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Abstract Background As U.S. legislators are urged to combat ghost networks in behavioral health and address the provider data quality issue, it becomes important to better characterize the variation in data quality of provider directories to understand root causes and devise solutions. Therefore, this manuscript examines consistency of address, phone number, and specialty information for physician entries from 5 national health plan provider directories by insurer, physician specialty, and state. Methods We included all physicians in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) found in ≥ 2 health insurer physician directories across 5 large national U.S. health insurers. We examined variation in consistency of address, phone number, and specialty information among physicians by insurer, physician specialty, and state. Results Of 634,914 unique physicians in the PECOS database, 449,282 were found in ≥ 2 directories and included in our sample. Across insurers, consistency of address information varied from 16.5 to 27.9%, consistency of phone number information varied from 16.0 to 27.4%, and consistency of specialty information varied from 64.2 to 68.0%. General practice, family medicine, plastic surgery, and dermatology physicians had the highest consistency of addresses (37-42%) and phone numbers (37-43%), whereas anesthesiology, nuclear medicine, radiology, and emergency medicine had the lowest consistency of addresses (11-21%) and phone numbers (9-14%) across health insurer directories. There was marked variation in consistency of address, phone number, and specialty information by state. Conclusions In evaluating a large national sample of U.S. physicians, we found minimal variation in provider directory consistency by insurer, suggesting that this is a systemic problem that insurers have not solved, and considerable variation by physician specialty with higher quality data among more patient-facing specialties, suggesting that physicians may respond to incentives to improve data quality. These data highlight the importance of novel policy solutions that leverage technology targeting data quality to centralize provider directories so as not to not reinforce existing data quality issues or policy solutions to create national and state-level standards that target both insurers and physician groups to maximize quality of provider information.

Background: As U.S. legislators are urged to combat ghost networks in behavioral health and address the provider data quality issue, it becomes important to better characterize the variation in data quality of provider directories to understand root causes and devise solutions. Therefore, this manuscript examines consistency of address, phone number, and specialty information for physician entries from 5 national health plan provider directories by insurer, physician specialty, and state. Methods: We included all physicians in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) found in ≥ 2 health insurer physician directories across 5 large national U.S. health insurers. We examined variation in consistency of address, phone number, and specialty information among physicians by insurer, physician specialty, and state. Results: Of 634,914 unique physicians in the PECOS database, 449,282 were found in ≥ 2 directories and included in our sample. Across insurers, consistency of address information varied from 16.5 to 27.9%, consistency of phone number information varied from 16.0 to 27.4%, and consistency of specialty information varied from 64.2 to 68.0%. General practice, family medicine, plastic surgery, and dermatology physicians had the highest consistency of addresses (37-42%) and phone numbers (37-43%), whereas anesthesiology, nuclear medicine, radiology, and emergency medicine had the lowest consistency of addresses (11-21%) and phone numbers (9-14%) across health insurer directories. There was marked variation in consistency of address, phone number, and specialty information by state. Conclusions: In evaluating a large national sample of U.S. physicians, we found minimal variation in provider directory consistency by insurer, suggesting that this is a systemic problem that insurers have not solved, and considerable variation by physician specialty with higher quality data among more patient-facing specialties, suggesting that physicians may respond to incentives to improve data quality. These data highlight the importance of novel policy solutions that leverage technology targeting data quality to centralize provider directories so as not to not reinforce existing data quality issues or policy solutions to create national and state-level standards that target both insurers and physician groups to maximize quality of provider information. [ABSTRACT FROM AUTHOR]

Flock health planning has been advocated as part of a wider drive within livestock production for veterinarians and farmers to adopt a prevention‐focused approach to veterinary medicine. This approach has, at its core, a cyclical process of assessment, evaluation, action and re‐assessment, and is documented, at least in summary, in a health plan (HP). The HP has become a defining pillar of farm quality assurance schemes (QASs), introduced to address calls for greater transparency and accountability in food production. There is limited current information on the attitudes and behaviours surrounding flock HPs in the sheep sector and the barriers to greater involvement in an active process of continual improvement through reflective flock health planning. This study aims to address these issues with reference to the national flock in Northern Ireland. A mixed‐methods approach was used to explore farmers' and veterinarians' opinions and behaviours related to QASs and HP, with data obtained through an online scoping questionnaire, semi‐structured interviews with 27 farmers and 15 veterinarians, and discussion groups with farmers and veterinarians. No evidence of a positive association between a farm having a HP and implementation of 12 industry‐recommended flock health activities was identified using the Fisher's exact test. Farmers reported a reluctance to pay for veterinary advice while some veterinarians reported a lack of time to develop HPs for farmers, and sheep‐related work generally. Farmers predominantly saw the HP as a static, physical document, which had limited impact on their management practices, rather than a proactive, reflective and collaborative planning process. Veterinarians tasked with completing HPs felt restricted by limited knowledge of on‐farm practices, flock production data and a lack of confidence in the accuracy of on‐farm medicine records. This led some to believe that the HPs may fail to address critical issues. A new approach to engage farmers and veterinarians together in active flock health planning needs to be developed. This will need a sustainable delivery plan. Then the focus can be shifted towards ongoing reflective health planning to drive change for the betterment of sheep health and welfare. [ABSTRACT FROM AUTHOR]

Purpose Our community hospital was recently charged with providing care for pediatric people with cystic fibrosis (PwCF). Pediatric PwCF generally need a higher level of care than is required by other pediatric patients cared for at our institution. This project aimed to prepare the pharmacy department to care for this specialized population safely and efficiently. Summary The implementation process was divided into 3 phases to accomplish the larger purpose. These phases were as follows: (1) creating order sets and protocols; (2) providing staff and clinical pharmacists with training and resources; and (3) creating and managing clinical decision support. The central aspect of preparing inpatient pharmacy staff to care for PwCF was the development of antibiotic dosing protocols and order sets comprised of intravenous and oral antibiotics as well as aminoglycoside and vancomycin pharmacokinetic guides. A pharmacokinetic calculator was created to assist with aminoglycoside dosing and monitoring. During phase 2, pharmacist education modules were created to provide guidance on cystic fibrosis and medications commonly used to treat it. As the newly designed protocols were enacted, education was provided on how to use them. Phase 3 occurred concurrently, as clinical decision support was vital to completing phases 1 and 2. Conclusion The phased approach was imperative to the project's success and kept individual components on track. All parts were completed in just over one year. [ABSTRACT FROM AUTHOR]

Ehsan Ameri 1, Ali Farhadi Mahali2 , Mojtaba Tabari3 Background: Improving the quality of visit services in laboratories of medical-teaching centers of universities of medical sciences plays a major role in providing better services to patients. The present study aimed to evaluate the policy of improving the quality of visit services of the reform plan in laboratories of medical-teaching centers in Golestan province. Methods: The present research was cross-sectional and had a descriptive-analytical type. A total of 384 staff in the diagnostic laboratories were selected for the study using a simple random sampling method. The data collection tool included a 35-item researcher-made questionnaire. Results: There was a gap between the current and desired status of the fourth axis of the health system reform plan. The gap was about -0.01, indicating that there was a gap between the current and desired status and it was related to the supervision department according to the respondents in the target statistical population. Conclusion: The implementation of this plan was effective in improving the quality of visit services in laboratories of medical-teaching centers in Golestan province but this effectiveness did not meet the goals of the fourth axis of the reform plan. Therefore, the factors, which caused a lack of supervision among the executive departments of laboratories of medical-teaching centers in Golestan province, should be removed for increasing the effectiveness of this plan.

Climate change has a particularly detrimental effect on the cardiovascular system, which is highly vulnerable to harmful impacts. The accumulation of particulate matter (PM) and greenhouse gasses in the environment negatively impacts the cardiovascular system through several mechanisms. The burden of climate change-related diseases falls disproportionately on vulnerable populations, including the elderly, the poor, and those with pre-existing health conditions. A key component of addressing the complex interplay between climate change and cardiovascular diseases is acknowledging health disparities among vulnerable populations resulting from climate change, familiarizing themselves with strategies for adapting to changing conditions, educating patients about climate-related cardiovascular risks, and advocating for policies that promote cleaner environments and sustainable practices. [ABSTRACT FROM AUTHOR]

Background: Improving the quality of visit services in laboratories of medical-teaching centers of universities of medical sciences plays a major role in providing better services to patients. The present study aimed to evaluate the policy of improving the quality of visit services of the reform plan in laboratories of medical-teaching centers in Golestan province. Methods: The present research was cross-sectional and had a descriptive-analytical type. A total of 384 staff in the diagnostic laboratories were selected for the study using a simple random sampling method. The data collection tool included a 35-item researcher-made questionnaire. Results: There was a gap between the current and desired status of the fourth axis of the health system reform plan. The gap was about -0.01, indicating that there was a gap between the current and desired status and it was related to the supervision department according to the respondents in the target statistical population. Conclusion: The implementation of this plan was effective in improving the quality of visit services in laboratories of medical-teaching centers in Golestan province but this effectiveness did not meet the goals of the fourth axis of the reform plan. Therefore, the factors, which caused a lack of supervision among the executive departments of laboratories of medical-teaching centers in Golestan province, should be removed for increasing the effectiveness of this plan [ABSTRACT FROM AUTHOR]

Physical activity is recommended as first-choice treatment in chronic pain conditions. The aim was to describe the content and perceptions of person-centred health plans, and to evaluate patients' implementation of the health plan in their everyday life. A descriptive retrospective review was conducted of person-centred health plans to support physical activity in 133 participants. Quantitative content analysis was used to analyse the content of the health plans. Questionnaires on physical activity and on implementation and perception of the health plans, and a test of physical capacity were administered. Participants' goals were found to be related to physical function (n = 118), general health (n = 90), activity and participation (n = 80) and symptoms (n = 35). Participants identified personal (n = 174), social (n = 69) and material resources (n = 36). They identified fears and obstacles related to health issues (n = 95), difficulties getting it done (n = 41), competing priorities (n = 19) and contextual factors (n = 12). Participants identified need for external support (n = 110). Participants' level of physical activity and physical capacity increased significantly during the first 6 months of the study. The person-centred approach seems helpful in enhancing motivation to achieve set goals and strengthen self-efficacy in physical activity also supported by increased physical activity and physical capacity. A person-centred approach can be helpful to enhance motivation to achieve set goals and self-efficacy to manage symptoms when engaging in physical activity. Shared documentation of a personal health plan helps to visualize resources to promote regular physical activity as well as alternative ways to reach set goals. The co-created health-plan captures the participant's goals, resources, fears and need of support, helps the participant to overcome challenges, and supports the participant to be physically active. [ABSTRACT FROM AUTHOR]

Preventing pathogens from entering and spreading on farms is the first step in reducing health problems. For this study a BiosEcurity Assessment Tool was developed to identify strengths and weaknesses in biosecurity on broiler farms, which was used as a starting point to formulate tailor-made health plans to improve broiler health and reduce antimicrobial use. Farms were divided into 3 separate areas according to associated biosecurity risk; high disease risk external areas (red zone), medium risk service areas (orange zone), and the clean and highly secure access-restricted green zone. In the Netherlands, Cyprus, and Greece, 13, 15, and 7 broiler houses were monitored for 4 production cycles (2 preintervention and 2 postintervention cycles). At the start of the study the BiosEcurity Assessment Tool assessment was performed and a health plan was made in consultation with the veterinarian. After the second cycle a start was made with the implementation of the health plan. Overall, the biosecurity level in the green and orange zones were significantly higher in the Netherlands compared to Greece and Cyprus, but there was no difference for the red zone or the transition zones between the countries. The interventions in the health plans were mostly directed towards those measures that could be implemented in the short term and with low costs in the green zone. In Cyprus a decrease in antimicrobial use was found postintervention. This was not the case in Greece and the Netherlands. In Cyprus and Greece footpad lesion improved after interventions were implemented, although this may have been an effect of season. In Dutch farms no improvement was detected, but both antimicrobial use and footpad lesions were lower at the start of the study compared to Cypriot and Greek farms. In conclusion, the BEAT shows to be a promising tool to assess biosecurity risks on broiler farms. The biosecurity assessment in combination with the farm specific health plans could contribute to antimicrobial reduction on broiler farms.

Background: Migraine is a common neurological disorder characterized by repeated headaches of varying intensity. The prevalence and severity of migraine headaches disproportionally affects women, particularly during the postpartum period. Moreover, migraines during pregnancy have been associated with adverse maternal outcomes, including preeclampsia and postpartum stroke. However, due to the lack of a validated instrument for uniform case ascertainment on postpartum migraine headache, there is uncertainty in the reported prevalence in the literature. Objective: The aim of this study was to evaluate the completeness and accuracy of reporting postpartum migraine headache coding in a large integrated health care system's electronic health records (EHRs) and to compare the coding quality before and after the implementation of the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes and pharmacy records in EHRs. Methods: Medical records of 200 deliveries in all 15 Kaiser Permanente Southern California hospitals during 2 time periods, that is, January 1, 2012 through December 31, 2014 (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9-CM] coding period) and January 1, 2017 through December 31, 2019 (ICD-10-CM coding period), were randomly selected from EHRs for chart review. Two trained research associates reviewed the EHRs for all 200 women for postpartum migraine headache cases documented within 1 year after delivery. Women were considered to have postpartum migraine headache if either a mention of migraine headache (yes for diagnosis) or a prescription for treatment of migraine headache (yes for pharmacy records) was noted in the electronic chart. Results from the chart abstraction served as the gold standard and were compared with corresponding diagnosis and pharmacy prescription utilization records for both ICD-9-CM and ICD-10-CM coding periods through comparisons of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), as well as the summary statistics of F-score and Youden J statistic (J). The kappa statistic (κ) for interrater reliability was calculated. Results: The overall agreement between the identification of migraine headache using diagnosis codes and pharmacy records compared to the medical record review was strong. Diagnosis coding (F-score=87.8%; J=82.5%) did better than pharmacy records (F-score=72.7%; J=57.5%) when identifying cases, but combining both of these sources of data produced much greater accuracy in the identification of postpartum migraine cases (F-score=96.9%; J=99.7%) with sensitivity, specificity, PPV, and NPV of 100%, 99.7%, 93.9%, and 100%, respectively. Results were similar across the ICD-9-CM (F-score=98.7%, J=99.9%) and ICD-10-CM coding periods (F-score=94.9%; J=99.6%). The interrater reliability between the 2 research associates for postpartum migraine headache was 100%. Conclusions: Neither diagnostic codes nor pharmacy records alone are sufficient for identifying postpartum migraine cases reliably, but when used together, they are quite reliable. The completeness of the data remained similar after the implementation of the ICD-10-CM coding in the EHR system. [ABSTRACT FROM AUTHOR]

ObjectiveOut-of-network emergency department (ED) use, or use that occurs outside the contracted network, may lead to increased care fragmentation and cost. We examined factors associated with out-of-network ED use among Medicaid beneficiaries.Data sources and study settingEnrollment, claims, and encounter data for adult Medi-Cal health plan members with 1+ ED visits and complete Medicaid eligibility during the study period from 2013 to 2014.Study designWe analyzed the data to identify factors associated with out-of-network ED use classified by mode of arrival (ambulance vs. nonambulance).Data extraction methodsWe extracted encounter, ambulance, and ED census data and linked them together based on ED visit date.Principal findingsOf 11,143 ED visits, 6,808 (61.1 percent) were out-of-network. The number of hours the study ED was on ambulance diversion increased the odds of out-of-network visits for the 3,365 (30.2 percent) ED visits arriving by ambulance. For all visit types, assignment to a primary care clinic at the in-network hospital and having had any primary care visit during the study period decreased the odds of out-of-network ED care. Individuals were more likely to go out-of-network for ED care if they lived in neighborhoods containing out-of-network EDs.ConclusionsThere are a number of factors related to out-of-network ED use, including the proximity and density of out-of-network EDs, race and ethnicity, a prior history of out-of-network ED use, and individuals' connection to primary care. EDs that serve Medicaid beneficiaries may need to explore alternative sites and modalities of care as alternatives to the ED, and consider their ability to absorb large numbers of out-of-network visits given already limited capacity.

Higher scrutiny is befalling public payors regarding drug costs and patient access to medications. These issues exist in a complex contractual environment where minimal oversight of pharmacy claim adjudication and reimbursement practices can occur. The complexity of prescription benefits, and the lack of defined expectations or accountability in the system contribute to a sense of frustration by the public. Key areas of improvement for this sector of the health care industry include legislative and regulatory shifts requiring ongoing analyses, reporting, and accountability of pharmacy benefit managers (PBMs) in order to improve payment transparency. These improvements will enable plans to eliminate misaligned incentives in the industry and drive value. Changes in public sector programs should be comprehensive in their approach so that the policy will result in a reduction in costs, enhanced patient access, better patient safety, and improved health outcomes. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to design a comprehensive model to evaluate the health system reform plan so the indicators of this model can lead to the health reform planchr('39')s effectiveness. Hence, this planchr('39')s effective factors, including policymakers and managers, suppliers, and clients, were identified and explained. Methods: According to the practical purpose and nature of the research, the combined/mixed research method was used, in 2018-2019. For the qualitative phase, the Delphi technique was used in exploratory interviews, and quantitative methods were used to collect data through a questionnaire. In the quantitative phase, 400 employees of 10 hospitals were selected by stratified random sampling; and in the second section, 300 clients were randomly selected in two hospitals with the highest and lowest evaluation scores in the previous phase. Content analysis method and Delphi technique were used for classification and analysis of qualitative data, and SPSS Ver.22, AMOS Ver.24, and Expert Choicev24 were used for data description and dimensions and indiceschr('39') weight extraction. Dimensions under consideration include the financial, social responsibility, growth and learning, citizens and client, and internal process fields. Results: The components with the highest and lowest weight and impact on the effectiveness of the plan were identified in the following dimensions: financial field, Social responsibility field, growth and learning field, citizens and client field, internal process field, including weights 0.266, 0.244, 0.202, 0.164, 0.124, respectively. Conclusion: Given the results, the components, indicators, dimensions, and levels of the model designed, the comprehensive evaluation of the Health System Reform Plan in Iran (CEHSRP-IR) with the normal mean was confirmed by the statistical population, and this model can be used in all organizations implementing this plan.

As healthcare information technology (HIT) advances, major stakeholders in the healthcare industry such as healthcare providers, health plan organizations, and business associates are generating and exchanging enormous amounts of patient data throughout the healthcare supply chain. Along with the explosive growth of electronic patient data, these stakeholders have experienced an increasing number of data breaches. Despite the significant consequences of the data breaches such as the loss of client privacy, regulatory penalty, and financial loss, there is a lack of studies on sector level trend analysis and risk profiling. This study develops a diversity index that can be used to compare the distribution of data breaches between three sectors of the healthcare industry. To enhance the understanding of the data breaches, this study utilizes a temporal aggregation of the data breaches, analyzes data breach risks, and develops a data-driven risk profile. The findings of this study can be used to improve the cybersecurity management of healthcare organizations. [ABSTRACT FROM AUTHOR]

Background: Health insurance plans are increasingly offering mailed fecal immunochemical test (FIT) programs for colorectal cancer (CRC) screening, but few studies have compared the outcomes of different program models (eg, invitation strategies). Methods: This study compares the outcomes of 2 health plan–based mailed FIT program models. In the first program (2016), FIT kits were mailed to all eligible enrollees; in the second program (2018), FIT kits were mailed only to enrollees who opted in after an outreach phone call. Participants in this observational study included dual‐eligible Medicaid/Medicare enrollees who were aged 50 to 75 years and were due for CRC screening (1799 in 2016 and 1906 in 2018). Six‐month FIT completion rates, implementation outcomes (eg, mailed FITs sent and reminders attempted), and program‐related health plan costs for each program are described. Results: All 1799 individuals in 2016 were sent an introductory letter and a FIT kit. In 2018, all 1906 were sent an introductory letter, and 1905 received at least 1 opt‐in call attempt, with 410 (21.5%) sent a FIT. The FIT completion rate was 16.2% (292 of 1799 [95% CI, 14.5%‐17.9%]) in 2016 and 14.6% (278 of 1906 [95% CI, 13.0%‐16.2%]) in 2018 (P =.36). The overall implementation costs were higher in 2016 ($40,156) than 2018 ($34,899), with the cost per completed FIT slightly higher in 2016 ($138) than 2018 ($126). Conclusions: An opt‐in mailed FIT program achieved FIT completion rates similar to those of a program mailing to all dual‐eligible Medicaid/Medicare enrollees. Lay Summary: Health insurance plans can use different program models to successfully mail fecal test kits for colorectal cancer screening to dual‐eligible Medicaid/Medicare enrollees, with nearly 1 in 6 enrollees completing fecal testing. In this study, a health insurance plan demonstrates its ability to deliver 2 different mailed fecal immunochemical test (FIT) program models, with vendors used to manage some program elements. These mailed FIT programs began to close gaps in colorectal cancer screening rates in the health plan's dual‐eligible Medicaid/Medicare population. [ABSTRACT FROM AUTHOR]

Statement of the Problem: The oral health reform plan has been added to the Iran's health reform plan since the beginning of 2015. Evaluation of Iran’s oral health reform plan has rarely been conducted. Purpose: The aim of this study was to evaluate the change in DMFT among the six-grade primary school children of the city of Shiraz, two years after implementation of oral health reform plan. Materials and Method: A repeated cross-sectional study was conducted on six-grade primary school children of Shiraz in 2015 and 2017. About four hundred children were selected each year by cluster randomization sampling. The schools were randomly selected from three socioeconomically different types of schools including private schools, state schools in affluent areas, and state schools in deprived areas. The DMFT Index of selected children was compared between 2015 and 2017, and among three socioeconomically different areas. One-way ANOVA and Poisson regression tests were used for statistical analysis. Results: The mean DMFT of children was 1.47±1.83 in 2015 and 1.29±1.79 in 2017. There was significant difference in mean DMFT value between years 2015 and 2017 (p= 0.048). The percentage of children with untreated dental caries was 46% and 36.7% in 2015 and 2017 respectively. There was no statistically difference in DMFT of the three socioeconomically different schools. Conclusion: There has been significant improvement in DMFT of sixth grade school children of Shiraz two years after implementation of oral health reform plan.

Today, health is a human right in India, and the government is working hard for universalization of health services provision till the grassroots. Health without accountability is a challenging task in hand, and recently, state governments drafted a bill toward public health system to move in the strengthened direction of accountability mechanism. Accountability is the quality or state of being accountable, and it is an important component of the health-care reforms in India. This article provides more nuanced understanding of accountability which includes the specification of accountability, conceptual framework of accountability, and its potential approaches for how accountability is viewed today in India with reference to the Central, State, District, and other stakeholders. It examines the role of accountability in making accountable health plans, and its relationship governance/ownership structures as a key component of health-care reforms as improved accountability is a major element in improving the health system performance. The article elaborates on the definition of accountability in terms of answerability and sanctions and distinguishes the three types of accountability, namely financial, performance, and political/democratic. The article describes three accountability-enhancing strategies, namely reducing the pilferage, assuring acquiescence with procedures and standards, and improved learning from the past experience. The recent events in Indian health care put forward a serious issue on how accountability can be fixed if health mishaps happened and how we can make our health plans accountable to the needs and aspiration for the people of India. Overall, the accountability is discouraging and more needs to be done to enhance the accountability compliance in India.

Background: The purpose of this study is to evaluate a relationship between expansion of High Deductible Health Plans (HDHPs) and the number of thyroid surgery cases with associated postoperative outcomes in the fiscal year., Methods: Data from TriNetX was used to evaluate the trends in thyroid surgery from 2005 and 2021 between the end of the year (Quarter 4) and the beginning of the year (Quarter 1). Risk of postoperative outcomes were statistically interrogated., Results: The average rate of thyroid surgery in cases/year between Quarter 4 and Quarter 1 was similar after expansion of HDHPs (152; 146; p = 0.64). There was no increased risk of postoperative complications. The rate of surgery decreased significantly for patients with Medicare after implementation of the revised American Thyroid Association (ATA) guidelines (Quarter 4: p = 0.03; Quarter 1: p = 0.02)., Conclusions: Patients are less likely to delay thyroid surgery at the end of the year despite higher deductibles., Competing Interests: Declaration of competing interest There are no outside sources of funding and no conflicts of interest. Acknowledgements: Stacy M. Schreiber-Lopez, for assisting with the UTMB Institutional Review Board., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Homelessness is a pervasive public health problem in the United States (U.S.). Under the U.S. Affordable Care Act, the nation's public health insurance program (Medicaid) was expanded to serve more individuals, including those experiencing homelessness. Coupled with changes in financial incentives designed to reduce healthcare costs, health plans, hospitals and large health systems have started to operate permanent supportive housing (PSH) programmes as a healthcare benefit. To better understand patient perceptions of care coordination in a PSH programme operated by a large health plan in Southern California, we conducted 22 semi‐structured in‐depth patient interviews between October and November 2019. Two coders analysed these data inductively and deductively, using pre‐identified domains and open coding. Coding reliability and thematic saturation were also assessed. Findings indicated positive experiences with care coordination for physical health and social supports, such as food distribution and transportation. Identified service gaps included mental health support and help securing public assistance (e.g., cash benefits). Opportunities to enhance PSH care coordination were also identified, such as the need for a simplified approach. Hospitals, health plans and systems considering PSH programmes may look to these results for implementation guidance. [ABSTRACT FROM AUTHOR]

Objective: To determine how Medicare Advantage (MA) health plan networks impact access to high-volume hospitals for cancer surgery. Background: Cancer surgery at high-volume hospitals is associated with better short- and long-term outcomes. In the United States, health insurance is a major detriment to seeking care at high-volume hospitals. A third of older (>65 years) Americans are enrolled in privatized MA health plans. The impact of MA plan networks on access to high-volume surgery hospitals is unknown. Methods: We analyzed in-network hospitals for MA plans offered in Los Angeles county during open enrollment of 2015. For the purposes of this analysis, MA network data from provider directories were linked to hospital volume data from California Office of Statewide Health Planning and Development. Volume thresholds were based on published literature. Results: A total of 34MAplans enrolled 554,754 beneficiaries in Los Angeles county during 2014 open enrollment for coverage starting in 2015 (MA penetration ~43%). The proportion of MA plans that included high-volume cancer surgery hospital varied by the type of cancer surgery. While most plans (>71%) included at least one high-volume hospital for colon, rectum, lung, and stomach; 59% to 82% of MA plans did not include any high-volume hospitals for liver, esophagus, or pancreatic surgery. A significant proportion of beneficiaries in MA plans did not have access to high-volume hospitals for esophagus (93%), stomach (44%), liver (39%), or pancreas (70%) surgery. In contrast, nearly all MA beneficiaries had access to at least one high-volume hospital for lung (93%), colon (100%), or rectal (100%) surgery. Overall, Centers for Medicare & Medicaid Services plan rating or plan popularity were not correlated with access to high-volume hospital (P > 0.05). Conclusions: The study identifies lack of high-volume hospital coverage in MA health plans as a major detriment in regionalization of cancer surgery impacting at least a third of older Americans. [ABSTRACT FROM AUTHOR]

This report provides a pre-reform snapshot of health status and utilization characteristics of Californians who were either enrolled in commercial or public managed care plans or who were uninsured in 2007. Using the most recently available data from the 2007 California Health Interview Survey (CHIS), this report provides a detailed profile of demographic characteristics, disease conditions, health status, health care use, and barriers to care among California residents. Among the findings are a high need for certain types of health care, such as mental health services, as well as a growing reliance on high-deductible health plans, especially among the low-income and self-employed.

Statement of the Problem: The oral health reform plan has been added to the Iran's health reform plan since the beginning of 2015. Evaluation of Iran's oral health reform plan has rarely been conducted. Purpose: The aim of this study was to evaluate the change in DMFT among the six-grade primary school children of the city of Shiraz, two years after implementation of oral health reform plan. Materials and Method: A repeated cross-sectional study was conducted on six-grade primary school children of Shiraz in 2015 and 2017. About four hundred children were selected each year by cluster randomization sampling. The schools were randomly selected from three socioeconomically different types of schools including private schools, state schools in affluent areas, and state schools in deprived areas. The DMFT Index of selected children was compared between 2015 and 2017, and among three socioeconomically different areas. Oneway ANOVA and Poisson regression tests were used for statistical analysis. Results: The mean DMFT of children was 1.47±1.83 in 2015 and 1.29±1.79 in 2017. There was significant difference in mean DMFT value between years 2015 and 2017 (p= 0.048). The percentage of children with untreated dental caries was 46% and 36.7% in 2015 and 2017 respectively. There was no statistically difference in DMFT of the three socioeconomically different schools. Conclusion: There has been significant improvement in DMFT of sixth grade school children of Shiraz two years after implementation of oral health reform plan. [ABSTRACT FROM AUTHOR]

Today, health is a human right in India, and the government is working hard for universalization of health services provision till the grassroots. Health without accountability is a challenging task in hand, and recently, state governments drafted a bill toward public health system to move in the strengthened direction of accountability mechanism. Accountability is the quality or state of being accountable, and it is an important component of the health-care reforms in India. This article provides more nuanced understanding of accountability which includes the specification of accountability, conceptual framework of accountability, and its potential approaches for how accountability is viewed today in India with reference to the Central, State, District, and other stakeholders. It examines the role of accountability in making accountable health plans, and its relationship governance/ownership structures as a key component of health-care reforms as improved accountability is a major element in improving the health system performance. The article elaborates on the definition of accountability in terms of answerability and sanctions and distinguishes the three types of accountability, namely financial, performance, and political/democratic. The article describes three accountability-enhancing strategies, namely reducing the pilferage, assuring acquiescence with procedures and standards, and improved learning from the past experience. The recent events in Indian health care put forward a serious issue on how accountability can be fixed if health mishaps happened and how we can make our health plans accountable to the needs and aspiration for the people of India. Overall, the accountability is discouraging and more needs to be done to enhance the accountability compliance in India. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer screening rates remain low, especially among certain racial and ethnic groups and the uninsured and Medicaid insured. Clinics and health care systems have adopted population-based mailed fecal immunochemical testing (FIT) programs to increase screening, and now health insurance plans are beginning to implement mailed FIT programs. We report on challenges to and successes of mailed FIT programs during their first year of implementation in two health plans serving Medicaid and dual eligible Medicaid/Medicare enrollees.Methods: This qualitative descriptive study gathered data through in-depth interviews with staff and leaders at each health plan (n = 10). The Consolidated Framework for Implementation Research, field notes from program planning meetings between the research team and the health plans, and internal research team debriefs informed interview guide development. Qualitative research staff used Atlas.ti to code the health plan interviews and develop summary themes through an iterative content analysis approach.Results: We identified first-year implementation challenges in five thematic areas: 1) program design, 2) vendor experience, 3) engagement/communication, 4) reaction/satisfaction of stakeholders, and 5) processing/returning of mailed kits. Commonly experienced challenges by both health plans related to the time-consuming nature of the programs to set up, and complexities and delays in working with vendors. We found implementation successes in the same five thematic areas as well as four additional areas of: 1) leadership support, 2) compatibility with the health plan, 3) broader impacts, and 4) collaboration with researchers. Commonly experienced successes included the ability to adapt the mailed FIT program to the individual health plan culture and needs, and the synchronicity between the programs and their organizational missions and goals.Conclusions: Both health plans successfully adapted mailed FIT programs to their own culture and resources and used their strong quality management resources to maximize success in overcoming the time demands of setting up the program and working with their vendors. Mailed FIT programs administered by health plans, especially those serving Medicaid- and dual eligible Medicaid/Medicare-insured populations, may be an important resource to support closing gaps in colorectal cancer screening among traditionally underserved populations. [ABSTRACT FROM AUTHOR]

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The article titled "Sanitary management strategies in the grazing pig production model, experiences with the San Pedreño Creole breed in the northeast of Antioquia" presents sanitary management strategies in pig production in grazing, specifically with the San Pedreño Creole breed in the northeast of Antioquia. Preventive medicine and therapeutic management strategies were designed and evaluated for various diseases that affect the production model, such as cutaneous abscess, milk fever, inguinal hernia, bacterial pneumonia, rectal prolapse, and multiple trauma. A primary medicine plan was developed for endoparasites, coccidia, and porcine circovirus type 2, with the aim of reducing the incidence of these pathologies in the pig population. The San Pedreño breed shows adaptive capacity and low susceptibility to diseases, but requires continuous vaccination and deworming plans to protect the population. [Extracted from the article]

This publication is derived from and rooted in the authors' experience in designing the Health Support of a remote industrial site. Summarizing the main steps of this design is the purpose of the approach. As a first step devoted to “Evaluation” (Chapters 1–5) are displayed the fundamentals for designing a Project Health Plan, such as a realistic and operative definition of “patient stabilization” and the principles of tactical reasoning for Medevacs, specifying how pathophysiology and logistic constraints should be correlated. A core element of the conceptual work consists in partnering these two domains, which usually each go their own way. Both should be considered in terms of delays: in life threatening situations, pathophysiology allows for a (maximum) delay before effective stabilization, while logistics dictates a (minimum) delay for reaching a stabilization facility. Ensuring that these two delays match is the desired result. Clearly, this conceptual work will unfold its full potential in low sanitary level countries, where most industrial commodities Projects take place, and where these delays are the longest. Next is detailed the audit/study preparation, i.e., the data gathering needed to get a clear picture of the Project conditions and concerns, workforce headcount and pattern, evacuation vectors and delays, and reference documents. Finally, risk assessment and a review of health facilities—in the vicinity and further away—complete the evaluation work. In a second phase devoted to “Implementation” (Chapters 6–9) is detailed how contracts with health providers, and health exhibits of industrial contracts should be conceived, and how on-site health support is designed, from the necessity of a pre-employment check to the design and organization of routine and emergency medicine facilities. Emergency preparedness and response plans, as well as medical coordination, should integrate with the HSE command chart. Overall, this document strongly advocates for joint engineering between HSE officers and medical specialists. An overview of key points for hygiene—often a separate topic covered in an offprint—is proposed. Finally, forward guidance for writing the audit/study report is proposed. This audit/study report must result in conclusive recommendations. Hence, a guide is proposed so that the report becomes a matrix of the Health Plan itself, and will be ended by a summary of findings and recommendations ready-to-use in Project management. In this way, the Health Plan will be launched, and gradually evolve and be amended as a “living document” throughout the lifetime of the Project.

The Hygeia Community Health Plan was designed such that agriculture-based households can have access to affordable healthcare services. It is also aimed at providing financial risk protection against catastrophic healthcare costs which if persistent, could possibly drive them into poverty. This paper used a well-structured questionnaire to solicit responses on the effect of the Hygeia Community Health Plan on the welfare of farming households in Kwara State, Nigeria. A two-stage sampling technique was used to sample 175 farming households comprising of 115 beneficiaries and 60 non-beneficiaries from Shonga, Bacita and Lafiagi districts of Edu local government area of Kwara State, Nigeria. The ordinary least square and logit model were used in the analysis of the data for this study. The results of the analysis showed that the Hygeia community health plan was positively and statistically significant in influencing the per capita income, per capita calorie intake and the food security status of farming households in the area. Therefore, it was recommended that the government should create an enabling environment or partner with private insurance organizations. This will help them work out a plan to help rural households in other parts of the country access affordable healthcare services easily. This will help in the attainment of the universal access to health services in Kwara State and country Nigeria at large.

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One of the ways to analyze the economic sustainability of medical health plan operators is through the analysis of the accident rate. This study aims to analyze the accident rate of the various types of plans of a medical health plan operator located in the city of Tangará da Serra - MT. The research is characterized as a case study and has an exploratory nature, using a quantitative approach, using primary sources of research related to the years 2015, 2016 and 2017. The results showed that the surveyed operator obtained in the years under analysis the loss ratio of 71, 28%, 70.66% and 72.46% respectively, with a three-year average of 71.47%. In Brazil, the operators of the same size in the year of 2013 had an average loss ratio of 85.1%. Thus, operator, in the period under analysis, presented an index below the national average and within the index acceptable in the literature (75%). [ABSTRACT FROM AUTHOR]

Copyright of Acta Agriculturae Slovenica is the property of Biotechnical Faculty of the University of Ljubljana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The idiosyncrasy of the medical profession, the characteristic personality traits of the physician and the lack of specific training to properly recognize and treat one's own vulnerability dispose this group to suffer more mental pathology and probably worse control of other medical diseases. Most of the studies promoted so far focus on the psychiatric and addictive concerns of the physician, from the point of view of the sick doctor as being at risk for malpractice and to guarantee the safety of their patients. The narrative review of scientific literature (MEDLINE, EMBASE and IME 1985-2016) has shown that we do not have in the Spanish-speaking environment updated information about the doctor as a patient, despite being a topic of incipient media repercussion and undoubtedly relevant from the point of view of patient safety, professionalism and medical ethics and as well as the welfare of professionals. The characteristic of a sick doctor are more complex than the rest of patients with a conflict of roles and repercussions on professional ethics and the quality of care. [ABSTRACT FROM AUTHOR]