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North Dakota: A Model for Rural Health Care?
North Dakota faces challenges common to many rural areas of the U.S., from attracting health care professionals to deploying adequate resources in small, geographically dispersed communities. Despite these disadvantages, the state's health care system appears to be performing better than that in many other states—rural or urban—in providing its residents with accessible, good-quality care while also keeping costs down. A recent Commonwealth Fund report describes the state's efforts to support primary care and medical homes, cooperative networks of providers that help organize care delivery, and innovative use of technology to meet patient needs and hold down costs.

Docs Treating Minority Patients Carry Heavy Burden
Primary care physicians treating a disproportionate share of black and Latino patients provide more charity care, see more patients, depend more heavily on low-paying Medicaid, and earn lower incomes than physicians seeing mostly white patients, a recent Commonwealth Fund–supported study found. As documented in a Health Affairs Web Exclusive, physicians treating large numbers of minority patients typically spend less time with each patient and have a harder time obtaining specialty care referrals than other physicians do. Researchers James Reschovsky and Ann O'Malley from the Center for Studying Health System Change say expanding insurance coverage and raising Medicaid's payment rates to equal Medicare's could help reduce quality disparities.

Regs Not Enough to Fix Nursing Homes
While regulation is necessary to uphold minimum standards of nursing home care, Fund assistant vice president Mary Jane Koren, M.D., argues more fundamental reform is needed to "move nursing homes to a higher level of performance." Testifying before a House oversight subcommittee on May 15, Koren outlined steps Congress could take to support the “culture change” movement to transform institutional long-term care settings into homelike facilities that provide resident-centered care. These include: improving the consumer information available on the federal Nursing Home Compare Web site; developing payment methods that reward homes participating in quality improvement efforts; and directing the Medicare Quality Improvement Organizations to play a more active role in helping nursing homes undergo transformation.

Focus on Developmental Screening
Most parents likely assume their pediatrician is using standardized guidelines during well-child visits to assess their young child's development and behaviors—critical for the early identification and treatment of any suspected delays. But physician surveys have found that only about one of five doctors routinely use developmental screening tests. The new issue of Quality Matters, published bimonthly on The Commonwealth Fund's Web site, includes a review of efforts nationwide to encourage developmental screening for young children as a routine part of preventive care—among them, the ABCD Screening Academy, a partnership of the Fund and the National Academy for State Health Policy.

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