Search

BACKGROUND: Many states recently have experimented with managed care as a way both to control costs and to enhance continuity of care in their publicly financed programs. A few states have applied managed care models to the care of chronically ill children. One marker for the effects of managed care is changes in use of the emergency department (ED). OBJECTIVE: We sought to determine whether a managed care program can reduce ED use for children with chronic health problems. SUBJECTS: We studied chronically ill children who were dually enrolled in Michigan's Title V program for children with special health care needs and Medicaid and who were enrolled in a managed care option at some time during the study period. The managed care model emphasized care coordination and did not include strong financial incentives for utilization and cost control. Sample consisted of 8580 person-months. METHOD: We used a fixed-effect negative binomial Poisson regression model to compare ED use before and after joining a managed care plan to test whether managed care use was associated with reduced likelihood of ED use. RESULTS: Managed care enrollment was associated with a 23% reduction in the incidence of ED use among children dually enrolled in Medicaid and Title V. CONCLUSIONS: A managed care model is associated with statistically significant and substantive reductions in observed use of ED care within an important population of children facing chronic illness. [ABSTRACT FROM AUTHOR]

Objective: To estimate trends in the prevalence of methamphetamine treatment during pregnancy in the United States., Methods: Data were obtained from the Treatment Episode Data Set, an administrative data set that captures admissions to federally funded treatment centers in the United States. Demographic and treatment-related measures were examined among women admitted for methamphetamine use and stratified by year of admission to assess trends over time., Results: From 1994 to 2006 there were 245,970 pregnant women admitted. In 1994, methamphetamine accounted for 8% of admitted pregnant women, rising to 24% by 2006. This proportion was higher than methamphetamine admissions among both nonpregnant women (12%) and men (7%). The majority of methamphetamine admissions occurred in the West (73%) among white (64%) unemployed (88%) women. Over the time of analysis, women admitted for methamphetamine treatment became sicker (measured by increasing co-occurring psychiatric disorders) and more marginalized (measured by increasing dependent-living situations and criminal justice involvement)., Conclusion: Methamphetamine has become the primary substance compelling treatment during pregnancy. Our findings suggest a need for more effective drug and alcohol screening by clinicians who are positioned to identify and address such concerns outside the criminal justice system., Level of Evidence: III.