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New Child Well-Being Rankings Released - Governing Magazine
New Child Well-Being Rankings Released
BY J.B. WOGAN | JUNE 25, 2013 GOVERNING MAGAZINE
What state last year increased its percentage of children attending preschool, fourth graders reaching proficiency in reading and eighth graders reaching proficiency in math?
The surprising answer: Mississippi .
For the past 24 years, the Annie E. Casey Foundation has published child well-being rankings for every state. For most of those years,Mississippi has had a stranglehold on last place. Not in 2013. The Magnolia State saw improvements on eight of 16 indicators. Beyond the gains in education, Mississippi recorded fewer teen births per 1,000 teenagers and a lower percentage of children without health insurance, moving it to 49th on the foundation's state-by-state child well-being rankings (New Mexico fell to 50th).
The new child well-being rankings mark the first time the Annie E. Casey Foundation has made year-to-year comparisons across all 16 indicators. Before 2012, the foundation's researchers focused on 10 indicators, which gave more weight to health outcomes. The past two years includes data for four categories: economic well-being, education, family and community, and health. The nation made gains in all four education domains and all four health domains. The worst results were in economic well-being, where the country lost ground in three of four indicators. About 16.4 million children lived in poor families in 2011, a slight increase from 15.7 million in 2010, according to the report.
The foundation researchers who collected and analyzed the data knew North Dakota and its neighboring states were benefiting from a growth in the energy sector, but "how much that means to the well-being of families is kind of surprising," said Laura Speer, the foundation's associate director for policy reform and data.
While North Dakota has the lowest unemployment rate in the country, the fastest growing gross domestic product and the fastest growing personal income, the child-specific measures tracked by the Anne E. Casey Foundation actually got worse in the last 5 to 8 years. The latest data raise a question for Karen Olson, program director for the North Dakota Kids Count: Even with the boom in natural gas and oil, are residents really immune from effects of the Great Recession? Maybe not, according to Olson.
To some extent, the latest Kids Count data isn't reporting anything new. After all, the numbers are culled from existing public resources such as the U.S. Census Bureau's annual American Community Survey and the National Assessment of Educational Progress, a standardized test from the U.S. Department of Education. Nonetheless, packaging that information together and framing it in a state-by-state context can make an impact on local policymakers.
Eight years ago the foundation's Kids Count Data Book found that Delaware was the worst in the country in its rate of infant mortalities. In response, then-Gov. Ruth Ann Minner convened a task force to study the issue and make recommendations on how to lower the state's infant mortality rate. The state set aside $1 million in 2006 and another $2 million in 2007 to address infant mortality, establishing monitoring systems, launching public information campaigns and expanding prenatal care.
Infant mortality isn't listed among the 2013 Kids Count health indicators, but a related factor, low-birth weight, is. Between 2001 and 2005, an average of 9.4 babies out of every 1,000 had low-birth weights in Delaware , according to the Centers for Disease Control and Prevention. Over the next five years, the average fell to 8.9 per 1,000 babies. Also, the state reduced another factor related to infant mortalities -- the rate of premature births -- according to a six-year progress report by the Delaware Health Mother and Infant Consortium.
Janice Barlow, who oversees a state branch of Kids Count in Delaware , said that since 2005 the state has seen incremental improvements in the health of newborns, but progress has been slow. Even after nearly a decade of efforts to improve outcomes, Delaware 's infant mortality rate was 7.7 deaths per 1,000 live births, higher than the national average of 6.1.
Of the ongoing effort, Barlow said: "It takes a lot of work and a lot of focus to have a change."
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Pilot Study Suggests Ways Primary Providers Can Deliver Specialty Care
Pilot Study Suggests Ways Primary Providers Can Deliver Specialty Care
By Rebecca Adams, CQ HealthBeat Associate Editor
Using telemedicine or physician assistants and primary care providers to deliver specialty care instead of specialists seems to give patients broader access to the services without compromising quality, according to an evaluation of initiatives in six states that are still in the early stages.
The 24-page study by the Center for Studying Health System Change for the Commonwealth Fund evaluated efforts to increase access to specialty care among patients, including those enrolled in Medicaid, in Connecticut, Illinois, Minnesota, New Mexico, Oregon and Tennessee. Each model, the study said, showed the potential to be used in other states.
“Some respondents found quality of care and patient outcomes to be the same, if not better” than when patients were treated by specialty providers. The programs have not been fully analyzed to determine cost savings but the study said that comprehensive evaluations by other groups are planned for the projects in New Mexico , Connecticut andMinnesota . Each initiative had different ways of expanding access to specialty services.
Some of the early results included, for example, an increase in the Connecticut project in the percentage of diabetic patients that got retinopathy screening. The percentage grew from 10 percent to 40 percent. In that project, the program created a telehealth program in 2009 to look for early signs of blindness in people with diabetes. Medical assistants were taught to use retinal cameras to take images of patients. The images were then sent to ophthalmologists for diagnosis. Using telehealth for diabetic retinopathy saved about $28 a patient, or about 35 percent of the cost per patient when compared to an exam by a specialist, according to the report. The project is run by Community Health Centers Inc., the Yale Medical Group and the University of Connecticut . The community health centers care for about 130,000 patients.
In New Mexico , waits for rheumatology appointments at the University of New Mexico fell from six months to one month after a videoconference-based project was created. In that program — known as Project ECHO (an acronym for Extension for Community Healthcare Outcomes) — primary care providers were trained to act as quasi-specialists. Primary care doctors and other primary care providers ask specialists for advice on how to treat patients with specific conditions, and, over time, the primary care providers learn enough to treat many common concerns without having to refer the patients to specialists. One primary care provider in the project sent all patients with rheumatology needs to specialists before the training, but after the project was implemented, that rate of referral fell to about 10 percent of cases.
The quality of care seemed “to be the same, if not better,” said the study. The authors noted that patients treated for hepatitis C through Project ECHO had about the same outcomes as patients treated by specialists.
The report also said that in Oregon , the use of physician assistants helped orthopedic patients who didn’t need surgery to get therapy in a quicker way than waiting for specialty care. The physician assistants also were able to replace temporary splints for patients with routine broken bones with less of a wait than the patients would have had to endure to see an orthopedist. The use of casts early on helps to heal the bones.
Some advocates of the projects hope to expand them. But the study concluded that this could be tough to do, particularly without changes to current Medicaid payment policies.
The study said potential changes might include: paying providers to consult with specialists or treat patients remotely, allowing federally qualified health centers to provide more specialty care, funding the training of primary care providers in specialty care and changing, for example, the way coordinating patient care is paid for in managed care contracts.