Patient assessments of care and utilization in Medicaid managed care: PCCMs vs. PSOs.

States are experimenting with different forms of delivery and financing to make Medicaid expenditures more predictable. Florida Medicaid is experimenting with a relatively new form of managed care, the provider-sponsored organization (PSO). Using the Donabedian structure-process-outcome (SPO) model, patient experiences and utilization in Florida PSOs and primary care case management (PCCM) were compared. The study analyzed Consumer Assessments of Healthcare Providers and Systems (CAHPS) data for 1,257 Medicaid beneficiaries in Florida in 2005. Results showed that beneficiaries in the PSOs had similar ratings and reports of care to those in the PCCM. However, PSOs had lower physician visits compared to the PCCM, indicating potential access barriers to primary care. The PSO's impact on emergency department (ED) utilization and specialist utilization was similar to that of the PCCM. The PSOs may lower costs, but the savings may be due to lower physician utilization rather than better case management. This is important since states that are experimenting with PSOs in their Medicaid programs are looking to these organizations to improve beneficiary care while lowering costs.

Survey response style and differential use of CAHPS rating scales by Hispanics.

BACKGROUND: Previous Consumer Assessments Of Healthcare Providers And Systems (CAHPS) studies have shown that Hispanics report care that is similar to or less positive than for non-Hispanic whites, yet have more positive ratings of care. OBJECTIVE: To examine differential use of the 0-10 rating scales in the CAHPS health plan survey by Hispanic ethnicity and insurance status (Medicaid vs. commercial managed care). DATA: CAHPS 2.0H adult Medicaid and commercial data submitted to the National Committee for Quality Assurance. MEASURES: The dependent variables are the CAHPS 2.0 ratings of care: personal doctor or nurse, specialists, and health care received. Ratings were categorized into 4 levels: 0-4, 5-8, 9, and 10. The independent variable is a 4-level categorical variable: Hispanic Medicaid, Hispanic commercial, (non-Hispanic) white Medicaid, and (non-Hispanic) white commercial. Six potential confounders were controlled: gender, age, education, self-rated health, survey mode, and survey language. ANALYSIS: Multinomial logistic regression was used to test for differences in extreme response styles. RESULTS: Hispanics exhibited a greater tendency toward extreme responding in the CAHPS ratings than non-Hispanic whites-in particular, they were more likely than whites in commercial plans to endorse a "10," and often, scores of 4 or less, relative to an omitted category of "5" to "8." CONCLUSIONS: The observed higher Hispanic ratings may be partially attributed to differences in response style rather than superior care. This suggests caution in the use of central tendency measures and the proportion of 10 ratings when examining racial/ethnic differences in CAHPS ratings of care. It is advisable to consider pooling responses at the top end (eg, 9 and 10) and lower end (eg, 0-6) of the response scale when making racial/ethnic comparisons.

Exploring the temperature-stress metabolome of Arabidopsis.

Metabolic profiling analyses were performed to determine metabolite temporal dynamics associated with the induction of acquired thermotolerance in response to heat shock and acquired freezing tolerance in response to cold shock. Low-M(r) polar metabolite analyses were performed using gas chromatography-mass spectrometry. Eighty-one identified metabolites and 416 unidentified mass spectral tags, characterized by retention time indices and specific mass fragments, were monitored. Cold shock influenced metabolism far more profoundly than heat shock. The steady-state pool sizes of 143 and 311 metabolites or mass spectral tags were altered in response to heat and cold shock, respectively. Comparison of heat- and cold-shock response patterns revealed that the majority of heat-shock responses were shared with cold-shock responses, a previously unknown relationship. Coordinate increases in the pool sizes of amino acids derived from pyruvate and oxaloacetate, polyamine precursors, and compatible solutes were observed during both heat and cold shock. In addition, many of the metabolites that showed increases in response to both heat and cold shock in this study were previously unlinked with temperature stress. This investigation provides new insight into the mechanisms of plant adaptation to thermal stress at the metabolite level, reveals relationships between heat- and cold-shock responses, and highlights the roles of known signaling molecules and protectants.