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Michael Rachlis. Prescription for Excellence: How Innovation is Saving Canada's Health Care System. Toronto: HarperCollins Publishers Ltd., 2004. xiv + 418 pp. $32.95 cloth. There is no aspect of Canadian [...]

Objective. Although privately owned practices provide the majority of primary care for children, little is known about the organizational characteristics of these practices or how these characteristics affect the quality of care for children. The purpose of this study was to describe selected organizational characteristics and preventive service delivery features that might affect the quality of primary care for children in private practices. Methods. A cross-sectional study of 44 private pediatric and family medicine practices in 2 regions of North Carolina was performed. Preventive service performance was assessed through chart abstraction for 60 randomly selected children between 24 and 30 months of age, for evaluation of immunizations and anemia, tuberculosis, and lead screening delivery by 2 years of age. Organizational characteristics were determined through surveys of all physicians and staff members. We used descriptive statistics and scatter plots to describe variations in organizational characteristics and preventive services. Results. Overall, practices demonstrated low levels of preventive service performance, with substantial variation among practices. Only 39% of children received 3 of the 4 recommended preventive services measured (practice range: 2-88%). Few practices demonstrated evidence of a systematic approach to prevention. For example, only 12 (27%) of the 44 practices used >1 of 5 recommended preventive service delivery strategies. Furthermore, practices varied greatly with respect to many of the measured organizational characteristics, which were consistent with organizational stress in some cases. For example, turnover of clinicians and staff members was remarkably high, with practices losing an average of 27% of their clinicians every 4 years (range: 0-170%) and 39% of their office staff members every 2 years (range: 0-170%). Conclusions. Private practices caring for children in North Carolina demonstrated low overall performance for the 4 recommended preventive services examined, with large variations among practices. Few practices had evidence of comprehensive systems for prevention. There was also evidence of substantial variation in many organizational characteristics. Some organizational characteristics were at levels that might impede delivery of high-quality primary care for children. These findings suggest a growing need for research that examines the impact of organizational characteristics on the quality of care in private practices. Pediatrics 2005;115:1704-1711; private practices, preventive services, organizational management. ABBREVIATIONS. FTE, full-time equivalent; RCT, randomized, controlled trial; OSI, Office Systems Index., In a recent report on health care quality, the Institute of Medicine recommended fundamental change in the US health care system, citing remarkable variation as well as shortcomings in many [...]

Objectives. We measured the effect of Hurricane Floyd on Medicaid enrollment and health services use in the most severely affected counties of North Carolina. Methods. We used differences-in-differences models on balanced panels of Medicaid claims and enrollment data. Results. Overall spending per enrollee showed little short-term effect but demonstrated a moderate increase 1 year after the storm. We found very modest short-term increases in Medicaid enrollment, a small long-term decrease in enrollment, and large increases in the long-term use of emergency room and outpatient services. Conclusions. Our findings suggest that hurricane victims experienced substantial changes in patterns of care that endured for much longer than the initial crisis period. These findings can have important implications for the management of disaster relief for this population.

Limited understanding of factors such as travel time, availability of emergency obstetric care (EmOC), and satisfaction/perceived quality of care on the utilisation of maternal health services exists in fragile and conflict-affect settings. We examined these key factors on three utilisation outcomes: at least one skilled antenatal care (ANC) visit, in-facility delivery, and bypassing the nearest public facility for childbirth in Afghanistan from 2010 to 2015. We used three-level multilevel mixed effects logistic regression models to assess the relationships between women's and their nearest public facilities' characteristics and outcomes. The nearest facility score for satisfaction/perceived quality was associated with having at least one skilled ANC visit (AOR: 2.02, 95% CI: 1.21, 3.36). Women whose nearest facility provided EmOC had a higher odds of in-facility childbirth compared to women whose nearest facility did not (AOR: 1.24, 95% CI: 1.04, 1.48). Nearest hospital travel time (AOR: 0.95, 95% CI: 0.93, 0.98) and nearest facility satisfaction/perceived quality (AOR: 0.34, 95% CI: 0.14, 0.82) were associated with lower odds of women bypassing their nearest facility. Afghanistan has made progress in expanding access to maternal healthcare services during the ongoing conflict. Addressing key barriers is essential to ensure that women have access to life-saving services. [ABSTRACT FROM AUTHOR]