Stephen Metraux

Physician Utilization by Insurance Type Among Youth With Type 2 Diabetes

Carrie MacAdam-Marx — Thu, 16 Sep 2010 08:21:58 PDT

Objective: To evaluate the relationship between insurance type (Medicaid vs private insurance) and access to physician care for youth with type 2 diabetes mellitus by quantifying whether these youth saw a physician during the year before their first diabetes documentation. Study Design: Retrospective cohort study. Methods: Youth with Medicaid or private insurance aged 5 to 19 years with type 2 diabetes were identified by an electronic medical record review. The first indication of type 2 diabetes defined the index date. Youth with type 1 diabetes and female patients with polycystic ovaries were excluded. Descriptive statistics evaluated differences in office visits before the index date between patients with the 2 insurance types. Multivariate logistic regression analysis evaluated the likelihood of having an office visit during the year before the index date among youth with Medicaid versus private insurance, controlling for youth characteristics. Results: Of 2496 included youth, 400 (16.0%) had Medicaid coverage. More than 60% were female, the mean age was 14.5 years, and 68.8% were obese. On average, youth had 1.9 office visits during the year before the index date. Medicaid covered youth were not significantly less likely to have had an office visit (odds ratio, 0.77; P = .09) or fewer total office visits (incident rate ratio, 1.13; P = .16) during the year before the index date. Conclusions: The likelihood of youth with type 2 diabetes and a source of physician care having a physician office visit during the year before the index date did not differ between patients with Medicaid versus private insurance. This suggests that the amount of physician care before diagnosis of type 2 diabetes does not differ for Medicaid-covered youth if they can establish a source of care. Additional research is investigating whether physician access before diagnosis is associated with access to diabetes-related care after diagnosis.

Disparities in Level of Amputation Among Minorities: Implications for Improved Preventative Care

Kristin M. Lefebvre — Tue, 07 Sep 2010 10:20:35 PDT

Objectives: The purpose of this study was to evaluate the relationship between race and level of amputation and to discuss the implications if a disparity was found. Methods: From the 2003 Healthcare Cost and Utilization Nationwide Inpatient Sample, 80 845 (weighted) discharges with a diagnosis of vascular disease and black or white race were evaluated for a disparity in level of amputation. Level of amputation was categorized using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes into above-knee and below-knee amputation. SPSS 15.0 complex samples software (SPSS Inc, Chicago, Illinois) was used for univariate and multivariate statistical analysis. Results: Bivariate (p < .001) and logistic regression (p < .001; OR, 1.51; 95% CI, 1.4-1.7) analyses revealed a significant association between race and level of amputation. Other covariates were also significant for influencing level of amputation and include age (p < .001; OR, 1.03; 95% CI, 1.02-1.03), female gender (p < .001; OR, 1.33; 95% CI, 1.2-1.5), Charlson Comorbidity Index (p < .001; OR, 1.12; 95% CI, 1.1-1.2), Medicare (p < .017; OR 1.34; 95% CI, 1.1-1.9), Medicaid (p < .003; OR, 1.63; 95% CI, 1.2-2.2, peripheral arterial disease (p < .001; OR, 1.22. CI, 1.1-1.4) and cerebrovascular disease (p < .001; OR, 1.80; 95% CI, 1.5-2.1). Conclusions: Black race is significantly more associated with above-knee amputation when compared to white race. The consequences of higher-level evaluation could lend to disparities in overall health between the black and white races.

The Prevalence of Musculoskeletal Conditions Among the Adult U.S. Population: Considerations for Physical Therapists.

Michael P. Johnson — Tue, 07 Sep 2010 10:13:09 PDT

Study Design: Retrospective, Cross-sectional. Objectives: Identify the prevalence of musculoskeletal conditions (MSC) among the non-institutionalized U.S. population using an expanded set of ICD-9-CM codes that correspond to the range of conditions seen in Physical Therapist (PT) Practice. Examine prevalence rates among adults and older adults (65 years and older). Background: MSCs are the most common health problem in the U.S. and prevalence increases with age. Previous studies examining MSC prevalence were based on a limited set of conditions seen by physicians, therefore may not be representative of those who receive PT services. Disease prevalence is used to determine resource allocation for health care services. Methods and Measures: Data from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) were used, including all respondents with a diagnosed MSC (ICD-9-CM codes). Descriptive analyses were used to examine MSC prevalence, by year, from 1997 through 2000. Results: Final weighted samples ranged from N=75.5 to 80.6 million. The prevalence of MSCs was higher among all adults (34-36%) and adults 65 years and older (52-54%) than has been previously reported. Conclusions: Higher prevalence of MSCs has implications when determining overall health care costs as well as workforce needs within the physical therapy profession. HPA Resource/ HPA Journal 2009; 9(2): J1 – J8.]

Examining Relationships Between Receiving Mental Health Services in the Pennsylvania Prison System and Time Served

Stephen Metraux — Wed, 18 Mar 2009 11:01:09 PDT

Where to From Here: A Policy Research Agenda Based on the Analysis of Administrative Data

Dennis P. Culhane — Sat, 10 May 2008 15:33:32 PDT

Homelessness and Public Shelter Provision in New York City

Dennis P. Culhane — Sat, 10 May 2008 15:31:01 PDT

Family Dynamics, Housing and Recurring Homelessness Among Women in New York City Homeless Shelters

Stephen Metraux — Sat, 10 May 2008 15:26:29 PDT

Waiting for the Wrecking Ball: Skid Row in Postindustrial Philadelphia

Stephen Metraux — Sat, 10 May 2008 15:24:52 PDT

Assessing Relative Risk for Homeless Shelter Usage in New York City and Philadelphia

Dennis P. Culhane — Sat, 10 May 2008 15:23:43 PDT

Assessing Homeless Population Size through the Use of Emergency and Transitional Shelter Services in 1998: Results from the Analysis of Administrative Data in Nine US Jurisdictions

Stephen Metraux — Sat, 10 May 2008 15:21:19 PDT

The Impact of Supportive Housing for Homeless People with Severe Mental Illness on the Utilization of the Public Health, Corrections, and Emergency Shelter Systems: The New York-New York Initiative

Dennis P. Culhane — Sat, 10 May 2008 15:15:30 PDT

Assessing the Impact of the New York/New York Supported Housing Initiative for Homeless Persons with Severe Mental Illness on Public Shelter Use in New York City

Stephen Metraux — Sat, 10 May 2008 15:08:01 PDT

A Study of the Impacts of Welfare Reform in Philadelphia: Public Shelter Utilization, Demand for Public Housing Programs, and Public Housing Program Recipient Outcomes

Dennis P. Culhane — Sat, 10 May 2008 13:37:17 PDT

The Cost of Care for Medicaid Recipients with Serious Mental Illness and HIV/AIDS

Aileen B. Rothbard — Sat, 10 May 2008 13:33:02 PDT

Prevalence of Child Welfare Services Involvement among Homeless and Low-Income Mothers: A Five-year Birth Cohort Study

Jennifer F. Culhane — Sat, 10 May 2008 13:14:23 PDT

Prevalence of Child Welfare Services Involvement among Homeless and Low-Income Mothers: A Five-year Birth Cohort Study

David A. Webb — Sat, 10 May 2008 13:08:56 PDT

Public Shelter Admissions among Young Adults with Child Welfare Histories by Type of Service and Type of Exit

Jung Min Park — Fri, 09 May 2008 11:00:36 PDT

Homeless Shelter Use and Reincarceration Following Prison Release: Assessing the Risk

Stephen Metraux — Fri, 09 May 2008 10:58:03 PDT

Homelessness and HIV Risk Behaviors Among Intravenous Drug Users

Stephen Metraux — Fri, 09 May 2008 10:55:28 PDT

Child Welfare Involvement Among Homeless Children

Jung Min Park — Fri, 09 May 2008 10:48:52 PDT