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Inpatient Rehabilitation Model for Evaluation: Should the Tail Wag the Dog?
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| Presenter(s):
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| Harriet Aronow,
Cedars-Sinai Medical Center,
harriet.aronow@cshs.org
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| Pamela Roberts,
Cedars-Sinai Medical Center,
pamela.roberts@cshs.org
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| Abstract:
Hospital care quality and outcomes are on a fast track to public disclosure and to form the basis of “pay for performance” policies. However, the evaluation model from which quality and outcome information are being fed into the policy arena is flawed. Continuous Quality Improvement (CQI), with its roots in management science, has been the dominant model for quality improvement in hospitals. While it has accommodated patient outcomes it has maintained its adherence to methods that focus on control over processes.
One small branch of hospital services, physical and medical rehabilitation (PMR), has had a parallel historical development adhering to the evaluation science methodologies that have roots in biological and social science. Inpatient PMR programs use a multi-disciplinary team model of care and, aligned with the mission of rehabilitation, understand that outcomes are really tested once the patient has returned to the community. The PMR model of evaluation has incorporated CQI, evidence-based practice and medical/social science approaches to improve process and outcomes.
The purpose of this presentation is to compare and contrast the two models of evaluation, CQI and evaluation science, and to suggest a merged approach – based on the model developed in inpatient PMR – that has important applications in hospital care systems challenged by aging and increasingly complex patients.
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Predictors of Utilization of Genetic Counseling services for Hereditary Breast and Ovarian Cancer
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| Presenter(s):
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| Alanna Kulchak Rahm,
Kaiser Permanente,
alanna.k.rahm@kp.org
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| Jason Glanz,
Kaiser Permanente,
jason.m.glanz@kp.org
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| Abstract:
Attendance at genetic counseling for Hereditary Breast and Ovarian Cancer (HBOC) has rarely been studied separately from testing utilization. At Kaiser Permanente Colorado, consistently only 30% of all members referred for HBOC attend genetic counseling. A multivariable regression model was utilized to determine predictors of attendance on a sample of women referred for HBOC. Additional predictors were determined from a cross-sectional telephone survey. 572 women were referred from April 2003 – April 2005; 298 (52%) responded to the survey. Analysis of all referrals showed that women with cancer were 40% less likely to attend, as were women with a >10% calculated risk of BRCA1/2 mutation. Older age and referral by an oncologist also predicted attendance. Analysis of survey variables further showed that women who self-rate being extremely concerned about their health were 12 times more likely to attend. Higher family income and college education also predicted attendance.
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Evaluating the Effectiveness of Foster Care Policy at Increasing Preventive Care Visits
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| Presenter(s):
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| Angela Snyder,
Georgia State University,
angiesnyder@gsu.edu
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| Glenn Landers,
Georgia State University,
glanders@gsu.edu
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| Mei Zhou,
Georgia State University,
alhmzzx@langate.gsu.edu
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| Abstract:
This evaluation uses 2005 Medicaid claims data to compare the utilization of routine preventive care among children in the foster care system, children receiving adoption assistance, children receiving Supplemental Security Income (SSI), and low-income Medicaid children. Logistic regression is used to estimate the likelihood of an annual EPSDT visit and at least one dental visit by group. 55% of the foster care, 30% of the adoption assistance, 32% of the SSI, and 31% of the low-income Medicaid children received a preventive check-up during 2005. Compared to children in the adoption assistance (odds ratio [OR], 1.53), SSI (OR, 1.51), and low-income (OR, 2.03) Medicaid groups, foster care children were more likely to receive an annual EPSDT screening when controlling for health status and demographic variables. However, foster care children were less likely than children receiving adoption assistance (OR, 0.58) and low-income Medicaid (OR, 0.62) to have a dental visit during the same year.
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