Directing Discipline: State Medical Board Responsiveness to State Legislatures.

State medical boards are increasingly responsible for regulating medical and osteopathic licensure and professional conduct in the United States. Yet, there is great variation in the extent to which such boards take disciplinary action against physicians, indicating that some boards are more zealous regulators than others. We look to the political roots of such variation and seek to answer a simple, yet important, question: are nominally apolitical state medical boards responsive to political preferences? To address this question, we use panel data on disciplinary actions across sixty-four state medical boards from 1993 through 2006 and control for over-time changes in board characteristics (e.g., composition, independence, budgetary status), regulatory structure, and resources. We show that as state legislatures become more liberal [conservative], state boards increasingly [decreasingly] discipline physicians, especially during unified government and in the presence of highly professional legislatures. Our conclusions join others in emphasizing the importance of state medical boards and the contingent nature of political control of state regulation. In addition, we emphasize the roles that oversight capacity and strategy play in offsetting concerns regarding self-regulation of a powerful organized interest.

Development of Vermont assessment of sex offender risk-2 (VASOR-2) reoffense risk scale.

The present study aimed to revise the Vermont Assessment of Sex Offender Risk (VASOR) Reoffense Risk Scale, a commonly used sex offender risk assessment tool. The revised tool was named the VASOR-2. Among models tested to revise the scale, a logistic regression model showed the best balance between simplicity of use, goodness of fit, and internal validity (as tested with K-10 cross-validation), and maximized predictive accuracy. Predictive accuracy was tested using four meta-analytically combined data sets drawn from Canada and Vermont (N = 1,581). At 5-year fixed follow-up, the predictive accuracy for sexual recidivism for VASOR-2 (AUC = .74) was similar to the VASOR (AUC = .71). The findings show the VASOR-2 is well calibrated with observed recidivism rates for all but the highest risk sex offenders. The instrument showed good interrater reliability (ICC = .88). An advantage of the VASOR-2 is that it has fewer items and simpler scoring instructions than the VASOR. Norms are presented for a contemporary, nonselected, routine sample of Vermont sex offenders (n = 887).

The sex offender treatment intervention and progress scale (SOTIPS): psychometric properties and incremental predictive validity with static-99R.

The Sex Offender Treatment Intervention and Progress Scale (SOTIPS) is a 16-item rating scale designed to assess dynamic risk among adult male sex offenders and degree of change at 6-month intervals during treatment. The purpose of the present study was to examine the psychometric properties of the SOTIPS in a construction sample of 759 adult male sex offenders who were under correctional supervision and enrolled in cognitive-behavioral community treatment in Vermont between 2001 and 2007. The scale showed acceptable interrater reliability. SOTIPS scores at 1, 7, and 13 months after participants began treatment predicted sexual, violent, and any recidivism, and return to prison at fixed 1- and 3-year follow-up periods (AUCs = .60 to .85). Combined SOTIPS and Static-99R scores predicted all recidivism types (AUCs = .67 to .89) and outperformed either instrument alone when both instruments had similar predictive power. Participants who demonstrated treatment progress, as reflected by reductions in SOTIPS scores, showed lower rates of recidivism than those who did not.

National profile of children with Down syndrome: disease burden, access to care, and family impact.

OBJECTIVE: To measure the co-morbidities associated with Down syndrome compared with those in other children with special health care needs (CSHCN). Additionally, to examine reported access to care, family impact, and unmet needs for children with Down syndrome compared with other CSHCN. STUDY DESIGN: An analysis was conducted on the nationally representative 2005 to 2006 National Survey of Children with Special Health Care Needs. Bivariate analyses compared children with Down syndrome with all other CSHCN. Multivariate analyses examined the role of demographic, socioeconomic, and medical factors on measures of care receipt and family impact. RESULTS: An estimated 98,000 CSHCN have Down syndrome nationally. Compared with other CSHCN, children with Down syndrome had a greater number of co-morbid conditions, were more likely to have unmet needs, faced greater family impacts, and were less likely to have access to a medical home. These differences become more pronounced for children without insurance and from low socioeconomic status families. CONCLUSIONS: Children with Down syndrome disproportionately face greater disease burden, more negatively pronounced family impacts, and greater unmet needs than other CSHCN. Promoting medical homes at the practice level and use of those services by children with Down syndrome and other CSHCN may help mitigate these family impacts.

The impact of socioeconomic factors on asthma hospitalization rates by rural classification.

Asthma hospitalization rates have increased in the past decade. Research has shown that there are multiple correlates for this increase but that driving causal factors may differ for asthma hospitalization rates in rural and non-rural settings. Here we examine the socioeconomic correlates to asthma hospitalization rates in Maine for both rural and non-rural populations to examine the similarity and differences in causal factors. Findings indicate a clear SES gradient relative to asthma hospitalization rates; as population measured SES decreased, asthma hospitalization rates increased. The associated causal factors were found to differ in rural and non-rural areas. In non-rural areas, the presence of insurance was associated with increases in the asthma hospitalization rates while in rural areas, income, occupation and the percentage of non-English language speaking persons were associated with lower asthma hospitalization rates. Public policy should focus on targeted prevention strategies at the community level, especially in rural areas where cultural competency and socioeconomic factors are increasingly important.

The Validity of Online Patient Ratings of Physicians: Analysis of Physician Peer Reviews and Patient Ratings.

BACKGROUND: Information from ratings sites are increasingly informing patient decisions related to health care and the selection of physicians. OBJECTIVE: The current study sought to determine the validity of online patient ratings of physicians through comparison with physician peer review. METHODS: We extracted 223,715 reviews of 41,104 physicians from 10 of the largest cities in the United States, including 1142 physicians listed as "America's Top Doctors" through physician peer review. Differences in mean online patient ratings were tested for physicians who were listed and those who were not. RESULTS: Overall, no differences were found between the online patient ratings based upon physician peer review status. However, statistical differences were found for four specialties (family medicine, allergists, internal medicine, and pediatrics), with online patient ratings significantly higher for those physicians listed as a peer-reviewed "Top Doctor" versus those who were not. CONCLUSIONS: The results of this large-scale study indicate that while online patient ratings are consistent with physician peer review for four nonsurgical, primarily in-office specializations, patient ratings were not consistent with physician peer review for specializations like anesthesiology. This result indicates that the validity of patient ratings varies by medical specialization.

A structured method of assessing dynamic risk factors among sexual abusers with intellectual disabilities.

The nature and severity of dynamic risk factors among a group of 87 adult male sexual abusers with intellectual disabilities were examined as was the psychometric properties of a new scale designed to measure these risk factors. The Treatment Intervention and Progress Scale for Sexual Abusers with Intellectual Disabilities (TIPS-ID) is composed of 25 dynamic risk factors linked to sexual reoffense. Data analyses indicate support for the item composition and reliability of the scale. Ratings from this scale differentiated participants on several clinical variables related to problem severity but not on a measure of static risk. These results are discussed in terms of their clinical and research implications.

Sex offender modus operandi stability and relationship with actuarial risk assessment.

Three studies conducted in Vermont yielded data on 82 sexual recidivists' index offenses (Time 1) and sexual reoffenses (Time 2) across 16 modus operandi (MO) characteristics. The current study examines the stability of these 16 characteristics between Time 1 and Time 2 offenses. Probabilities of Time 1-Time 2 characteristic combinations are reported, including when controlling for static risk as measured by the Static-99R and Vermont Assessment of Sex Offender Risk-2 (VASOR-2). Overall, considerable stability of offenders' MO was evident between Time 1 and Time 2 offenses. Victim characteristics and offense behaviors were the most stable MO characteristics, and degree of force used and victim injury were less stable and trended toward less forceful and less injurious reoffenses. Controlling for static risk had little impact on the patterns of MO stability.

National Survey of Providers Treating Patients With Metabolic Disorders Identified by Newborn Screening Demonstrates Challenges Faced by Clinical Care Systems.

OBJECTIVES: To evaluate care processes for infants who are identified by newborn screening (NBS) and diagnosed with metabolic disorders during their first year of life. METHODS: A survey instrument was used to assess the scope and intensity of services needed to provide quality health care for patients from birth to 1 year of age who have a metabolic disorder identified by NBS. Significance testing was not performed; descriptive analyses are reported. RESULTS: Providers spend significant amounts of time on activities that are not direct patient care. The most challenging aspect of their work was the lack of reimbursement for care. CONCLUSION: Provision of genetics services for patients with a metabolic disorder is time and labor intensive, and insurance coverage and reimbursement for these services remain inadequate. Health care payment and/or system reform is necessary to provide optimal care to patients with metabolic disorders identified by NBS.

Using the Electronic Health Record in Nursing Research: Challenges and Opportunities.

Changes in the patient record from the paper to the electronic health record format present challenges and opportunities for the nurse researcher. Current use of data from the electronic health record is in a state of flux. Novel data analytic techniques and massive data sets provide new opportunities for nursing science. Realization of a strong electronic data output future relies on meeting challenges of system use and operability, data presentation, and privacy. Nurse researchers need to rethink aspects of proposal development. Joining ongoing national efforts aimed at creating usable data output is encouraged as a means to affect system design. Working to address challenges and embrace opportunities will help grow the science in a way that answers important patient care questions.

The impact of community notification on sex offender reintegration: a quantitative review of the research literature.

The purpose of this review was to better understand the impact of community notification, known as "Megan's Law," on sex offenders' reintegration into the community. Eight quantitative studies that examined the social and psychological impact of community notification on adult sex offenders (N = 1,503) were reviewed. The pattern of results across studies showed considerable similarities despite marked variability in the populations examined, survey methods used, and response rates obtained. Sex offenders rarely reported being the target of vigilante attacks. Substantial minorities reported exclusion from residence and job loss as social consequences of being publicly identified as sex offenders in their communities. The majority of offenders reported negative psychological consequences of notification but also identified benefits of knowing that others were monitoring their behavior. More intrusive notification strategies were associated with higher rates of socially destabilizing consequences. Results are discussed in terms of their policy and research implications.

Access to genetic counseling for children with autism, Down syndrome, and intellectual disabilities.

OBJECTIVE: We examined the need for genetic counseling services (GCS) for families of children with autism spectrum disorder (ASD), Down syndrome (DS), and/or mental retardation (MR) and factors that influence the receipt of needed GCS for those children relative to other children with special health care needs (CSHCN). METHODS: Analysis was conducted on the 2005-2006 National Survey of Children With Special Health Care Needs, a nationally representative sample. Bivariate analyses were conducted by examining need for and receipt of GCS for children with ASD, DS, and/or MR and other CSHCN as well as differences by contextual variables using the health belief model (HBM). Logistic regression analyses were conducted to assess the relative impact of receipt of needed GCS by HBM constructs. RESULTS: Families of children with diagnoses of ASD, DS, and/or MR perceive significantly higher need for GCS than other CSHCN. The presence of a medical home is the single most important factor in facilitating access to GCS, together with the presence of insurance, particularly private or a combination of private and public insurance. As income and education attainment decrease, barriers to GCS rise. CONCLUSIONS: This analysis supports strategies for improving linkages between specialty providers and the medical home at which primary care is delivered. Increased effort should be made to attend to those who experience barriers that result from lack of insurance, poverty, low education, or racial or ethnic differences. Health professionals need to collaborate in developing solutions to underinsurance or lack of insurance for CSHCN.

Community management of sex offenders with intellectual disabilities: characteristics, services, and outcome of a statewide program.

The state of Vermont closed its only institution for persons with intellectual disabilities in 1993 and moved to a totally community-based model of services. Here we describe the characteristics of the near exhaustive statewide sample of adult male sex offenders with intellectual disabilities (N=103) who received these services between 1993 and 2004, discuss these services, and examine the sexual recidivism rates of the sample. Over an average follow-up period of 5.8 years, 10.7% of the sample was identified as having sexually reoffended. Most reoffenses were noncontact, and most victims were staff members, relatives, or housemates of the abuser. Results are discussed in terms of their clinical, policy, and research implications.

Outcomes in a community sex offender treatment program: a comparison between polygraphed and matched non-polygraphed offenders.

This study compared a group of 104 adult male sex offenders who received community cognitive-behavioral treatment, correctional supervision, and periodic polygraph compliance exams with a matched group of 104 sex offenders who received the same type of treatment and supervision services but no polygraph exams. Polygraph exams focused on whether participants were following their conditions of community supervision and treatment and had avoided committing new sexual offenses. The two groups were exact pair-wise matched on three variables: (1) Static-99 risk score (Hanson & Thornton 2000, Law and Human Behavior, 24, 119-136), (2) status as a completer of prison sex offender treatment, and (3) date placed in the community. At fixed 5-year follow-up periods, the number of individuals in the polygraph group charged with committing a new non-sexual violent offense was significantly lower than in the no polygraph group (2.9% versus 11.5%). However, there were no significant between-group differences for the number of individuals charged for new sexual (5.8% versus 6.7%), any sexual or violent (8.7% versus 16.3%), or any criminal offense (39.4% versus 34.6%). The results are discussed in terms of their clinical and research implications.

Collaboration among sex offender treatment providers and probation and parole officers: the beliefs and behaviors of treatment providers.

New and emerging collaborative responses to sex offender management are challenging traditional notions about how treatment providers and probation and parole officers (POs) deliver services to this difficult population. Typically, sex offender treatment professionals provide community-based services to offenders who are supervised by POs. Yet, no comprehensive survey has investigated how treatment providers and POs collaborate and view their relationships with each other. This national random survey examined the beliefs and behaviors of community-based adult sex-offender treatment providers concerning various types of provider and PO interactions and collaborative models. Overall, treatment providers reported that they value frequent and substantive communication with POs concerning mutual clients. There was, however, considerable diversity in practice and opinion among providers with regard to POs leading, coleading, and observing sex offender treatment groups. Treatment providers' opinions about various clinical, ethical, and legal issues evident in these collaborative approaches are examined.