Baltimore's consumer ombudsman and assistance program: an emerging public health service in Medicaid Managed Care.

OBJECTIVES: To present Baltimore City Health Department's (BCHD) experience in developing and operating an ombudsprogram for Maryland's Medicaid Managed Care HealthChoice Program as an innovative public health response to its MCH Title V assurance functions. METHODS: This paper presents a case study that 1) describes Baltimore City's Consumer Ombudsman and Assistance Program (COAP) in terms of development, function, structure, and resources; 2) provides a summary of its first 30 months' experiences, both quantitatively and qualitatively; and 3) describes COAP's successes, value, and limitations with respect to its three essential roles--a) conflict resolution for individuals, b) education for consumers, providers and advocates, and c) catalyst for quality improvement. OUTCOMES: Over 1300 cases (involving enrollment, access, billing, and treatment issues) were referred to COAP by the State's Complaint Resolution Section during the first 2 1/2 years of HealthChoice. Ombudsman interventions resulted in conflict resolution for enrollees using a continuum of education, mediation and advocacy, and in generating systematic data for systems change through collaboration with state and community public health, managed care organization, provider, consumer, and advocacy officials and groups. CONCLUSIONS: Public health ombudsprograms can effectively assist and educate enrollees; and provide concurrent, or real-time, information for consumer, provider, health plan, and advocacy groups, as well as public policymakers and legislators to better inform systems improvement and innovation. The community-based ombudsman role is an effective mechanism to ensure appropriate care for MCH populations and others with special needs. Such efforts can be funded by federal/state Medicaid administrative funds and are a sound investment in assuring access to comprehensive care for vulnerable populations.

Patterns of ICD-9 diagnoses among adolescents using school-based clinics: diagnostic categories by school level and gender.

PURPOSE: Understanding utilization patterns in school clinics is important in discerning potential health outcomes among adolescents. This study reports on high-middle school and gender differences in ICD-9 diagnostic codes for students using Baltimore school clinics in the academic year 1989-90. METHODS: 12,953 visits resulted in 17,241 individual diagnoses. Data were grouped into 17 major diagnostic categories, subcategories for reproductive health and mental health, and 20 sentinel diagnoses. RESULTS: Reproductive health diagnoses were most common for high school clinics (28% of all diagnoses). Mental health (psychosocial) diagnoses were most common for middle school clinics (30%). Adolescent women were much more likely to use clinics for reproductive health care needs than adolescent men. Adolescent men and women used the clinics with equal frequency for mental health, although specific diagnoses varied considerably by gender. CONCLUSIONS: This overview of diagnostic patterns among adolescents using Baltimore's school-based clinics provides a unique view of differences in health care needs between younger and older teens and between male and female teens. These data have meaningful implications for clinic staffing and enhanced outreach efforts.

Quail fetal antigen (QFA): identification and comparison with chicken fetal antigen.

Quail fetal antigen (QFA), an analogous hematopoietic antigen to chicken fetal antigen (CFA), was identified and shown to be a developmental antigen on the blood cells of Japanese quail and other avian species. Rabbit antiserum against 14-day embryonic quail red blood cells (RBCs) was specifically adsorbed to achieve fetal specificity and to eliminate any cross reactivity with the CFA system. Complement-mediated microcytotoxicity and hemagglutination assays were used to detect the presence of QFA on hematopoietic cells. QFA was found on 100% of the peripheral RBCs from 10-day quail embryos but incidence of the antigen gradually declined with increasing development. Complete loss of QFA from RBCs occurred just prior to sexual maturation between 31 and 42 days of age. No qualitative differences in erythroid expression of QFA were observed during development; however, RBCs from both embryonic duck and interspecific quail- chicken hybrids reacted with R-anti QFA. Like CFA, quail fetal antigen was associated with lymphocytes, particularly those from primary lymphoid organs. Similarities in the developmentally controlled tissue distribution of QFA and CFA suggest that developmental hematopoietic antigens are a common feature of avian species and are useful cell surface markers for studies of development and differentiation.