Abstracts

"Quality Improvement in Medicaid Managed Care: Experience of the Best Clinical and Administrative Practices Initiative." Journal on Quality and Patient Safety, February 2006, Marsha Gold, Tara Krissik, and Jessica Mittler. Although strategies such as pay-for-performance, accreditation, and consumer information to improve quality of care are proliferating, they are likely to be ineffective unless health plans and providers can respond by making appropriate changes and assessing the effectiveness of their interventions. This article describes and evaluates lessons from a recent initiative designed to help Medicaid managed care plans undertake such improvements—the Best Clinical and Administrative Practices initiative developed by the Center for Health Care Strategies and funded by the Robert Wood Johnson Foundation. The authors note that plans felt the collaborations helped them change the way they thought about quality improvement and take concrete steps to improve quality both in the short and long term. The initiative also highlighted challenges associated with change, including the need to enhance information technology to better measure and monitor the effects of interventions. Reprints available while supply lasts; call 609-275-2350.

"Translating Research to Action: Improving Physician Access in Public Insurance." Journal of Ambulatory Care Management, January-March 2006, Marsha Gold, Sylvia Kuo, and Erin Fries Taylor. Policymakers struggle with how to ensure adequate access to physician services in public programs such as Medicaid and SCHIP. The authors synthesize research on this topic and provide a framework that policymakers can use to identify and measure barriers to access, determining where and why problems exist and how to intervene. They also discuss important factors in translating research for use by policymakers. Reprints available while supply lasts; call 609-275-2350.

"The Effectiveness of Early Head Start for 3-Year-Old Children and Their Parents: Lessons for Policy and Programs." Developmental Psychology, vol. 41, no. 6, November 2005, John M. Love, Ellen E. Kisker, Christine Ross, Helen Raikes, Jill Constantine, Kimberly Boller, Jeanne Brooks-Gunn, Rachel Chazan-Cohen, Louisa Banks Tarullo, Christy Brady-Smith, Allison Sidle Fuligni, Peter Z. Schochet, Diane Paulsell, and Cheri Vogel. Early Head Start, a federal program begun in 1995 for low-income pregnant women and families with infants and toddlers, was evaluated through a randomized trial of 3,001 families in 17 programs. Interviews with primary caregivers, child assessments, and observations of parent-child interactions were completed when children were three years old. Caregivers were diverse in race-ethnicity, language, and other characteristics. The program children performed better than control children in cognitive and language development, displayed higher emotional engagement of the parent and sustained attention with play objects, and were lower in aggressive behavior. Compared with controls, EHS parents were more emotionally supportive, provided more language and learning stimulation, read to their children more, and spanked less. The strongest and most numerous impacts were for programs that offered a mix of home-visiting and center-based services and fully implemented the performance standards early.

"Private Plans in Medicare: Another Look." Health Affairs, September/October 2005, Marsha Gold. Previous efforts by Congress to expand the role of private plans in Medicare have met with limited success. Although the same fate may befall Medicare Advantage, the political environment has changed, and powerful political interests now support Medicare privatization. Only time will tell whether these interests—and the policies they are pursuing—will offset the historical barriers limiting the role of private plans in Medicare.

"Healthy Marriage Programs: Learning What Works." The Future of Children: Marriage and Child Wellbeing, fall 2005, Robin Dion. Public and private interest in programs to strengthen the institution of marriage and reduce the number of children growing up without both their parents is growing. The central policy question is whether it is possible to effectively implement programs that can increase the number of children who are raised by both parents in healthy and stable marriages, especially within disadvantaged populations known to be at higher risk for family instability. The author describes such marriage programs; discusses the main challenges and opportunities in implementing them in low-income populations; and explains how researchers, policymakers, and practitioners are beginning to learn whether they work.

"The Value of Experience: Differences in Knowledge Among Medicare Beneficiaries." Inquiry, fall 2005, Merrile Sing and Beth Stevens. This new study shows that Medicare beneficiary information-gathering behavior and experience with Medicare managed care were more highly associated with knowledge about Medicare managed care than formal education, age, income, or membershIp in a managed care plan before enrolling in Medicare. Practical life experience appears to outweigh traditional factors in beneficiary knowledge of Medicare and managed care.

"A National Study of Neighborhood Safety, Outdoor Play, Television Viewing, and Obesity in Preschool Children." Pediatrics, September 2005, Hillary L. Burdette and Robert C. Whitaker. Do preschool children have a higher prevalence of obesity, spend less time playing outdoors, and spend more time watching television when they live in a neighborhood that their mothers perceive as unsafe? This study of three-year-olds in 20 U.S. cities found that if mothers perceive their neighborhood as unsafe, their children tend to watch more television, but they are no more likely to be obese and do not spend any less time playing outdoors than children in safer neighborhoods. Researchers used data from the Fragile Families and Child Wellbeing Study, a birth cohort study of nearly 5,000 children born in 20 large U.S. cities from 1998 to 2000.

"Insuring the Uninsured: Finding the Road to Success." Frontiers of Health Services Management, July 2005, Deborah Chollet. This article outlines strategies proposed to expand health insurance, many of which have been tried in limited ways, and describes experiences with these attempts. The discussion is organized from the perspective of two opposing points of view: (1) approaches that would support private coverage and largely rely on demand incentives; and (2) approaches that presuppose a more direct government role. The author reaches no conclusion about which strategy might be a wiser course of action but does take measure of the likely effects of each approach.

"Increasing Breastfeeding Rates in New York City, 1980-2000." Journal of Urban Health, June 2005, Melanie Besculides, Karine Grigoryan, and Febienne Laraque. Although breastfeeding rates in New York City have more than doubled since 1980, there is still much progress to be made and work to be done to maintain recent gains. This article examines patterns of breastfeeding among women delivering infants in New York City and compares them with national breastfeeding trends. Of 16,932 newborns, representing approximately 80 percent of all reported live births in the city during the study period, 5,305 (31 percent) were exclusively breastfed, 6,189 (37 percent) were fed a combination of breast milk and formula, and the remaining 5,438 (32 percent) were exclusively formula-fed. Infants born in private hospitals were 1.6 times more likely to be exclusively breastfed, compared with infants discharged from public hospitals (33 percent versus 21 percent). Similarly, private patients were more likely than service patients to exclusively breastfeed their infants (40 percent versus 23 percent) and to use a combination of breast and formula (that is, any breastfeeding) (74 percent versus 62 percent). From 1980 to 2000, the proportion of exclusive breastfeeding increased from 25 percent to 31 percent, the percentage of combined feeding increased from 8 percent to 37 percent, and the percentage of any breastfeeding increased from 33 percent to 68 percent. Reprints available while supply lasts; call 609-275-2350.

"Challenges in Improving Care For High-Risk Seniors in Medicare." Health Affairs Web Exclusive, April 2005, Marsha Gold, Timothy Lake, William E. Black, and Mark Smith. Despite strong interest in improving care for high-risk elders, demonstration projects typically show negative results. This paper examines a large foundation-sponsored initiative to gain insight into why success can be so elusive. The findings indicate that flaws in concept, design, and implementation may make it more challenging for demonstrations, especially those involving cost and utilization reductions, to achieve their goals.

"The Economic Consequences of the Dissolution of Cohabitating Unions." Journal of Marriage and Family, April 2005, Sarah Avellar and Pamela J. Smock. Although the economic effects of divorce have been well studied, cohabitation has not been similarly explored. This analysis uses a sample from the National Longitudinal Survey of Youth to document changes in economic well-being at the end of a cohabiting relationship and compare the results to a sample of divorced respondents. After dissolution, formerly cohabiting men's economic standing declines moderately, whereas formerly cohabiting women's declines much more precipitously, leaving a substantial proportion in poverty. This effect is pronounced for African American and Hispanic women. Though the end of the relationship does reinforce gender stratification, it is also an "equalizer" between married and cohabiting women, leaving them in strikingly similar economic positions.

"WIC Food Packages: Time for a Change." Institute of Medicine, Food and Nutrition Board Committee to Review the WIC Food Packages of which Barbara Devaney is a member, April 2005. This new report proposes a number of changes to the WIC nutrition assistance program to encourage participants to consume more whole grains, fruits, and vegetables, as well as to promote breast-feeding, among other goals. If implemented, these revisions would be the most substantial changes to the mix of foods offered through WIC since the supplemental nutrition program for low-income women, infants, and children was launched in 1974. The recommendations also are the first effort to apply the new Dietary Guidelines for Americans to a national food program.

"Fatigue Effects." In Polling America: An Encyclopedia of Public Opinion, Volume One, edited by Samuel J. Best and Benjamin Radcliff, 2005, Krisztina Marton. This article discusses influences on data quality resulting from the cognitive burden imposed by a survey, which typically affects questions placed toward the end of a long questionnaire. The author notes that, while the existence of a fatigue effect makes intuitive sense, the empirical evidence supporting this effect is mixed. Ways to minimize the possibility of biases introduced in the data due to fatigue include using effective questionnaire design techniques and working to retain respondent motivation throughout the survey.

"Interviewing Effects." In Polling America: An Encyclopedia of Public Opinion, Volume One, edited by Samuel J. Best and Benjamin Radcliff, 2005, Janice Ballou. This article describes errors to data quality introduced by those implementing survey procedures. The author notes that these errors can occur at every stage of the data collection process, and identifying and limiting their impact pose considerable challenges. She identifies three ways to minimize interviewing effects: (1) acknowledge the importance of the interviewer’s role; (2) take action to control for effects related to recruitment, training, and supervision; and (3) assess interview situations to identify when factors related to questionnaire topic, interviewer skills, and interviewer and respondent interaction are likely to impact data quality.

"Survey Introductions." In Polling America: An Encyclopedia of Public Opinion, Volume Two, edited by Samuel J. Best and Benjamin Radcliff, 2005, Janice Ballou. This article describes survey introductions and the importance of the initial contact between interviewers and respondents. The author notes that effective introductions are critical to achieving high response rates and limiting survey costs. Effective survey introductions depend on identifying elements that can motivate participation in a given survey, using the elements to craft a script, and adapting the script to the particular survey mode being employed.

"Building Financial Bridges to Economic Development and Community Integration: Recommendations for a Research Agenda on Asset Development for People with Disabilities." Journal of Social Work in Disability & Rehabilitation, 2005, Michelle Putnam, Michael Sherraden, Karen Edwards, Shirley Porterfield, David Wittenburg, Karen Holden, and Patricia Welch Saleeby. Research on asset accumulation for people with disabilities is quite limited, but the scant literature that does exist suggests that they have significantly fewer assets than people without disabilities. Public policies that promote asset accumulation may influence their financial independence at young, middle, and older ages and help promote stability and community reintegration. This article suggests four areas that are important for building a research agenda on asset development for people with disabilities: (1) understanding their asset ownership; (2) analyzing the role of income, employment, health, and tax policies in asset accumulation; (3) assessing capacity of asset-building programs to meet the needs of people with disabilities; and (4) developing theories of disability and the place of assets in the disability equation. Reprints available while supply lasts; call 609-275-2350.

"Community Case Management for Former Jail Inmates: Its Impacts on Rearrest, Drug Use, and HIV Risk." Journal of Urban Health, 2005, Karen Needels, Susanne James-Burdumy, and John Burghardt. Dramatically increasing incarceration rates have led to large concentrations of formerly imprisoned people in poverty-stricken urban areas. Identifying ways to help ex-offenders with multiple, serious problems who are at risk of poor postrelease outcomes is an important policy concern. The authors examine the effectiveness of one strategy, called Health Link, that recruited adult women and adolescent men incarcerated in a New York City jail and offered intensive discharge planning and case management during the challenging first year after release. They found that participation in drug treatment programs increased, but evidence for reduced drug use was weak. There were no reductions in rearrest rates or in activities associated with a high risk of HIV infection. The authors conclude that a well-executed case management program can make modest differences in a few short-term outcomes, but the intervention did not lead to the hoped-for changes indicating greater success in community reintegration or improved health. Reprints available while supply lasts; call 609-275-2350.

"How Mothers See Fathers." In Good Parents or Good Workers? How Policy Shapes Families' Daily Lives, 2005, Allison Zippay and Anu Rangarajan. Eager to promote the involvement of absent fathers in the lives of their children, the architects of welfare reform strengthened paternity establishment and child support enforcement, in addition to increasing benefits for two-parent families. In response, policymakers are spearheading initiatives aimed at promoting healthy marriages and enhancing unmarried fathers' capacity for supporting their children emotionally and financially. Underlying the enthusiasm for these programs is the assumption that a stronger father presence is beneficial to families, even though the women who have been involved with these men are largely absent from the lobby for father-oriented initiatives. This chapter focuses on the role of fathers in low-income families' lives, describing how the mothers feel about the prospect of increased father involvement and how they view fathers' role in their children's lives.

"Physician Participation in Medicaid Managed Care: The California Experience." Managed Care Quarterly, 2005, Jessica Mittler and Marsha Gold. Many policymakers hope that Medicaid can improve patients' access to physician services by moving to a managed care model. The authors report that managed care plans surveyed in California generally did not have problems getting physicians to participate in Medi-Cal or Healthy Families, although problems arose for some specialties and areas, especially when supply was short. The findings highlight the importance of continued monitoring of access as well as collaborations among plans, providers, and government to strengthen participation and access.

"The Medicaid Managed Care Program." In To Improve Health and Health Care, vol.9, 2005, Marsha Gold, Justin White, and Erin Fries Taylor. In the 1990s, insurance companies and employers began to rely on managed care to control costs, and state governments followed suit by adopting managed care in Medicaid programs. To deal with the challenges associated with developing effective state Medicaid managed care programs, the Robert Wood Johnson Foundation developed the Medicaid Managed Care Initiative in 1995 to help states, health plans, and consumers build strong programs to reduce the cost and improve the quality of health care for low-income Americans. This chapter of the anthology describes the initiative and offers an assessment of it that builds on the program evaluation.

"The Challenge of Achieving High Work Participation Rates in Welfare Programs." Washington, DC: Brookings Institution, October 2004, LaDonna Pavetti. Efforts to reform the welfare system over the past two decades have focused on reducing dependency by getting welfare recipients to work. By the time the TANF program was created by the welfare reform law of 1996, there was widespread agreement in the states that welfare recipients should be required to look for work and to do so shortly after—or even before—they began receiving cash assistance. Once TANF was implemented, work became a central focus of local welfare offices. However, as shown by recent debates on reauthorization, consensus on work requirements remains elusive and information on how to achieve high participation rates is limited. This brief looks at policy changes and service strategies that states and local welfare agencies might consider to help achieve higher work participation rates.

"Low-Income Fathers' Involvement in Their Toddlers' Lives: Biological Fathers from the Early Head Start Research and Evaluation Study." In Fathering: A Journal of Theory, Research, and Practice about Men as Fathers, winter 2004, Natasha J. Cabrera, Rebecca M. Ryan, Jacqueline D. Shannon, Jeanne Brooks-Gunn, Cheri Vogel, Helen Raikes, Catherine Tamis-LeMonda, and Rachel Cohen. Uses data from Mathematica's Early Head Start Research and Evaluation Project to examine father involvement (whether fathers are accessible to, engaged with, and show responsibility for their two-year-old children). More than 80 percent of the two-year-old children in the study have accessible biological fathers. The majority of nonresident boyfriends and nonresident friends, as well as over a third of fathers in no relationship with the mother, are seeing their children at least once every three months. These accessible fathers are engaged in a range of activities and show responsibility for their children, although patterns vary by the father-mother relationship status and father residency. Fathers who have at least a romantic relationship with the mother are more involved with their children than those in no relationship. Many fathers who have no relationship with the mother of their child have some contact with the child, suggesting that the relationship between mother and father is not the only factor helping fathers stay involved with their children. Finally, fathers report doing a lot more caregiving than has been suggested by other studies.

"Preferences and Perceptions About Getting Support Expressed by Low-Income Fathers." In Fathering: A Journal of Theory, Research, and Practice about Men as Fathers, winter 2004, Jean Ann Summers, Kimberly Boller, and Helen Raikes. Examines the perspectives of fathers of low-income children about their needs and resources for support to help them with their parenting responsibilities, including barriers to fathering, sources of help available, and supports that might be useful. The primary barrier was difficulty juggling work and other time demands, and having time for fathering. A number of fathers reported no barriers and did not want help or support. Fathers described their primary sources of support as their spouse or partner, their own parents (especially their mothers), and their own internal resources (for example, motivation, patience). 

“Preventing Childhood Obesity: Health in the Balance.” Institute of Medicine, 2004, Committee on Prevention of Obesity in Children and Youth, of which Robert C. Whitaker was a member. The increasing number of obese children and youth throughout the U.S. has led policymakers to rank obesity as a critical health threat. This report provides a broad-based examination of the nature, extent, and consequences of obesity in the nation, including the social, environmental, medical, and dietary factors responsible. It also offers a prevention-oriented action plan that identifies the most promising short-term and longer-term interventions, as well as recommendations for the roles and responsibilities of industry, advertising, the media, schools, parents, and health care professionals in obesity prevention.

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