Room for improvement: gastrointestinal disorders and payment errors.

The physician is central to deciding whether a patient requires acute inpatient hospital treatment and is also responsible for appropriately documenting the record which permits accurate diagnostic-related grouping (DRG) coding. An area of particular concern both nationally and in New York State has been patients admitted with gastrointestinal (GI) disorders; specifically, DRGs 174 (GI hemorrhage with complication) and 182 (esophagitis, gastroenteritis, and miscellaneous digestive disorders age > 17 with complication comorbidity). A baseline sample of 600 cases from fiscal year (FY) 2006 was selected from 20 hospitals and underwent review for both admission necessity and DRG assignment. The results were disseminated to the hospitals. In addition, hospitals with a >10% error rate were required to implement an improvement plan. A re-measurement sample of 300 cases was taken from FY 2007 for review. The aggregate error rate was 13.3% at baseline and decreased to 8.0% on re-measurement (P < 0.05). Admission denials decreased from 8.0 to 4.7% related primarily to DRG 182. Errors in DRG assignment decreased from 5.7 to 3.3% related primarily to DRG 174. Of note, the greatest improvement in both admission and DRG errors was seen in the hospitals required to implement a formal improvement plan. These data show that a program that includes emphasis on education of physicians on the importance of admission criteria and careful documentation of the record can reduce both inappropriate admissions and improve accuracy of DRG assignment.

Possible selves and academic outcomes: How and when possible selves impel action.

Puzzled by the gap between academic attainment and academic possible selves (APSs) among low-income and minority teens, the authors hypothesized that APSs alone are not enough unless linked with plausible strategies, made to feel like "true" selves and connected with social identity. A brief intervention to link APSs with strategies, create a context in which social and personal identities felt congruent, and change the meaning associated with difficulty in pursuing APSs (n = 141 experimental, n = 123 control low-income 8th graders) increased success in moving toward APS goals: academic initiative, standardized test scores, and grades improved; and depression, absences, and in-school misbehavior declined. Effects were sustained over a 2-year follow-up and were mediated by change in possible selves.

The role of psychosocial factors in the transition to substance use: are they protective among urban minority adolescents?

Changes in psychosocial risk and protective factors associated with the onset of substance use were examined in a sample of 556 urban public school sixth graders. General linear modeling analyses indicated that students who did not use substances by the end of sixth grade consistently had higher scores on protective factors than did students who were already using substances at the beginning of sixth grade. Students who began to use during the school year were in flux with scores similar to nonusers at Time 1 and scores closer to early users by Time 2. These findings suggest that interventions which focus on skill enhancement during the transition to middle school may be effective at delaying the onset of substance use. Editors' Strategic Implications: The authors find the same protective factors in this urban, primarily African American sample that are typical in suburban, White samples. Developmentalists and school officials will find interesting the changing effects of protective factors against early substance use during the transitional sixth grade year.

A possible selves intervention to enhance school involvement.

We developed a 9-week after-school, small group, activities-based intervention focused on enhancing youth's abilities to imagine themselves as successful adults and connecting these future imagines to current school involvement. We describe and evaluate this programme comparing three cohorts of urban African American middle school students (n=62 experimental, n=146 control), controlling for sex and previous school involvement. By the end of the school year, intervention youth reported more bonding to school, concern about doing well in school, "balanced" possible selves, plausible strategies to attain these possible selves, better school attendance, and for boys, less trouble at school.