Disease management program improves asthma outcomes.

OBJECTIVE: To show that a disease management program that empowers patients with asthma to participate in the management of their condition can improve quality of life and reduce the use of medical services. STUDY DESIGN: Utilization and quality-of-life data were tracked to identify outcome changes in patients with moderate to severe asthma. Baseline measures were used as a control and were compared with measures taken at 6 and 12 months after enrollment. PATIENTS AND METHODS: Study participants were from a single Medicaid managed care plan in western Pennsylvania. Patients' quality of life during their participation in the program was tracked through an outside pharmacoepidemiologic research firm. Utilization data were updated with every interaction between a patient and case management nurse. RESULTS: Both quality-of-life and utilization data show statistically significant improvements at 6 months. Further, 12-month data show improvement that is statistically significant in all measures with the exception of the adult quality-of-life measure, where a small sample size limited the statistical results. CONCLUSIONS: A collaborative, proactive approach to asthma management improves patients' quality of life and reduces use of costly medical services.

Avoiding the cost burden of newborn screening for the poor and uninsured: Mississippi's model.

The Mississippi State Department of Health Genetic Screening Program began in 1982 with hospitals joining the program on a volunteer basis. In 1985 legislation which mandated Newborn Screening provided the Mississippi Department of Health with the responsibility to promulgate rules and regulations establishing laboratory standards, to assure that each newborn was screened and to bill the hospital for each test. The Mississippi State Department of Health charges $12.75 per each newborn tested. This cost includes PKU, T4 (TSH if T4 is abnormal), and Hemoglobinopathy screening, as well as an administrative and follow-up charge. In order to compare the costs of existing systems which coordinate services related to newborn screening, a survey has been done. The confirmatory test for hemoglobinopathy screening will be performed in the Mississippi State Department of Health Laboratory beginning July 1, 1990. This will enable the Mississippi Genetic Screening Program to charge for patients who qualify for Medicaid.

BSER abnormalities in a multiple sclerosis patient with normal peripheral hearing acuity.

The measurement of brain stem evoked potentials has proven clinically useful in determining the presence of multiple sclerosis plaques along the auditory areas of the brain stem. Abnormalities in brain stem evoked responses (BSER) have been identified in patients who manifest normal hearing acuity when evaluated via conventional audiometric techniques. The following case presentation illustrates this confounding clinical finding. The patient was a 20-year-old female who had been previously diagnosed as having multiple sclerosis. Within one month after being evaluated by BSER testing, she was struck and killed by lightning. Although she had a detailed history of normal hearing acuity (documented over the last six years), BSER test results yielded significantly abnormal neural conduction times when the left ear was ipsilaterally stimulated. A histopathologic examination of the patient's brain stem verified involvement of the auditory tracts. Thus physical corroboration of the abnormal BSER results was obtained in the presence of normal hearing acuity.