Drivers of High-cost Medical Complexity in a Medicaid Population.

Background: Efforts to improve outcomes for the 10% of patients using two thirds of health care expenditures increasingly include addressing social determinants. Empiric evidence is needed to identify the highest impact nonmedical drivers of medical complexity and cost.

Objectives: This study examines whether complex, highest cost patients have different patterns of critical life adversity than those with better health and lower utilization.

Post-discharge intervention in vulnerable, chronically ill patients.

Background: Studies suggest that the inpatient to outpatient transition of care is a vulnerable period for patients, and socioeconomically disadvantaged populations may be particularly susceptible.

Objective: In this prospective cohort study, clustered by hospital, we sought to determine the feasibility and utility of a simple, post-discharge intervention in reducing hospital readmissions.

Methods: Chronically ill Medicaid managed care members were consecutively identified from the discharge records of 10 area hospitals.

An alternative to pay-for-performance: one health plan's approach to quality improvement.

To address concerns about the quality of care, health plans have used varying approaches to support quality improvement (QI). Pay-for-performance (P4P) is the most commonly used and discussed approach. P4P programs have many challenges in design and execution, particularly for Medicaid providers.

Using health-related quality of life assessments to evaluate care support within Medicaid.

CareOregon, an Oregon-based not-for-profit Medicaid health plan, successfully piloted a "CareSupport" model that identifies high-risk members and clinically stratifies them for intervention. Internal analyses indicate that CareSupport lowers utilization and cost; CareOregon, however, has lacked patient-reported outcome data on the health-related quality of life (HRQL) of CareSupport participants. Between September 2005 and November 2006, we conducted a pilot study in which the Health Utilities Index Mark 3 (HUI3), a generic preference-based measure of health status and HRQL, was integrated into CareOregon's existing screening algorithm for possible admission into CareSupport.

The economics of depression in primary care: de-fragmentation in the Oregon Medicaid market.

The Oregon Medicaid program legislatively separates the administration of physical health and mental health services, even though behavioral and physical health conditions significantly impact each other. To overcome this barrier and enhance integrated care, CareOregon, a large Medicaid only health plan partnered with two of its largest provider groups to pilot two different models of integration. In one, an "ownership" model, behavioral health specialists were employed by Federally Qualified Health Center primary care clinics and functioned in a common care model with other providers.

Indirect institutional revenue generated from an academic primary care clinical network.

Background And Objectives: As the financial performances of US academic health centers have faltered under managed care and the Balanced Budget Act of 1997, increasing attention has been paid to the costs and benefits of operating primary care networks. This study examines the indirect revenues to a university hospital and faculty group practice that result from such a primary care network using a method of abstracting billing data.

Methods: A primary care patient cohort was identified by selecting all patients who generated at least one charge in any of the 10 primary care clinics in the network over a 15-month period.

Sexual advances by patients in dental practice: implications for the dental and dental hygiene curricula.

The occurrence of patient initiated sexual advances toward dental health professionals has not previously been examined. Information from other health care specialties and reports from dental and dental hygiene students indicate that such advances do occur and that providers are rarely educated to deal effectively with them. Utilizing an anonymous survey of 300 Oregon dentists and 300 dental hygienists, this study sought to quantify the frequency of patient initiated sexual advances toward dental professionals and to survey practitioners as to their reactions to and methods of dealing with such advances.

Sex and the teacher--learner relationship in medicine.

As the numbers of women medical students, residents, and faculty increase, sexuality in teacher-learner relationships will present challenges for individuals and institutions. Ethical and legal guidelines regarding sexual harassment and contact already exist for many medical schools, hospitals, and professional organizations, as well as state and federal law. Individuals and institutions can begin to address these issues through policy development and educational sessions addressing human sexuality, communication skills, and the process of becoming a physician.