Caring for people with developmental disabilities: survey of nurses about their education and experience.

Over 500 nurses in New Jersey responded to a survey on education and training in the area of developmental disabilities. Respondents provided information on their work experience, experience with patients who have developmental disabilities, and opportunities for continuing medical education. Results showed that although many nurses thought educational activities related to developmental disabilities were important, only about 10% said that they received "a lot" of training. Most respondents (almost 60%) said that they received little or no training in the area, and most received no specific training on developmental disabilities since receiving their licenses or in their current job. Implications of these findings in light of the movement of people with developmental disabilities into community-living and managed care plans are discussed.

Correlations among the Reiss Screen, the Adaptive Behavior Scale Part II, and the Aberrant Behavior Checklist.

Relations among instruments used in community mental health services for people with developmental disabilities were explored with 284 individuals. Correlation coefficients among the instrument subscales were interpreted in terms of statistical significance and effect size. Of the 157 coefficients, 44% were significant, p < .001, and 35% represented large effects, r > .50. Reiss Screen subscale scores correlated with Irritability, Lethargy, and Hyperactivity on the Aberrant Behavior Checklist (ABC) and with Social Behavior and Disturbing Interpersonal Behavior on the ABS Part II. Stepwise regression analyses predicting Reiss Screen scores from the ABS and ABC resulted in a significant regression, with an overall adjusted R2 of .67. Variance was largely accounted for by two ABS domains and two ABC subscales.

Quality of health care for people with developmental disabilities: the challenge of managed care.

Health care quality issues for people with developmental disabilities under managed care were explored. Health-related quality was defined in terms of four domains: structure, process, outcome, and satisfaction. Three general problems in the assessment of health care quality were identified: lack of quality measures, patient response problems, and lack of system elements. Selected current measurement systems were described in relation to their use for people with developmental disabilities. An approach to developing quality measures was outlined using Healthy People 2000, Health Plan Employer Data Information Set, and clinical practice issues. The movement toward quality improvement was examined and recommendations presented for steps in developing and measuring health care quality.

Overview and implications of Medicaid managed care for people with developmental disabilities.

The inclusion of people with developmental disabilities in managed care as part of general efforts by states to enroll and Medicaid recipients in such plans was reviewed. Managed care was defined and the processes by which managed care organizations deliver services were explained. Escalating costs and utilization were discussed as the primary reason for the shift to managed care. The use of Medicaid Section 1115 waivers by states to include Medicaid recipients was explored. The relation between acute health care and long-term care, and the utilization patterns in each, were briefly described. Finally, elements of managed care that are particularly important to people with developmental disabilities, such as care coordination, maintenance of quality, and individual and family support, were discussed.

Technical elements, demonstration projects, and fiscal models in Medicaid managed care for people with developmental disabilities.

We presented a general model of the structure and functioning of managed care and described elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to service delivery for people with developmental disabilities. A number of technical elements of managed care systems were delineated and reviewed in relation to the inclusion of people with developmental disabilities. Several managed care demonstration projects were described and, finally, a multi-year hypothetical budget model, including long-term care, was presented as a framework for considering how managed care affects specific service structures. Implications for people with developmental disabilities were discussed.

Effect of magnesium sulfate on the development of cystic periventricular leukomalacia in preterm infants.

To determine if magnesium sulfate has an effect on the development of cystic periventricular leukomalacia in preterm infants, this retrospective case control study was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight < 1750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life. Infants exposed to magnesium sulfate in utero were less likely to develop periventricular leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p = 0.035) (OR = 0.196, 95% CI = 0.039-0.988). Pre-eclampsia as an independent factor was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% CI = 0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to have a reduced risk of developing cystic periventricular leukomalacia.

Characteristics of hospitalizations for people with developmental disabilities: utilization, costs, and impact of care coordination.

Hospitalizations and the impact of care coordination were studied in two large databases for people with developmental disabilities. Acute care admissions for alternate years between 1983 and 1991 were analyzed and compared to the data for the nondisabled population of New Jersey. The statewide dataset included 22,294 admissions; the coordinated dataset included 692 admissions to a community hospital. Under the diagnostic-related group reimbursement system, admissions for the general population remained constant, whereas hospital days and average length of stay dropped during the study period. Increases in admissions (56%) and days (42%) were found for people with developmental disabilities. Their total hospital charges rose 206%, almost twice the rate for the general population. Care coordination moderated all of these differences.

An evaluation of care coordination in controlling inpatient hospital utilization of people with developmental disabilities.

All admissions of people with developmental disabilities to a community hospital over 3 years were examined to evaluate the impact of a coordinated care model on length of stay and hospital charges. Admissions were divided into two groups, those receiving either coordinated care (program group) or routine care by community physicians (usual care group). The program group had shorter average lengths of stay and lower hospital charges than did the usual care group, especially when charges were adjusted for case mix. Similarity of severity across the groups was measured by number of discharge diagnoses and Medicaid case weights. Over the 3 years, for the 115 admissions in the program group, these differences amounted to more than $200,000 in potentially unnecessary hospital charges. Implications of care coordination services for community-based health care planning were presented.

Managed health care services for people with mental retardation: impact on inpatient utilization.

All admissions of people with mental retardation to a community hospital during one year were examined to determine the effects of a managed-care model on selected outcome variables. Hospitalization outcomes for patients receiving health care services through the program (care coordination group) were compared to those not enrolled (usual care group). Patients in the care coordination group were found to have shorter hospital stays, when adjusted for diagnosis-related groups; fewer readmissions; and were less severely ill upon admission. Cost data were extrapolated to show that costs of care coordination activities were partially offset by reductions in inpatient utilization.

Modelling and role-modelling: integrating nursing theory into practice.

This article contrasts two clinical cases using a relatively new paradigm and theory, modelling and role-modelling. The concepts and linkages from modelling and role-modelling are presented and are the basis for analysing the outcomes of of two patients. The case study approach communicates an understanding of the theory modelling and role-modelling and assists nurses to develop expertise in its use.

Age differences in free recall rehearsal strategies.

Younger (mean age = 23.9 years) and older (mean age = 73.9 years) adults were compared on a free recall task with lists of categorizable words. One-half of the subjects were given instructions to rehearse overtly during list study, and the remainder received standard (covert) instructions. Relative to covert rehearsal, overt rehearsal did not appear to affect the type of study strategy used by subjects. Age differences in free recall and category clustering were found, paralleled by clear age differences in rehearsal strategies. Young adults' rehearsal was active, serially organized early in a list, and then categorically organized for the rest of a list. Older adults' rehearsal was inactive and essentially nonstrategic, consisting mostly of single mentions of each list item. These results also show that direct strategy measures provide more information about the processes underlying age differences in memory than do outcome measures alone.