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  • New in the Literature: Supine Sleep Position and Infant Rolling Abilities (Early Hum Dev. 2012 Nov 21. [Epub ahead of print])

    The introduction of the supine sleep position to reduce the prevalence of Sudden Infant Death Syndrome has not altered the timing or sequence of infant rolling abilities, say authors of an article published online in Early Human Development. This information is valuable to health care providers involved in the surveillance of infants' development, they add. Original normative age estimates for these 2 motor abilities are still appropriate. 

    The aim of this study was to compare the order and age of emergence of rolling prone to supine and supine to prone before the introduction of back to sleep guidelines and 20 years after their introduction. The original normative data for the Alberta Infant Motor Scale (AIMS) were collected just prior to the introduction of back to sleep guidelines in 1992. Currently these norms are being reevaluated. Data of rolling patterns of infants 36 weeks of age or younger from the original sample (n=1,114) and the contemporary sample (n=351) were evaluated to compare the sequence of appearance of prone to supine and supine to prone rolls (proportion of infants passing each roll) and the ages of emergence (estimated age when 50% of infants passed each roll).

    According to the results, the sequence of emergence and estimated age of appearance of both rolling directions were similar between the 2 time periods.

    Stop the Therapy Cap: Contact Your Members of Congress on Monday

    APTA, in conjunction with the Therapy Cap Coalition, is launching a national grassroots campaign to "Stop the Therapy Cap" on Monday, December 3. The patient impact of the cap is the theme of Monday's campaign. Almost 50 associations, organizations and patient groups will be sending action alerts to their members. With about 30 days left until expiration of the therapy cap exceptions process, the goal is to create a significant surge in Congressional e-mails and phone calls urging members of Congress to stop the therapy cap from taking effect in 2013.  

    APTA has provided association members form letters and e-mails in its Legislative Action Center. To access the materials, log in to the website, click "Take Action" under "Stop the Medicare Therapy Cap and Prevent SGR Payment Cuts," and follow the instructions. If you have time, personalize the e-mail and let Congress know how the cap impacts your patients.

    Congress has been very clear: it will not take action without input from constituents. If you only send 1 advocacy e-mail or make 1 advocacy phone call this year, do it on Monday. 

    APTA will send out an Action Alert Monday morning with talking points and instructions for contacting your legislators. Also, ask your patients to e-mail or call their members of Congress on Monday using APTA’sPatient Action Center. For more information on APTA's advocacy efforts, visit the Medicare Therapy Cap website.

    Time is running out! Take 5 minutes on Monday and contact your legislators. You can make a difference and help prevent a hard Medicare therapy cap of $1,900 from being implemented in 2013.

    Online Access to Providers, Records Increases Clinical Services

    Allowing patients to e-mail their clinicians and access their records online is associated with more, not fewer, telephone calls, office visits, and clinical services in general, says a Medscape Medical News article based on a study published in the November 21 issue of JAMA.  

    Researchers studied the effect of an online Web portal for patients enrolled in Kaiser Permanente (KP) Colorado. The portal, called My Health Manager (MHM), connects to KP's electronic health record system. MHM allows patients access test results, request medicine refills, schedule nonurgent appointments, and exchange messages with their clinicians on nonurgent health issues.

    The authors measured the use of health care services by 44,321 users of MHM before and after KP Colorado adopted the system compared with health care use by an equal number of nonusers. All patients in the study were continuously enrolled in KP Colorado for at least 2 years from March 2005 through June 2010.

    Lead author Ted Palen, MD, PhD, MSPH, and coauthors found that the number of office visits by MHM users increased by 0.7 per member per year compared with nonusers. Telephone encounters rose at a smaller rate of 0.3 per member per year. The rates of after-hours clinic visits, emergency department encounters, and hospitalizations per 1,000 members per year rose significantly, by 18.7, 11.2, and 19.9, respectively. These patterns held true whether the patients were younger or older than 50 years, says the article.  

    In contrast, a 2007 KP study of this issue in the organization's Northwest region reported that office visits decreased between 7% and 10% for patients using the patient portal. At that time, however, only 6% of KP Northwest patients were signed up for it. Today, roughly 50% of all KP patients, and about 60% of those in Colorado, are logging on.

    Online access might have helped patients take more responsibility for their health care, which led them to use more services, Palen told Medscape Medical News. Or perhaps patients who signed up for MHM were already likely to use more services because of clinical characteristics that the study failed to control for. Future research will try to tease out cause and effect, he said.

    An even more important question to answer, said Palen, is the effect of the online clinician–patient relationship on clinical outcomes. If virtual visits lead to more face-to-face visits, does a patient's health necessarily improve as a result?