贫困地区更需要生殖健康优质服务

<正> 《中共中央国务院关于加强人口与计划生育工作稳定低生育水平的决定》颁布后,内蒙古自治区卓资县结合全县开展的“三个代表”宣教活动将生殖健康优质服务作为“两个转变”的突破口列入了全县人口与计划生育工作目标管理之中,认真探索在贫困地区广大农村如何开展“计划生育/生殖健康”优质服务的可行之路。     

Youth with Special Health Care Needs: Transition to Adult Health Care Services

Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.     

Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Hispanics With Dementia

ObjectivesAs the number of Hispanics with dementia continues to increase, greater use of post-acute care in nursing home settings will be required. Little is known about the quality of skilled nursing facilities (SNFs) that disproportionately serve Hispanic patients with dementia and whether the quality of SNF care varies by the concentration of Medicare Advantage (MA) patients with dementia admitted to these SNFs.DesignCross-sectional study using 2016 data from Medicare certified providers.Setting and ParticipantsOur cohort included 177,396 beneficiaries with probable dementia from 8884 SNFs.MethodsWe examined facility-level quality of care among facilities with high and low proportions of Hispanic beneficiaries with probable dementia enrolled in MA and fee-for-service (FFS) using data from Medicare-certified providers. Three facility-level measures were used to assess quality of care: (1) 30-day rehospitalization rate; (2) successful discharge from the facility to the community; and (3) Medicare 5-star quality ratings.ResultsAbout 20% of residents were admitted to 1615 facilities with a resident population that was more than 15% Hispanic. Facilities with a higher share of Hispanic residents had a lower proportion of 4- or 5-star facilities by an average of 14% to 15% compared with facilities with little to no Hispanics. In addition, these facilities had a 1% higher readmission rate. There were also some differences in the quality of facilities with high (>26.5%) and low (<26.5%) proportions of MA beneficiaries. On average, SNFs with a high concentration of MA patients have lower readmission rates and higher successful discharge, but lower star ratings.Conclusions and ImplicationsAchieving better quality of care for people with dementia may require efforts to improve the quality of care among facilities with a high concentration of Hispanic residents.     

Disparities in Access to Easy-to-Use Services for Children with Special Health Care Needs

Objectives Families, clinicians and policymakers desire improved delivery of health and related services for children with special health care needs (CSHCN). We analyzed factors associated with ease of use in obtaining such services. We also explored what were specific difficulties or delays in receiving services. By examining data from the National Survey of Children with Special Health Care Needs (NS-CSHCN 2009–2010) and using the revised criteria for “ease of use,” we were able to assess the percentage of parents who reported that their experiences seeking services for their children met those criteria. Methods We performed Chi square tests to examine associations between the independent variables and their relationship to the difficulties or delays assessed in the survey; including: eligibility, availability of services, waiting lists, cost, and access to information. We used logistic regression to determine the association of meeting the “ease of use” criteria with socio-demographic, complexity of need, and access variables. Results Overall, a third of families of CSHCN (35.3 %) encounter difficulties, delays, or frustrations in obtaining health and related services. The lack of access to health and community services in this study fell most heavily on children from racial/ethnic minority backgrounds, those in poverty, and those with complex emotional/behavioral or developmental needs and functional limitations. Conclusions for Practice CSHCN require services from a broad array of providers across multiple systems. Unfortunately, there are certain difficulties that hamper the accessibility of these systems. These findings underscore the need for both practice-level response and systems-level reform to ensure equitable distribution of health and community resources.     

Why Health Care Needs Design Research: Broadening the Perspective on Communication in Pediatric Care Through Play

Today’s pediatric health care lacks methods to tap into the emotional state of hospitalized pediatric patients (age 4–6 years). The most frequently used approaches were developed for adults and fail to acknowledge the importance of imaginary experiences and the notion of play that may appeal to children. The scope of this article is to introduce a new design-oriented method of gathering information about the emotional state of pediatric patients using an experimental computer game called the Child Patient game (CPgame). The CPgame was developed at a Danish hospital, and the results of the preliminary tests show that games could serve as a system in which children are willing to express their emotions through play. The results are based on two comparative analyses of the CPgame through which it is possible to identify three different types of players among the patients playing the game. Furthermore, the data reveal that pediatric patients display a radically different play pattern than children who are not in hospital. The inquiry takes an interdisciplinary approach; it has obvious health care-related objectives and seeks to meet the urgent need for new methods within health care to optimize communication with young children. At the same time, design research (i.e., the development of new knowledge through the development of a new design) heavily impacts the method.     

Medical Home Care for Children With Special Needs: Access to Services and Family Burden

Medical home services, family burden, and time coordinating health care may differ across disorder groups. Children ages 3 to 17 years from the 2005–2006 National Survey of Children with Special Health Care Needs were divided into 5 groups: attention deficit hyperactivity disorder, mental health disorder, chronic illness, cognitive/developmental disorder, and healthy children. Children with mental health or cognitive/developmental conditions were significantly less likely to receive medical home services but more likely to present family burden, with similar findings for children from low socioeconomic status, exhibiting moderate to severe symptoms, and/or from non-White backgrounds. Health professionals must screen children for mental disorders and assist parents in obtaining necessary services.     

The Provision of Home Health Care Services Through Health Maintenance Organizations:

No abstract available for this article.     

Effects of Payment Changes on Trends in Post-Acute Care

Objective. To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies.
Data Sources. Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data.
Study Design. We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems.
Data Extraction Methods. A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement.
Principal Findings. Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill.
Conclusions. Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites.     

Children's Special Health Care Services Program: Impact of Administrative Changes on Rural Needs

This study measured the impact of 1993 Children's Special Health Care Services (CSHCS) program changes on the health care needs of rural children with chronic conditions who, in a 1991 study, were found to have significantly higher unmet health care needs compared to their urban counterparts. A follow-up survey was conducted in 1994 to 1995. The percentage of rural families indicating unmet needs declined for nearly all health-care-related items from 1991 to 1994-1995. The 1993 administrative changes in the CSHCS program have improved access to medical care and social support services for rural families, eliminating much of the urban-rural gap.