Biomedical subjects

Brenda L Beaty

Publications and source records attributed to Brenda L Beaty.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Using an immunization registry: effect on practice costs and time.

INTRODUCTION: Immunization registries can consolidate immunization records scattered among different providers, allowing immunization documentation for legal purposes, generation of needed-immunization lists, inventory management, and outreach for underimmunized children. They have been endorsed by the Centers for Disease Control and Prevention and health professionals as a means of sustaining high immunization rates. However, some providers perceive the cost of registry use as a barrier to participation. We sought to determine the effects of registry use on cost and time. METHODS: We used a pre-post design and a cost-accounting approach to measure labor costs and time for immunization-related activities possibly affected by registry use before development of a regional registry in Colorado and after the registry was being fully used. Two rural family practices, 2 rural community health centers (CHCs), 3 urban pediatric practices, and 2 rural public health agencies participated in both periods. RESULTS: Cost per shot increased slightly in the postregistry period for private practices and CHCs ($0.56 per shot in 2001 dollars) and public health agencies ($0.38). Since costs can increase for several reasons, including salary increases above inflation, we analyzed time spent per shot and found that staff time decreased for private practices and CHCs but increased substantially for public health agencies. CONCLUSIONS: The study findings suggest to private practices that registry participation can provide a net benefit by making the vaccination process more efficient and, absent above-average salary increases, less costly. Public health agencies, however, would have to rely exclusively on the registry and eschew the use of paper vaccination records to realize efficiencies seen by other practice types.

Costs and Cost Analysis↗

PubMedDate not supplied

Disenrollment from a state child health insurance plan: are families jumping S(c)HIP?

BACKGROUND: Colorado's Child Health Plan Plus (CHP+) is a non-Medicaid state child health plan that began enrollment in April 1998. Families are disenrolled 12 months after enrollment if they fail to re-enroll. OBJECTIVE: To assess insurance coverage before and 1 year after initial enrollment in CHP+; reasons for disenrollment; and factors associated with re-enrollment. DESIGN/METHODS: We interviewed 480 randomly selected families 2 months after initial enrollment into CHP+ (September 1999 through January 2000) and 1 year later. RESULTS: Prior to CHP+, 38% of families had Medicaid (MK), 35% were privately insured (PI), 6% were uninsured (UI), and 20% had other/unknown insurance. After the 12 months, 34% were re-enrolled, 16% got other insurance (6% MK, 10% PI/other), 4% had children older than 18 years, and 46% were UI (9% had intentionally and 37% had unintentionally disenrolled from CHP+). All unintentionally disenrolled families were planning to re-enroll and 90% still appeared eligible. In multivariate analysis, having a primary care provider prior to enrollment was associated with re-enrollment (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1 to 2.6), but having problems with the application process impeded re-enrollment (OR 0.7, 95% CI 0.6 to 0.9). CONCLUSIONS: Only about a third of families eligible for State Children's Health Insurance Program successfully re-enrolled before their termination date. Institution of a passive renewal process would decrease unnecessary disenrollment in eligible families.

Adolescent↗

PubMedDate not supplied

Quality improvement in immunization delivery following an unsuccessful immunization recall.

OBJECTIVES: Within a clinic serving disadvantaged children, 1) to evaluate a multifaceted quality improvement (QI) project to improve immunization (IZ) up-to-date (UTD) rates and 2) to assess the efficacy of IZ reminder/recall performed following QI. METHODS: A year-long QI project followed by a trial of reminder/recall. QI interventions were targeted at previously identified barriers to IZ and were designed specifically to improve the efficacy of reminder/recall. QI interventions were designed to 1) increase the use of medical record releases to document IZs received elsewhere; 2) improve the accuracy of parental contact information; and 3) reduce missed opportunities by utilizing chart prompts, provider education, and provider reminders. Following QI, we conducted a randomized trial of reminder/recall. RESULTS: UTD rates for 7-11 month olds increased from 21% before the QI project to 52% after (P <.0001); rates for 12-18 month olds increased from 16% before QI to 44% after (P <.0001); 19-25 month olds 18% before to 33% after (P <.001). After QI, an average of 61 records per month were updated with IZs received elsewhere. However, the accuracy of parental contact information worsened (29% unreachable before QI vs 44% after, P <.001) and missed opportunities did not improve (8% before vs 6% after, P = not significant [NS]). A subsequent trial of reminder/recall did not increase UTD rates, with 17% of recalled children brought UTD vs 16% of controls (P = NS). CONCLUSIONS: Clinic-based QI increased documented UTD rates in a disadvantaged patient population. However, IZ reminder/recall did not further increase UTD rates above the rates achieved by the QI process.

Delivery of Health Care↗

PubMedDate not supplied

Provider adoption of pneumococcal conjugate vaccine and the impact of vaccine shortages.

OBJECTIVES: To 1) determine the factors associated with provider acceptance of pneumococcal conjugate vaccine and 2) describe how providers prioritize pneumococcal conjugate vaccine during shortages. DESIGN/METHODS: During April-November 2002, we conducted a mailed survey of rural and urban Colorado practitioners who provided routine pediatric immunizations. Three groups were surveyed: 1) all immunization providers (n = 51) in 2 geographically large rural areas, identified through a regional immunization registry; 2) all providers (n = 61) from private pediatric practices in metropolitan Denver that were actively participating in the same registry; and 3) all family physicians (n = 244) from the same urban areas as the pediatric practices. RESULTS: Response rate was 60%. Provider adoption of pneumococcal conjugate vaccine was strong: 66% of urban family physicians, 84% of rural providers, and 98% of urban pediatric providers always recommended pneumococcal conjugate vaccine to healthy children < or = 23 months old when vaccine supplies were adequate. In multivariate analysis, vaccine nonadopters were significantly more likely than adopters to report financial barriers to vaccination (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.58, 6.35) and concerns about vaccine safety (OR 3.37, 95% CI 1.37, 8.26). Eighty-nine percent of respondents had encountered pneumococcal conjugate vaccine shortages. During shortages, children <5 years old with a chronic medical condition were considered the highest priority for vaccination. CONCLUSIONS: While provider acceptance of pneumococcal conjugate vaccine appears high, concerns about vaccine safety, cost, and availability exist, and these concerns will need to be addressed to maximize prevention of invasive pneumococcal disease in children.

Attitude of Health Personnel↗