MCH Alert


Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html


June 18, 2010

1. Library Releases New Edition of Knowledge Path About Adolescent Violence Prevention
2. Report Focuses on What Americans Do to Find and Effectively Use Safe, Acceptable Health Care
3. Brief Outlines Opportunities to Improve Early Identification and Treatment of Maternal Depression
4. Study Examines Medicaid Reforms in Oregon and the Use of Dental Care by Women of Childbearing Age
5. Authors Analyze Pediatric Emergency Department Use by Adults with Chronic Pediatric Disorders

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1. LIBRARY RELEASES NEW EDITION OF KNOWLEDGE PATH ABOUT ADOLESCENT VIOLENCE PREVENTION

Adolescent Violence Prevention: Knowledge Path is an electronic guide to recent resources from the public health, medical, criminal justice, education, and social services literature that measure, document, and monitor adolescent violence; identify risk and protective factors; and report on promising intervention strategies. The new edition of the knowledge path, produced by the Maternal and Child Health Library (MCH Library), includes information about, and links to, Web sites, publications, databases, hotlines, and news and commentary. Separate sections list resources for professionals (health professionals, policymakers, educators, and community activists), and for families. Resources on specific aspects of adolescent violence are also presented in a separate section. Topics include bullying, dating violence, family violence, firearms, media violence, school violence, suicide, and violent crime victims. The knowledge path is available at http://www.mchlibrary.info/KnowledgePaths/kp_adolvio.html

MCH Library knowledge paths on other topics are available at http://www.mchlibrary.info/KnowledgePaths/index.html. The MCH Library welcomes feedback on the usefulness and value of these knowledge paths. A feedback form is available at http://www.mchlibrary.info/feedback/index.html

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2. REPORT FOCUSES ON WHAT AMERICANS DO TO FIND AND EFFECTIVELY USE SAFE, ACCEPTABLE HEALTH CARE

Snapshot of People's Engagement in Their Health Care focuses on actions that individuals must take to obtain the greatest benefit from the health care services available to them. The report, produced by the Center for Advancing Health, provides a brief overview of what is known about people's attitudes about engaging in their health care and then reports on the public's current level of activity based on behaviors documented in publicly available population surveys. Topics include the size of the engagement challenge (what percentage of the U.S. population practices various engagement behaviors?) and the scope of the challenge (what are some of the characteristics that distinguish those who are less likely to participate in their own care?). The findings are grounded in what individuals are actually doing (and not doing) to benefit from their health care vs. their knowledge, attitudes, and intentions. Goals and recommendations for policy and practice are included. The report is available at http://www.cfah.org/pdfs/CFAH_Snapshot_2010_Full.pdf

Readers: This report lays the groundwork for a series of ten white papers that will present a synthesis of the literature about what it takes for individuals to engage in their care. Each paper will focus on one of ten sets of engagement behaviors described in this report and will describe what is at stake as well as the tasks, challenges, and current efforts to support those behaviors. The white papers will be released during 2010-2012.

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3. BRIEF OUTLINES OPPORTUNITIES TO IMPROVE EARLY IDENTIFICATION AND TREATMENT OF MATERNAL DEPRESSION

Identifying and Treating Maternal Depression: Strategies and Considerations for Health Plans reviews the types, prevalence, and symptoms of maternal depression and related conditions in the United States; the costs (including monetary, life course, and developmental impacts); screening tools and recommendations for early identification and treatment; barriers to diagnosis and access to care; and opportunities for health plans to support a comprehensive approach to care. The brief was produced by the National Institute for Health Care Management Research and Educational Foundation with support from the Health Resources and Services Administration's Maternal and Child Health Bureau. Contents include definitions for a spectrum of depressive conditions that can affect mothers (up to 12 months postpartum) and mothers-to-be, including prenatal depression, postpartum depression, and postpartum psychosis. Risk factors, screening, and treatment for depression in pregnant and parenting adolescents and support and training to enhance primary care for postpartum depression are also addressed. Information on how to access selected screening tools is provided as an appendix. The brief is available at http://nihcm.org/pdf/FINAL_MaternalDepression6-7.pdf

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4. STUDY EXAMINES MEDICAID REFORMS IN OREGON AND THE USE OF DENTAL CARE BY WOMEN OF CHILDBEARING AGE

"Our results suggest that Oregon health care policy reforms from 2000 through 2005 resulted in decreased enrollment and dental care use by three vulnerable groups: low-income pregnant women, women who had dependent children and women in their child-bearing years who had no dependent children," state the authors of an article published in the June 2010 issue of the Journal of the American Dental Association. Oregon was the first state to make changes to its Medicaid program to prioritize treatment and implement managed care to control rising costs and expand coverage to include more people who were previously uninsured. These public dental insurance reforms were instituted at about the time that dentists and physicians began to recognize the importance of dental care for pregnant women. The article examines patterns of dental care use among Medicaid beneficiaries after reforms had taken place. The authors focus on the effects of changes in Medicaid policy on women with household incomes below 100 percent of the Federal Poverty Level who were in their childbearing years.

The researchers obtained Oregon Medicaid enrollment and claims data for women ages 15-45 for the years 2000-2002 and for 2005 from the Oregon Department of Human Services' Division of Medical Assistance Programs. During the study period, the Oregon Health Plan (OHP) Plus provided comprehensive dental care benefits for adults with children, pregnant women, and children. OHP Standard provided only limited emergency dental care to adults with no children. All women who were enrolled in Medicaid were assigned to the fee-for-service (FFS) system, but they could request care from a managed care provider. Both programs (FFS and managed care) offered dental coverage during pregnancy and up to 2 months postpartum. The analyses examined dental service claims for three groups of women who were eligible for Medicaid: (1) women ages 15-45 who were pregnant and enrolled in OHP Plus; (2) women ages 19-45 who were not pregnant and had at least one child (OHP Plus); and (3) women ages 19-45 who were neither pregnant nor living with a dependent child (OHP Standard). The researchers computed use rates for each group and examined the number of claims in three categories (diagnostic, preventive, and restorative). They also calculated average adjusted rates for the periods 2000-2002 and 2005 for each of the three groups and, within each group, compared use rates during the two periods (2000-2002 and 2005).

When they compared the adjusted use rates in the two periods under study (2000-2002 and 2005) for each group, the authors found that
"Our results show that the use of dental care, particularly preventive and restorative care, by pregnant women and mothers was low and decreased across time," state the authors.

Milgrom P, Lee RS-Y, Huebner CE, et al. 2010. Medicaid reforms in Oregon and suboptimal utilization of dental care by women of childbearing age. Journal of the American Dental Association 141(6):688-695. Abstract available at http://jada.ada.org/cgi/content/abstract/141/6/688

Readers: More information is available from the following MCH Library resource:

- Oral Health and Pregnant Women, Infants, Children, and Adolescents: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_oralhealth.html

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5. AUTHORS ANALYZE PEDIATRIC EMERGENCY DEPARTMENT USE BY ADULTS WITH CHRONIC PEDIATRIC DISORDERS

"We found that adults with chronic pediatric disorders use the PED [pediatric emergency department] in substantial numbers, write the authors of an article published in the June 2010 issue of Archives of Pediatrics and Adolescent Medicine. Advances in medical technology have markedly improved the survival of children with previously fatal medical conditions. As a result, increasing numbers of pediatric patients with chronic disorders are surviving into adulthood. These adults are known as "transition patients," and they may be more likely than other adults to seek medical attention for their acute medical problems in a PED. The demands that transition patients currently place on PEDs are poorly understood. Researchers and policymakers are working to determine and to encourage the best means of providing transition patients with appropriate emergency medical care. However, until they have a clear picture of the current use of PEDs, it will be difficult for them to support such use or to advocate convincingly for alternative emergency care delivery systems. The authors of this article sought to evaluate the use of PEDs by adults with chronic pediatric disorders and to consider the demands for resources that they place on PEDs and pediatric hospitals.

The authors designed a retrospective descriptive study to describe transition patient use of the PED at a pediatric specialty hospital. Data were collected during 2005 at the Primary Children's Medical Center (PCMC) in Salt Lake City, UT, an urban, tertiary care, free-standing pediatric hospital with an annual PED volume of more than 43,000 patient encounters. The main outcome measures were association of the presenting complaint with the patient's chronic pediatric disorder, emergency department interventions and dispositions, and duration of inpatient admissions.

The authors found that
The authors conclude that "as this cohort of transition patients continues to grow, PEDs should carefully consider how best to provide transition patients with appropriate care."

McDonnell WM, Kocolas I, Roosevelt AT, et al. 2010. Pediatric emergency department use by adults with chronic pediatric disorders. Archives of Pediatrics and Adolescent Medicine 164(6):572-576. Available at http://archpedi.ama-assn.org/cgi/content/abstract/164/6/572

Readers: More information is available from the following MCH Library resource:

- Children and Adolescents with Special Health Care Needs: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_CSHCN.html#transition

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MCH Alert © 1998-2010 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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EDITOR/ADMINISTRATOR: Jolene Bertness, M.Ed.
CO-EDITOR: Tracy Lopez, M.S.L.S.
COPYEDITOR/WRITER: Ruth Barzel, M.A.
WRITER: Beth DeFrancis, M.L.S.

MCH Alert
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