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Bureau of Primary Health Care
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Assessment of Selected Domestic Violence Programs in Primary Health Care Settings
This assessment profiled in-depth the domestic violence programs and protocols of nine Bureau of Primary Health Care (BPHC) funded community-based primary health care centers. The protocol, the foundation of a clinical domestic violence program, served as the plan for identifying and responding to individuals who have experienced domestic violence. Primary health care providers across the country are beginning to acknowledge family and intimate partner violence (FIPV), or domestic violence, as one of the most prevalent and serious public health issues affecting millions. Although domestic violence has devastating consequences for women, men, and their families, it disproportionately affects women. The domestic violence programs identified as complete in this assessment shared features, and developed other unique elements to enhance their program’s service mix and ability to respond to the needs of the communities they serve. Most programs profiled in this assessment served racially, ethnically, and culturally diverse populations, and were located in rural and urban settings. Attempts to highlight programs that were geographically dispersed across the United States were also made during the program selection process. To prevent domestic violence and change social attitudes regarding its acceptance, the majority of domestic violence programs profiled in the assessment conducted some form of outreach or education for their clients and the general public regarding domestic violence.
FEDERAL CONTACT: Dr. Shari Campbell, 301-594-4251 PIC ID: 7284
PERFORMER: North American Management Company, Alexandria, VA
Enabling Services and Perinatal Care: Final Report
Providing enabling services -- key strategy used by all Bureau of Primary Health Care grantees, may include transportation, translation, case management, health education, nutrition counseling and outreach--are not typically reimbursed under managed care. The purpose of this study was to: analyze the types and levels of enabling services provided by Community Migrant Health Centers (C/MHCs), determine how these services have changed, and analyze whether enabling services improve outcomes and reduce costs. The study drew upon aggregate data from the BPHC Uniform Data System, the annual report submitted by all grantees. A total of 650 grantees filed reports in 1996 and 1997. In 1997, enabling service personnel accounted for almost one-quarter of total direct care staff, and sample grantees expended $211 million on these services (about 13% of total direct service cost). About 95 percent of grantees provided case management and health education services. At the other end of the spectrum, under 20 percent provided child care on-site or operated food banks and/or delivered meals. It was found that health center prenatal care users are twice as likely to be teenagers, and twice as likely to be Hispanic, than is the case for the US prenatal population. As a whole, about 72 percent of C/MHC grantees have specialized obstetrical staff; the average grantee with specialized staff has 1.3 OB- GYN/Certified Nurse Midwife full-time employees. The report concludes that the breadth of perinatal services, coupled with staffing that promotes continuity of care, contribute to appropriate and timely use of prenatal and after-delivery services by mothers and infants.
FEDERAL CONTACT: Fred Butler, 301-549-4281 PIC ID: 7126
PERFORMER: MDS Associates, Inc., Wheaton, MD
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HIV/AIDS Bureau
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Assessing the Impact of Increased Medicaid Dental Reimbursement Rates On the Utilization and Access of Dental Services in South Carolina
In January 2000, the South Carolina Medicaid program set new fees at a level such that each procedure would reimburse 75 percent of the dentists at their full, usual, and customary level. This was a stark departure from the usual approach taken, where state Medicaid agencies would approve modest increases in fees --normally a proportion of the full, usual, and customary level. Given that the South Carolina reimbursements were set such that most dentists would pay no financial penalty for filling a time slot with a Medicaid patient instead of a private pay patient, policy makers hoped that dentists would respond to the fee changes. The reform increased the number of: (1) Medicaid children receiving services; (2) services Medicaid children received; and (3) participating dentists, but not the Medicaid load per participating dentist. Consequently, the results indicate that the January 2000 reform had the desired results. It is recommended that South Carolina policy makers consider maintaining their commitment to a Medicaid reimbursement that reflects the 75th percentile of private pay fees for dental procedures.
FEDERAL CONTACT: John Kehoe, 404-562-7983 PIC ID: 7196
PERFORMER: Medical University of South Carolina, Charleston, SC
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Maternal and Child Health Bureau
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Application of a Distance Learning Evaluation Plan to Data Skills Online
This study examined the contribution of different distance learning approaches to continuing education and professional training to the Health Resources and Services Administration’s (HRSA’s) mission. This document demonstrated how this framework can be applied to a specific distance learning training program, Data Skills Online, a Web-based, self-instructional training program targeting public health professionals at state and local levels, as part of an Maternal and Child Health Bureau--initiated evaluation that targeted training objectives and components of Data Skills Online that related to distance learning. Recommendations included the following: (1) collect data from diverse pool using a variety of methods and, (2) build process evaluation activities into grant requirements and provide grantees with a standard set of required data elements as well as a template for data entry.
FEDERAL CONTACT: Jacob Tenenbaum, 301-443-9011 PIC ID: 7114
PERFORMER: The Lewin Group, Falls Church, VA
Discontinuous Coverage in Medicaid and the Implications of 12-Month Continuous Coverage for Children
This report analyzes the extent to which a policy of continuous coverage improves the continuity of Medicaid coverage and decreases the incidence of gaps in coverage that result when children temporarily lose Medicaid eligibility. The Balanced Budget Act of 1997 gave states the option of providing up to 12 months of continuous coverage for children through age 18 enrolled in Medicaid and SCHIP. Using 1994- 1995 Medicaid enrollment and payment data from four states--California, Michigan, Missouri, and New Jersey--this study examined the implications of a policy of 12-month continuous coverage. Findings on the impacts of 12-month continuous coverage indicate: (1) the number of children eligible for continuous coverage and ever enrolled during a year would increase, (2) the total number of months during which children are covered would increase, (3) the average cost per enrollee month would decline slightly, (4) among children who would qualify, payments would increase, (5) administrative costs associated with disenrollments, re-enrollments, and redeterminations in states using a six-month redetermination period would fall substantially, (6) staff costs associated with those categories in #5 are only a small portion of administrative expenses associated with the cost of operating public health insurance, and (7) effects on emergency room use and payments were not conclusive.
FEDERAL CONTACT: Jacob Tenenbaum, 301-443-9011 PIC ID: 7774
PERFORMER: Mathematica Policy Research, Inc. Plainsboro, NJ and, Boston University Medical Center Boston, MA
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Office of the Administrator
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Big Cities Health Inventory
This report is the fourth in a series from the Chicago Department of Public Health presenting city-to-city comparisons of leading measures of health. This edition established an advisory group to help guide the reports’ focus and content. Based on the committee’s recommendations, the report includes, for the first time, Healthy People 2010 objectives to serve as benchmarks. The report focuses on 20 indicators of health: five indicators of communicable diseases, nine causes of mortality, and six indicators of maternal and child health. The data presented here and in other studies analyzing urban health suggest that there is a unique urban health profile influenced by the dynamics peculiar to large cities. For example, the health outcome of the nation’s largest cities are less favorable than those of smaller urban and rural areas. The three largest cities in the U.S., New York, Los Angeles and Chicago had considerably different health profiles. New York ranked among the top ten cities for incidence of HIV, TB and HIV-related mortality. Chicago ranked highest in syphilis and homicide. Los Angeles ranked in the middle for most indicators. A better understanding of what caused such different health outcomes may improve health policies and programs in these cities.
FEDERAL CONTACT: Michael Millman, 301-443-0368 PIC ID: 7241
PERFORMER: Chicago Center for Health Systems Development, Chicago, IL
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