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Chronic Care Initiative at Community Health Centers Producing Results
A federal initiative to improve chronic disease care provided by community health centers has significantly improved the "processes of care" for asthma and diabetes, say Harvard Medical School researchers. The study, cofunded by The Commonwealth Fund, the Health Resources and Services Administration, and the Agency for Healthcare Research and Quality and published in the New England Journal of Medicine, found that centers participating in the interventions showed considerable improvement in diabetics' receipt of foot exams and asthma patients' use of anti-inflammatory medications, among other indicators. The federal government plans to expand the number of community health centers, which already are a major source of care for minorities and other disadvantaged populations.

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Study: Language Barriers Linked to Medical Errors
For the more than 20 million U.S. adults with limited English proficiency (LEP), a lack of good communication with doctors can have particularly serious consequences. In a Fund-supported study in the International Journal for Quality in Health Care, Joint Commission researchers found that LEP patients were more likely than English-speaking patients to experience an adverse event that caused physical harm (49% vs. 30%). What's more, a greater proportion of adverse events experienced by LEP patients resulted in moderate or severe—albeit temporary—harm. The study underscores the importance of language translation services, provided by trained medical interpreters, to ensuring safe, quality care for the LEP population.

High Admin Costs for Trade Act Tax Credit
In his latest assessment of the federal Health Coverage Tax Credit program for The Commonwealth Fund, the Urban Institute's Stan Dorn sheds light on one aspect that has received little attention thus far: the extent to which public dollars are spent on administering the program, rather than purchasing health care services. While administrative costs have fallen significantly since the program's start-up, Dorn has found they still comprise a whopping 34 percent of total spending. The tax credits, created by the Trade Act of 2002, are available to certain early retirees and workers displaced by international trade.

Medicaid Rules Create Revolving Door for Children
A recent Health Affairs study examining Medicaid enrollment patterns among children found that while the state–federal program provides a "long-term continuous source of coverage for millions of children," it also creates "a revolving door for others." Led by Gerry Lynn Fairbrother, Ph.D., of Cincinnati Children's Hospital, the research team concluded that most Medicaid coverage gaps, though short, are long enough to cause a disruption in children's health and health care. The researchers recommend eliminating or simplifying onerous application processes and recertification procedures to help keep children enrolled.

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Transforming the U.S. Child Health System
Fragmented, underperforming, and fraught with inefficiencies is how Neal Halfon, M.D., and his UCLA colleagues describe the child health care system in the U.S. In an article in Health Affairs, Halfon et al. propose an agenda for radical system change. Instead of the current patchwork of programs and funding streams, they call for "a more comprehensive and holistic approach to optimizing health development." Specific reforms discussed in the piece include: establishing a federal agency to consolidate funding and planning for children's health initiatives, improving early childhood services, using health information technology to coordinate care, and organizing local child health development systems to manage care delivery. In another article in this issue, The Commonwealth Fund's Edward L. Schor, M.D., Melinda K. Abrams, and Katherine Shea provide a timely reminder that health care services for children, including preventive and developmental services, are a smart investment for society. Medicaid: Health Promotion and Disease Prevention for School Readiness focuses on the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program—the child health portion of Medicaid—and makes recommendations for reform.

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