When coverage expands: children's health insurance program as a natural experiment in use of health care services.

Background: Expanding insurance coverage is designed to improve access to primary care and reduce use of emergency department (ED) services. Whether expanding coverage achieves this is of paramount importance as the United States prepares for the Affordable Care Act.

Objectives: Emergency and outpatient department use was examined after the State Children's Health Insurance Program (CHIP) coverage expansion, focusing on adolescents (a major target group for CHIP) versus young adults (not targeted).

Variation in inpatient tonsillectomy costs within and between US hospitals attributable to postoperative complications.

Background: Tonsillectomy is the second most common inpatient procedure in US children. However, the factors that influence tonsillectomy-related costs are unknown.

Objective: The objective of the study was to describe variation in US inpatient tonsillectomy costs and examine whether postoperative complications contribute to these disparities in costs.

Posttonsillectomy hemorrhage in children with von Willebrand disease or hemophilia.

Importance: It is uncertain whether children with bleeding disorders are at higher risk of posttonsillectomy hemorrhage compared with the general pediatric population.

Objectives: To estimate the national rate of posttonsillectomy hemorrhage in children previously diagnosed with von Willebrand disease (VWD) or hemophilia, and to analyze potential risk factors for postoperative bleeding in these children.

Design: A cross-sectional analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) from the Agency for Healthcare Research and Quality for 2000, 2003, 2006, and 2009.

The influence of evidence in the surgical treatment of thumb basilar joint arthritis.

Background: For surgical treatment of thumb carpometacarpal joint arthritis, current evidence suggests that simple trapeziectomy is as effective as and may be safer than trapeziectomy and ligament reconstruction with or without tendon interposition. The authors examined whether current practice patterns in the surgical treatment of thumb carpometacarpal joint arthritis reflect adoption of simple trapeziectomy as best practice, and investigated whether surgeon preferences and third-party payer patterns are associated with use of simple trapeziectomy.

Methods: The authors performed a retrospective cross-sectional study of 6776 surgical treatments for thumb carpometacarpal joint arthritis using the all-payer State Ambulatory Surgery Database for Florida, from 2006 to 2009.

Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006.

Background: Traditionally, thyroid surgery has been an inpatient procedure due to the risk of several well-documented complications. Recent research suggests that for selected patients, outpatient thyroid surgery is safe and feasible, with the additional potential benefit of cost savings. In recognition of these observations, we hypothesized that there would be an increase in U.

American Muslim perceptions of healing: key agents in healing, and their roles.

American Muslims represent a growing and diverse community. Efforts at promoting cultural competence, enhancing cross-cultural communication skills, and improving community health must account for the religio-cultural frame through which American Muslims view healing. Using a community-based participatory research model, we conducted 13 focus groups at area mosques in southeast Michigan to explore American Muslim views on healing and to identify the primary agents, and their roles, within the healing process.

The voices of limited English proficiency Latina mothers on pediatric primary care: lessons for the medical home.

The objective of this study is to inform medical home implementation in practices serving limited English proficiency Latino families by exploring limited English proficiency Latina mothers' experiences with, and expectations for, pediatric primary care. In partnership with a federally-qualified community health center in an urban Latino neighborhood, we conducted semi-structured interviews with 38 low-income Latina mothers. Eligible participants identified a pediatric primary care provider for their child and had at least one child 3 years old or younger, to increase the probability of frequent recent interactions with health care providers.

The role of imams in American Muslim health: perspectives of Muslim community leaders in Southeast Michigan.

American Muslims are a diverse and growing population, numbering nearly 200,000 in Southeast Michigan. Little empirical work exists on the influence of Islam upon the healthcare behaviors of American Muslims, and there is to date limited research on the roles that imams, Muslim religious leaders, play in the health of this community. Utilizing a community-based participatory research (CBPR) model through collaboration with four key community organizations, we conducted semi-structured interviews with 12 community leaders and explored their perceptions about the roles imams play in community health.

Prematurity and low birth weight as potential mediators of higher stillbirth risk in mixed black/white race couples.

Objective: Although births of multiracial and multiethnic infants are becoming more common in the United States, little is known about birth outcomes and risks for adverse events. We evaluated risk of fetal death for mixed race couples compared with same race couples and examined the role of prematurity and low birth weight as potential mediating risk factors.

Methods: We performed a retrospective cohort analysis using data from the 1998-2002 California Birth Cohort to evaluate the odds of fetal death, low birth weight, and prematurity for couples with a mother and father who were categorized as either being of same or different racial groups.

Physician views on barriers to primary care for young adults with childhood-onset chronic disease.

Objective: Growing numbers of children with severe chronic illnesses are surviving to adulthood. Little is known about what primary care physicians perceive as the resources for and barriers to providing primary care services for young adults who transfer care from pediatric to adult medicine practitioners. The objective of this study was to describe primary care physicians' resources for and barriers to caring for young adults with childhood-onset chronic diseases.

Comfort of general internists and general pediatricians in providing care for young adults with chronic illnesses of childhood.

Background: As an increasing number of patients with chronic conditions of childhood survive to adulthood, experts recommend that young adults with chronic conditions transfer from child-focused to adult-focused primary care. Little, however, is known about how comfortable physicians are caring for this population.

Objectives: To assess the comfort of general internists and general pediatricians in treating young adult patients with chronic illnesses originating in childhood as well as the factors associated with comfort.

Payer leverage and hospital compliance with a benchmark: a population-based observational study.

Background: Since 1976, Medicare has linked reimbursement for hospitals performing organ transplants to the attainment of certain benchmarks, including transplant volume. While Medicare is a stakeholder in all transplant services, its role in renal transplantation is likely greater, given its coverage of end-stage renal disease. Thus, Medicare's transplant experience allows us to examine the role of payer leverage in motivating hospital benchmark compliance.

Operative mortality after renal transplantation--does surgeon type matter?

Purpose: Currently there are 64 accredited renal transplantation fellowships in Canada and the United States. Only 27% are limited in scope to kidney transplants. In the remaining fellowships the trainee learns to transplant multiple abdominal organs.

A population-based study on alcohol and high-risk sexual behaviors in Botswana.

Background: In Botswana, an estimated 24% of adults ages 15-49 years are infected with HIV. While alcohol use is strongly associated with HIV infection in Africa, few population-based studies have characterized the association of alcohol use with specific high-risk sexual behaviors.

Methods And Findings: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana using a stratified two-stage probability sample design.

Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns.

Background: The Botswana government recently implemented a policy of routine or "opt-out" HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults.

Methods And Findings: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favor of routine testing.

Racial treatment trends in localized/regional prostate carcinoma: 1992-1999.

Background: African-American men have a greater incidence of and mortality from prostate carcinoma compared with white men, and they are less likely to receive definitive therapy (radical prostatectomy or external beam radiation therapy). During the 1990s, the use of brachytherapy increased; however, its influence on racial and ethnic prostate carcinoma treatment trends remains unclear. The objective of this study was to describe treatment trends over the period 1992-1999 for localized/regional prostate carcinoma among white, Hispanic, and African-American men.

Assessment of torture and ill treatment of detainees in Mexico: attitudes and experiences of forensic physicians.

Context: International and Mexican human rights organizations have documented torture of detainees (ie, those held and indicted but not sentenced) in all 31 states and the Federal District of Mexico, but little is known about the attitudes and experiences of forensic physicians examining detainees.

Objective: To assess forensic physicians' experiences with and attitudes toward the nature and extent of torture and ill treatment among detainees examined in the previous year.

Design, Setting, And Participants: With the support of the Mexican Office of the Federal Attorney General, as part of a larger initiative to implement governmental reforms to eradicate torture in Mexico, an anonymous, self-administered, written, 80-item survey designed to assess correspondence of physician practices and attitudes with international standards on forensic investigation and documentation of torture was distributed to all federal forensic physicians (n = 115) and a convenience sample of state forensic physicians (n = 99) in Mexico in 2002.

The risk for infant mortality among adolescent childbearing groups.

Objective: To evaluate risk disparities and risk factors for infant mortality among adolescent childbearing age groups.

Methods: We combined the 1995 and 1996 comprehensive U.S.

Medicaid managed care: are academic medical centers penalized by attracting patients with high-cost conditions?

Objective: To determine whether case-mix and health utilization disparities exist between Medicaid enrollees within a Michigan managed care organization (MCO) who selected primary care providers (PCPs) affiliated with a major academic medical center (AMC) and enrollees who selected community providers.

Study Design: A retrospective cohort study using cost estimates obtained from claims data and based on a standardized Medicaid fee schedule.

Methods: We established the prevalence of 25 high-cost chronic medical conditions from the claims data for capitated Medicaid enrollees from January 1, 1997, through October 31, 1999.

The rheumatoid hand: a predictable disease with unpredictable surgical practice patterns.

Objectives: To evaluate variation in fusion, arthroplasty, and tenosynovectomy rates among rheumatoid arthritis (RA) patients across states; to evaluate associations between surgery rates and the density of hand surgeons; and to evaluate differences in treatment by sex of the patient.

Methods: Data were obtained from the 1996 and 1997 Healthcare Cost and Utilization Project database. The procedure codes for fusion, arthroplasty, and tenosynovectomy were matched to patients with the diagnostic code of RA, which provided the total number of procedures performed in each state.

Young maternal age associated with increased risk of postneonatal death.

Objective: To determine whether full-term, healthy infants born to early adolescent mothers (15 years old and younger) are at higher risk of postneonatal death compared with infants of adult mothers.

Methods: We combined the comprehensive 1996 and 1997 United States birth cohorts to compare postneonatal mortality rates among maternal age groups. With postneonatal death as our main outcome measure, we used multivariable logistic regression to model adjusted odds ratios.

Perioperative cardiovascular risk stratification of patients with diabetes who undergo elective major vascular surgery.

Background: The importance of diabetes mellitus (DM) as an independent risk factor for perioperative cardiac morbidity after vascular surgery is controversial. This study examined the impact of DM on perioperative outcomes and length of stay in patients who underwent major vascular surgery.

Methods: Patients who underwent elective aortic reconstruction (n = 2792), lower extremity bypass (n = 3838), carotid endarterectomy (n = 5522), and major amputation (n = 3883) from 1997 to 1999 were identified in the National Surgical Quality Improvement Program database of the Department of Veterans Affairs.