A Primer for Managed Care Residents: How to Conduct Research Using Live Medical and Pharmacy Claims Data.

Managed care organizations are growing more sophisticated in their ability to analyze data. There are increasing numbers of data analysts at managed care organizations, as well as more types of real-time, or "live," data available. These data range from pharmacy claims and enrollment files to medical claims, medical records, and linkages to external data. Moreover, the data are often curated in a way that allows for easier data analysis. Using these data, managed care residents are often required to perform a project to evaluate a utilization management policy or clinical program. Yet, there is a lack of guidance specific to managed care organizations on how to conduct such a research study using "live" claims data. This Viewpoint article provides a primer for managed care residents and other managed care professionals who are seeking to use data to help inform decisions on how to manage their beneficiaries' health and costs. DISCLOSURES: There was no funding source for this manuscript. Hung reports a grant from the Agency for Healthcare Research and Quality and personal fees from Blue Cross Blue Shield Association, outside the submitted work. Gedey, Groeneweg, and Jay have nothing to disclose.

Aligning collaborative and culturally responsive evaluation approaches.

The authors, three African-American women trained as collaborative evaluators, offer a comparative analysis of collaborative evaluation (O'Sullivan, 2004) and culturally responsive evaluation approaches (Frierson, Hood, & Hughes, 2002; Kirkhart & Hopson, 2010). Collaborative evaluation techniques immerse evaluators in the cultural milieu of the program, systematically engage stakeholders and integrate their program expertise throughout the evaluation, build evaluation capacity, and facilitate the co-creation of a more complex understanding of programs. However, the authors note that without explicit attention to considerations raised in culturally responsive evaluation approaches (for example, issues of race, power, and privilege), the voices and concerns of marginalized and underserved populations may be acknowledged, but not explicitly or adequately addressed. The intentional application of collaborative evaluation techniques coupled with a culturally responsive stance enhances the responsiveness, validity and utility of evaluations, as well as the cultural competence of evaluators.

Retention and attrition factors for female certified athletic trainers in the National Collegiate Athletic Association Division I Football Bowl Subdivision setting.

CONTEXT: Organizational effectiveness and the continuity of patient care can be affected by certain levels of attrition. However, little is known about the retention and attrition of female certified athletic trainers (ATs) in certain settings. OBJECTIVE: To gain insight and understanding into the factors and circumstances affecting female ATs' decisions to persist in or leave the National Collegiate Athletic Association Division I Football Bowl Subdivision (NCAA D-I FBS) setting. DESIGN: Qualitative study. SETTING: The 12 NCAA D-I FBS institutions within the Southeastern Conference. PATIENTS OR OTHER PARTICIPANTS: A total of 23 women who were current full-time ATs (n = 12) or former full-time ATs (n = 11) at Southeastern Conference institutions participated. DATA COLLECTION AND ANALYSIS: Data were collected via in-depth, semistructured interviews, transcribed verbatim, and analyzed via a grounded theory approach. Peer review and member checking methods were performed to establish trustworthiness. RESULTS: The decision to persist involved 4 main factors: (1) increased autonomy, (2) increased social support, (3) enjoyment of job/fitting the NCAA D-I mold, and (4) kinship responsibility. Two subfactors of persistence, the NCAA D-I atmosphere and positive athlete dynamics, emerged under the main factor of enjoyment of job/fitting the NCAA D-I mold. The decision to leave included 3 main factors: (1) life balance issues, (2) role conflict and role overload, and (3) kinship responsibility. Two subfactors of leaving, supervisory/coach conflict and decreased autonomy, emerged under the main factor of role conflict and role overload. CONCLUSIONS: A female AT's decision to persist in or leave the NCAA D-I FBS setting can involve several factors. In order to retain capable ATs long term in the NCAA D-I setting, an individual's attributes and obligations, the setting's cultural issues, and an organization's social support paradigm should be considered.

Dental service utilization by independently dwelling older adults in Manitoba, Canada.

OBJECTIVES: The objectives of this study were to determine the rate of use of dental services by independently living older dentate and edentulous adults and the factors affecting utilization. METHODS: Data were derived from the cross-sectional Manitoba Study of Health and Aging. A personal interview included over 240 questions addressing sociodemographics, well-being, oral and general health, and health service utilization. Variables that were significantly associated with visitation on bivariate analysis were entered into separate logistic regressions for dentate and edentulous participants. The Anderson model of health service utilization was used to categorize variables with significant independent effects as predisposing, enabling and need factors. RESULTS: The 1,751 participants had a mean age of 76.2 years (standard deviation 7.1); 58.5% were women and 72.7% were edentulous. Only 383 participants (21.9%) reported having visited a dentist in the past 6 months. The visitation rate for dentate seniors (36.2%) was significantly higher (p < 0.001) than that for edentulous seniors (13.5%). Multiple logistic regression analysis revealed significant independent effects of 5 variables for each group. Predisposing factors predicting visitation for both groups were higher level of education and frequent use of professional services. For dentate adults, dental visitation was predicted by 3 enabling factors (main supporting person not a family member, fewer restrictions on activities of daily living and residence in a major urban centre) but no need factors. For edentulous participants, dental visitation was predicted by only 1 enabling factor (higher income) and 2 need factors (recent dental problems and longer duration of denture use). DISCUSSION: Regular dental visits are important in maintaining good health, for edentulous as well as dentate seniors. Despite this fact, older Manitobans, especially the edentulous, are not accessing care in an appropriate manner. One unexpected finding was that despite equivalent abilities, cognitive status and health problems, those who had a family member as their main supporting person were less likely to have a dental visit than those supported by non-family members. This may relate to resistance from family members to provide appropriate support for dental visits, an issue considered by some to be a form of elder abuse. CONCLUSION: Despite some common predisposing factors, the variables influencing dental utilization were different for dentate and edentulous participants, with enabling factors playing a bigger role for the dentate and need factors of greater importance for the edentulous. These findings seem to indicate that older dentate adults who visit the dentist do so because they can, while older edentulous adults who visit the dentist do so because they must.