The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island.
OBJECTIVES: The purpose of this study was to determine whether adequacy of prenatal care utilization improved after the implementation of a Medicaid managed care program in Rhode Island. METHODS: Rhode Island birth certificate data (1993-1995; n = 37021) were used to analyze pre- and post-program implementation changes in adequacy of prenatal care utilization. Logistic regression models were used to characterize the variation in prenatal care adequacy as a function of both time and the various covariates. RESULTS: Adequacy of prenatal care utilization for Medicaid patients improved significantly after implementation of the program, from 57.1% to 62.1% (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1, 1.3). After the program was implemented, Medicaid patients who went to private physicians' offices for prenatal care were 1.4 times as likely as before to receive adequate prenatal care (OR = 1.4, 95% CI = 1.2, 1.7). CONCLUSIONS: Unlike many other Medicaid expansions for pregnant women, the RIte Care program in Rhode Island has resulted in significant improvement in adequacy of prenatal care utilization for its enrollees. This improvement was due to specific program interventions that addressed and changed organizational and delivery system barriers to care. (+info)
Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units.
OBJECTIVES: This multisite study sought to identify (1) any differences in admission risk (defined by gestational age and illness severity) among neonatal intensive care units (NICUs) and (2) obstetric antecedents of newborn illness severity. METHODS: Data on 1476 babies born at a gestational age of less than 32 weeks in 6 perinatal centers were abstracted prospectively. Newborn illness severity was measured with the Score for Neonatal Acute Physiology. Regression models were constructed to predict scores as a function of perinatal risk factors. RESULTS: The sites differed by several obstetric case-mix characteristics. Of these, only gestational age, small for gestational age. White race, and severe congenital anomalies were associated with higher scores. Antenatal corticosteroids, low Apgar scores, and neonatal hypothermia also affected illness severity. At 2 sites, higher mean severity could not be explained by case mix. CONCLUSIONS: Obstetric events and perinatal practices affect newborn illness severity. These risk factors differ among perinatal centers and are associated with elevated illness severity at some sites. Outcomes of NICU care may be affected by antecedent events and perinatal practices. (+info)
Satisfaction with methods of Spanish interpretation in an ambulatory care clinic.
OBJECTIVE: To describe the utilization of various methods of language interpretation by Spanish-speaking patients in an academic medical clinic and to determine patients' and physicians' satisfaction with these methods. METHODS: Survey administered to medical residents and Spanish-speaking patients asking about their experience and satisfaction with various methods of language interpretation. MAIN RESULTS: Both patients and residents had the highest level of satisfaction for professional interpreters (92.4% vs 96.1% reporting somewhat or very satisfactory, p =.17). In contrast, patients were significantly more satisfied than residents with using family members and friends (85.1% vs 60.8%, p <.01). Physicians and patients agreed that accuracy, accessibility, and respect for confidentiality were highly important characteristics of interpreters (>90% of both groups reporting somewhat or very important). However, patients were more concerned than residents about the ability of the interpreter to assist them after the physician visit (94% vs 45.1%, p < 0.01). CONCLUSIONS: Using family members and friends as interpreters for Spanish-speaking patients should be more seriously considered; however, in order to optimize patient satisfaction, differences between patients and providers should be taken into account when using interpretation in medical settings. (+info)
Effects of a community-based intervention on physical activity: the Pawtucket Heart Health Program.
OBJECTIVES: The effect of a community-based physical activity program in Pawtucket, RI, was evaluated relative to one in a comparison community. METHODS: Cross-sectional surveys of 7529 residents of Pawtucket, RI, and 7732 residents of the comparison city were conducted at 2-year intervals during 7 years of intervention. RESULTS: There were no differences in self-reported knowledge of the benefits of physical activity, attempts to increase exercise, or prevalence of physical inactivity between Pawtucket and the comparison community. CONCLUSIONS: Future community-based physical activity interventions should attempt to involve a wider range of individuals. (+info)
Diabetes preventive-care practices in managed-care organizations--Rhode Island, 1995-1996.
Diabetes mellitus affects 8% of the U.S. adult population and can lead to debilitating complications, including blindness, renal failure, cardiovascular disease, mobility impairment, and lower extremity amputation. Preventive care such as glycemic control and regular foot and eye examinations are recommended because of their efficacy in reducing diabetes-related complications. In the United States, managed care is an important provider of medical services for persons with diabetes. Persons with diabetes receiving care from a major health-maintenance organization (HMO) or a major preferred provider organization (PPO) in Rhode Island were surveyed in 1995 and 1996 to assess the level of care for three recommended preventive-care practices for diabetes: an annual dilated eye examination, semi-annual foot examination, and annual glycosylated hemoglobin (GHb) assessment. This report summarizes the findings from this survey, which indicated that 87% of persons with diabetes received eye examinations and approximately 55% received semi-annual foot examinations and annual GHb assessments. (+info)
Infectious necrotizing enteritis and mortality caused by Vibrio carchariae in summer flounder Paralichthys dentatus during intensive culture.
An epizootic causing mortality among cultured summer flounder Paralichthys dentatus occurred in summer of 1998 at a land-based facility on Narragansett Bay, Rhode Island, USA. The disease, flounder infectious necrotizing enteritis (FINE), was characterized by reddening around the anal area, distended abdomens filled with opaque serosanguineous fluid, enteritis and necrosis of the posterior intestine. In extreme cases of the disease, the posterior intestine was detached from the anus and was observed coming out the vent. The intestine of individuals that recovered from the disease ended in a blind-sac; the abdomens of these fish were distended, due to food and water inside the intestinal blind-sac. A bacterium was isolated from ascites fluid and kidney of moribund flounder and identified as the causative agent in challenge experiments. The pathogen was identified as Vibrio carchariae by morphological and biochemical characteristics and sequence of the 16S rRNA. The LD50 estimate was 5 x 10(5) colony-forming units injected intraperitoneally into 100 to 200 g summer flounder. (+info)
Sex-specific trends in validated coronary heart disease rates in southeastern New England, 1980-1991.
Although the national decline in coronary heart disease mortality began earlier and was steeper in women relative to men, recent data suggest that the decline in women has slowed. The purpose of this study was to document sex-specific trends in coronary disease morbidity and mortality for the period 1980-1991 in two southeastern New England communities, and to determine whether temporal trends have been similar in men and women aged 35-74 years. Analyses were based on 6,282 validated in-hospital and out-of-hospital coronary disease events ascertained by the retrospective surveillance system of the Pawtucket Heart Health Program. Total (fatal plus non-fatal) coronary disease rates remained stable during this period. The flat trend was the result of an increase in non-fatal hospitalizations and a simultaneous decrease in both in-hospital and out-of-hospital mortality. The decline in fatal coronary disease was steeper for men, for both in- and out-of-hospital mortality, although the sex difference was statistically significant only for out-of-hospital deaths. In-hospital case-fatality for validated coronary disease declined for both men and women. The steeper decline in coronary disease mortality for men suggests the need for more information regarding sex differential trends in prevention, diagnosis, classification, and treatment. (+info)
The doctor-patient relationship and HIV-infected patients' satisfaction with primary care physicians.
OBJECTIVE: To assess the extent to which perceptions of specific aspects of the doctor-patient relationship are related to overall satisfaction with primary care physicians among HIV-infected patients. DESIGN: Longitudinal, observational study of HIV-infected persons new to primary HIV care. Data were collected at enrollment and approximately 6 months later by in-person interview. SETTING: Two urban medical centers in the northeastern United States. PARTICIPANTS: Patients seeking primary HIV care for the first time. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was patient-reported satisfaction with a primary care physician measured 6 months after initiating primary HIV care. Patients who were more comfortable discussing personal issues with their physicians (P =. 021), who perceived their primary care physicians as more empathetic (P =.001), and who perceived their primary care physicians as more knowledgeable with respect to HIV (P =.002) were significantly more satisfied with their primary care physicians, adjusted for characteristics of the patient and characteristics of primary care. Collectively, specific aspects of the doctor-patient relationship explained 56% of the variation in overall satisfaction with the primary care physician. CONCLUSIONS: Patients' perceptions of their primary care physician's HIV knowledge and empathy were highly related to their satisfaction with this physician. Satisfaction among HIV-infected patients was not associated with patients' sociodemographic characteristics, HIV risk characteristics, alcohol and drug use, health status, quality of life, or concordant patient-physician gender and racial matching. (+info)