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The study aims to evaluate the benefits and advantages of opt-out rapid HIV screening and detection of HIV infection in emergency department patients. The results indicated that such screening resulted in a modest increase in identification of patients with HIV who were generally identified late in the course of their disease.

It is well documented that lack of health insurance has a negative effect on health status. Studies have shown that uninsured children are more likely to receive services through an [...], Objective. To examine differences in health care services utilization between children who are enrolled in the Child Health Insurance Plan (CHIP) and uninsured children and between children before and during their enrollment period in CHIP. Methods. Denver County CHIP enrollment data from 1998 through 2000 were merged with Denver Health utilization data from 1998 through 2000 to determine utilization rates for CHIP-enrolled children at Denver Health (n = 2005). The first method compared the rates of CHIP-enrolled children with those of uninsured children (n = 20 374) during the same time period. The second method compared the utilization of services for children enrolled in CHIP during 1999 before CHIP enrollment (n = 748) and during CHIP enrollment (n = 757). The outcomes measured include emergency, urgent care, specialty care, well-child care, dental visits, and immunizations. Results. For the first method, CHIP children were more likely to have well-child care, dental, and specialty visits and the recommended immunizations than uninsured children. They were less likely to have an emergency care visit than uninsured children. For the second method, before enrolling in CHIP, children had fewer outpatient visits and were less likely to have a well-child care visit than during their enrollment span in CHIP. There was not a significant difference before and during enrollment for the other outcome measures for these children. Conclusions. These results indicate that children who are enrolled in CHIP are more likely to receive preventive care services and less likely to use emergency care than uninsured children, even within a safety net institution, emphasizing the benefits of public insurance programs for children. Pediatrics 2002;110:940-945; CHIP, uninsured, immunizations, well-child care, safety net.

Abstract Background Most studies of diabetes self-management that show improved clinical outcome performance involve multiple, time-intensive educational sessions in a group format. Most provider performance feedback interventions do not improve intermediate outcomes, yet lack targeted, patient-level feedback. Methods 5,457 low-income adults with diabetes at eight federally-qualified community health centers participated in this nested randomized trial. Half of the patients received report card mailings quarterly; patients at 4 of 8 clinics received report cards at every clinic visit; and providers at 4 of 8 clinics received quarterly performance feedback with targeted patient-level data. Expert-recommended glycemic, lipid, and blood pressure outcomes were assessed. Assessment of report card utility and patient and provider satisfaction was conducted through mailed patient surveys and mid- and post-intervention provider interviews. Results Many providers and the majority of patients perceived the patient report card as being an effective tool. However, patient report card mailings did not improve process outcomes, nor did point-of-care distribution improve intermediate outcomes. Clinics with patient-level provider performance feedback achieved a greater absolute increase in the percentage of patients at target for glycemic control compared to control clinics (6.4% vs 3.8% respectively, Generalized estimating equations Standard Error 0.014, p < 0.001, CI -0.131 - -0.077). Provider reaction to performance feedback was mixed, with some citing frustration with the lack of both time and ancillary resources. Conclusions Patient performance report cards were generally well received by patients and providers, but were not associated with improved outcomes. Targeted, patient-level feedback to providers improved glycemic performance. Provider frustration highlights the need to supplement provider outreach efforts. Trial Registration ClinicalTrials.gov: NCT00827710

Background: There is a need for randomized, prospective trials of case management interventions with resource utilization analyses., Objectives: To determine whether algorithm-driven telephone care by nurses improves lipid control in patients with diabetes., Design: Prospective, randomized, controlled trial., Participants: Adults with diabetes at a federally funded community health center were randomly assigned to intervention (n = 381) or usual-care (n = 381) groups., Interventions: Nurses independently initiated and titrated lipid therapy and promoted behavioral change through motivational interviewing and self-management techniques. Other parameters of diabetes care were addressed based on time constraints., Main Measures: The primary outcome was the proportion of patients with a low-density lipoprotein (LDL) less than 100 mg/dL. Secondary outcomes included the number of hospital admissions, total hospital charges per patient, and the proportion of patients meeting other lipid, glycemic, and blood pressure guidelines., Key Results: The percent of patients with an LDL < 100 mg/dL increased from 52.0% to 58.5% in the intervention group and decreased from 55.6% to 46.7% in the control group (P < .01). Average cost per patient to the healthcare system was less for the intervention group ($6600 vs $9033, P = .03). Intervention patients trended toward fewer hospital admissions (P = .06). The intervention did not affect glycemic and blood pressure outcomes., Conclusions: Nurses can improve lipid control in patients with diabetes in a primarily indigent population through telephone care using moderately complex algorithms, but a more targeted approach is warranted. Telephone-based outreach may decrease resource utilization, but more study is needed.

To determine the impact of information technology on embedding the latent tuberculosis infection (LTBI) screening guidelines in an electronic medical record (EMR) in a large health care system. The long-term goal of the study is to test clinician adherence to LTBI screening guidelines using an EMR system. However, preliminary results are presented on the potential impact on providers on implementing the alerts on targeted high-risk patients.