Medicaid coverage of tobacco-dependence treatment for pregnant women: impact of the Affordable Care Act.

Background: Twenty percent of pregnant women enrolled in Medicaid use tobacco products. The Affordable Care Act (ACA) requires Medicaid to cover tobacco-dependence treatments for pregnant women beginning in 2010.

Purpose: To summarize the impact of the ACA provisions on Medicaid coverage of tobacco-dependence treatments for pregnant women.

Impact of participation in the California Healthcare-Associated Infection Prevention Initiative on adoption and implementation of evidence-based practices for patient safety and health care-associated infection rates in a cohort of acute care general hospitals.

Background: In 2008, hospitals were selected to participate in the California Healthcare-Associated Infection Prevention Initiative (CHAIPI). This research evaluates the impact of CHAIPI on hospital adoption and implementation of evidence-based patient safety practices and reduction of health care-associated infection (HAI) rates.

Methods: Statewide computer-assisted telephone surveys of California's general acute care hospitals were conducted in 2008 and 2010 (response rates, 80% and 76%, respectively).

Effects of asthma education on children's use of acute care services: a meta-analysis.

Objective: National Heart, Lung, and Blood Institute clinical practice guidelines strongly recommend that health professionals educate children with asthma and their caregivers about self-management. We conducted a meta-analysis to estimate the effects of pediatric asthma education on hospitalizations, emergency department visits, and urgent physician visits for asthma.

Patients And Methods: Inclusion criteria included enrollment of children aged 2 to 17 years with a clinical diagnosis of asthma who resided in the United States.

The demand for health insurance coverage for tobacco dependence treatments: support for a benefit mandate and willingness to pay.

One solution for reducing tobacco use is to expand health insurance coverage for tobacco dependence treatments (TDTs), but the public demand for a coverage mandate is unknown. This study finds that demand for coverage of TDTs among a random sample of adult Californians with employer-sponsored health insurance is strong, with 62% indicating that health insurers should be required to offer coverage as part of their standard plans and a majority (56%) indicating a willingness to pay $3 more for their annual health insurance premium to finance cessation coverage. Compared to never smokers, current and former smokers are no more likely to support a benefit mandate to require coverage of cessation treatments, but the adjusted odds are approximately three times greater that current and former smokers are willing to pay $3 more toward their annual premium to finance cessation coverage.

Medicaid provider delivery of the 5A's for smoking cessation counseling.

This paper assesses rates of the 5A's (ask, advise, assess, assist, and arrange) of brief provider counseling received by Medicaid-enrolled smokers and recent quitters and the differences in receipt of counseling as a function of age, gender, race, ethnicity, and health status. A random sample telephone survey was conducted among Medicaid-enrolled smokers and recent quitters in four geographic areas in the United States. Multivariate logistic regression models estimated the relationships between demographic characteristics and delivery of the 5A's.

Addressing food security through public policy action in a community-based participatory research partnership.

Community-based participatory research (CBPR) is an increasingly utilized research approach that involves the affected community identifying a health-related problem, developing a research agenda, and planning an appropriate intervention to address the problem. This report on a CBPR partnership in San Francisco's Bayview Hunters Point neighborhood documents the rise of a community food security policy in response to youth-involved research that found poor access to quality food in an economically disadvantaged area of the city. To analyze the impact of the research on public policy, a framework of specific steps in the policy-making process is used to organize and better understand the partnership's objectives, activities, strategies, and successes.

Adoption of system strategies for tobacco cessation by state medicaid programs.

Background: The Public Health Service's Clinical Practice Guideline for treating tobacco dependence recommends 6 system-wide strategies for health administrators, insurers, and purchasers to support tobacco cessation.

Methods: A 24-question survey was sent to each state Medicaid program office in the fall of 2005, including questions to assess whether each state Medicaid program adopted 4 of the 6 system strategies most relevant to Medicaid contracting.

Results: The number of system strategies adopted by state Medicaid programs in 2005 ranged from 0 to 4 of the 4 strategies examined.

Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors.

This study examines the Chronic Care Model (CCM) as a framework for preventing health risk behaviors such as tobacco use, risky drinking, unhealthy dietary patterns, and physical inactivity. Data were obtained from primary care practices participating in a national health promotion initiative sponsored by the Robert Wood Johnson Foundation. Practices owned by a hospital health system and exhibiting a culture of quality improvement were more likely to offer recommended services such as health risk assessment, behavioral counseling, and referral to community-based programs.

Importance of adult literacy in understanding health disparities.

Background: In several recent studies, the importance of education and race in explaining health-related disparities has diminished when literacy was considered. This relationship has not been tested in a nationally representative sample of U.S.

The costs and effectiveness of different benefit designs for treating tobacco dependence: results from a randomized trial.

This research estimated the costs and effectiveness of three different benefit designs for treating tobacco dependence: drugs only (nicotine replacement therapy patch, nasal spray, inhaler, and Zyban); drugs and counseling (drugs and proactive telephone counseling); and drugs if counseling (drugs conditional on enrollment in counseling). A sample of 393 adult smokers enrolled in a California preferred provider organization was randomly assigned to one of three study groups. After eight months, there were no significant increases in quit attempts or quit rates in the groups with covered drugs and counseling compared to the group with drug coverage only.

State-mandated benefit review laws.

Objective: To determine which states have laws that require the review of mandated health insurance benefits and describe the various approaches states take in reviewing mandated benefits, as stated in the mandated benefit review (MBR) laws.

Data Sources: We queried online databases of the individual state statutes and reviewed the state statutes and state legislative agendas for all 50 states and Washington, DC to identify those states with active MBR laws as of September 2004.

Study Design: We reviewed the identified MBR laws to catalog their various components.

An analysis of California Assembly Bill 2185: mandating coverage of pediatric asthma self-management training and education.

Objective: To summarize for the California Legislature the evidence on the medical effectiveness of pediatric asthma self-management training and education (PASMTE), including the use of peak flow meters, spacers, and nebulizers and the impact that mandated coverage of these services and devices under Assembly Bill (AB) 2185 would have on total health care expenditures, monthly premiums, health services utilization, and the public's health.

Medical Effectiveness Findings: The review of the literature finds that PASMTE is medically effective and has favorable effects on the health of children with symptomatic asthma, as well as reduces asthma-related emergency room visits and hospitalizations. There was inadequate evidence to assess the effectiveness of the three medical devices independently of PASMTE.

The routine use of health risk appraisals: results from a national study of physician organizations.

Purpose: To document use of health risk appraisals (HRAs) by U.S. physician organizations as part of their overall approach to health promotion and to identify associated organizational characteristics.

The use of patient and physician reminders for preventive services: results from a National Study of Physician Organizations.

Background: Clinical preventive services improve patient health, and reminder systems can increase the use of such services. However, physician organizations often underutilize clinical preventive service reminders. Little is known about the incentives, capabilities, and organizational characteristics associated with the use of reminders by physician organizations.

Physician and enrollee knowledge of Medicaid coverage for tobacco dependence treatments.

Background: The 2000 Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, recommends health insurance coverage for tobacco-dependence treatments proven effective in helping smokers to quit. Two states with comprehensive coverage for tobacco-dependence treatments in their Medicaid programs were selected to document awareness of coverage for tobacco-dependence treatments among primary care physicians who treat Medicaid enrollees and Medicaid-enrolled smokers.

Methods: In 2000, surveys were conducted among Medicaid smokers (n =400) and physicians (n =160) to document knowledge of covered tobacco-dependence treatments under state Medicaid programs in two states with comprehensive coverage.