Marguerite E. Burns

Recoverin Regulates Light-dependent Phosphodiesterase Activity in Retinal Rods

The Ca2+-binding protein recoverin may regulate visual transduction in retinal rods and cones, but its functional role and mechanism of action remain controversial. We compared the photoresponses of rods from control mice and from mice in which the recoverin gene was knocked out. Our analysis indicates that Ca2+-recoverin prolongs the dark-adapted flash response and increases the rods sensitivity to dim steady light. Knockout rods had faster Ca2+ dynamics, indicating that recoverin is a significant Ca2+ buffer in the outer segment, but incorporation of exogenous buffer did not restore wild-type behavior. We infer that Ca2+-recoverin potentiates light-triggered phosphodiesterase activity, probably by effectively prolonging the catalytic activity of photoexcited rhodopsin.

Insurance Coverage of Smoking Cessation Treatment for State Employees

Public health experts recommend that health insurance include coverage for smoking cessation treatment as an evidence-based strategy to reduce smoking. As employers, states can implement this policy for more than 5 million individuals nationwide. This study identified the extent to which states require smoking cessation treatment insurance coverage for their employees; of 45 states, 29 required coverage for at least 1 US Public Health Service (PHS)-recommended treatment, and only 17 of 45 provided coverage that was fully consistent with PHS recommendations.

Medicaid Managed Care and Health Care Access for Adult Beneficiaries with Disabilities

OBJECTIVE To evaluate the impact of Medicaid managed care organizations (MCO) on health care access for adults with disabilities (AWDs). DATA SOURCES Mandatory and voluntary enrollment data for AWDs in Medicaid MCOs in each county were merged with the Medical Expenditure Panel Survey and the Area Resource File for 1996-2004. STUDY DESIGN I use logit regression and two evaluation perspectives to compare access and preventive care for AWDs in Medicaid MCOs with FFS. From the states perspective, I compare AWDs in counties with mandatory, voluntary, and no MCOs. From the enrollees perspective, I compare AWDs who must enroll in an MCO or FFS to those who may choose between them. PRINCIPAL FINDINGS Mandatory MCO enrollees are 24.9 percent more likely to wait >30 minutes to see a provider, 32 percent more likely to report a problem accessing a specialist, and 10 percent less likely to receive a flu shot within the past year. These differences persist from the state evaluation perspective. CONCLUSIONS States should not expect a dramatic change in health care access when they implement Medicaid MCOs to deliver care to the adult disabled population. However, continued attention to specialty care access is warranted for mandatory MCO enrollees.

Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions

OBJECTIVE To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions. DESIGN Patient-level randomized quality improvement intervention. SETTING An academic medical center serving a predominantly low-income population in the Boston, Massachusetts area and 10 affiliated primary care practices. PARTICIPANTS Medical service patients with an in-network primary care physician who were discharged to home (n = 423) and had one of five risk factors for readmission within 30 days. INTERVENTION Inpatient introductory visit and weekly post-discharge telephonic support for 4 weeks to assist patient in coordinating medical visits, obtaining and using medications, and in self-management. MAIN OUTCOME MEASURES Number of completed CHW contacts; CHW-reported barriers and facilitators to assisting patients; primary care, emergency department and inpatient care use. RESULTS Roughly 70% of patients received at least one post-discharge CHW call; only 38% of patients received at least four calls as intended. Hospital readmission rates were lower among CHW patients (15.4%) compared with usual care (17.9%); the difference was not statistically significant. CONCLUSION Under performance-based payment systems, identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of all hospitals, especially safety-net systems. This pilot study suggests that with appropriate supportive infrastructure, hospital-based CHWs may represent a feasible strategy for improving transitional care among vulnerable populations. An ongoing, randomized, controlled trial of a CHW intervention, developed according to the lessons of this pilot, will provide further insight into the utility of this approach to reducing readmissions.

Medicaid Managed Care and Cost Containment in the Adult Disabled Population

Background:Despite the increasing enrollment of adult disabled beneficiaries into Medicaid managed care organizations (MCOs), there is little evidence of its (hoped for) effectiveness at reducing Medicaid expenditures. Objective:To evaluate the impact of Medicaid MCOs on health care expenditures for adults with disabilities. Research Design:I employ a repeated observations design comparing individual monthly Medicaid expenditures across beneficiaries who reside in counties with mandatory, voluntary, and no MCOs. County-level Medicaid MCO program status for adults with disabilities was merged with the Medical Expenditure Panel Survey and the Area Resource File for 1996–2004. Two-part regression models are used to estimate the probability and level of Medicaid expenditure. Subjects:Working age Medicaid beneficiaries who receive Supplement Security Income for disability comprise the sample of 1613 individuals. Measures:Outcome measures include total and service-specific Medicaid expenditures. Results:On average, total monthly Medicaid expenditures per beneficiary do not differ between FFS and MCO counties although some service-specific spending differs. Relative to FFS counties, average monthly Medicaid spending per beneficiary is higher for prescription medications in voluntary (

Using self-reported health measures to predict high-need cases among Medicaid-eligible adults.

24) and mandatory (

Assessing the impact of high deductible health plans on health-care utilization and cost: a changes-in-changes approach.

25) MCO counties. Average Medicaid monthly spending for other medical care and dental care is

State Discretion Over Medicaid Coverage for Mental Health and Addiction Services

4 to

Community-level tobacco interventions: perspective of managed care.

11 higher per beneficiary in MCO relative to FFS counties. Conclusions:Medicaid MCO programs as implemented are not associated with lower Medicaid spending; thus, state Medicaid programs should consider additional policy tools to contain health care expenditures in this population.

Effects of Eliminating Drug Caps on Racial Differences in Antidepressant Use Among Dual Enrollees With Diabetes and Depression

OBJECTIVE To assess the ability of different self-reported health (SRH) measures to prospectively identify individuals with high future health care needs among adults eligible for Medicaid. DATA SOURCES The 1997-2008 rounds of the National Health Interview Survey linked to the 1998-2009 rounds of the Medical Expenditure Panel Survey (n = 6,725). STUDY DESIGN Multivariate logistic regression models are fitted for the following outcomes: having an inpatient visit; membership in the top decile of emergency room utilization; and membership in the top cost decile. We examine the incremental predictive ability of six different SRH domains (health conditions, mental health, access to care, health behaviors, health-related quality of life [HRQOL], and prior utilization) over a baseline model with sociodemographic characteristics. Models are evaluated using the c-statistic, integrated discrimination improvement, sensitivity, specificity, and predictive values. PRINCIPAL FINDINGS Self-reports of prior utilization provide the greatest predictive improvement, followed by information on health conditions and HRQOL. Models including these three domains meet the standard threshold of acceptability (c-statistics range from 0.703 to 0.751). CONCLUSIONS SRH measures provide a promising way to prospectively profile Medicaid-eligible adults by likely health care needs.