Following are highlights from Effective Clinical Practice, published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) and the Alliance of Community Health Plans. The mission of Effective Clinical Practice is: "To help improve the delivery of health care and direct future investigation into the organization and practice of clinical medicine."
Education increases new moms' attempts to breast-feed, but is it for all moms?
Prenatal education or postpartum support increased the likelihood of breast-feeding among new mothers in a managed care plan. Among the 5,213 new moms surveyed nationally, 75 percent tried breast-feeding. Almost half of the respondents had attended a childbirth class; most felt they received enough breast-feeding information after delivery ("Breast-Feeding Education and Support: Association with the Decision to Breast-Feed," p. 116). An editorial says the health benefits of breast-feeding in developed countries are overstated, and that mothers who bottle-feed should not be made to feel guilty or inadequate ("Should All Mothers Breast-Feed?," p. 141).
Risk adjustment for Medicare patients may unfairly compensate health plans
As of January 2000, capitated Medicare payments to HMOs of $5,100 per patient are risk-adjusted for health status, which is based on previous hospital admissions. A health policy analyst says that because of discretionary admissions for conditions like congestive heart failure, risk-adjustment may reward plans that hospitalize more liberally while penalizing more conservative plans ("Does Risk Adjustment for Medicare Patients Reward Caring for Sick Patients or Liberal Admission Practices?," p. 147).
CQI, Bully for business, folly for health interventions?
Use of a Continuous Quality Improvement (CQI) program to increase preventive services in managed care organizations resulted in only slight increases. For 22 months, researchers tracked preventive services in 4,500 patients at 44 primary care clinics. Results showed that of eight preventive services, only pneumococcal vaccination and cholesterol testing increased significantly, by 17 percent and 4.6 percent, respectively ("Failure of a Continuous Quality Improvement Intervention To Increase the Delivery of Preventive Services," p. 105).
These highlights are not intended to substitute for articles as sources of information. For copies of articles, please call 215-351-2655 or e-mail lteer@mail.acponline.org