A Review of Unsolicited Comments on the CAHPS 5.0 Health Plan Survey.

The CAHPS Health Plan Survey (CAHPS 5.0) collects invaluable information regarding consumer experiences with their health plans, and these data inform healthcare policies at both the state and federal levels. The purpose of this paper was to explore unsolicited comments provided on the CAHPS 5.0 survey of one state's Medicaid program. Secondary data analysis was conducted of unsolicited, written comments received from Medicaid recipients who completed the CAHPS 5.0 adult or child postal survey between 2016 and 2018. The majority of unsolicited comments were moderately or very negative in attitude (or tone) for adult and child surveys. Analysis of unsolicited comments yielded 3 themes: positive experiences with Medicaid, limitations of coverage, and direct requests for assistance. Providing space for Medicaid patients to share comments and receiving further guidance for content analysis would provide valuable context for interpreting overall survey results. Comments may also help Medicaid program administrators respond to the frequently complex and challenging experiences of navigating a continually evolving state health insurance program by the most vulnerable populations.

Social factors and public policies associated with state infant mortality rates.

Despite mounting evidence that social factors and public policies affect state infant mortality rates (IMRs), few researchers have examined variation in IMRs associated with those factors and policies. We quantified disparities in infant mortality by state social factors and public policy characteristics. We hypothesized that some social factors and public policies would be more strongly associated with infant mortality than others, and that states with similar factors and policies would form clusters with varying levels of infant mortality. We examined associations of women's economic empowerment, health and well-being, political participation, reproductive rights, and work and family-related policies with state IMRs in 2012 and 2015, using indicators created by the Institute for Women's Policy Research. Methods included generalized linear models, principal component analysis, and cluster analysis. Health and well-being predicted IMRs (2012, 2015, both p < .05), as did poverty and opportunity, and reproductive rights (2012, p < .10). Consistent with our hypothesis, states formed clusters, with the states in each cluster having similar social factors and public policies, and similar IMRs. Women's health status and insurance coverage were more predictive of state IMRs than other social factors. Improving health and insurance coverage may be an effective way to reduce state IMRs.

Pediatric Practice Readiness for Disaster Response.

OBJECTIVES: The American Academy of Pediatrics (AAP) calls for the inclusion of office-based pediatricians in disaster preparedness and response efforts. However, there is little research about disaster preparedness and response on the part of pediatric practices. This study describes the readiness of pediatric practices to respond to disaster and delineates factors associated with increased preparedness. METHODS: An AAP survey was distributed to members to assess the state of pediatric offices in readiness for disaster. Potential predictor variables used in chi-square analysis included community setting, primary employment setting, area of practice, and previous disaster experience. RESULTS: Three-quarters (74%) of respondents reported some degree of disaster preparedness (measured by 6 indicators including written plans and maintaining stocks of supplies), and approximately half (54%) reported response experience (measured by 3 indicators, including volunteering to serve in disaster areas). Respondents who reported disaster preparation efforts were more likely to have signed up for disaster response efforts, and vice versa. CONCLUSIONS: These results contribute information about the state of pediatric physician offices and can aid in developing strategies for augmenting the inclusion of office-based pediatricians in community preparedness and response efforts.

Pediatric dental care use and parent- or caregiver-rated oral health among Alabama children enrolled in Medicaid.

BACKGROUND: Reducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children's dental care use, including the association with children's oral health. METHODS: A cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means. RESULTS: The 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33). CONCLUSIONS: It was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship. PRACTICAL IMPLICATIONS: Oral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children's oral health.

Man Versus Machine: Comparing Double Data Entry and Optical Mark Recognition for Processing CAHPS Survey Data.

OBJECTIVE: Historically, double data entry (DDE) has been considered the criterion standard for minimizing data entry errors. However, previous studies considered data entry alternatives through the limited lens of data accuracy. This study supplies information regarding data accuracy, operational efficiency, and cost for DDE and Optical Mark Recognition (OMR) for processing the Consumer Assessment of Healthcare Providers and Systems 5.0 survey. METHODS: To assess data accuracy, we compared error rates for DDE and OMR by dividing the number of surveys that were arbitrated by the total number of surveys processed for each method. To assess operational efficiency, we tallied the cost of data entry for DDE and OMR after survey receipt. Costs were calculated on the basis of personnel, depreciation for capital equipment, and costs of noncapital equipment. RESULTS: The cost savings attributed to this method were negated by the operational efficiency of OMR. There was a statistical significance between rates of arbitration between DDE and OMR; however, this statistical significance did not create a practical significance. CONCLUSIONS: The potential benefits of DDE in terms of data accuracy did not outweigh the operational efficiency and thereby financial savings of OMR.

Promoting Continuous Quality Improvement in the Alabama Child Health Improvement Alliance Through Q-Sort Methodology and Learning Collaboratives.

OBJECTIVE: Q-sort methodology is an underutilized tool for differentiating among multiple priority measures. The authors describe steps to identify, delimit, and sort potential health measures and use selected priority measures to establish an overall agenda for continuous quality improvement (CQI) activities within learning collaboratives. METHODS: Through an iterative process, the authors vetted a list of potential child and adolescent health measures. Multiple stakeholders, including payers, direct care providers, and organizational representatives sorted and prioritized measures, using Q-methodology. RESULTS: Q-methodology provided the Alabama Child Health Improvement Alliance (ACHIA) an objective and rigorous approach to system improvement. Selected priority measures were used to design learning collaboratives. An open dialogue among stakeholders about state health priorities spurred greater organizational buy-in for ACHIA and increased its credibility as a statewide provider of learning collaboratives. CONCLUSIONS: The integrated processes of Q-sort methodology, learning collaboratives, and CQI offer a practical yet innovative way to identify and prioritize state measures for child and adolescent health and establish a learning agenda for targeted quality improvement activities.

Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

OBJECTIVE: The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. DESIGN: Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. RESULTS: There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. CONCLUSIONS: The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

Planning and executing complex large-scale exercises.

INTRODUCTION: Increasingly, public health departments are designing and engaging in complex operations-based full-scale exercises to test multiple public health preparedness response functions. The Department of Homeland Security's Homeland Security Exercise and Evaluation Program (HSEEP) supplies benchmark guidelines that provide a framework for both the design and the evaluation of drills and exercises; however, the HSEEP framework does not seem to have been designed to manage the development and evaluation of multiple, operations-based, parallel exercises combined into 1 complex large-scale event. METHODS: Lessons learned from the planning of the Mississippi State Department of Health Emergency Support Function--8 involvement in National Level Exercise 2011 were used to develop an expanded exercise planning model that is HSEEP compliant but accounts for increased exercise complexity and is more functional for public health. RESULTS: The Expanded HSEEP (E-HSEEP) model was developed through changes in the HSEEP exercise planning process in areas of Exercise Plan, Controller/Evaluator Handbook, Evaluation Plan, and After Action Report and Improvement Plan development. The E-HSEEP model was tested and refined during the planning and evaluation of Mississippi's State-level Emergency Support Function-8 exercises in 2012 and 2013. DISCUSSION: As a result of using the E-HSEEP model, Mississippi State Department of Health was able to capture strengths, lessons learned, and areas for improvement, and identify microlevel issues that may have been missed using the traditional HSEEP framework. NEXT STEPS: The South Central Preparedness and Emergency Response Learning Center is working to create an Excel-based E-HSEEP tool that will allow practice partners to build a database to track corrective actions and conduct many different types of analyses and comparisons.

A Regional Public Health Field Placement Program: making an IMPACT.

Beginning in 2010, the U.S. Department of Health and Human Services, Health Resources and Services Administration, made provisions in its Public Health Training Center cooperative agreements for field placements. This article describes best practices and lessons learned establishing and managing the South Central Public Health Partnership's Interns and Mentors Program for ACTion (IMPACT) Field Placement Program, which was initially funded through the Centers for Disease Control and Prevention's Centers for Public Health Preparedness Cooperative agreement in 2002. The IMPACT program is based on a six-step process that has been developed and refined over its 10-year history: (a) identifying field placement opportunities, (b) marketing field experience opportunities to students, (c) selecting students seeking field experience opportunities, (d) placing students with practice partners, students with practice partners, (e) evaluating student progress toward field experience objectives, and (f) evaluating the program. This article describes the program's structure and processes, delineates the roles of its academic and practice partners, discusses evidence of its effectiveness, and describes lessons learned from its decade-long history. Hopefully, this information will facilitate the establishment, management and evaluation of internship and field placement programs in other Public Health Training Centers and academic public health programs.

The effects of the April 2011 tornado outbreak on personal preparedness in Jefferson County, Alabama.

OBJECTIVE: The purpose of this study was to examine the effects of a tornado disaster on the personal preparedness of local residents to determine (1) to what extent the tornado outbreak experience had altered preparedness awareness, willingness to act, and levels of personal preparedness of residents as measured by possession of a preparedness kit; and (2) what effect this experience had on the variables associated with having a complete disaster preparedness kit. DESIGN: Two random digit-dialed surveys were completed following the Behavioral Risk Factor Surveillance System protocols. The pre-tornado survey was conducted between October and December 2010 and the post-tornado survey was conducted between January and March 2012. RESULTS: After the April 2011 tornado outbreak, 86.08% of the respondents (n = 1364) reported that they had thought more about personal or family preparedness and 59.65% (n = 907) reported that they had taken actions to increase their level of preparedness. Overall, general awareness of preparedness media campaigns increased significantly (almost 24%; P < .0001), as did the percentage of those having a complete disaster preparedness kit (a 66% increase, not quite doubled from 2010 to 2012; P < .0001). CONCLUSIONS: Findings of the study indicate that the disaster had a significant impact on the local residents' (1) awareness of preparedness campaigns, (2) awareness of the need to be prepared, (3) willingness to become better prepared, and (4) possession of a disaster and emergency preparedness kit and its associated items.

Influenza immunization in older adults with and without cancer.

OBJECTIVES: To compare the likelihood of receiving an influenza immunization in older adults before and immediately after a cancer diagnosis occurring in 2001 and for the same time periods with older adults not diagnosed with cancer. DESIGN: Retrospective analysis comparing influenza immunization rates of Medicare beneficiaries with and without a diagnosis of cancer. SETTING: Surveillance, Epidemiology, and End Results-Medicare Data. PARTICIPANTS: Propensity score matching matched a group of 35,229 persons without cancer with 35,257 individuals diagnosed with cancer in 2001. MEASUREMENTS: Receipt of influenza vaccination based upon Medicare Claims Data. RESULTS: A difference-of-difference analysis revealed that influenza immunization rates increased over time for persons diagnosed with cancer (46.8% before to 50.8% after cancer diagnosis), but the increase was greater in beneficiaries without a cancer diagnosis (42.6% to 79.7%) (P < .001; 95% confidence interval = 0.320-0.324). Logistic regression analysis revealed that individuals without a cancer diagnosis were 7.25 times as likely to receive an influenza immunization. CONCLUSION: Older adults who have been recently diagnosed with cancer receive influenza immunizations at much lower rates than older adults who have not been diagnosed with cancer despite interaction with healthcare providers. Opportunities exist to improve influenza immunization in this population, who are susceptible to influenza because of compromised immune systems.

Southeastern Regional Pediatric Disaster Surge Network: a public health partnership.

In the event of a natural or man-made disaster involving large numbers of children, resources in the Southeastern U.S. are extremely limited. This article chronicles the efforts of the Alabama Department of Public Health, the Mississippi State Department of Health, and the South Central Center for Public Health Preparedness in conjunction with more than 40 organizations to develop a voluntary network of health-care providers, public health departments, volunteers, and emergency responders from Alabama, Florida, Louisiana, Mississippi, and Tennessee. The purpose of the Southeastern Regional Pediatric Disaster Surge Network (the Network) is to improve the pediatric preparedness response strategies of public health, emergency response, and pediatric providers in the event of large-scale emergencies or disasters that overwhelm local or state pediatric resources. The planning and development of the Network is proceeding through three general phases--information sharing, mutual goal setting and collective action, and long-term formal linkages. In Phase 1, critical planning tasks to be undertaken in the development of the Network were identified. In Phase 2, the agencies developed a draft operational handbook that served as the basis for a formal memorandum of understanding. In Phase 3, participants will engage in exercises and evaluations that will further identify and work out logistical and operational details.

Creating a regional pediatric medical disaster preparedness network: imperative and issues.

Over the past few decades, the number of disasters, both natural and human initiated has increased. As a result, since the September 11, 2001 attacks on the World Trade Center and Pentagon, there has been a new emphasis on disaster preparedness. However, the preparedness emphasis has been primarily directed toward adults and little attention has been specifically given to the needs of children. One reason for the lack of attention to pediatric needs in disaster planning is that childhood is seldom viewed as a separate and special stage of growth, fundamentally different from adulthood. The expectation during emergencies is that the care provided for adults is appropriate for children. The purpose of this paper is to examine the types of and increase in disasters and discuss the importance of specifically addressing the special needs of children in disaster planning. Further the paper argues for a regional network approach to emergency pediatric care that would increase surge capacity for children during disasters and other emergencies.