Search

Purpose: We undertook a study to evaluate variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California, and its relationship to emergency department (ED) use after Medicaid expansion.Methods: We placed simulated calls by purported Medi-Cal enrollees to 581 primary care clinicians (PCCs) listed as accepting new patients in online directories of Medi-Cal managed care plans. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used in analyses. We developed multilevel, mixed-effect models to evaluate variation in appointment access. Multiple linear regression was used to examine the relationship between primary care access and ED use by county.Results: Availability of PCC new patient appointments to Medi-Cal enrollees lacking a PCC varied significantly across counties in the multilevel model, ranging from 77 enrollees (95% CI, 70-81) to 472 enrollees (95% CI, 378-628) per each available new patient appointment. Just 19% of PCCs had available appointments within the state-mandated 10 business days. Clinicians at Federally Qualified Health Centers had higher availability of new patient appointments (rate ratio = 1.56; 95% CI, 1.24-1.97). Counties with poorer PCC access had higher ED use by Medi-Cal enrollees.Conclusions: In contrast to findings from other states, access to primary care in Northern California was limited for new patient Medi-Cal enrollees and varied across counties, despite standard statewide reimbursement rates. Counties with more limited access to primary care new patient appointments had higher ED use by Medi-Cal enrollees. [ABSTRACT FROM AUTHOR]

This study looks at the educational outcomes of adopted children as perceived by their parents. Descriptive and multivariate analyses were performed using data from the 2007–2008 National Survey of Adoptive Parents. Our findings suggest that adoptive parents believe math and reading performance to be affected by special health care needs and household income. The odds of truancy and suspension are also believed to be affected by special heath care needs and gender. Though educational disruptions are infrequent, few adopted children perform at or above average in reading or math. These findings can be used to inform policy makers about post-adoption services. [ABSTRACT FROM PUBLISHER]

U.S. emergency departments are experiencing extreme levels of crowding. This study estimates the impact of emergency department crowding on patient mortality. Identification relies on the abrupt crowding shocks felt by "old" emergency departments at the time a new emergency department opens nearby. Using death records linked to hospital administrative records, I find that a 10% alleviation of emergency department patient volume significantly lowers the average patient's chance of mortality. Improvements appear to be realized both inside the hospital and after the patient has left. [ABSTRACT FROM AUTHOR]