Melvin A. Kohn

Neurocysticercosis in Oregon, 1995–2000

The unexpected death of a teenager from neurocysticercosis prompted an investigation of this disease in Oregon. We found 89 hospitalizations, 43 newly diagnosed cases, and 6 deaths from 1995 to 2000. At least five cases occurred in persons who had not traveled or lived outside the United States. Enhanced surveillance for neurocysticercosis is warranted.

Five years of legal physician-assisted suicide in Oregon.

To the Editor: Physician-assisted suicide for terminally ill residents of Oregon has been legal since October 1997.1 Although it has been challenged several times in court and by a referendum, the ...

Using Diagnostic Codes to Screen for Intimate Partner Violence in Oregon Emergency Departments and Hospitals

Objectives. Many of the 2.5 million Americans assaulted annually by intimate partners seek medical care. This project evaluated diagnostic codes indicative of intimate partner violence (IPV) in Oregon hospital and emergency department (ED) records to determine predictive value positive (PVP), sensitivity, and usefulness in routine surveillance. Statewide incidence of care for IPV was calculated and victims and episodes characterized. Methods. The study was a review of medical records assigned ≥1 diagnostic codes thought predictive of IPV. Sensitivity was estimated by comparing the number of confirmed victims identified with the number predicted by statewide telephone survey. Patients were aged ≥2 years, treated in any of 58 EDs or hospitals in Oregon during 2000, and discharged with one of three primary or 12 provisional codes suggestive of IPV. Outcome measures were number of victims detected, PPV and sensitivity of codes for detection of IPV, and description of victims. Results. Of 58 hospitals, 52 (90%) provided records. Case finding using primary codes identified 639 victims, 23% of all estimated female victims seen in EDs or hospitalized statewide. PVP was 94% (639/677). Provisional codes increased sensitivity (51%) but reduced PVP (50%). Highest incidence occurred in women aged 20–39 years, and those who were black. Hospitalizations were highest among women aged

Public health surveillance approaches in Oregon's Medicaid population.

50 years, black people, or those with comorbid illness. Conclusions. Three diagnostic codes used for case finding detect approximately one-quarter of ED- and hospital-treated victims, complement surveys, and facilitate description of injured victims.

Tracking Oregon Medicaid patients' enrollment and health utilization patterns.

The development of methods for public health surveillance in Medicaid populations is an important goal for public health practice. In Oregon, we developed approaches to case finding using claims and self-reported data obtained from the Medicaid beneficiary population. Disease rosters, derived from claims data, form the basis for analyses pertaining to particular health conditions. Self-reported information obtained through a telephone survey forms the basis for analyses pertaining to behavioral risk factors, disease history, and other information not available in claims data. We also describe some projects in which we plan to use combined claims and survey data. We describe our experiences with using these techniques and provide examples from projects in progress or planned. Our initial experiences suggest that these approaches enhance our ability to conduct public health surveillance in Oregons Medicaid population.

Security aspects of electronic data interchange between a state health department and a hospital emergency department.

The Oregon Medicaid program consists of various sub-programs with different eligibility requirements and multiple health care delivery systems. Administrative events, such as the loss of Medicaid eligibility or a change in health plan enrollment, can cause disruptions in the continuity of medical care and may contribute to missed opportunities to provide appropriate medical services, including preventive care. Thus, in order to improve public health surveillance and describe the health care utilization patterns of Oregons Medicaid beneficiaries, a standardized approach was developed to track the enrollment status of Medicaid patients for extended periods of time.

Diabetes preventive care in Oregon's Medicaid population.

Electronic emergency department reporting provides the potential for enhancing local and state surveillance capabilities for a wide variety of syndromes and reportable conditions. The task of protecting data confidentiality and integrity while developing electronic data interchange between a hospital emergency department and a state public health department proved more complex than expected. This case study reports on the significant challenges that had to be resolved to accomplish this goal; these included application restrictions and incompatibilities, technical malfunctions, changing standards, and insufficient dedicated resources. One of the key administrative challenges was that of coordinating project security with enterprise security. The original project has evolved into an ongoing pilot, with the health department currently receiving secure data from the emergency department at four-hour intervals. Currently, planning is underway to add more emergency departments to the project.

The 10-year experience of Oregon's Death with Dignity Act: 1998-2007

The purpose of this study was to estimate the prevalence of diabetes in Oregons adult Medicaid population and to compare the level of diabetes-related preventive care with the states general population. Responses to telephone interviews conducted in 1999 among 2,770 randomly selected adult Medicaid beneficiaries and 7,229 Oregon residents were compared. Diabetes prevalence among adult Medicaid recipients (11.1% [95% Cl, 9.9% to 12.2%]) was more than twice that in the general population (4.7% [95% Cl, 4.2% to 5.3%]). During the year prior to the interview, adults with diabetes in the Medicaid and general populations reported performing the following preventive care, respectively: > or = 2 diabetes care visits (80%, 77%); foot examination (74%, 74%); dilated eye examination (73%, 68%); influenza vaccine (65%, 61%); self-monitored blood glucose daily (63%, 61%); pneumococcal vaccine (51%, 47%); regular aspirin use (48%, 53%); and awareness of Hemoglobin A1c (34%, 39%). Although the reported prevalence of diabetes in Oregons Medicaid population is high, the prevalence of diabetes preventive care activities was similar to the states general population. Nonetheless, specific services in both populations could be improved.