Producing comparable cost and quality results from all-payer claims databases.

OBJECTIVES: To describe how all-payer claims databases (APCDs) can be used for multistate analysis, evaluating the feasibility of overcoming the common barrier of a lack of standardization across data sets to produce comparable cost and quality results for 4 states. This study is part of a larger project to better understand the cost and quality of healthcare services across delivery organizations. STUDY DESIGN: Descriptive account of the process followed to produce healthcare quality and cost measures across and within 4 regional APCDs. METHODS: Partners from Colorado, Massachusetts, Oregon, and Utah standardized the calculations for a set of cost and quality measures using 2014 commercial claims data collected in each state. This work required a detailed understanding of the data sets, collaborative relationships with each other and local partners, and broad standardization. Partners standardized rules for including payers, data set elements, measure specifications, SAS code, and adjustments for population differences in age and gender. RESULTS: This study resulted in the development of a Uniform Data Structure file format that can be scaled across populations, measures, and research dimensions to provide a consistent method to produce comparable findings. CONCLUSIONS: This study demonstrates the feasibility of using state-based claims data sets and standardized processes to develop comparable healthcare performance measures that inform state, regional, and organizational healthcare policy.

A program to improve access to health care among Mexican immigrants in rural Colorado.

CONTEXT: Migration to the United States from Mexico is increasing every year. Mexican immigrants tend to be poor, uninsured, monolingual Spanish speakers without adequate access to appropriate medical care. As a further barrier, many are also undocumented. PURPOSE: This article describes a program developed to improve access to health care among Mexican immigrants in northern Colorado. METHODS: The program was implemented by a migrant/community health center in rural northern Colorado based on findings from an in-depth health needs survey of the target population. The program consists of community outreach services vertically integrated into the main medical clinics, which comprise Salud Family Health Centers. A mobile unit went to nontraditional areas identified by community workers as gathering places for Mexican immigrants. Services provided included preventive health care (screening for diabetes, hypertension, mental health problems, dental problems, and HIV); education; and primary care for acute problems. Patients were referred to a health care home for ongoing care. RESULTS: In the first 6 months, 1,553 Mexican immigrants were seen on the mobile unit. Hypertension and psychosocial problems were the most common problems in this population. Thirty-five percent of patients who received consultation in the mobile unit have visited any of the clinics for follow-up within the following year. CONCLUSIONS: A community-based mobile outreach program targeted toward Mexican immigrants can be effective in uncovering medical and mental illness and in directing patients to a health care home. This is an important first step in eliminating health disparities among this population.

Utilización de servicios para problemas de salud mental en población femenina: tres estudios / The use of services for mental health problems among the feminine population: three studies

Se presentan los resultados de tres estudios sobre la utilización de servicios de salud mental. El primero incluye una muestra urbana en la que se compara el uso de servicios de las mujeres en relación con el de los hombres, mientras que en los otros dos se incluyen sólo grupos de mujeres, en un caso rurales y en el otro urbanas. Entre las diferencias importantes en el uso de servicios de las mujeres y de los hombres se enocntró que en los casos de depresión severa, las mujeres acuden menos con amigos o familiares y solicitan más la ayuda profesional, mientras que los hombes indican que no solicitan yuda porque piensan que otra persona los puede ayudar y porque no desean dejar de trabajar por las consecuencias enconómicas que ésto puede ocasionar. Las diferencias encontradas en las personas con depresión moderada se refieren al tipo de ayuda formal a la que acuden: los varones a especialistas privados y a centros de salud mental especializados, mientras que las mujeres para no solicitar ayuda son: por vergüenza, porque nadie podría entender su problema ni podría ayudarla, por pensar que otra persona puede ayudarlas, por falta de disponibilidad del servicio y por no tener quién les cuide los niños. En el segundo estudio se observó que son pocas las mujeres que solicitan ayuda cuando padecen síntomas depresivos mientras que cuando el problema lo presenta alguno de sus hijos acuden más a instancias formales de atención que cuando son ellas quienes lo padecen. En el área rural se encontró que las comunidades carecen de servicios especializados, lo que limita las posibilidades de obtener un tratamiento adecuado. El uso generalizado de servicios alternativos, como la ayuda de amigos, el apoyo de sacerdotes y la utilización de remedios caseros, se presentan como soluciones viables a sus problemas