Medicaid

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Medicaid

Budget Cuts in a Shelby County Clinic: A Case Study


Rebecca manages a Shelby County clinic in Memphis, Tennessee. The clinic serves the local Medicaid population. The clinic’s budget was cut by 15%. Rebecca must determine what clinical services can be eliminated or introduced to best address the healthcare needs of the patients. In order to make the best decision for the clinic and the patients, Rebecca will use the Informed Decisions Toolbox (IDT) (Arroyo et al, 2007). Following is a case study of Rebecca’s decision making process. The IDT will be defined and Rebecca will follow the steps to make an informed decision. Her decision to focus the clinic’s efforts on early intervention, preventive medicine, STD/HIV prevention, and case management will be explained. Why the Four A’s tool is determined to be the most effective in making the decision will be addressed (Arroyo et al, 2007). Finally, the use of the toolbox and the affect on the clinic’s accountability, knowledge transfer, and becoming a questioning organization will be studied.
The Informed Decisions Toolbox (IDT)
The Informed Decisions Toolbox (IDT) is a set of tools that can be useful to healthcare managers when making decisions. The toolbox consists of six steps that can lead to a well-informed decision:
Step 1: Framing the question
Step 2: Finding sources of information
Step 3: Assessing the accuracy of the evidence
Step 4: Assessing the applicability of the evidence
Step 5: Assessing the "actionability" of the evidence
Step 6: Determining if the information is adequate
(Arroyo et al, 2007)
Step 1: Framing the Question
First, Rebecca must formulate a question. “A well-defined question will explicitly state the intervention, the outcome of interest, the type of setting, the time frame, and the population” (Arroyo et al, 2007, para. 12). The intervention is the 15% budget cut and the outcome of interest is to add or reduce services to better serve the patients. The setting is a...

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