Billing and payment of commercial and Medicaid health plan adult vaccination claims in Michigan since the Affordable Care Act.

Background: Provider concern regarding insurance non-payment for vaccines is a common barrier to provision of adult immunizations. We examined current adult vaccination billing and payment associated with two managed care populations to identify reasons for non-payment of immunization insurance claims.

Methods: We assessed administrative data from 2014 to 2015 from Blue Care Network of Michigan, a nonprofit health maintenance organization, and Blue Cross Complete of Michigan, a Medicaid managed care plan, to determine rates of and reasons for non-payment of adult vaccination claims across patient-care settings, insurance plans, and vaccine types.

Western organizational change capacity theory and its application to public health organizations in China: A multiple case analysis.

As health reform becomes a crucial task for both Chinese and United States government, public health organizations are required to adopt changes based on reform policy. Organizational Change Capacity theory is a Western theory that indicates the capacities that organizations should possess when pursuing successful organizational change. This study seeks to understand the applicability of this theory to Chinese public health organizations by contrasting organizations that have achieved success or remained challenged in implementing organizational change to optimize health reform.

The Impact of Commercial Health Plan Prior Authorization Programs on the Utilization of Services for Low Back Pain.

Study Design: An observational study.

Objective: The aim of this study was to evaluate the impact of a health plan's prior authorization (PA) programs for low back pain (LBP) in a non-Medicare population by assessing changes in pre-surgical nonoperative care; lumbar fusion trends; and overall back surgery rates compared with another health plan with a similar program and national benchmarks. The PA programs require mandatory physiatrist consultation before surgical evaluation, with subsequent additional LBP surgery PA.

Emergency department use associated with primary care office management.

Objectives: The goal of this pilot study is to demonstrate whether revisiting and focusing on simple and generally known primary care office management practices has a meaningful impact on emergency department (ED) utilization for conditions that likely could have been treated in the primary care office setting (primary care physician [PCP] treatable).

Study Design: Cohort study using health plan administrative data from 2007 to 2010 involving primary care physicians (PCPs) affiliated with both Blue Care Network of Michigan, a nonprofit health maintenance organization, and Oakland Southfield Physicians PC, a Metropolitan Detroit independent practice association. PCPs were assigned to cohorts according to pre-intervention increasing or decreasing temporal trends in annual ED visit rates for PCP-treatable conditions by 12-month continuously enrolled commercial members with the same emergency care copay.

Updating the FORECAST formative evaluation approach and some implications for ameliorating theory failure, implementation failure, and evaluation failure.

Historically, there has been considerable variability in how formative evaluation has been conceptualized and practiced. FORmative Evaluation Consultation And Systems Technique (FORECAST) is a formative evaluation approach that develops a set of models and processes that can be used across settings and times, while allowing for local adaptations and innovations. FORECAST integrates specific models and tools to improve limitations in program theory, implementation, and evaluation.

Effect of cost efficiency reporting on utilization by physician specialists: a difference-in-difference study.

Objective: To assess whether health plan implementation of specialist profile reports not associated with any health plan administered reward or consequence that measured physician cost efficiency relative to peers, and shared with specialists and primary care referral sources only, were associated with changes in specialist behaviour.

Data Source/study Setting: Blue Care Network of Michigan is a non-profit statewide Health Maintenance Organization and wholly owned subsidiary of Blue Cross Blue Shield of Michigan. This study used administrative data from 2002 to 2006 and included only providers and adult (ages 18-65) commercial membership located in Southeastern Michigan.

A meta-analysis of social capital and health: a case for needed research.

Social capital refers to various levels of social relationships formed through social networks. Measurement differences have lead to imprecise measurement. A meta-analysis of eligible studies assessing the bivariate association between social capital and self-reported health and all-cause mortality was performed.

Building a larger tent for public health: implications of the SOPHE-AAHE unification.

The unification of the American Association for Health Education (AAHE) and the Society for Public Health Education (SOPHE) generates a long-desired synergy, a ramping up of our leadership influence in promoting health. It also serves as an ongoing opportunity to reflect on how we synergize the distinct philosophic, scientific, and practical approaches that our AAHE colleagues bring in constructing a larger tent for public health education. Running parallel to our union with AAHE is the undertaking by several schools of health, physical education, and recreation (HPER) to become schools of public health.

Using the interactive systems framework to support a quality improvement approach to dissemination of evidence-based strategies to promote early detection of breast cancer: planning a comprehensive dynamic trial.

Dissemination efforts must optimize interventions for new settings and populations. As such, dissemination research should incorporate principles of quality improvement. Comprehensive Dynamic Trial (CDT) designs examine how information gained during dissemination may be used to modify interventions and improve performance.

Polyketide synthase pathways identified from a metagenomic library are derived from soil Acidobacteria.

Polyketides are structurally diverse secondary metabolites, many of which have antibiotic or anticancer activity. Type I modular polyketide synthase (PKS) genes are typically large and encode repeating enzymatic domains that elongate and modify the nascent polyketide chain. A fosmid metagenomic library constructed from an agricultural soil was arrayed and the macroarray was screened for the presence of conserved ketosynthase [β-ketoacyl synthase (KS)] domains, enzymatic domains present in PKSs.

Gram negative shuttle BAC vector for heterologous expression of metagenomic libraries.

Bacterial artificial chromosome (BAC) vectors enable stable cloning of large DNA fragments from single genomes or microbial assemblages. A novel shuttle BAC vector was constructed that permits replication of BAC clones in diverse Gram-negative species. The "Gram-negative shuttle BAC" vector (pGNS-BAC) uses the F replicon for stable single-copy replication in E.

Changes in soil Acidobacteria communities after 2,4,6-trinitrotoluene contamination.

Despite their widespread occurrence in soils, the ecology of Acidobacteria and their response to environmental perturbations due to human activities remain very poorly documented. This study was aimed at assessing changes in the diversity and abundance of Acidobacteria in soils contaminated with 2,4,6-trinitrotoluene (TNT) compared with nonpolluted soils. The analysis of Acidobacteria communities at two sites with long-term and short-term contamination revealed that TNT has a drastic impact on the relative abundance of Acidobacteria in soil bacterial 16S rRNA gene libraries.

Empowerment evaluation for violence prevention public health programs.

The formative evaluation consultation and systems technique (FORECAST) approach to evaluating complex community programs is described as an empowerment evaluation strategy. First, empowerment evaluation is defined and contrasted with more-traditional approaches, such as experimental and quasi-experimental designs. Then FORECAST is described, illustrating how it was applied in four community projects.

A construct for building the capacity of community-based initiatives in racial and ethnic communities: a qualitative cross-case analysis.

This article reports on a qualitative cross-case study that compares patterns of implementation across community-based public health initiatives resulting in a construct for building the capacity of such initiatives in racial and ethnic communities. By specifying which capacities provide optimum leverage, community initiatives may increase precision in developing intervention strategies that focus on those pivotal capacities that are necessary for producing desired outcomes. First, community capacity is defined and briefly contrasted with social capital.

A construct for building the capacity of community-based initiatives in racial and ethnic communities: a qualitative cross-case analysis.

Objective: This article reports on a qualitative study that contrasts implementation patterns across community-based public health initiatives, resulting in a construct for building the capacity of such initiatives in racial and ethnic communities. By specifying which capacities provide optimum leverage, community initiatives may increase precision in developing intervention strategies that are pivotal in producing desired outcomes.

Method: Cross-case comparisons were made on the basis of intensive interviews with key initiative leaders.

The 6-step model for community empowerment: revisited in public housing communities for low-income senior citizens.

The 6-step community empowerment model was replicated in communities with different geographical, racial, and age backgrounds from the original application. Resident groups of Blue Ribbon Health Panels (BRHPs) in federally funded senior housing in Pennsylvania followed the 6 steps to identify community health issues, to develop strategies to address priority issues, and to implement the strategies in collaboration with partner agencies. The 6-step model served as an operationalization strategy of community empowerment by facilitating quick accomplishments of communities' desired outcomes, legitimizing and motivating BRHP efforts.

Recovery, purification, and cloning of high-molecular-weight DNA from soil microorganisms.

We describe here an improved method for isolating, purifying, and cloning DNA from diverse soil microbiota. Soil microorganisms were extracted from soils and embedded and lysed within an agarose plug. Nucleases that copurified with the metagenomic DNA were removed by incubating plugs with a high-salt and -formamide solution.

The public health role in the primary prevention of diabetes: recommendations from the chronic disease directors' project.

Aim: The article reports on the recommendations from the Diabetes Primary Prevention Project that was initiated and funded by the Division of Diabetes Translation, Centers for Disease Control and Prevention, and developed by the National Association of Chronic Disease Directors.

Method: Essential components of statewide programs are delineated for effective interventions for diabetes primary prevention. The recommendations were derived from a structured process that is detailed on the basis of a cross-comparison of state-level diabetes prevention initiatives in six states where such programs were most developed.

Engaging partners to initiate evaluation efforts: tactics used and lessons learned from the prevention research centers program.

Background: The Centers for Disease Control and Prevention's (CDC's) Prevention Research Centers (PRC) Program underwent a 2-year evaluation planning project using a participatory process that allowed perspectives from the national community of PRC partners to be expressed and reflected in a national logic model.

Context: The PRC Program recognized the challenge in developing a feasible, useable, and relevant evaluation process for a large, diverse program. To address the challenge, participatory and utilization-focused evaluation models were used.

Patients with Complex Chronic Diseases: perspectives on supporting self-management.

A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking.