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ObjectiveTo assess the status of pulse oximetry screening and barriers to implementing screening programs.MethodsThis was a prospective pre-post intervention survey of nurse managers and medical directors of hospital-based birthing centers in Oregon, Idaho, and Southern Washington. The intervention was a 7-minute video demonstrating and discussing pulse oximetry screening for critical congenital heart disease.ResultsAnalysis of matched pairs showed a significant increase in the use of pulse oximetry screening during the study period from 52% to 73% (P < .0001). Following implementation of the video, the perception of all queried potential barriers decreased significantly among individuals from hospitals self-identified as nonscreening at baseline. Viewing the educational video was associated with an increase in the percentage of individuals from nonscreening hospitals that rated screening as "very beneficial" (45% vs 90%, P = .0001).ConclusionsAn educational video was associated with improved opinions of pulse oximetry screening among hospitals not currently screening.

Purpose: Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care. Design and Methods: Two control groups were used; one was drawn from nonenrollees living in the same area (Control-In) and another from comparable individuals living in another urban area where the program was not available (Control-Out). Cohorts living in the community and in nursing homes were included. Quality measures for both groups included mortality rates, preventable hospital admissions, and preventable emergency room (ER) visits. For the community group, nursing home admission rates were also tracked. For nursing home residents, quality measures included quality indicators derived from the Minimum Data Set. Results: There were no differences in mortality rates for either cohort. MSHO had fewer short-stay nursing home admissions but no difference for stays 90 days or longer. MSHO community and nursing home residents had fewer preventable hospital and ER visits compared to Control-In. There were no major differences in nursing home quality indicator rates. Implications: The cost of changing the model of care for dual eligibles from a mixture of fee-for-service and managed care to a merged managed-care approach cannot be readily justified by the improvements in quality observed.

Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will reduce the rate of untoward events and reduce the use of hospitals. Four aspects of quality were assessed: mortality, preventable hospitalizations, quality indicators derived from the Minimum Data Set, and change in functioning. Design and Methods: The care provided by Evercare was compared with that for two control groups: (a) other residents in the same homes not enrolled in Evercare and (b) residents in homes in the same geographic area that did not participate in Evercare. Data came from various sources, including the Minimum Data Set. Utilization was based on Medicare data for controls and United Healthcare data for Evercare residents. Survival analysis was used to estimate mortality rates. Various risk adjustment methods were applied to the quality indicators. Results: The hazard rates of mortality were significantly lower for Evercare residents than for other residents in the same nursing homes. Evercare residents had fewer preventable hospitalizations; the difference was significant for one control group. The rates of quality indicators and functional change were equivalent. Implications: Evercare, with its use of nurse practitioners, represents a model that can provide more efficient care that is of at least comparable quality.

Background. The Program for All-inclusive Care of the Elderly (PACE) has been hailed as successful but of limited appeal. This study contrasts the effects on hospital utilization of PACE and a more liberal variant, the Wisconsin Partnership Program (WPP). Methods. Hospital and emergency room (ER) utilization data from two sites that used both PACE and WPP to serve elderly clients were compared. The analysis of utilization was conducted using a cross-sectional longitudinal approach. The statistical significance of the difference between WPP and PACE groups was calculated by using regressions that adjusted for gender, race (white/nonwhite), age, original reason for entitlement in Medicare (elderly/disabled), dual eligibility, diagnoses during the previous 6 months, and county of residence. Results. The PACE enrollees had fewer hospital admissions, preventable hospital admissions, hospital days, ER visits, and preventable ER visits than the WPP enrollees had. There was no difference in the length of hospital stays. Conclusions. PACE is more effective in controlling hospital and ER utilization than is the more flexible variant (WPP).

Purpose: Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care. Design and Methods: Two control groups were used; one was drawn from nonenrollees living in the same area (Control-In) and another from comparable individuals living in another urban area where the program was not available (Control-Out). Cohorts living in the community and in nursing homes were included. Quality measures for both groups included mortality rates, preventable hospital admissions, and preventable emergency room (ER) visits. For the community group, nursing home admission rates were also tracked. For nursing home residents, quality measures included quality indicators derived from the Minimum Data Set. Results: There were no differences in mortality rates for either cohort. MSHO had fewer short-stay nursing home admissions but no difference for stays 90 days or longer. MSHO community and nursing home residents had fewer preventable hospital and ER visits compared to Control-In. There were no major differences in nursing home quality indicator rates. Implications: The cost of changing the model of care for dual eligibles from a mixture of fee-for-service and managed care to a merged managed-care approach cannot be readily justified by the improvements in quality observed. Key Words: Medicare, Medicaid, Quality indicators, Activity of daily living, Mortality, Preventable hospitalizations

Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will reduce the rate of untoward events and reduce the use of hospitals. Four aspects of quality were assessed: mortality, preventable hospitalizations, quality indicators derived from the Minimum Data Set, and change in functioning. Design and Methods: The care provided by Evercare was compared with that for two control groups: (a) other residents in the same homes not enrolled in Evercare and (b) residents in homes in the same geographic area that did not participate in Evercare. Data came from various sources, including the Minimum Data Set. Utilization was based on Medicare data for controls and United Healthcare data for Evercare residents. Survival analysis was used to estimate mortality rates. Various risk adjustment methods were applied to the quality indicators. Results: The hazard rates of mortality were significantly lower for Evercare residents than for other residents in the same nursing homes. Evercare residents had fewer preventable hospitalizations; the difference was significant for one control group. The rates of quality indicators and functional change were equivalent. Implications: Evercare, with its use of nurse practitioners, represents a model that can provide more efficient care that is of at least comparable quality. Key Words: Nurse practitioner, Preventable hospitalization, Quality indicators, Managed care

Evaluation of dogs with splenic masses to better educate owners as to the extent of the disease is a goal of many research studies. We compared the use of ultrasonography (US) and contrast-enhanced computed tomography (CT) to evaluate the accuracy of detecting hepatic neoplasia in dogs with splenic masses, independently, in series, or in parallel. No significant difference was found between US and CT. If the presence or absence of ascites, as detected with US, was used as a pretest probability of disease in our population, the positive predictive value increased to 94% if the tests were run in series, and the negative predictive value increased to 95% if the tests were run in parallel. The study showed that CT combined with US could be a valuable tool in evaluation of dogs with splenic masses.