Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees: An Evaluation of a 1915 (b) and (c) Waiver Program.

Importance: Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.

Objective: We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.

Design, Setting, And Participants: We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.

Executive functioning in attention-deficit/hyperactivity disorder: questioning the notion of planning deficits with heart rate reactivity.

This study employed a paired stimulus paradigm to compare phasic changes in heart rate among children (age categories 6-8, 9-10, and 11-12) and adults (age categories 18-19 and 20-22) with attention-deficit/hyperactivity disorder (ADHD) and age-matched controls. A sample of 95 participants (19 ADHD-diagnosed children, 34 controls, 20 ADHD-diagnosed adults, and 22 controls) solved a planning task, the Tower of London, through 4 levels of difficulty. It was hypothesized that groups with ADHD would show greater heart rate acceleration and less final deceleration than would controls, and that these heart rate responses would change with age and difficulty level as well.

Planning: fixed-foreperiod event-related potentials during the Tower of London task.

Slow wave ERPs were recorded from 28 young adults as they generated plans for various difficulty levels of a fixed-foreperiod version of the Tower of London task. The resulting waveform included three segments: (1) a left-lateralized negative early-interval wave, which was frontally maximal but not sensitive to difficulty, (2) a right-lateralized frontally maximal mid-interval wave, which was more positive for more difficult problems, and (3) a left lateralized centrally maximal negative-ramping contingent negative variation (CNV) late wave, which was more negative for more difficult problems. The current study adds to the current literature in that it finds that the frontal and central neural utilization with difficulty changes across plan generation.