect utilization. Sections include methods, data sources, variable descriptions, findings, and study limitations. Statistical data are provided throughout the report, in table and graph formats. References are also provided.
•
Room to grow: Promoting child development through Medicaid and CHIP Source: New York, NY: Commonwealth Fund. 2001. 36 pp. Contact: Available from Commonwealth Fund, One East 75th Street, New York, NY 10021-2692. Telephone: (888) 777-2744 or (212) 606-3800 / fax: (212) 606-3500 / e-mail:
[email protected] / Web site: http://www.cmwf.org. Available at no charge; also available from the Web site at no charge. Summary: This report, written primarily for policy makers and state health administrators, begins with an overview of Medicaid and the State Children's Health Insurance Program (SCHIP) and examines opportunities for states to use program funds to design quality preventive health services for young children. Additional topics include promoting coverage of early childhood development services and improving the quality of developmental services. Appendices describe the Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) program; income and asset standards under Medicaid and SCHIP programs; application and enrollment simplification efforts; pediatric developmental assessment services; and types of providers who can deliver services. The report contains numerous charts.
•
Reinventing Medicaid: Hoosier HealthWise and children's health insurance in Indiana Source: Washington, DC: National Health Policy Forum. 2000. 10 pp. Contact: Available from National Health Policy Forum, George Washington University, 2021 K Street, N.W., Suite 500, Washington, DC 20052. Telephone: (202) 872-1390 / fax: (202) 862-9837 / e-mail:
[email protected] / Web site: http://www.nhpf.org/. $15.00, plus shipping and handling; also available from the Web site at no charge. Summary: This site visit report describes the Indiana Children's Health Insurance Program and examines its outreach and enrollment processes to see what other states might learn from the program. Contents include program background and overview,
208
Medicaid
panel observations and advice to other states, the visit agenda, a list of participants, and biographical sketches. •
Making Medicaid and SCHIP work for families and children Source: New York: Carnegie Corporation; Washington, DC: Center for Health Services and Policy, George Washington University. [2000]. 38 pp. Contact: Available from Carnegie Corporation of New York, 437 Madison Avenue, New York, NY 10022. Telephone: (212) 371-3200 / fax: (212) 754-4073 / Web site: http://www.carnegie.org. Contact for cost information. Summary: This Starting Points issue brief is designed to help policy makers, consumer groups, health and childhood development professionals, and organizations providing child development services better understand the Medicaid and State Children_s Health Insurance (SCHIP) programs and how they can be used to build effective and comprehensive health services for young children. Topics include information about children and health insurance, program design options for Medicaid and SCHIP, and examples of community innovations. It is divided into several parts, an overview of Medicaid and SCHIP; options and eligibility and enrollment; options and issues in benefits and coverage; state considerations in the use of managed care arrangements; and respecting families in the enrollment and care process. Numerous charts, tables, and figures present statistical and programmatic information. Selected resources and Web sites conclude the brief.
•
Comparing physician and dentist fees among Medicaid programs Source: Oakland, CA: Medi-Cal Policy Institute. 2001. ca. 100 pp. Contact: Available from Medi-Cal Policy Institute, 476 Ninth Street, Oakland, CA 94607. Telephone: (510) 286-8976 / fax: (510) 238-1382 / Web site: www.medi-cal.org. Available at no charge; also available from the Web site at no charge. Summary: This study for use by policymakers compares fee-for-service payment rates for medical and dental care in the Medi-Cal program to the rates paid by every other state's Medicaid program, and contrasts the states' fees as a percentage of Medicare's average allowed charge. There are eight sections, including an executive summary, that discuss the methodology of the survey, the participants, and the results. The survey instrument is provided as the first appendix. Other appendices provided are notes on the fee selection process for each state, charts on baseline Medicaid fee data for each state, and an overview on state-specific rankings, also presented in a chart format.
The NLM Gateway11 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd.
11 12
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
Physician Resources
209
Type “Medicaid” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 20191 2063 380 1483 978 25095
HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.15 Simply search by “Medicaid” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists16 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.17 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.18 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/. 13
Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.
14
The HSTAT URL is http://hstat.nlm.nih.gov/.
15
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 16 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 17
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 18 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
210
Medicaid
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
•
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
211
APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on Medicaid can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to Medicaid. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to Medicaid. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “Medicaid”:
212
•
Medicaid
Guides on medicaid Medicaid http://www.nlm.nih.gov/medlineplus/medicaid.html
•
Other guides Disabilities http://www.nlm.nih.gov/medlineplus/disabilities.html Financial Assistance http://www.nlm.nih.gov/medlineplus/financialassistance.html Health Insurance http://www.nlm.nih.gov/medlineplus/healthinsurance.html Medicare http://www.nlm.nih.gov/medlineplus/medicare.html
Within the health topic page dedicated to diseasex, the following was listed: •
General/Overviews Medicaid: A Brief Summary Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/publications/overview-medicare-medicaid/default4.asp
•
Specific Conditions/Aspects Alternatives to Nursing Home Care: Program of All Inclusive Care for the Elderly (PACE) Source: Centers for Medicare & Medicaid Services http://www.medicare.gov/nursing/alternatives/pace.asp Home Health Services (Medicaid) Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/services/homehlth.asp Hospice Services (Medicaid) Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/services/hospice.asp Institutions for Mental Diseases (Medicaid) Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/services/imd.asp Intermediate Care Facility for People with Mental Retardation Program (ICF/MR) Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/icfmr/default.asp Medicaid and Acquired Immunodeficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) Infection Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/hiv/hivfs.asp
Patient Resources
213
Medicaid Buy-In for Working People with Disabilities Source: Social Security Administration http://www.ssa.gov/work/ResourcesToolkit/Health/newbuyin.html Medicaid Institutional Reimbursements for Nursing Facility Services Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/services/nfpmts.asp Medicaid Physical Therapy, Occupational Therapy, and Services for Individuals with Speech, Hearing, and Language Disorders Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/services/ptot.asp Nursing Facility Services for Individuals Age 21 and Older Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/services/nursfac.asp Personal Care Services (Medicaid) Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/services/pcserv.asp Rehabilitation Services (Medicaid) Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/services/rehab.asp Reporting Fraud and Abuse in Your State Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/states/fraud/rptfraud.asp? Who Is Eligible for Medicaid? Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/whoiseligible.asp •
Children Insure Kids Now: Find Your State Source: Dept. of Health and Human Services http://www.insurekidsnow.gov/states.htm Insure Kids Now: Questions and Answers Source: Dept. of Health and Human Services http://www.insurekidsnow.gov/questions.htm Medicaid and Child Health Care Source: American Academy of Pediatrics http://www.aap.org/advocacy/washing/elections/med_factsheet_pub.htm State Children's Health Insurance Program (SCHIP): State Plan Map Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/schip/statemap.asp Welcome to the State Children's Health Insurance Program Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/schip/about-schip.asp?
214
•
Medicaid
Latest News Centers for Medicare & Medicaid Services (CMS) Accepts Comments on Proposed Regulations via Internet for First Time Source: 01/30/2004, Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/media/press/release.asp?Counter=957 Centers for Medicare & Medicaid Services (CMS) Issues Interim Final Rule Addressing Physician Self-Referrals Source: 03/25/2004, Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/media/press/release.asp?Counter=985 Centers for Medicare & Medicaid Services (CMS) Urges States to Adopt Disease Management Programs, Agency Will Match State Costs Source: 02/26/2004, Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/media/press/release.asp?Counter=967 Medicaid Private Care Weaker Source: 04/15/2004, United Press International http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_17180 .html
•
Law and Policy Continued Medicaid Eligibility (Section 1619(B)) Source: Social Security Administration http://www.ssa.gov/work/ResourcesToolkit/Health/1619b.html Immigrant Eligibility for Medicaid and SCHIP Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/immigrants/default.asp Increased Federal Medical Assistance Percentage Legislation: Questions & Answers http://cms.hhs.gov/medicaid/mbes/fy03fmapleg.pdf Medicaid Alliance for Program Safeguards Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/states/fraud/backgrnd.asp Medicaid Drug Rebate Program Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/drugs/drughmpg.asp Medicaid Eligibility Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/eligibility/criteria.asp Medicaid Services Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/mservice.asp Most Common Medicaid "Rip Offs" Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/states/fraud/ripoffs.asp
Patient Resources
215
TWWIIA (Ticket to Work and Work Incentives Improvement Act) Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/twwiia/factsh01.asp? •
Lists of Print Publications Medicare & Medicaid Paper-Based Manuals Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/manuals/cmstoc.asp
•
Organizations Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/ Families USA http://fusa.convio.net/site/PageServer Women, Infants, and Children (WIC) Source: Food and Nutrition Service http://www.fns.usda.gov/wic/
•
Research Study Identifies Barriers to Pediatric Health Care for Children on Medicaid Source: American Academy of Pediatrics http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZCGAD9D4 D&sub_cat=440
•
Statistics Medicaid Program Statistics Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/msis/mstats.asp Medicaid Statistics and Data Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/medicaid/mcaidsad.asp
•
Women Breast and Cervical Cancer Prevention and Treatment Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/bccpt/default.asp Special Medicaid Coverage for Pregnant Women Source: Centers for Medicare & Medicaid Services http://www.cms.hhs.gov/hiv/maternal4.asp
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating
216
Medicaid
unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on Medicaid. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Medicaid Cutbacks: Anticipated Effects on Alzheimer Patients and Families Source: Cambridge, MA: Alzheimer's Disease and Related Disorders Association of Eastern Massachusetts, Inc. 1991. [4 p.]. Contact: Available from Alzheimer's Disease and Related Disorders Association of Eastern Massachusetts, Inc. One Kendall Square, Building 600, Cambridge, MA 02139. (617) 494-5150. PRICE: Single copy free. Summary: These two information sheets are public policy alerts for residents of Massachusetts. One sheet alerts residents to recent action by the Massachusetts House which passed a fiscal 1992 budget that cuts Medicaid funding by 20 percent. The House also repealed the state laws that create Medicaid eligibility for four groups, which will affect over 100,000 residents. This sheet urges residents to contact their state senators as soon as possible. The other sheet urges residents to contact their representatives in the U.S. Congress to demonstrate a groundswell of support for increased funding for Alzheimer's disease in 1992.
•
Your guide to Medicaid Source: Des Moines, IA: Iowa Department of Human Services. 2000. 21 pp. Contact: Available from Iowa Department of Human Services, Hoover State Office Building, Fifth Floor, Des Moines, IA 50319. Telephone: (515) 281-8477 / Web site: http://www.dhs.state.ia.us/. Available at no charge. Summary: This booklet for Iowans explains what Medicaid covers and how to use the program. It includes information on medical and dental service providers, co-payment, prescription drug coverage, and other services commonly used by health care consumers. Also provided is an overview of the Medicaid managed care program, MediPASS, toll-free hotlines, and patients' rights.
•
Alaska's medical assistance programs: Medicaid, Denali KidCare, CAMA Source: Juneau, AK: Division of Medical Assistance, Alaska Department of Health and Social Services. 2000. 27 pp. Contact: Available from Barbara Hale, (907) 465-5833, Fax: (907) 465-2204,
[email protected], Alaska Department of Health and Human Services, Division of Medical Assistance, Alaska Office Building, P.O. Box 110600, Juneau, AK 99811. Telephone: (907) 465-3090 or (800) 811- 7470 / Web site: http://www.hss.state.ak.us/dma. Available at no charge; also available from the Web site at no charge.
Patient Resources
217
Summary: This booklet for the public includes an overview of Alaska's medical assistance program and serves as a guideline to help readers determine if they should apply for coverage. It includes three sections. Section one discusses the Medicaid program: eligibility, the application process, and services covered by the program. The second section outlines the state program Denali Kid Care, a health insurance program for children and adolescents from birth through age 18 and for pregnant women who meet income guidelines. Section three gives an overview of the state program CAMA (Chronic Acute Medical Assistance) designed to help Alaskans get urgent medical care they need who may not be otherwise qualify for Medicaid. •
What is Medicaid?: A guide to medical assistance Source: Boise, IA: Idaho Department of Health and Welfare. 2000. 41 pp. Contact: Available from Idaho Department of Health and Welfare, 450 West State Street, Boise, ID 83720. Telephone: (208) 334-5500 / Web site: http://www2.state.id.us/dhw/. Available at no charge. Summary: This booklet for the public is a guide for Medicaid services and benefits available in Idaho. It includes information on where to apply for Medicaid in Idaho; the differences and similarities between Medicaid, Medicare, and SCHIP; the Idaho Medicaid managed care program Healthy Connections; Medicaid services and limits; and patient rights. Also provided are lists of state administrative offices, regional Medicaid offices, Healthy Connections representatives, regional mental health authorities, and other assistance phone numbers.
•
Children's dental care access in Medicaid: The role of medical care use and dentist participation Source: Rockville, MD: Agency for Healthcare Research and Quality. 2003. 6 pp. Contact: Available from U.S. Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. Telephone: (301) 427-1360 AHRQ public affairs or (301) 4271200 or (800) 358-9295 AHRQ Clearinghouse / e-mail:
[email protected] / Web site: http://www.ahrq.gov. Available from the Web site at no charge. Summary: This brief reports on children's dental care use in the Alabama and Georgia Medicaid programs before these state's efforts to improve dentist participation in Medicaid. Topics include which Medicaid-enrolled children were more likely to receive dental care, what dental services were most frequently used, and whether medical care use and/or the number of participating dentists were associated with greater dental care use. Statistics, definitions, study methodology, and resources are also provided.
•
Medicaid fee-for-service handbook Source: Lansing, MI: Michigan Department of Community Health. 2000. 16 pp. Contact: Available from Michigan Department of Community Health, Lewis Cass Building, Sixth Floor, 320 South Walnut Street, Lansing, MI 48913. Telephone: (517) 3733500 or (800) 642-3195 or (517) 373-3573 TDD / e- mail:
[email protected] / Web site: http://www.michigan.gov/mdch. Available at no charge. Summary: This brochure explains how to get care under the Michigan Medicaid program for participants who are not enrolled in a health plan. The brochure includes information on specific services covered by the Medicaid program, including nonemergency transportation, emergency room care, and services that require additional
218
Medicaid
out-of-pocket fees. It also includes information on Medicaid health care programs (e.g., well-child care), participant rights and responsibilities under the Medicaid program, and how to get answers to questions or ask for help. •
Medicaid health care coverage Source: Lansing, MI: Michigan Department of Community Health. 2000. 2 pp. Contact: Available from Michigan Department of Community Health, Lewis Cass Building, Sixth Floor, 320 South Walnut Street, Lansing, MI 48913. Telephone: (517) 3733500 or (800) 642-3195 or (517) 373-3573 TDD / e- mail:
[email protected] / Web site: http://www.michigan.gov/mdch. Available from the Web site at no charge. Summary: This brochure for consumers explains how to get care under the Michigan Medicaid program. The brochure outlines the differences between Medicaid and Medicare, and includes information about services available, how to apply, how to qualify, and how to find additional information.
•
Medicaid managed care and MCH: Fact sheets. (Draft) Source: Arlington, VA: National Center for Education in Maternal and Child Health. 1995. 66 pp. Contact: Available from Librarian, National Center for Education in Maternal and Child Health, 2000 15th Street, North, Suite 701, Arlington, VA 22201-2617. Telephone: (703) 524-7802 / fax: (703) 524- 9335 / e-mail:
[email protected] / Web site: http://www.ncemch.org. Available for loan. Summary: This collection of fact sheets contains materials on various aspects of Medicaid managed care. They provide an introduction to Medicaid managed care, and cover the Section 1915(b) and Section 1115 health care reform waivers. Individual fact sheets review issues relating to access and utilization, cost, quality, patient satisfaction, EPSDT, children with special health needs, the public health role, planning and monitoring, and quality assurance. The fact sheets were originally prepared for the 'PIC Briefing Book: Medicaid Managed Care and MCH' which was produced for the October, 1994 meeting of the MCH Partnership for Information and Communication (PIC) Interorganizational Work Group. [Funded by the Maternal and Child Health Bureau].
•
The relationship between the Title V MCH Services block grant and Medicaid (Title XIX) Source: Washington, DC: Association of Maternal and Child Health Programs. 1995. 2 pp. Contact: Available from Association of Maternal and Child Health Programs, 1220 19th Street, N.W., Suite 801, Washington, DC 20036. Telephone: (202) 775-0436 / fax: (202) 775-0061 / e-mail:
[email protected] / Web site: http://www.amchp.org. Summary: This fact sheet describes the distinct features of the MCH Services Block Grant, Title V of the Social Security Act; and Medicaid, Title XIX of that act. The fact sheet describes each program separately and then indicates how the two programs were designed to work together. It refers to a 1994 U.S. General Accounting Office report, 'Medicaid Prenatal Care,' which describes how well the programs work together in various states, and cites North Carolina and Washington in particular.
Patient Resources
•
219
Alabama Medicaid covered services and copayments Source: [Montgomery, AL]: Alabama Medicaid Agency. 2000. 4 pp. Contact: Available from Alabama Medicaid Agency, 501 Dexter Avenue, P.O. Box 5624, Montgomery, AL 36103-5624. Telephone: (800) 362-1504 / Web site: http://www.Medicaid.state.al.us/. Contact for cost information. Summary: This fact sheet discusses covered services and copayments for Alabama Medicaid recipients for dental, health, hospital, nursing home, and transportation services.
•
Medicaid Expansion Update Contact: Project Inform, HIV Treatment Hotline, 205 13th St Ste 2001, San Francisco, CA, 94103, (415) 558-8669, http://www.projectinform.org. Summary: This fact sheet discusses federal and state expansion of Medicaid and how it applies to persons with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). The fact sheet explains the reasons why Medicaid has been expanded and reviews the history of the Medicaid expansion effort. It describes a number of factors such as: eligibility, benefits, service delivery, community input, legislative requirements, and costs, that states must consider when expanding Medicaid. The fact sheet examines the future of Medicaid for persons with HIV/AIDS.
•
Impact of the Administration's Medicaid reform proposal on dental services Source: Washington, DC: Children's Dental Health Project. 2003. 1 p. Contact: Available from Children's Dental Health Project, 1990 M Street, N.W., Suite 200, Washington, DC 20036. Telephone: (202) 833-8288 / fax: (202) 318-0667 / e-mail:
[email protected] / Web site: http://www.cdhp.org. Available from the Web site at no charge. Summary: This fact sheet discusses how proposed reforms to Medicaid and the State Children's Health Insurance Program might affect the availability of dental services. This fact sheet also discusses why it is important to maintain services for all Medicaid beneficiaries.
•
Medicaid program at a glance Source: Washington, DC: Kaiser Commission on the Future of Medicaid. 1997. 2 pp. Contact: Available from Kaiser Commission on the Future of Medicaid, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347- 5270 / fax: (202) 347-5274. Available at no charge. Summary: This fact sheet discusses what is Medicaid, who is covered by Medicaid, what services are covered under Medicaid, how is care delivered under Medicaid, and recent beneficiary and expenditure growth.
•
Immigrants and the Medicaid and CHIP programs Source: Washington, DC: Families USA Foundation. 1999. 6 pp. Contact: Available from Justine Zabala, Families USA, 1334 G Street, N.W, Washington, DC 20005. Telephone: (202) 628-3030 / fax: (202) 347-2417 / e-mail:
[email protected] / Web site: http://www.familiesusa.org. Available at no charge.
220
Medicaid
Summary: This fact sheet explains how the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) restricted the eligibility of immigrants for Medicaid, the Childrens Health Insurance Program (CHIP), and Supplemental Security Income. The first part of the fact sheet describes the eligibility rules for the programs. The second part discusses barriers to immigrants participating in them and suggests ways to restore eligibility. •
Medicaid-welfare links Source: Washington, DC: Families USA Foundation. 1999. 2 pp. Contact: Available from Justine Zabala, Families USA, 1334 G Street, N.W, Washington, DC 20005. Telephone: (202) 628-3030 / fax: (202) 347-2417 / e-mail:
[email protected] / Web site: http://www.familiesusa.org. Available at no charge. Summary: This fact sheet focuses on the change in Medicaid and welfare qualifications since the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) replaced the Aid to Families with Dependent Children (AFDC) Program with the Temporary Assistance for Needy Families (TANF) Program. Intended for health advocates, the fact sheet lists provisions of the new law and explains their applications. The second part of the fact sheet suggests ways health care advocates can help families retain health insurance under the new program.
•
Dental care for children in Medicaid Source: Denver, CO: National Conference of State Legislatures. 2001. 2 pp. Contact: Available from National Conference of State Legislatures, 7700 East First Place, Denver, CO 80230. Telephone: (303) 364-7700 or (303) 364- 7812 book order line / fax: (303) 364-7800 / e-mail:
[email protected] / Web site: http://www.ncsl.org. $3.50, plus shipping and handling. Summary: This fact sheet focuses on the primary dental care needs and services provided for children under Medicaid and reviews federal and state initiatives to improve access and treatment services. Two charts provide information on the percentage of children in Medicaid who received dental care and which states provide services to more than 30 percent of children. Selected references and contacts are provided.
•
Medicaid and managed care Source: Washington, DC: Kaiser Commission on the Future of Medicaid. 1997. 2 pp. Contact: Available from Kaiser Commission on the Future of Medicaid, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347- 5270 / fax: (202) 347-5274. Available at no charge. Summary: This fact sheet gives an overview of enrollment in Medicaid managed care and reviews the major models of managed care delivery.
•
Dental coverage under Medicaid Source: Washington, DC: Center for Policy Alternatives. 1999. 2 pp. Contact: Available from Center for Policy Alternatives, 1875 Connecticut Avenue, N.W., Suite 710, Washington, DC 20009. Telephone: (202) 387- 6030 / fax: (202) 986-2539 / email:
[email protected]. Available at no charge.
Patient Resources
221
Summary: This fact sheet includes basic information about dental coverage under Medicaid. It discusses who has dental coverage under Medicaid, the role of the State Children's Health Insurance Program, provisions under Medicaid and managed care, and enrollment and utilization of dental services including provider participation. Policy recommendations are also included. •
Meeting the needs of people with chronic and disabling conditions in Medicaid managed care: Fact sheet Source: Washington, DC: Families USA Foundation. 1998. 7 pp. Contact: Available from Publications, Families USA Foundation, 1334 G Street, N.W, Washington, DC 20005. Telephone: (202) 628-3030 / fax: (202) 347-2417 / e-mail:
[email protected] / Web site: http://www.familiesusa.org. Summary: This fact sheet is excerpted from a report of the same title. The topics discussed are the needs of people with disabling and chronic conditions for individualized care, service beyond traditional medical care, comprehensive service systems, and care without a cure as part of Medicaid managed care. The forms of care for people with disabling and chronic conditions, problems common in states where managed care plans have been established, and how states have addressed these problems are also discussed. In addition, a list of tools for advocates of people with disabilities and chronic conditions is provided.
•
The new children's health insurance program: Should states expand Medicaid? Source: Washington, DC: Urban Institute. 1997. 8 pp. Contact: Available from Urban Institute, 2100 M Street, N.W, Washington, DC 20037. Telephone: (202) 261-5709 / fax: (202) 429-0687 / e-mail:
[email protected] / Web site: http://www.urban.org. Available at no charge. Summary: This fact sheet lists the changes in funding sources for states to provide health insurance for low income children in the Balanced Budget Act of 1997, which creates the State Children's Health Insurance Program (S-CHIP), enacted as Title XXI of the Social Security Act. It describes issues for the states, such as using the program funds to expand Medicaid or to establish a new program. The fact sheet provides an overview of the new program and discusses options for the states, operational considerations, and political considerations.
•
Managed care for children with special health care needs: Florida Medicaid plans Source: [Tallahassee, FL]: CMS Network. 1996. 4 pp. Contact: Available from Florida Department of Health and Rehabilitative Services, Children's Medical Services, 1317 Winewood Boulevard, Tallahassee, FL 32399-0700. Telephone: (850) 487-2945 / fax: (850) 487-3729http://www.state.fl.us/health/. Summary: This fact sheet outlines the definitions and procedures in the bill, CS/CS for SB886, enacted by the Florida legislature. The bill established the Children's Medical Services Network which delivers health services for children with special health needs. The sheet also lists issues affecting the implementation.
•
Florida's mobile van experience: Medicaid-supported school-based dental care Source: [Washington, DC]: Center for Health and Health Care in Schools. [2001]. 3 pp.
222
Medicaid
Contact: Available from Center for Health and Health Care in Schools, George Washington University School of Public Health and Health Services, 1350 Connecticut Avenue, Suite 505, Washington, DC 20036. Telephone: (202) 466-3396 / fax: (202) 4663467 / e-mail:
[email protected] / Web site: http://www.healthinschools.org. Available from the Web site at no charge. Summary: This fact sheet presents an overview of Florida's experiences with the use of mobile dental vans in the provision of school-based dental care. The fact sheet presents information on the negative aspects of Florida's initial mobile van experience and approaches developed in response to these experiences. The fact sheet also outlines the positive experiences among fourschools. •
Medicaid: HCFA fact sheet Source: Washington, DC: Health Care Financing Administration, U.S. Department of Health and Human Services. 1994. 4 pp. Contact: Available from Communications Services Division, Public Affairs Office, U.S. Health Care Financing Administration, 7500 Security Boulevard, C2-26-12, Baltimore, MD 21244 / Web site: http://www.hcfa.gov. Available at no charge. Summary: This fact sheet provides basic information and statistics on Medicaid coverage. Brief statements are included on covered services, optional services and waivers, Medicaid managed care, payments, Medicare coverage, nursing home care, and AIDS. A table of medical assistance payments since 1980 also is included.
•
Understanding dental Medicaid: Mandatory and optional populations and benefits Source: Washington, DC: Children's Dental Health Project. [2003]. 1 p. Contact: Available from Children's Dental Health Project, 1990 M Street, N.W., Suite 200, Washington, DC 20036. Telephone: (202) 833-8288 / fax: (202) 318-0667 / e-mail:
[email protected] / Web site: http://www.cdhp.org. Available from the Web site at no charge. Summary: This fact sheet provides information about who is currently eligible for dental services through Medicaid and about who is 'optional' (i.e., may be selected to receive benefits at each state's discretion). The fact sheet explains how dental benefits under Medicaid are handled and describes how the current Administration's proposed changes to Medicaid could impact dental services. References are provided.
•
Medicaids financial protections for Medicares poor and near poor Source: Menlo Park, CA: Henry J. Kaiser Family Foundation. 1997. 2 pp. Contact: Available from Henry J. Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, CA 94025. Telephone: (650) 854-9400 or (800) 656- 4533 / fax: (650) 854-4800 / Web site: http://www.kff.org. Available at no charge. Summary: This fact sheet reviews Medicaids role in providing financial assistance to Medicares low income beneficiaries. It includes a legislative history of Medicaid buy-in programs.
•
The facts about obesity, Medicaid and Medicare Source: American Obesity Association.
Patient Resources
223
Contact: American Obesity Association, 1250 24th Street, N.W., Suite 300, Washington, DC 20037. 1-800-98-OBESE. Summary: This fact sheet states that Medicaid does not cover obesity, and under Medicare, hospital and physician services for obesity are clearly excluded. Recipients of Medicaid are primary women and children who are poor and members of minority groups. Given the high prevalence of obesity among those populations, it is presumed that many Medicaid recipients are likely to have obesity. •
Low-income children: The effect of expanding Medicaid on well-child visits Source: Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services. 1994. 3 pp. Contact: Available from AHCPR Clearinghouse, U.S. Agency for Healthcare Research and Quality , 2101 East Jefferson Street, Suite 501, Rockville, MD 20852. Telephone: (800) 358-9295 clearinghouse or (301) 594-1364 AHCPR public affairs / Web site: http://www.ahcpr.gov. Available at no charge. Summary: This fact sheet summarizes findings of a study that examined data from the 1987 National Medical Expenditure Study to determine the effect of insurance coverage on the incidence of well-child visits for preschool children in low-income families. It describes factors other than insurance and income that appear to affect the level of these visits.
•
State Medicaid Dental Program Managers and HRSA/HCFA Oral Health Initiative (OHI) Team Meeting, April 30, 2000 Source: Arlington, VA: National Center for Education in Maternal and Child Health. 2000. 22 items. Contact: Available from Librarian, National Center for Education in Maternal and Child Health, 2000 15th Street, North, Suite 701, Arlington, VA 22201-2617. Telephone: (703) 524-7802 / fax: (703) 524- 9335 / e-mail:
[email protected] / Web site: http://www.ncemch.org. Photocopy available at no charge. Summary: This information package was given to participants at the State Medicaid Dental Program Managers and Health Resources and Services Administration (HRSA)/Health Care Financing Administration (HCFA) Oral Health Initiative (OHI) Team Meeting, which was held in April 2000 in Oak Brook, IL. The package includes lists of key HRSA and HCFA personnel, the meeting schedule, and descriptive material about oral health initiatives and funding. [Funded by the Maternal and Child Health Bureau].
•
Medicaid services state by state Source: Washington, DC: Division of Intergovernmental Affairs, Health Care Financing Administration, U.S. Department of Health and Human Services. 1995. 2 pp. Contact: Available from Center for Medicaid and State Operations, U.S. Health Care Financing Administration, 7500 Security Boulevard, C2-26-12, Baltimore, MD 21244 / Web site: http://www.hcfa.gov. Available at no charge. Summary: This oversized chart enumerates the basic required Medicaid services and shows the optional services offered by the individual states, the District of Columbia, American Samoa, Guam, Puerto Rico, and the Virgin Islands in a tabular display. The
224
Medicaid
reverse side of the poster indicates changes made in state Medicaid programs listing services added or deleted in each state. •
Medicaid reform: A Twentieth Century Fund guide to the issues Source: New York, NY: Twentieth Century Fund Press. 1995. 28 pp. Contact: Available from Sara Wright, Twentieth Century Fund Press, 41 East 70th Street, New York, NY 10021. Telephone: (212) 535-4441 / fax: (212) 535-7534 / e-mail:
[email protected] / Web site: http://epn.org/tcf.html. $4.50 includes shipping and handling. Summary: This pamphlet presents facts, figures, and arguments about what's right and what's wrong with Medicaid. Also listed are the potential risks associated with the Congressional reform proposals.
•
Influencing state Medicaid managed care contracts to improve perinatal health-A case study in Virginia Source: Rockville, MD: Maternal and Child Health Bureau, U.S. Department of Health and Human Services. 1996. 4 pp. Contact: Available from U.S. Maternal and Child Health Bureau, U.S. Department of Health and Human Services, Parklawn Building, Room 18-05, 5600 Fishers Lane, Rockville, MD 20857. Telephone: (301) 443-2170 or (301) 443-0205 / fax: (301) 443-1797 / e-mail:
[email protected] / Web site: http://www.dhhs.gov/hrsa/mchb. Summary: This pamphlet presents recommendations made by state health leaders and leading obstetricians and gynecologists in Virginia for improving perinatal health outcomes under publicly funded systems of managed care that should be incorporated into Virginia's new Medicaid managed care contract being developed.
•
Crisis in Care: The Facts Behind Children's Lack of Access to Medicaid Dental Care Source: Arlington, VA: National Center for Education in Maternal and Child Health. May 1998. [3 p.]. Contact: Available from National Maternal and Child Health Clearinghouse. 2070 Chain Bridge Road, Suite 450, Vienna, VA 22182-2536. (703) 356-1964. Fax (703) 821-2098. Website: www.nmchc.org. PRICE: Single copy free. Summary: This policy brief from the National Center for Education in Maternal and Child Health (NCEMCH) reviews the facts behind childrens' lack of access to Medicaid dental care. Despite remarkable improvements in oral health and dental awareness, tooth decay in children has held on stubbornly and oral disease remains pervasive among millions of children, especially those from families with low incomes and from minority groups. The policy brief reviews the related statistics and then discusses why tooth decay is still an important policy problem, who is responsible for addressing this issue, the role of Medicaid, and strategies to address the problem. The author contends that Medicaid and CHIP (Children's Health Insurance Program) can work for children if concerted and cooperative efforts are made through honest negotiation, appropriate funding, generation of political will, and thoughtful program reform. Shared ownership of the problem and strong partnerships among families, health providers, and Medicaid and CHIP officials are essential. 17 references.
Patient Resources
•
225
Legislation, Regulation, and Interpretations Governing Children's Medicaid Dental Services Source: Washington, DC: Children's Dental Health Project. June 1998. 16 p. Contact: Available from National Maternal and Child Health Clearinghouse. 2070 Chain Bridge Road, Suite 450, Vienna, VA 22182-2536. (703) 356-1964. Fax (703) 821-2098. Website: www.nmchc.org. PRICE: Single copy free. Summary: This report reviews legislation, regulation, and interpretations governing children's Medicaid dental services. Medicaid was enacted as Title XIX of the Social Security Amendments of 1965; the Social Security Amendments of 1967 added the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit and required implementation by July 1, 1969. Final regulations became effective in February 1997. The Omnibus Reconciliation Act of 1989 required states to issue schedules specifying the desired frequency of medical, dental, vision, and hearing screenings, based on professional practice standards, report more detailed information on use of EPSDT services to the Health Care Financing Administration (HCFA), and provide all services needed to treat any condition identified by a screen even if the State does not include this service in its Medicaid plan. This report reprints relevant sections of the legislation, and of the Code of Federal Regulations (CFR). The document concludes with a summary of case law interpreting legislation and regulations governing provision of oral health care services to Medicaid beneficiaries. The relevant law references are cited.
•
Medicaids role for children Source: Washington, DC: Kaiser Commission on the Future of Medicaid. 1997. 2 pp. Contact: Available from Kaiser Commission on the Future of Medicaid, 1450 G Street, N.W., Suite 250, Washington, DC 20005. Telephone: (202) 347- 5270 / fax: (202) 347-5274. Available at no charge. Summary: This updated fact sheet provides an overview of the eligibility, benefits, and financing of coverage for children and a summary of recent legislative changes.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “Medicaid” (or synonyms). The following was recently posted: •
Recommendations for blood lead screening of young children enrolled in Medicaid: targeting a group at high risk Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 2000 December 8; 25 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2738&nbr=1964&a mp;string=Medicaid
226
Medicaid
Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •
Centers for Medicare & Medicaid Services' (CMS) Professionals Page Summary: This web page links health care professionals to selected information on the Medicaid and Medicare programs. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1395
•
CMS Employment Opportunities Summary: A list of current employment opportunities at the Centers for Medicare and Medicaid Services. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2763
•
CMS Professionals Page Summary: Links to plan and provider information online provided by the Centers for Medicare and Medicaid Services for the use of physicians, health plans and organizations, care providers, carriers, Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4335
•
Financial Help for Diabetes Care Summary: An overview of financial resources that may be helpful in diabetes care: Medicaid, Medicare, managed care, health insurance. Includes suggestions for obtaining help from local resources. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6505
Patient Resources
•
227
Financial Help for Treatment of Kidney Failure Summary: Provides an overview of financial help that may be available for the treatment of kidney failure: Medicare, Medicaid, private insurance, VA, SSDI, and SSI benefits. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6506
•
Maternal HIV Consumer Information Project: What Women and Doctors Need to Know Summary: This page provides links to valuable information on reducing the transmission of HIV to infants and Medicaid coverage for pregnant women. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=759
•
Medicaid Alliance for Program Safeguards Summary: The Centers for Medicare and Medicaid Services' effort to detect and prevent fraud and abuse in the Medicaid program is based on a partnership and cooperative effort with beneficiaries, Medicaid Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1398
•
Medicaid Consumer Information Summary: This web site links the consumer to selected information on the Medicaid program and policy. Includes information on welfare reform and provides both State and Federal contact resources. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=317
•
Medicaid Drug Rebate Program Summary: The Medicaid Drug Rebate Program requires a drug manufacturer to enter into and have a national rebate agreement with the Secretary of the Department of Health and Human Services for States to receive Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1400
228
•
Medicaid
Medicaid Home Health Services Summary: Medicaid recipients entitled to nursing services are also entitled to home health services. This article outlines the State's definition of home health services and lists optional services. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=482
•
Medicaid Hospice Services Summary: Hospice services assist people who are terminally ill. Eligibility, living options for Medicaid recipients, services covered only by Medicaid, and reimbursement are explained. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=475
•
Medicaid Information Summary: This main page to the Centers for Medicare and Medicaid Services links to consumer information, state and territorial information, and national account representatives. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6894
•
Medicaid Institutional Reimbursements for Nursing Facility Services Summary: This article outlines State requirements in providing medical assistance and assurances to support their payment system. It outlines three payment systems. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=474
•
Medicaid Nursing Facility Services for Individuals Age 21 and Older Summary: Medicaid covers nursing facility services for recipients age 21 and older. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=473
Patient Resources
•
229
Medicaid Personal Care Services Summary: Personal care services provided through Medicaid assist people with daily living. Eligibility, authorization of service, qualifying providers, and approved locations of service are delineated. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=477
•
Medicaid Physical Therapy, Occupational Therapy, and Services for Individuals with Speech, Hearing, and Language Disorders Summary: This article defines physical, occupational, speech, hearing, and language therapies that may be provided by the State. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=478
•
Medicaid Rehabilitation Services Summary: This article defines rehabilitative services and lists types of facilities, mental health services, and services to improve physical function. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=476
•
Medicaid Statistics and Data Summary: This web site links to both State and Federal statistical data and reports on the operation of the Medicaid program. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1399
•
Medicaid Targeted Case Management Services Summary: Medicaid can be applied to targeted case management services, enabling States to provide broader services under Medicaid. This article explains the protocol for obtaining authorization as a provider. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=480
230
•
Medicaid
Medicaid: Institutions for Mental Diseases Summary: This article summarizes State coverage for inpatient psychiatric services according to age. It explains exclusions of certain categories and lists contacts. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=479
•
Medicare and Medicaid Feedback and Customer Service Summary: Instructions on how to contact Medicare/Medicaid customer service offices for concerns related to Medicare/Medicaid claims, payments, enrollment, quality of care, managed care, and more. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=320
•
Medicare and Medicaid Paper-Based Manuals Summary: This site provides access to electronic and print versions of program manuals from the Centers for Medicare and Medicaid Services. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1873
•
Medicare Eligibility, Enrollment, and Premiums Summary: The Centers for Medicare and Medicaid Services provide information about how Medicare and the managed care system operate. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3890
•
Medicare Quality Improvement Organizations (QIOs) Summary: The Centers for Medicare and Medicaid Services (CMS) administers the Quality Improvement Organization (QIO) Program, which is designed to monitor and improve utilization and quality of care for Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=760
Patient Resources
•
231
Medicare/Medicaid Survey and Certification of Nursing Homes Summary: Medicare nursing home policies and other related resources for beneficiaries, nursing home providers, researchers and Federal and state surveyors. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3888
•
News Page - National Medicare Education Program Summary: This news services site provides a direct link to Medicare and related activities of the Centers for Medicare and Medicaid Services, the National Medicare Education Program (NMEP) and other HHS Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3542
•
Partnerships & Medicare Education, Caregivers Resources Summary: The Centers for Medicare & Medicaid Services has two publications on the subject of Caregiving: Medicare Basics: A Guide for Caregivers and When Employees Become Caregivers: A Manager's Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7605
•
State and Federal Medicaid Contacts Summary: This service, provided by the Centers for Medicare and Medicaid Services, links to Medicaid resources including state-by-state listings of toll-free numbers and Medicaid officials, CMS regional Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1396
•
State Plan Services Under Medicaid Summary: An index of long term care services paid for by the Medicaid program. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2719
232
•
Medicaid
Welfare Reform and Medicaid Summary: Letters to State Medicaid Directors regarding the impact of Welfare Reform on some aspects of the Medicaid program and policies. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1397
•
What is Medicare? Summary: The Centers for Medicare and Medicaid Services administer Medicare, the Nation's largest health insurance program, which covers 37 million Americans. Source: Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2141 The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Medicaid. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/specific.htm
•
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
•
Med Help International: http://www.medhelp.org/HealthTopics/A.html
•
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
•
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
•
WebMDHealth: http://my.webmd.com/health_topics
Patient Resources
233
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Medicaid. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Medicaid. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Medicaid. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Medicaid” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Medicaid”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Medicaid” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.
234
Medicaid
The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “Medicaid” (or a synonym) into the search box, and click “Submit Query.”
235
APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.19
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
19
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
236
Medicaid
libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)20: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
•
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
•
Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
•
California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
•
California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
•
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
•
California: Gateway Health Library (Sutter Gould Medical Foundation)
•
California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
•
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
•
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
•
California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
•
California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
•
California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
•
California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
•
California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
•
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
•
Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
20
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries
237
•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
•
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
•
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
•
Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
•
Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
•
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
•
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
•
Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
•
Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
•
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
•
Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
•
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
•
Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
•
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
•
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
•
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
•
Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
•
Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
•
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
•
Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
238
Medicaid
•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
•
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
•
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
•
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
•
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
•
Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
•
Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
•
Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
•
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
•
Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
•
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
•
Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
•
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
•
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
•
Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
•
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
•
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
•
National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries
239
•
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
•
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
•
New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
•
New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
•
New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
•
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
•
Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
•
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
•
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
•
Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
•
Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
•
Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
•
Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
•
Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
•
Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
•
Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
240
Medicaid
•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
•
Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
•
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
•
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
241
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
•
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
243
MEDICAID DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Academic Medical Centers: Medical complexes consisting of medical school, hospitals, clinics, libraries, administrative facilities, etc. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]
Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adolescent Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders in individuals 13-18 years. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU]
244
Medicaid
Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosols: Colloids with a gaseous dispersing phase and either liquid (fog) or solid (smoke) dispersed phase; used in fumigation or in inhalation therapy; may contain propellent agents. [NIH]
Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airways: Tubes that carry air into and out of the lungs. [NIH] AK: Enzyme of the biosynthetic pathway. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergens: Antigen-type substances (hypersensitivity, immediate). [NIH]
that
produce
immediate
hypersensitivity
Allogeneic: Taken from different individuals of the same species. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather
Dictionary 245
than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]
Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anterior chamber: The space in front of the iris and behind the cornea. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms,
246
Medicaid
promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antidepressive Agents: Mood-stimulating drugs used primarily in the treatment of affective disorders and related conditions. Several monoamine oxidase inhibitors are useful as antidepressants apparently as a long-term consequence of their modulation of catecholamine levels. The tricyclic compounds useful as antidepressive agents also appear to act through brain catecholamine systems. A third group (antidepressive agents, secondgeneration) is a diverse group of drugs including some that act specifically on serotonergic systems. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]
Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought
Dictionary 247
to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Aqueous humor: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autosuggestion: Suggestion coming from the subject himself. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH]
248
Medicaid
Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benchmarking: Method of measuring performance against established standards of best practice. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists
Dictionary 249
mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchopulmonary: Pertaining to the lungs and their air passages; both bronchial and pulmonary. [EU] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and
250
Medicaid
secreted during physiological stress. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemopreventive: Natural or synthetic compound used to intervene in the early precancerous stages of carcinogenesis. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Child Care: Care of children in the home or institution. [NIH] Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Child Health Services: Organized services to provide health care for children. [NIH] Child Welfare: Organized efforts by communities or organizations to improve the health and well-being of the child. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental
Dictionary 251
protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH] Civil Rights: Legal guarantee protecting the individual from attack on personal liberties, right to fair trial, right to vote, and freedom from discrimination on the basis of race, religion, national origin, age, or gender. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations
252
Medicaid
which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Community Health Centers: Facilities which administer the delivery of health care services to people living in a community or neighborhood. [NIH] Community Mental Health Services: Diagnostic, therapeutic, and preventive mental health services provided for individuals in the community. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices
Dictionary 253
are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computer Literacy: General learning, knowledge, and fluency with computer terms; also, becoming familiar with how computers operate and how they are programmed. [NIH] Computer Systems: Systems composed of a computer or computers, peripheral equipment, such as disks, printers, and terminals, and telecommunications capabilities. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumer Organizations: Organized groups of users of goods and services. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]
Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the
254
Medicaid
new treatment works. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Critical Illness: A disease or state in which death is possible or imminent. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Custodial Care: Board, room, and other personal assistance services generally provided on a long term basis. It excludes regular medical care. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of
Dictionary 255
data and facts apart from bibliographic references to them. [NIH] Day Care: Institutional health care of patients during the day. The patients return home at night. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Death Certificates: Official records of individual deaths including the cause of death certified by a physician, and any other required identifying information. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deinstitutionalization: The practice of caring for individuals in the community, rather than in an institutional environment with resultant effects on the individual, the individual's family, the community, and the health care system. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Care for Children: The giving of attention to the special dental needs of children, including the prevention of tooth diseases and instruction in dental hygiene and dental health. The dental care may include the services provided by dental specialists. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]
Dental Facilities: Use for material on dental facilities in general or for which there is no specific heading. [NIH] Dental Health Services: Services designed to promote, maintain, or restore dental health. [NIH]
Dental Hygienists: Persons trained in an accredited school or dental college and licensed by the state in which they reside to provide dental prophylaxis under the direction of a licensed
256
Medicaid
dentist. [NIH] Dental Staff: Personnel who provide dental service to patients in an organized facility, institution or agency. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diagnostic Services: Organized services for the purpose of providing diagnosis to promote and maintain health. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disabled Children: Children with mental or physical disabilities that interfere with usual activities of daily living and that may require accommodation or intervention. [NIH] Disabled Persons: Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Susceptibility: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the individual more than usually susceptible to certain diseases. [NIH] Disease-Free Survival: Period after successful treatment in which there is no appearance of the symptoms or effects of the disease. [NIH] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Dispenser: Glass, metal or plastic shell fitted with valve from which a pressurized formulation is dispensed; an instrument for atomizing. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU] Domestic Violence: Deliberate, often repetitive, physical abuse by one family member
Dictionary 257
against another: marital partners, parents, children, siblings, or any other member of a household. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Drug Costs: The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (fees, pharmaceutical or prescription fees). [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Monitoring: The process of observing, recording, or detecting the effects of a chemical substance administered to an individual therapeutically or diagnostically. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Drug Utilization: The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles. [NIH] Drug Utilization Review: Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elder Abuse: Emotional, nutritional, or physical maltreatment of the older person generally by family members or by institutional personnel. [NIH] Electroconvulsive Therapy: Electrically induced convulsions primarily used in the
258
Medicaid
treatment of severe affective disorders and schizophrenia. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Eligibility Determination: Criteria to determine eligibility of patients for medical care programs and services. [NIH] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endodontics: A dental specialty concerned with the maintenance of the dental pulp in a state of health and the treatment of the pulp cavity (pulp chamber and pulp canal). [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences,
Dictionary 259
or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episode of Care: An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] ERV: The expiratory reserve volume is the largest volume of gas that can be expired from the end-expiratory level. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Excrete: To get rid of waste from the body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Expiratory Reserve Volume: The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU]
260
Medicaid
Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extrapyramidal: Outside of the pyramidal tracts. [EU] Family Health: The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members. [NIH]
Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Formularies: Lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from pharmacopoeias in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy. [NIH] Formulary: A book containing a list of pharmaceutical products with their formulas and means of preparation. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter. [NIH]
Dictionary 261
Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Programs: Programs and activities sponsored or administered by local, state, or national governments. [NIH]
262
Medicaid
Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Survival: The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Group Practice: Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Hallucinogens: Drugs capable of inducing illusions, hallucinations, delusions, paranoid ideations, and other alterations of mood and thinking. Despite the name, the feature that distinguishes these agents from other classes of drugs is their capacity to induce states of altered perception, thought, and feeling that are not experienced otherwise. [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Care Reform: Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively
Dictionary 263
assessed by the individual or by more objective measures. [NIH] Health Surveys: A systematic collection of factual data pertaining to health and disease in a human population within a given geographic area. [NIH] Hearing aid: A miniature, portable sound amplifier for persons with impaired hearing, consisting of a microphone, audio amplifier, earphone, and battery. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]
Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] HIV: Human immunodeficiency virus. Species of lentivirus, subgenus primate lentiviruses, formerly designated T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). It is acknowledged to be the agent responsible for the acute infectious manifestations, neurologic disorders, and immunologic abnormalities linked to the acquired immunodeficiency syndrome. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin
264
Medicaid
help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypersensitivity, Immediate: Hypersensitivity reactions which occur within minutes of exposure to challenging antigen due to the release of histamine which follows the antigenantibody reaction and causes smooth muscle contraction and increased vascular permeability. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]
Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH]
Dictionary 265
In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]
Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insurance Pools: An organization of insurers or reinsurers through which particular types
266
Medicaid
of risk are shared or pooled. The risk of high loss by a particular insurance company is transferred to the group as a whole (the insurance pool) with premiums, losses, and expenses shared in agreed amounts. [NIH] Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal
Dictionary 267
function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Language Development: The gradual expansion in complexity and meaning of symbols and sounds as perceived and interpreted by the individual through a maturational and learning process. Stages in development include babbling, cooing, word imitation with cognition, and use of short sentences. [NIH] Language Development Disorders: Conditions characterized by language abilities (comprehension and expression of speech and writing) that are below the expected level for a given age, generally in the absence of an intellectual impairment. These conditions may be associated with deafness; brain diseases; mental disorders; or environmental factors. [NIH] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Language Therapy: Rehabilitation of persons with language disorders or training of children with language development disorders. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]
Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lentivirus: A genus of the family Retroviridae consisting of non-oncogenic retroviruses that produce multi-organ diseases characterized by long incubation periods and persistent infection. Lentiviruses are unique in that they contain open reading frames (ORFs) between the pol and env genes and in the 3' env region. Five serogroups are recognized, reflecting the mammalian hosts with which they are associated. HIV-1 is the type species. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a
268
Medicaid
linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]
Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]
Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Local Government: Smallest political subdivisions within a country at which general governmental functions are carried-out. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphadenopathy: Disease or swelling of the lymph nodes. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammography: Radiographic examination of the breast. [NIH] Managed Care Programs: Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians
Dictionary 269
and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as health maintenance organizations and preferred provider organizations. [NIH] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Manic: Affected with mania. [EU] Marital Status: A demographic parameter indicating a person's status with respect to marriage, divorce, widowhood, singleness, etc. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Assistance: Financing of medical care provided to public assistance recipients. [NIH] Medical oncologist: A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often serves as the main caretaker of someone who has cancer and coordinates treatment provided by other specialists. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Health Services: Organized services to provide mental health care. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]
Mesolimbic: Inner brain region governing emotion and drives. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU]
270
Medicaid
Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Metastatic cancer: Cancer that has spread from the place in which it started to other parts of the body. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Motility: The ability to move spontaneously. [EU] Motivations: The most compelling inner determinants of human behavior; also called drives, urges, impulses, needs, wants, tensions, and willful cravings. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH]
Dictionary 271
Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologist: A doctor who specializes in the diagnosis and treatment of disorders of the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon,
272
Medicaid
and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Non-small cell lung cancer: A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Services: A general concept referring to the organization and administration of nursing activities. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Occupational Therapy: The field concerned with utilizing craft or work activities in the rehabilitation of patients. Occupational therapy can also refer to the activities themselves. [NIH]
Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Oncology: The study of cancer. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Organ Transplantation: Transference of an organ between individuals of the same species or between individuals of different species. [NIH] Organization and Administration: The planning and managing of programs, services, and resources. [NIH] Orthodontics: A dental specialty concerned with the prevention and correction of dental and oral anomalies (malocclusion). [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a
Dictionary 273
solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Pastoral Care: Counseling or comfort given by ministers, priests, rabbis, etc., to those in need of help with emotional problems or stressful situations. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Advocacy: Promotion and protection of the rights of patients, frequently through a legal process. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Peak flow: The maximum amount of air breathed out; the power needed to produce this
274
Medicaid
amount. [EU] Pediatric Dentistry: The practice of dentistry concerned with the dental problems of children, proper maintenance, and treatment. The dental care may include the services provided by dental specialists. [NIH] Peer Review: An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pensions: Fixed sums paid regularly to individuals. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perinatal Care: The care of a fetus or newborn given before, during, and after delivery from the 28th week of gestation through the 7th day after delivery. [NIH] Perineal: Pertaining to the perineum. [EU] Periodicity: The tendency of a phenomenon to recur at regular intervals; in biological systems, the recurrence of certain activities (including hormonal, cellular, neural) may be annual, seasonal, monthly, daily, or more frequently (ultradian). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontics: A dental specialty concerned with the histology, physiology, and pathology of the tissues that support, attach, and surround the teeth, and of the treatment and prevention of disease affecting these tissues. [NIH] Personal Space: Invisible boundaries surrounding the individual's body which are maintained in relation to others. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacopoeias: Authoritative treatises on drugs and preparations, their description, formulation, analytic composition, physical constants, main chemical properties used in identification, standards for strength, purity, and dosage, chemical tests for determining identity and purity, etc. They are usually published under governmental jurisdiction (e.g., USP, the United States Pharmacopoeia; BP, British Pharmacopoeia; P. Helv., the Swiss Pharmacopoeia). They differ from formularies in that they are far more complete: formularies tend to be mere listings of formulas and prescriptions. [NIH] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH]
Dictionary 275
Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]
Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot Projects: Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Preferred Provider Organizations: Arrangements negotiated between a third-party payer (often a self-insured company or union trust fund) and a group of health-care providers (hospitals and physicians) who furnish services at lower than usual fees, and, in return, receive prompt payment and an expectation of an increased volume of patients. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH]
276
Medicaid
Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Prescription Fees: The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Preventive Health Services: Services designed for promotion of health and prevention of disease. [NIH] Primum: The first atrial septum to appear in the embryonic heart. [NIH] Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests. [NIH] Privatization: Process of shifting publicly controlled services and/or facilities to the private sector. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Professional Practice: The use of one's knowledge in a particular profession. It includes, in the case of the field of biomedicine, professional activities related to health care and the actual performance of the duties related to the provision of health care. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective Payment System: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostate-Specific Antigen: Kallikrein-like serine proteinase produced by epithelial cells of
Dictionary 277
both benign and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer. EC 3.4.21.77. [NIH] Prosthodontics: A dental specialty concerned with the restoration and maintenance of oral function by the replacement of missing teeth and structures by artificial devices or prostheses. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Psychotropic Drugs: A loosely defined grouping of drugs that have effects on psychological function. Here the psychotropic agents include the antidepressive agents, hallucinogens, and tranquilizing agents (including the antipsychotics and anti-anxiety agents). [NIH] Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among
278
Medicaid
alternatives to guide and determine present and future decisions. [NIH] Public Sector: The area of a nation's economy that is tax-supported and under government control. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Pupil: The aperture in the iris through which light passes. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [NIH] Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of
Dictionary 279
an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Rationalize: To attribute one's actions to rational and creditable motives without adequate analysis of the true and unconscious motives. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]
Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Research Support: Financial support of research activities. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into
280
Medicaid
the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory syncytial virus: RSV. A virus that causes respiratory infections with cold-like symptoms. [NIH] Respiratory Therapy: Care of patients with deficiencies and abnormalities associated with the cardiopulmonary system. It includes the therapeutic use of medical gases and their administrative apparatus, environmental control systems, humidification, aerosols, ventilatory support, bronchopulmonary drainage and exercise, respiratory rehabilitation, assistance with cardiopulmonary resuscitation, and maintenance of natural, artificial, and mechanical airways. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU]
Dictionary 281
Risperidone: A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. [NIH] Rural Health: The status of health in rural populations. [NIH] Rural Population: The inhabitants of rural areas or of small towns classified as rural. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secular trends: A relatively long-term trend in a community or country. [NIH] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Selection Bias: The introduction of error due to systematic differences in the characteristics between those selected and those not selected for a given study. In sampling bias, error is the result of failure to ensure that all members of the reference population have a known chance of selection in the sample. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary
282
Medicaid
sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small cell lung cancer: A type of lung cancer in which the cells appear small and round when viewed under the microscope. Also called oat cell lung cancer. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and
Dictionary 283
types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Speech-Language Pathology: The study of speech or language disorders and their diagnosis and correction. [NIH] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirochete: Lyme disease. [NIH] Spirometry: Measurement of volume of air inhaled or exhaled by the lung. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] State Government: The level of governmental organization and function below that of the national or country-wide government. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other
284
Medicaid
disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]
Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Telecommunications: Transmission of information over distances via electronic means. [NIH]
Telemedicine: Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. [NIH] Temperament: Predisposition to react to one's environment in a certain way; usually refers to mood changes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH]
Dictionary 285
Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Toothache: Pain in the adjacent areas of the teeth. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trabecular Meshwork: A porelike structure surrounding the entire circumference of the anterior chamber through which aqueous humor circulates to the canal of Schlemm. [NIH] Tranquilizing Agents: A traditional grouping of drugs said to have a soothing or calming effect on mood, thought, or behavior. Included here are the anti-anxiety agents (minor tranquilizers), antimanic agents, and the antipsychotic agents (major tranquilizers). These drugs act by different mechanisms and are used for different therapeutic purposes. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell
286
Medicaid
to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Uncompensated Care: Medical services for which no payment is received. Uncompensated care includes charity care and bad debts. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urban Health: The status of health in urban populations. [NIH] Urban Population: The inhabitants of a city or town, including metropolitan areas and suburban areas. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH]
Dictionary 287
Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Utilization Review: An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Venous Insufficiency: Inadequacy of the venous valves and impairment of venous return (venous stasis) usually from the legs, often with edema and sometimes with stasis ulcers at the ankle. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventilator: A breathing machine that is used to treat respiratory failure by promoting ventilation; also called a respirator. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used
288
Medicaid
together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]
289
INDEX A Abdominal, 243, 273, 280, 286 Abdominal Pain, 243, 286 Academic Medical Centers, 94, 243 Accommodation, 243, 256 ACE, 12, 100, 243 Acquired Immunodeficiency Syndrome, 193, 243, 263 Activities of Daily Living, 35, 165, 243, 256 Adaptation, 243, 265 Adenocarcinoma, 243, 272 Adjustment, 24, 99, 243 Adjuvant, 14, 243 Adolescence, 25, 145, 243, 250 Adolescent Psychiatry, 77, 103, 243 Adrenal Cortex, 243, 254 Adrenergic, 243, 246, 257, 259 Adverse Effect, 244, 282 Aerosols, 244, 280 Affinity, 244 Age Groups, 52, 68, 244 Age of Onset, 244, 286 Aged, 80 and Over, 244 Agonist, 47, 244, 257, 272 Airways, 244, 280 AK, 201, 216, 244 Akathisia, 244, 247 Algorithms, 244, 248 Alkaloid, 244, 272 Allergens, 14, 244 Allogeneic, 55, 244 Alpha Particles, 244, 278 Alternative medicine, 176, 244 Alveoli, 244, 287 Ambulatory Care, 99, 120, 164, 244 Ameliorated, 62, 245 Amino Acids, 245, 277, 280, 281, 285, 286 Ammonia, 245, 286 Ampulla, 245, 258 Anal, 16, 35, 37, 42, 245, 259, 260, 268, 271, 274 Analgesic, 28, 245 Analogous, 22, 245, 285 Anaphylatoxins, 245, 252 Anatomical, 245, 247, 250, 258, 264 Androgens, 243, 245, 254 Anemia, 245, 263 Anesthesia, 5, 245, 246
Angiogenesis, 64, 245, 269 Angiography, 124, 245 Anions, 245, 266, 281 Ankle, 245, 287 Anomalies, 245, 272 Anterior chamber, 245, 266, 285 Antiallergic, 245, 254 Anti-Anxiety Agents, 245, 277, 285 Antibacterial, 51, 246 Antibody, 244, 246, 252, 264, 265, 269, 270, 278, 282 Anticoagulant, 246, 277, 288 Antidepressant, 19, 27, 246 Antidepressive Agents, 246, 277 Antiemetic, 246, 247 Antigen, 244, 246, 252, 264, 265, 269 Antigen-Antibody Complex, 246, 252 Antihypertensive, 20, 109, 246 Anti-inflammatory, 10, 28, 39, 246, 247, 254, 261 Anti-Inflammatory Agents, 246, 247, 254 Antineoplastic, 246, 254 Antipsychotic, 75, 84, 112, 246, 271, 281, 285 Antiviral, 162, 247 Anuria, 247, 266 Anus, 245, 247, 249, 279 Apathy, 247, 271 Aphasia, 167, 247 Applicability, 52, 247 Aqueous, 50, 247, 248, 251, 267, 285 Aqueous humor, 50, 247, 251, 285 Arterial, 247, 261, 264, 277, 284 Arteries, 247, 248, 254, 266, 270, 271 Aspirin, 28, 247 Atrial, 101, 247, 276, 288 Atrial Fibrillation, 101, 247, 288 Atrium, 247, 287 Atypical, 247, 281 Auditory, 247, 263 Autonomic, 247 Autosuggestion, 247, 264 B Bacteria, 246, 247, 255, 258, 270, 282, 287 Bacteriuria, 247, 286 Basal Ganglia, 247, 251 Base, 35, 38, 42, 48, 78, 248, 255, 266, 267, 284
290
Medicaid
Benchmarking, 34, 248 Benign, 248, 271, 277, 278 Bile, 248, 261, 268 Biochemical, 248, 266, 281 Biological therapy, 248, 269 Biological Transport, 248, 256 Biopsy, 58, 248 Biotechnology, 71, 160, 176, 189, 248 Bipolar Disorder, 42, 79, 117, 248 Bladder, 248, 265, 276, 280, 286, 287 Blood Cell Count, 248, 263 Blood Platelets, 248, 281 Blood pressure, 164, 181, 246, 248, 249, 250, 256, 261, 264, 270 Blood vessel, 243, 245, 248, 249, 250, 251, 258, 282, 283, 284, 287 Body Fluids, 248, 257, 260, 272 Body Image, 25, 248 Bone Marrow, 55, 248, 268, 282 Bowel, 166, 245, 249, 256, 265, 266, 283, 286 Bowel Movement, 249, 256, 283 Brachytherapy, 249, 266, 278 Branch, 239, 249, 261, 273, 277, 282, 284 Bronchi, 249, 259 Bronchitis, 249, 251 Bronchopulmonary, 249, 280 Bronchoscopy, 104, 249 C Calcium, 249, 252, 269 Carbohydrate, 249, 254, 261 Carcinogenesis, 249, 250 Carcinoma, 249, 272, 283 Cardiac, 70, 247, 249, 259, 271, 280 Cardiopulmonary, 249, 280 Cardiovascular, 12, 68, 70, 120, 165, 249, 281 Cardiovascular disease, 12, 70, 165, 249 Carnitine, 123, 249 Case-Control Studies, 64, 249, 259 Catecholamine, 246, 249, 257, 274 Causal, 12, 26, 68, 250, 259, 266 Cause of Death, 250, 255 Central Nervous System, 250, 261, 281 Centrifugation, 250, 263 Cerebral, 45, 79, 100, 247, 250, 254, 255, 259, 277 Cerebral Palsy, 45, 79, 100, 250 Cerebrovascular, 249, 250 Cerebrum, 250, 254 Cervical, 30, 72, 76, 250 Cervix, 250
Chemoprevention, 28, 250 Chemopreventive, 28, 250 Chemoreceptor, 247, 250 Chemotactic Factors, 250, 252 Chemotherapy, 23, 121, 250, 269 Child Care, 68, 168, 218, 250 Child Development, 68, 207, 208, 250 Child Health Services, 43, 250 Child Welfare, 71, 86, 156, 250 Chin, 139, 250 Chiropractic, 121, 126, 127, 251 Cholesterol, 20, 164, 248, 251, 254 Cholinergic, 246, 251, 272 Chorea, 246, 251 Chromosome, 63, 251, 268 Chronic Disease, 45, 57, 61, 164, 251 Chronic Obstructive Pulmonary Disease, 11, 28, 64, 251 Ciliary, 247, 251 Ciliary processes, 247, 251 Civil Rights, 167, 251 Clinical Medicine, 26, 251, 275 Clinical trial, 8, 12, 23, 30, 145, 146, 189, 251, 253, 277, 279 Cloning, 248, 251 Coagulation, 248, 249, 251, 263, 275, 285, 288 Cofactor, 251, 277 Cognition, 251, 267, 271 Cohort Studies, 28, 251, 259 Colitis, 252 Collagen, 252, 260, 269 Colloidal, 252, 281 Colorectal, 13, 14, 15, 30, 39, 70, 252 Colorectal Cancer, 14, 15, 39, 252 Community Health Centers, 102, 130, 140, 252 Community Mental Health Services, 152, 252 Comorbidity, 15, 23, 29, 35, 37, 78, 252 Complement, 28, 48, 52, 245, 252, 253, 275 Complementary and alternative medicine, 119, 127, 252 Complementary medicine, 119, 253 Computational Biology, 189, 253 Computer Literacy, 16, 253 Computer Systems, 253, 257 Conception, 253, 260, 275 Confounding, 28, 54, 253 Confusion, 253, 271, 286 Congestion, 247, 253 Congestive heart failure, 11, 253
Index 291
Connective Tissue, 249, 252, 253, 261, 268, 280 Consciousness, 245, 246, 253, 255, 280 Constipation, 247, 253 Consultation, 79, 253 Consumer Organizations, 17, 253 Consumption, 29, 32, 76, 253, 257, 272, 280 Continuum, 13, 56, 253 Contraception, 87, 253 Contraindications, ii, 253 Control group, 10, 14, 253, 278 Convulsions, 254, 257 Coordination, 31, 43, 150, 254 Cornea, 50, 245, 247, 254 Coronary, 12, 249, 254, 270, 271 Coronary heart disease, 249, 254 Coronary Thrombosis, 254, 270, 271 Cortices, 254, 263 Corticosteroid, 47, 71, 116, 254 Cost Savings, 94, 125, 254 Critical Illness, 53, 254 Cross-Sectional Studies, 254, 259 Curative, 254, 284 Custodial Care, 163, 254 D Data Collection, 16, 49, 174, 198, 254, 260 Databases, Bibliographic, 189, 254 Day Care, 133, 150, 153, 164, 255 Deamination, 255, 286 Death Certificates, 70, 255 Degenerative, 255, 263, 270 Deinstitutionalization, 52, 168, 255 Delirium, 246, 255 Delivery of Health Care, 162, 252, 255, 262 Dementia, 28, 32, 33, 55, 60, 65, 163, 165, 182, 183, 243, 246, 255 Density, 18, 250, 255, 272 Dental Care for Children, 195, 255 Dental Caries, 22, 57, 61, 255 Dental Facilities, 170, 255 Dental Health Services, 57, 255 Dental Hygienists, 200, 255 Dental Staff, 168, 256 Dentists, 4, 5, 114, 117, 170, 180, 195, 200, 201, 207, 217, 256 Depressive Disorder, 42, 256, 268 Diabetes Mellitus, 62, 116, 256, 261, 265 Diagnostic procedure, 177, 256 Diagnostic Services, 162, 256, 284 Diastole, 256 Diastolic, 20, 256, 264 Diastolic pressure, 20, 256, 264
Diffusion, 14, 248, 256 Digestion, 248, 249, 256, 266, 268, 283 Digestive system, 147, 256, 261 Dilatation, 256, 276 Direct, iii, 5, 8, 17, 19, 20, 26, 29, 33, 35, 52, 56, 60, 65, 116, 129, 178, 231, 251, 256, 257, 279 Disabled Children, 157, 177, 256 Disabled Persons, 13, 31, 256 Discrimination, 8, 135, 163, 251, 256 Disease Susceptibility, 51, 256 Disease-Free Survival, 23, 256 Disparity, 23, 51, 66, 256 Dispenser, 165, 256 Disposition, 193, 256 Domestic Violence, 68, 256 Dopamine, 246, 257, 275, 281 Drug Costs, 27, 56, 102, 257 Drug Interactions, 109, 257 Drug Monitoring, 117, 257 Drug Tolerance, 257, 285 Drug Utilization, 46, 117, 135, 257 Drug Utilization Review, 47, 117, 257 Duct, 245, 257, 273, 281 Duodenum, 248, 257, 258, 283 Dyskinesia, 247, 257 Dysphoric, 256, 257 Dystonia, 247, 257 E Edema, 257, 287 Effector, 252, 257 Efficacy, 11, 12, 19, 23, 39, 51, 59, 257 Elder Abuse, 8, 257 Electroconvulsive Therapy, 19, 257 Electrolyte, 254, 255, 258, 260, 267, 270, 272 Electrons, 248, 258, 266, 278 Eligibility Determination, 197, 258 Emaciation, 243, 258 Emboli, 258, 288 Embolism, 258, 278, 288 Embolization, 258, 288 Embolus, 258, 265 Embryo, 258, 265, 275, 283 Embryo Transfer, 258, 275 Emphysema, 251, 258 Empirical, 16, 26, 41, 45, 48, 138, 140, 141, 258 Enamel, 255, 258 Endodontics, 170, 258 Endoscope, 258 Endoscopic, 39, 249, 258, 282
292
Medicaid
Endotoxins, 252, 258 End-stage renal, 181, 258 Environmental Health, 188, 190, 258 Enzymatic, 249, 252, 255, 259, 263, 280 Enzyme, 12, 28, 243, 244, 257, 259, 275, 277, 278, 287 Epidemic, 93, 159, 191, 259 Epidemiologic Studies, 23, 259 Epidemiological, 26, 259 Epinephrine, 243, 257, 259, 286 Episode of Care, 17, 60, 259 Epithelial, 243, 248, 259, 263, 276 Epithelial Cells, 259, 263, 276 Equipment and Supplies, 170, 259 ERV, 105, 259 Erythrocytes, 245, 248, 249, 259 Esophagus, 39, 108, 256, 259, 283 Ethnic Groups, 18, 40, 45, 259 Excrete, 247, 259, 266 Exogenous, 65, 259, 286 Expiration, 36, 259, 280 Expiratory, 47, 259 Expiratory Reserve Volume, 259 External-beam radiation, 259, 278 Extracellular, 253, 259, 260, 269 Extracellular Matrix, 253, 260, 269 Extracellular Matrix Proteins, 260, 269 Extrapyramidal, 244, 247, 257, 260 F Family Health, 205, 260 Family Planning, 130, 138, 189, 201, 260 Fat, 249, 254, 258, 260, 261, 280, 282 Fatigue, 260, 263 Fertilization in Vitro, 260, 275 Fetus, 260, 274, 276, 283, 287 Fluid Therapy, 260, 272 Focus Groups, 151, 199, 206, 260 Fold, 164, 260 Foramen, 251, 260 Forearm, 248, 260 Formularies, 27, 159, 202, 260, 274 Formulary, 27, 74, 83, 202, 260 Frail Elderly, 38, 65, 182, 260 Fraud, 98, 131, 134, 135, 155, 156, 161, 227, 260 G Gallbladder, 243, 256, 261 Gamma Rays, 261, 278 Gas, 245, 256, 259, 261, 264, 280, 287 Gas exchange, 261, 280, 287 Gastric, 249, 261, 263 Gastroenterologist, 39, 261
Gastrointestinal, 39, 259, 261, 281, 283 Gastrointestinal tract, 261, 281, 283 Gene, 63, 160, 248, 261 General practitioner, 170, 261 Genetics, 67, 261 Geriatric, 11, 19, 35, 58, 100, 162, 261 Gestation, 261, 274, 283 Gestational, 126, 261 Gland, 243, 261, 268, 273, 275, 276, 281, 285 Glucocorticoids, 243, 254, 261 Glucose, 256, 261, 265 Glucose Intolerance, 256, 261 Governing Board, 261, 275 Government Programs, 4, 261 Grade, 30, 262 Graft, 62, 262, 264 Graft Survival, 62, 262 Gravidity, 262, 273 Group Practice, 16, 160, 161, 262 H Habitual, 20, 262 Hallucinogens, 262, 277 Health Behavior, 25, 40, 262 Health Care Costs, 20, 32, 40, 133, 150, 191, 262, 268 Health Care Reform, 6, 138, 157, 171, 173, 218, 262 Health Expenditures, 262 Health Promotion, 30, 262 Health Status, 44, 59, 65, 135, 260, 262 Health Surveys, 61, 263 Hearing aid, 162, 165, 263 Hearing Disorders, 162, 263 Heart attack, 20, 249, 263 Heart failure, 100, 263 Heart Transplantation, 122, 263 Hematocrit, 79, 181, 248, 263 Hemodialysis, 263, 266, 267 Hemorrhage, 263, 283 Hemostasis, 263, 281 Hepatitis, 162, 263 Hepatocytes, 263 Heredity, 261, 263 Histamine, 245, 246, 263, 264 Histology, 263, 274 Homogeneous, 253, 263 Hormonal, 254, 263, 269, 274 Hormonal therapy, 263, 269 Hormone, 254, 259, 263, 265, 280, 285 Hospice, 7, 13, 191, 228, 264 Host, 51, 262, 264, 287
Index 293
Hybrid, 48, 264 Hydrogen, 248, 249, 260, 264, 270, 272, 277 Hypersensitivity, 244, 264, 280 Hypersensitivity, Immediate, 244, 264 Hypertension, 12, 77, 78, 86, 109, 164, 165, 249, 264, 285 Hypotension, 247, 254, 264 I Iatrogenic, 64, 264 Id, 118, 126, 217, 225, 232, 238, 240, 264 Immune response, 243, 246, 254, 264, 287 Immune system, 248, 264, 268, 287 Immunity, 243, 264 Immunodeficiency, 104, 191, 193, 202, 219, 243, 263, 264 Immunodeficiency syndrome, 191, 193, 202, 264 Immunologic, 250, 263, 264, 278 Immunology, 76, 120, 243, 244, 264 Immunosuppressive, 62, 264 Impairment, 33, 35, 54, 255, 257, 264, 267, 269, 277, 287 Implant radiation, 264, 266, 278 In situ, 15, 64, 265 In vitro, 28, 258, 265 In vivo, 64, 265 Incision, 265, 276, 280 Incontinence, 122, 265 Indicative, 153, 265, 273, 287 Induction, 245, 246, 265 Infancy, 104, 265 Infant Mortality, 137, 151, 265 Infant, Newborn, 244, 265 Infarction, 70, 265 Infection, 6, 24, 162, 193, 243, 247, 248, 250, 251, 255, 264, 265, 267, 268, 272, 280, 283 Inflammation, 246, 247, 249, 251, 252, 263, 265, 273, 280, 283, 286 Inflammatory bowel disease, 166, 265 Informed Consent, 25, 265 Insight, 34, 61, 265 Institutionalization, 26, 29, 182, 265 Insulin, 265, 286 Insurance Pools, 166, 169, 265 Insurance, Health, 50, 266 Intermittent, 260, 266, 268 Internal Medicine, 33, 89, 101, 106, 116, 122, 266, 271 Internal radiation, 266, 278 Intervention Studies, 35, 266 Intestine, 249, 252, 257, 264, 266, 267 Intracellular, 265, 266, 279
Ions, 248, 258, 264, 266 Iris, 142, 245, 254, 266, 278 Ischemic stroke, 34, 266 J Joint, 78, 181, 266, 284 K Kb, 188, 266 Keratolytic, 255, 266 Kidney Failure, 82, 227, 258, 266 Kidney Failure, Acute, 266 Kidney Failure, Chronic, 266 Kidney Transplantation, 62, 267 L Labile, 252, 267 Language Development, 267 Language Development Disorders, 267 Language Disorders, 229, 267, 283 Language Therapy, 63, 267 Large Intestine, 252, 256, 266, 267, 279 Latent, 42, 267 Length of Stay, 11, 102, 109, 136, 267 Lens, 247, 267, 279 Lentivirus, 263, 267 Lesion, 267, 282, 284, 286 Leukocytes, 248, 249, 250, 267 Library Services, 238, 267 Life Expectancy, 58, 267 Ligament, 267, 276 Linear Models, 32, 267 Linkage, 22, 40, 268 Lip, 21, 268 Lithium, 246, 268 Liver, 162, 243, 248, 249, 256, 261, 263, 268, 278, 286 Liver cancer, 162, 268 Liver Transplantation, 162, 268 Local Government, 37, 177, 268, 277 Localized, 255, 265, 268, 286 Longitudinal Studies, 48, 254, 268 Longitudinal study, 10, 26, 33, 268 Long-Term Care, 28, 30, 38, 39, 41, 48, 50, 53, 56, 58, 73, 88, 109, 116, 157, 163, 181, 190, 268 Lymph, 250, 263, 268 Lymph node, 250, 268 Lymphadenopathy, 263, 268 Lymphatic, 265, 268, 282 Lymphocyte, 243, 246, 268, 269 Lymphocyte Count, 243, 268 M Malignant, 39, 243, 246, 268, 271, 277, 278 Mammography, 23, 268
294
Medicaid
Managed Care Programs, 5, 65, 84, 152, 190, 193, 194, 268 Mandible, 250, 269 Manic, 246, 248, 268, 269, 277 Marital Status, 67, 165, 269 Matrix metalloproteinase, 63, 269 Mechanical ventilation, 53, 269 Mediate, 68, 257, 269 Mediator, 35, 269, 281 Medical Assistance, 51, 113, 179, 193, 201, 205, 216, 217, 222, 228, 269 Medical oncologist, 23, 269 MEDLINE, 189, 269 Melanin, 266, 269, 275, 286 Membrane, 252, 260, 269, 273, 275, 285 Memory, 255, 269 Mental Disorders, 42, 53, 147, 243, 267, 269, 277 Mental Health Services, iv, 8, 18, 37, 42, 47, 52, 69, 71, 75, 77, 78, 96, 108, 178, 209, 229, 252, 269 Mental Retardation, 86, 92, 112, 168, 269 Mesolimbic, 247, 269 Metabolite, 269, 276, 278 Metastasis, 269, 270, 271 Metastatic, 69, 270 Metastatic cancer, 69, 270 MI, 217, 218, 241, 270 Microbe, 270, 285 Micro-organism, 255, 270 Mineralocorticoids, 243, 254, 270 Minority Groups, 223, 224, 270 Mobility, 35, 51, 270 Modeling, 27, 37, 48, 139, 191, 270 Modification, 270, 278 Molecular, 63, 189, 209, 248, 253, 270, 279 Molecule, 246, 248, 252, 257, 270, 278, 279 Monitor, 24, 49, 50, 60, 66, 182, 198, 204, 230, 270 Monoclonal, 270, 278 Mood Disorders, 42, 270 Motility, 270, 281 Motivations, 25, 270 Movement Disorders, 246, 270 Mucins, 270, 281 Mucus, 270, 271, 286 Multivariate Analysis, 15, 271 Myocardial infarction, 70, 254, 270, 271, 288 Myocardium, 270, 271 N Nausea, 246, 271, 286
NCI, 1, 30, 146, 187, 271 Necrosis, 265, 270, 271 Neonatal, 24, 116, 126, 265, 271 Neonatal period, 24, 271 Neoplasms, 243, 246, 271, 278 Nephrology, 120, 271 Nerve, 243, 245, 251, 269, 271, 285 Nervous System, 250, 269, 271, 272, 284 Networks, 108, 173, 271 Neural, 271, 274 Neuroleptic, 4, 244, 246, 271 Neurologic, 246, 263, 271 Neurologist, 26, 271 Neurons, 271, 272, 284 Neutrons, 244, 272, 278 Nicotine, 116, 122, 272 Non-small cell lung cancer, 69, 272 Nursing Care, 7, 131, 272 Nursing Services, 228, 272 Nutritional Status, 29, 51, 272 Nutritional Support, 29, 272 O Occupational Therapy, 63, 229, 272 Office Visits, 164, 272 Oliguria, 266, 272 Oncologist, 269, 272 Oncology, 23, 69, 272 Opacity, 255, 272 Opportunistic Infections, 243, 272 Oral Health, 21, 25, 40, 51, 57, 61, 145, 170, 172, 180, 196, 203, 207, 223, 224, 225, 272 Organ Transplantation, 124, 272 Organization and Administration, 272 Orthodontics, 170, 272 Orthostatic, 247, 272 Osmotic, 272, 281 Ostomy, 97, 122, 273 Otitis, 6, 273 Otitis Media, 6, 273 Otolaryngologist, 7, 273 Outpatient, 42, 48, 54, 57, 75, 99, 131, 164, 259, 269, 273 Ownership, 137, 224, 273 P Palate, 21, 273 Palliative, 13, 69, 273, 284 Pancreas, 243, 256, 265, 273 Pancreatic, 249, 273 Parity, 33, 273 Parkinsonism, 247, 273 Pastoral Care, 120, 273 Patch, 116, 273
Index 295
Pathologic, 248, 254, 264, 273 Patient Advocacy, 21, 273 Patient Compliance, 15, 273 Patient Education, 14, 216, 236, 238, 241, 273 Patient Satisfaction, 73, 150, 198, 218, 273 Peak flow, 14, 74, 273 Pediatric Dentistry, 170, 274 Peer Review, 53, 115, 274 Pelvic, 274, 276 Pensions, 67, 274 Perception, 25, 145, 262, 263, 274 Perinatal, 154, 206, 224, 265, 274 Perinatal Care, 206, 274 Perineal, 274, 278 Periodicity, 150, 274 Periodontal disease, 22, 51, 274 Periodontics, 170, 274 Personal Space, 179, 274 Pharmacist, 8, 274 Pharmacodynamic, 12, 274 Pharmacologic, 245, 274, 285 Pharmacopoeias, 260, 274 Pharmacotherapy, 6, 78, 108, 274 Phenylalanine, 275, 286 Physical Therapy, 63, 229, 275 Physiologic, 244, 275, 279 Physiology, 243, 271, 274, 275 Pilot Projects, 30, 275 Pilot study, 10, 21, 44, 51, 275 Pituitary Gland, 254, 275 Plasma, 261, 263, 266, 270, 275, 281 Plasma protein, 275, 281 Policy Making, 17, 275 Polyposis, 252, 275 Posterior, 245, 266, 273, 275 Practice Guidelines, 209, 225, 275 Precancerous, 250, 275 Precursor, 257, 259, 275, 276, 286 Preferred Provider Organizations, 269, 275 Pregnancy Outcome, 77, 131, 132, 137, 275 Prenatal, 54, 99, 102, 116, 117, 122, 130, 133, 138, 141, 157, 218, 258, 276 Prenatal Care, 54, 99, 116, 117, 133, 141, 157, 218, 276 Prescription Fees, 257, 276 Prevalence, 25, 28, 34, 35, 42, 58, 61, 65, 67, 68, 76, 139, 145, 198, 223, 276 Preventive Health Services, 140, 150, 207, 276 Primum, 57, 276
Private Sector, 46, 276 Privatization, 52, 276 Probe, 51, 176, 276 Prodrug, 276, 278 Professional Practice, 225, 276 Progression, 12, 28, 31, 34, 276 Progressive, 255, 257, 262, 266, 271, 276 Prone, 19, 276 Prophylaxis, 88, 255, 276, 288 Proportional, 27, 57, 62, 276 Prospective Payment System, 11, 137, 276 Prospective study, 268, 276 Prostate, 13, 24, 30, 58, 70, 276, 278, 280, 286 Prostatectomy, 58, 276, 278 Prostate-Specific Antigen, 58, 276 Prosthodontics, 170, 277 Protein C, 277, 286 Protein S, 160, 248, 277, 280 Proteins, 245, 246, 252, 260, 269, 270, 275, 277, 279, 281, 285 Proteolytic, 252, 277 Protocol, 203, 229, 277 Protons, 244, 264, 277, 278 Psychiatry, 19, 84, 96, 117, 277, 287 Psychomotor, 255, 271, 277 Psychosis, 246, 261, 277 Psychotropic, 27, 42, 75, 80, 103, 113, 277 Psychotropic Drugs, 27, 80, 113, 277 Public Assistance, 38, 166, 269, 277 Public Policy, 15, 18, 19, 33, 61, 94, 132, 182, 189, 192, 195, 196, 216, 277 Public Sector, 47, 54, 278 Pulmonary, 248, 249, 253, 266, 278, 287, 288 Pulmonary Artery, 248, 278, 287 Pulmonary Edema, 266, 278 Pulmonary Embolism, 278, 288 Pulse, 270, 278 Pupil, 254, 278 Q Quality of Life, 11, 25, 51, 52, 58, 145, 181, 278 R Race, 4, 6, 23, 32, 34, 36, 40, 45, 52, 59, 61, 68, 81, 103, 131, 137, 251, 278 Radiation, 63, 69, 259, 261, 266, 272, 278, 288 Radiation therapy, 63, 69, 259, 266, 278 Radical prostatectomy, 58, 278 Radioactive, 264, 266, 278 Radiolabeled, 278
296
Medicaid
Radiotherapy, 249, 278 Ramipril, 12, 278 Random Allocation, 278 Randomization, 10, 278 Randomized, 12, 14, 19, 22, 25, 28, 39, 49, 57, 59, 145, 257, 279 Randomized clinical trial, 25, 145, 279 Rationalize, 7, 279 Receptor, 12, 63, 243, 246, 250, 257, 279, 281 Receptors, Serotonin, 279, 281 Rectal, 14, 279 Rectum, 247, 249, 252, 256, 261, 265, 267, 276, 279 Recur, 274, 279 Recurrence, 248, 250, 274, 279 Refer, 1, 252, 271, 272, 277, 279, 281 Regimen, 6, 42, 62, 257, 273, 274, 279 Registries, 69, 279 Rehabilitative, 11, 221, 229, 279 Relapse, 19, 279 Reliability, 23, 279 Remission, 248, 279 Reproduction Techniques, 275, 279 Research Design, 10, 12, 15, 16, 279 Research Support, 39, 279 Resolving, 164, 279 Respiration, 250, 270, 279, 280 Respirator, 269, 280, 287 Respiratory failure, 53, 280, 287 Respiratory Physiology, 280, 287 Respiratory syncytial virus, 88, 280 Respiratory Therapy, 63, 280 Restoration, 275, 277, 280, 288 Resuscitation, 280 Retinal, 256, 280 Retropubic, 276, 278, 280 Retropubic prostatectomy, 278, 280 Retrospective, 7, 15, 28, 46, 64, 116, 257, 280 Rheumatism, 280 Rheumatoid, 70, 280 Rheumatoid arthritis, 70, 280 Ribosome, 280, 285 Risk factor, 12, 13, 20, 22, 41, 46, 70, 116, 122, 259, 276, 280 Risk patient, 47, 280 Risperidone, 99, 281 Rural Health, 73, 91, 93, 104, 105, 113, 133, 197, 207, 281 Rural Population, 281
S Saliva, 22, 281 Salivary, 256, 281 Salivary glands, 256, 281 Schizophrenia, 41, 48, 75, 84, 99, 258, 281 Screening, 13, 15, 39, 55, 122, 137, 150, 151, 154, 200, 204, 207, 225, 251, 281, 286 Secretion, 254, 261, 263, 270, 271, 281 Secular trends, 109, 281 Sediment, 281, 286 Selection Bias, 53, 281 Self Care, 243, 281 Semen, 276, 281 Senile, 165, 281 Septum, 276, 281 Serine, 276, 281 Serotonin, 27, 246, 274, 279, 281, 286 Serum, 20, 181, 245, 252, 266, 270, 281 Serum Albumin, 181, 281 Sex Characteristics, 243, 245, 281 Sexually Transmitted Diseases, 82, 282 Shedding, 59, 282 Shock, 282, 286 Side effect, 244, 247, 248, 282, 285 Sigmoid, 282 Sigmoidoscopy, 23, 282 Signs and Symptoms, 279, 282 Skeleton, 266, 282 Skull, 282, 284 Small cell lung cancer, 69, 282 Sneezing, 282 Social Environment, 278, 282 Social Work, 22, 50, 71, 99, 134, 179, 193, 282 Socioeconomic Factors, 59, 282 Soft tissue, 248, 282 Solid tumor, 245, 282 Somatic, 243, 282 Specialist, 124, 170, 233, 282 Species, 244, 259, 263, 264, 267, 270, 272, 278, 282, 286, 287 Specificity, 23, 70, 244, 282 Speech-Language Pathology, 167, 283 Sperm, 245, 251, 283 Spinal cord, 250, 251, 271, 283 Spirochete, 283, 284 Spirometry, 14, 283 Spontaneous Abortion, 275, 283 Squamous, 272, 283 Squamous cell carcinoma, 272, 283 Stasis, 283, 287 State Government, 168, 169, 181, 283
Index 297
Statistically significant, 6, 283 Stent, 273, 283 Steroids, 254, 283 Stillbirth, 275, 283 Stimulant, 54, 263, 283 Stoma, 273, 283 Stomach, 243, 256, 259, 261, 264, 271, 283 Stool, 265, 267, 283 Stress, 5, 12, 14, 67, 139, 250, 271, 280, 283 Stroke, 11, 26, 32, 34, 55, 147, 188, 249, 266, 283 Subacute, 265, 283 Subclinical, 265, 283 Supplementation, 122, 123, 284 Support group, 121, 284 Suppression, 254, 284 Survival Rate, 62, 284 Symphysis, 250, 276, 284 Symptomatic, 10, 246, 284 Synaptic, 272, 284 Synaptic Transmission, 272, 284 Syphilis, 82, 284 Systemic, 47, 248, 255, 259, 265, 278, 284, 288 Systolic, 20, 264, 284 T Tardive, 247, 284 Telecommunications, 174, 253, 284 Telemedicine, 19, 284 Temperament, 68, 284 Temporal, 29, 59, 263, 284 Therapeutics, 77, 284 Threshold, 264, 284 Thrombosis, 277, 283, 284 Thrombus, 254, 265, 266, 285, 287 Thyroid, 285, 286 Tinnitus, 273, 285 Tolerance, 123, 261, 285 Toothache, 4, 285 Torsion, 265, 285 Toxic, iv, 264, 272, 285 Toxicity, 23, 257, 285 Toxicology, 190, 285 Toxins, 246, 258, 265, 285 Trabecular Meshwork, 50, 285 Tranquilizing Agents, 277, 285 Transfection, 248, 285 Translating, 52, 285 Translation, 53, 285 Translational, 63, 285 Translocation, 63, 285 Transmitter, 257, 269, 285
Transplantation, 62, 162, 179, 258, 286 Transurethral, 276, 286 Transurethral Resection of Prostate, 276, 286 Trauma, 50, 255, 271, 285, 286 Trigger zone, 247, 286 Tryptophan, 252, 281, 286 Tuberculosis, 253, 286 Type 2 diabetes, 6, 286 Tyrosine, 63, 257, 286 U Ulcer, 59, 286 Ulcerative colitis, 166, 265, 286 Ultrasonography, 39, 286 Uncompensated Care, 36, 286 Unconscious, 264, 279, 286 Urban Health, 14, 105, 109, 286 Urban Population, 286 Urea, 79, 266, 286 Uremia, 266, 286 Urethra, 276, 286, 287 Urinalysis, 164, 286 Urinary, 247, 265, 272, 276, 280, 286, 287 Urine, 247, 248, 265, 266, 272, 286, 287 Uterus, 250, 287 Utilization Review, 257, 287 V Vaccine, 243, 277, 287 Valves, 287 Vascular, 32, 34, 120, 264, 265, 285, 287 VE, 67, 112, 193, 287 Veins, 248, 287 Venereal, 284, 287 Venous, 120, 248, 277, 287, 288 Venous Insufficiency, 120, 287 Venous Thrombosis, 287, 288 Ventilation, 53, 287 Ventilator, 269, 280, 287 Ventricle, 278, 284, 287 Vertigo, 273, 287 Veterinary Medicine, 189, 287 Virulence, 285, 287 Virus, 104, 162, 191, 193, 202, 219, 243, 263, 280, 287 Vitro, 287 Vivo, 288 W Warfarin, 101, 288 Weight Gain, 126, 288 Wound Healing, 269, 288 X X-ray, 261, 278, 288
298
Index 299
300
Medicaid
