Navigating Medicare Part D Websites: Are the Part D Plans in Compliance?

Today, more than one half of older adults use the internet to obtain health-related information, and there is growing interest from governmental agencies in providing information online. The Centers for Medicare & Medicaid Services (CMS) provides guidance to Part D prescription drug plan sponsors about information to include on their websites. The current article examines compliance with the 2014 CMS guidance for Medication Therapy Management (MTM) program information on Part D plan sponsors' websites. There were 59.5% of plan sponsors that had a dedicated MTM program webpage, accessible within two clicks from the plan sponsor's home page and provided basic information, eligibility for MTM services, and access to a blank copy of a personalized medication list document. Although improvements in the provision of information about plan sponsors' MTM programs can be made, future work should evaluate the usability and effectiveness of the online MTM program information provided to Medicare beneficiaries. [Journal of Gerontological Nursing, 42(10), 9-14.].

Increasing smoke alarm operability through theory-based health education: a randomised trial.

BACKGROUND: Although working smoke alarms halve deaths in residential fires, many households do not keep alarms operational. We tested whether theory-based education increases alarm operability. METHODS: Randomised multiarm trial, with a single arm randomly selected for use each day, in low-income neighbourhoods in Maryland, USA. Intervention arms: (1) Full Education combining a health belief module with a social-cognitive theory module that provided hands-on practice installing alarm batteries and using the alarm's hush button; (2) Hands-on Practice social-cognitive module supplemented by typical fire department education; (3) Current Norm receiving typical fire department education only. Four hundred and thirty-six homes recruited through churches or by knocking on doors in 2005-2008. Follow-up visits checked alarm operability in 370 homes (85%) 1-3.5 years after installation. MAIN OUTCOME MEASURES: number of homes with working alarms defined as alarms with working batteries or hard-wired and number of working alarms per home. Regressions controlled for alarm status preintervention; demographics and beliefs about fire risks and alarm effectiveness. RESULTS: Homes in the Full Education and Practice arms were more likely to have a functioning smoke alarm at follow-up (OR=2.77, 95% CI 1.09 to 7.03) and had an average of 0.32 more working alarms per home (95% CI 0.09 to 0.56). Working alarms per home rose 16%. Full Education and Practice had similar effectiveness (p=0.97 on both outcome measures). CONCLUSIONS: Without exceeding typical fire department installation time, installers can achieve greater smoke alarm operability. Hands-on practice is key. Two years after installation, for every three homes that received hands-on practice, one had an additional working alarm. TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov number NCT00139126.

Estimating alcohol and drug involvement in hospitalized adolescents with assault injuries.

PURPOSE: Adolescents using alcohol and drugs are at higher risk for assaultive behaviors. We examined adolescents aged 10 to 20 years who were hospitalized for assault injuries between July 1995 and December 1998 in Maryland to determine the demographic and injury-related predictors of the presence of drug/alcohol use among adolescents, and to estimate the presence of drug/alcohol use among adolescents with undetermined drug and/or alcohol use. METHODS: Patient records for adolescents were selected from 2189 discharges from the Maryland Trauma Registry and 1625 discharges from the Maryland Hospital Discharge data system. Three discrete groups of adolescents were identified: (1) those on the Trauma Registry and in the Hospital Discharge data system (N = 1197), (2) only those on the Trauma Registry (N = 992), or (3) only those in the Hospital Discharge data system (N = 428). Multiple logistic regression was performed to determine the predictors of the presence of drug/alcohol use among adolescents in the Trauma Registry. These models were then used to estimate the presence of drug/alcohol use among adolescents with undetermined drug and/or alcohol use. RESULTS: Age, sex, mechanism of injury, day of hospital admittance, and time of day were significant predictors of alcohol/drug use. The proportion of predicted alcohol/drug involved hospitalized cases varied from 54% to 66%. CONCLUSION: Our methodology and findings contribute to the understanding of the epidemiology of assaultive behaviors and the role of alcohol/drug use in injury among adolescents.

The impact of poison control centers on poisoning-related visits to EDs--United States, 2003.

PURPOSE: This study analyzes the association between center usage rates and the rates of nonadmitted visits to emergency departments (EDs) for poisoning. BASIC PROCEDURES: With a log-normal regression model, we analyzed the association between the number of human exposure calls per hospitalized poisoning patient and the number of nonhospitalized ED visits. The data were from 14 states at county level. MAIN FINDINGS: A 1% higher poison control center (PCC) human exposure call rate for unintentional poisoning is associated, but not necessarily causally, with a 0.18% lower ED visit rate (P < .0001). If the observed association is causative, 15.5 PCC human poison exposure calls prevent one nonadmitted ED visit, yielding a $205 net cost saving and a benefit-cost ratio of 1.4. The savings ignore any reduction in hospital admissions. PRINCIPAL CONCLUSIONS: Increased PCC exposure calls appear to be associated with reduced ED use for unintentional poisoning and appear to reduce net medical spending.

The potential impact of poison control centers on rural hospitalization rates for poisoning.

OBJECTIVE: This study tested the hypothesis that underutilization of poison control centers is associated with increased rates of hospitalizations attributable to poisonings in rural areas. METHODS: To measure the potential impact of poison control centers on hospitalization rates in rural areas among people who visit emergency departments because of poisoning, we estimated the reduction in hospitalization rates associated with increased rates of calls to centers. We used the 2003 State Inpatient Database and State Emergency Department Database from the Healthcare Cost and Utilization Project to calculate the numbers of emergency department visits and hospitalizations for each county in the 12 states analyzed. We used Toxic Exposure Surveillance System data from the American Association of Poison Control Centers to calculate the number of human exposure calls per capita according to county. RESULTS: In rural counties, a 1% higher poison control center human poison exposure call rate was associated with a 0.19% lower hospitalization rate among people who visited emergency departments because of poisoning. If the observed association is causative, then 43.3 calls would prevent 1 hospital admission, yielding 7321 dollars in net cost savings and a return on investment of 5.9:1 (from the health care system perspective). CONCLUSIONS: Our results establish the existence of the hypothesized association between rural poison control center utilization rates and hospitalization rates among emergency department-treated poisoning patients.

Fatal crashes involving young unlicensed drivers in the U.S.

INTRODUCTION: Young unlicensed drivers' involvement in fatal crashes is a recurrent problem in the United States. METHODS: This descriptive study extracted cross-sectional data on fatal crashes from the Fatality Analysis Reporting System from 1998 to 2002. Young unlicensed driver fatal crashes are examined by age, gender, and region. RESULTS: There were 2,452 young unlicensed driver fatal crashes representing 10.8% of all young drivers' fatal crashes. By age, 72.5% are over 15 years, males are involved in 74.5%, and southern and western states have a higher percent of young unlicensed driver fatal crashes. CONCLUSIONS: Subgroups of young people based on their age, gender, and region are over-represented in fatal crashes as unlicensed drivers. Further studies are needed to investigate the context and factors of young unlicensed drivers, essential to tailor interventions. IMPACT ON INDUSTRY: Young unlicensed drivers circumvent the established licensing process and pose a serious threat to themselves and other road users.

Bridging the gap: bringing together intentional and unintentional injury prevention efforts to improve health and well being.

PROBLEM: Intentional and unintentional injury prevention efforts have traditionally been independent and non-integrated. Fostering collaboration between the sub-fields would enhance work within both sub-fields and advance injury prevention work as a whole. METHOD: A systematic assessment of similarities and differences between the sub-fields was performed, including an examination of relevant definitions and norms, research methods and findings, key risk and resiliency factors, and prevention strategies that would promote collaboration and better advance current prevention efforts. RESULTS/SUMMARY: Several areas exist in which injury prevention efforts could be coordinated or ideas and practices could be cross-applied, including training of practitioners, data collection and analysis, application of tools and methodologies, examination of risk and resiliency factors, and identification of funding sources and partners. IMPACT ON INDUSTRY: This paper delineates how intentional and unintentional injury prevention practitioners can more effectively collaborate to promote safer environments and further reduce incidence of injury. An integrated injury prevention approach could significantly impact the underlying contributors to both types of injury, allowing practitioners within both sub-fields to achieve greater outcomes through increased credibility, reduced duplication of efforts, more efficient use of resources, and unified injury prevention messages.

Are booster seats needed: comparing occupant outcomes ages 4-7 versus 8-13.

Booster seat laws are premised on the need to improve seat belt fit for young children to reduce their injury risk. This paper provides the first extensive examination of national crash data for children in seat belts. Using regression and other models, we found no evidence that crash-involved children ages 4-7 in lap-shoulder belts fare worse on average than similarly restrained children ages 8-13 or, in sensitivity analysis, than similarly restrained adults ages 18-34. If anything, they may fare better.