jGPHA Volume 1, Number 2 (2006)
Table to Contents
From the Editor
Historical Critique of the Leading Causes of Death in the United, States, M. Thomas
Practice in Action
A Needs Assessment of Hypertension in Georgia, F. Lopez, M., Rimando, & H. Khapekar
Racial Differences in Perception of Breast Cancer Risk in Rural Southeast Georgia, S. Tedders, A. Parrillo, K. Peace, & J. Knight
Care Quality for Adult Medicaid Beneficiaries with Type 2 Diabetes Varies by Primary Care Provider Subspecialty, R. Mayberry, R., Finley, E. Alema-Mensah, & T. Davis
Pregnancy and Delivery Costs in Georgia Medicaid: PCCM versus Fee-for-Service Enrollees, C. Raskind-Hood, E. Kathleen Adams, E., Alema-Mensah, &, R. Mayberry
McKinley Thomas, Augusta State University, Mercer University School of Medicine
Grace Baugh, Medical College of Georgia
Kathi J. Bivens, Augusta State University
Georgia L. Gerard-Reed, Augusta State University
Paula Dohoney, Augusta State University
Curtis Gobely, Georgia Division of Public Health
Mary Mathis, Mercer University
Anthony Parrillo, Georgia Southern University
Jane M. Perry, Georgia Division of Public Health
Rebecca Rogers, Augusta State University
Lee Tanenbaum, Georgia Division of Public Health
Anna Vickery, Medical College of Georgia
Naomi Williams, Medical College of Georgia
Pregnancy and Delivery Costs in Georgia Medicaid: PCCM versus Feefor- Service Enrollees4This study examines the enrollment, resource utilization, and prenatal care cost patterns among pregnant black and white women in Georgia’s PCCM program, Georgia Better Health Care (GBHC), compared with those acquiring pregnancy and delivery services through Georgia’s Fee for Service (FFS) sector. Birth certificate data from 1998 were linked with Medicaid enrollment and claims data from 1997 and 1998 to construct a retrospective pregnancy history for each Medicaid woman giving birth in Georgia hospitals in 1998. Total payments for pregnancy and delivery services and on the total number of prenatal care visits were derived for each woman in the sample. Multivariate logistic analyses were employed to assess the role of PCCM versus FFS in determining total payments and the likelihood of a prenatal hospitalization, length of hospital stay longer than 2 days following delivery, and cesarean section delivery. While prenatal pregnancy services and delivery costs were higher for those in PCCM than FFS, PCCM women had fewer prenatal care visits and were less likely to have delivery stays longer than 2 days postpartum compared with FFS women. The higher costs under PCCM are apparently related to the finding that this delivery system was highly associated with having more prenatal hospitalizations compared with FFS. In similar analyses conducted separately for white and black pregnant women, black women served by PCCM followed these overall results across delivery systems while there were no differences in the likelihood of a prenatal hospitalization or total prenatal care visits for whites served by PCCM versus FFS. In light of Georgia’s turn toward full capitation under its new managed care initiative, many issues regarding pregnancy services and delivery such as earlier program enrollment, coordination of care, payment policies and capitation rates will need to be addressed.
Care Quality for Adult Medicaid Beneficiaries with Type 2 Diabetes Varies by Primary Care Provider SubspecialtyThe Georgia Medicaid primary care case management (PCCM) program, phased in over the 1994- 1997 period, has now given way to a capitated managed care model of regional care management organizations (CMOs). Using Georgia Medicaid eligibility and provider claim data for 1996-1998, this study investigated diabetes care quality and whether it varied by primary care provider subspecialty in a longitudinal follow-up of newly diagnosed adults with type 2 diabetes during the early phase of the PCCM program. Results indicated that the quality of diabetes care was suboptimal and varied significantly by PCP subspecialty, with patients seen by generalists least likely to have their HbA1c monitored as recommended during office visits (odds ratio = 0.34, (95% confidence interval 0.16- 0.73). No PCP subspecialty consistently performed better or worse on all diabetes care quality indicators investigated. The lessons learned from this investigation are that variations in Medicaid care quality by PCP subspecialty is likely to remain and the new CMO model of care will unlikely demonstrate immediate improvement in diabetes care quality.
Racial Differences in Perception of Breast Cancer Risk in Rural Southeast GeorgiaA university-public health collaborative was formed to more fully understand cancer risk among rural women in Georgia. Objectives: This study sought to gain an understanding of racial differences with regard to behavioral risk, perception of breast cancer risk, and perception of barriers to screening. Design: Differences in subjects’ risk and risk perception were assessed by creating, piloting, and administering a written survey at local health departments. Sample: A purposive sample of females enrolled in breast and cervical cancer screening programs in four rural counties in southeast Georgia (n = 147) were surveyed. Subjects were randomly invited to participate. Incentives were provided to enhance participation. Results: White females were significantly more likely than were black females to perceive pollution (OR: 4.63; p = 0.038), smoking (OR: 2.39; p = 0.018), age (OR: 3.01; p = 0.013), and hormone replacement therapy (OR: 3.17; p = 0.005) as factors influencing their breast cancer risk, and to perceive cost as a barrier to screening (OR: 2.89; p = 0.032). From a risk perspective, black females were more likely than white females to have had five-or-more pregnancies (p = 0.005), and to have given birth before age fifteen (p = 0.011). Conclusions: This study provided important baseline data about breast cancer risk necessary in developing effective health promotion programs.
A Needs Assessment of Hypertension in GeorgiaHypertension is a leading cause of stroke, coronary artery disease, heart attack, and heart and kidney failure in the United States. In Georgia, the percentage of those with hypertension and related diseases remain above the national average. The aim of this paper is to offer a basic review of hypertension including physical complications of the disease and to provide statistics regarding the scope of hypertension in the state of Georgia. Additionally, the paper provides insights on current hypertension programs such as the National High Blood Pressure Education Program (NHBPEP) and Dietary Approaches to Stop Hypertension (DASH). In conclusion, a statewide or local hypertension education program should be implemented to improve awareness, treatment, opportunities, and control of hypertension in an effort to reduce cardiovascular disease rates in Georgia.