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Biomedical subjects

J M Perrin

Publications and source records attributed to J M Perrin.

At least 37 records · Page 2Linked to original sources
PubMed1998

High-expenditure children with Supplemental Security Income.

OBJECTIVE: To examine the clinical characteristics and health service use of children with high Medicaid expenditures. METHODOLOGY: We examined 1992 Medicaid claims and eligibility files from four states (California, Georgia, Michigan, Tennessee) for children with at least $10000 billed to Medicaid who obtained Medicaid through the Supplemental Security Income (SSI) Program and a comparison group (matched by age group and gender) of children receiving Medicaid for other reasons. We compared mean expenditures, examined expenses by category, and examined diagnoses associated with at least $10000 in expenses. RESULTS: In 1992, Medicaid paid on average approximately $1000 for children with non-SSI Medicaid enrollment. Expenditures for children with SSI were 2.9 to 9.4 times higher, but once the approximately 10% of children with high expenditures were excluded, SSI average expenditures were only 1.5 to 2.7 times higher than the non-SSI average. Children with high expenditures are likely to use hospitals and long-term care, and these services account for more than half of the average expenditures. Children with high expenditures and SSI are more likely to have chronic medical conditions than are their peers enrolled in Medicaid but not through SSI. CONCLUSIONS: A small proportion of children, even on SSI, account for very large proportions of Medicaid expenditures. Most children with SSI, despite having relatively severe mental health, physical, or developmental disabilities, have relatively modest Medicaid expenditures.

Child↗
PubMed1998

State variations in supplemental security income enrollment for children and adolescents.

OBJECTIVES: The purpose of this study was to determine the effects of poverty, program generosity, and health on state variations in enrollment of children and adolescents in the Supplemental Security Income (SSI) program during recent program expansions. METHODS: The relationship of state SSI rates for 1989 and 1992 to child poverty, health, and program generosity were determined by multiple regression. RESULTS: The mean percentage of children enrolled grew from 0.36% (1989) to 0.75% (1992). Poverty rates accounted for 78% of the variance among states in 1989 and 53% in 1992. Other indicators accounted for little variance. CONCLUSIONS: Differences in state poverty levels explained almost all variation in SSI enrollment.

Adolescent↗
PubMed1997

Concerns about child maltreatment in hospitalized children.

This study examined factors associated with clinicians' concerns about abuse and neglect and reporting hospitalized children to Child Protective Services (CPS). Data came from a cross-sectional chart review from a random sample of pediatric hospitalizations 1988-1990 in three cities for five condition groups (n = 5,446), and included evidence of clinicians' concerns about physical abuse or neglect and reports to CPS, family income, ethnicity, family structure, child's age, and illness severity at admission. Concerns about abuse were noted in 2.5% of the total sample, concerns about neglect in 3.1%, and 2.9% of children were reported to CPS. Concerns about abuse were most frequent in children with head trauma (8.2%), and concerns about neglect in children with toxic ingestion (12.3%). Young age of child, low income, and single parent family were independently associated with increased frequencies of concerns and reports. Low income was significantly associated with clinicians' concerns about neglect, but not abuse or reports to CPS. Ethnicity was not significant after controlling for income and family structure. Severity of illness was associated with concerns about physical abuse (p = .02) among children with head trauma, and with concerns about neglect and frequency of reporting among children with meningitis (p < .01). Our results confirm the associations among neglect, poverty, and single-parent families among hospitalized children. Increasing severity of illness may make clinicians consciously or unconsciously consider that care has been delayed and the child neglected.

Child↗
PubMed1997

Monitoring health care for children with chronic conditions in a managed care environment.

OBJECTIVE: Children with chronic health conditions face special issues in their interactions with managed care. These children often require additional and more varied services than do other children. Managed care plans increasingly include these children, especially with the growth of Medicaid managed care. This article examines the special issues facing children with chronic conditions and develops strategies for monitoring their care in managed care settings. METHODS: The project staff conducted an extensive review of the research and policy literature related to managed care and the special needs of families with children with chronic conditions. The project also reviewed current and proposed plans of federal, state, and private groups for monitoring and, working with parents and other outside groups, identified key issues to consider in developing monitoring plans. RESULTS: The relative rarity of many childhood conditions and the complex interactions among child, family, and community over time make assessment of their care difficult. We describe these child and family characteristics, outline essential features and domains for monitoring systems, and describe population-based and plan-based monitoring systems to assess managed care for these children and their families. CONCLUSIONS: Monitoring for children with chronic conditions in managed care arrangements will require public health agencies and health providers to define populations systematically, assess across a variety of conditions, and monitor several domains central to the health of these families.

Adolescent↗
PubMed1996

Primary care involvement among hospitalized children.

OBJECTIVE: To examine relations between characteristics of a child's usual source of primary care and involvement of that source before and during hospitalization. DESIGN: Medical record review of pediatric hospitalizations. SETTING: All hospitals in Boston, Mass; New Haven, Conn; and Rochester, NY admitting children during the calendar years 1988 through 1990. PATIENTS: The study included 1875 randomly selected pediatric hospitalizations for five diagnostic groups (i.e., asthma and other lower respiratory tract disease, abdominal pain [including appendicitis], meningitis [bacterial and viral], toxic ingestions, and head injury). Hospital records selected were limited to children aged between 1 month and 12 years and residing in the three study communities. OUTCOME MEASURES: Whether the primary care source examined the child before admission to the hospital, referred the child to the emergency department, or served as the in-hospital attending physician. RESULTS: Of the medical charts reviewed, 85.7% identified primary care sources. Children in Rochester had higher rates of medical visits before admission (P < .04), referrals (P < .001), and in-hospital care provided by the primary care physician (P < .001, chi 2) than children in Boston and New Haven. Patterns of primary care involvement also varied by source of care within cities, after controlling for income and severity of illness. Compared with children from Rochester community-based private practices, children in Boston receiving care from health centers, hospitals, or community-based private practices generally had 25% to 50% lower likelihood of positive findings on all primary care involvement measures. Children in New Haven receiving care from community-based private or hospital-based practices also had lower rates, but involvement rates were not higher when they received care from health centers. Other children in Rochester and children receiving care from health maintenance organizations in all cities demonstrated almost no significant differences compared with data from Rochester community practices. CONCLUSION: The source of primary care is associated with patterns of prehospital and hospital care among hospitalized children, although specific associations vary by city.

Child↗
PubMed1996

Stress and incidence of bleeding in children and adolescents with hemophilia.

OBJECTIVE: To examine the relationship of stress and incidence of bleeding in boys with hemophilia. STUDY DESIGN: We conducted a 6-month longitudinal study of 97 subjects (ages 4 to 16 years) from six hemophilia centers. Diaries recorded bleeding episodes (including site and history of previous trauma) and both child and parent daily stress. Parent and child stressful life event measures were obtained monthly. Socioeconomic data and clotting factor level were determined at enrollment. Logistic regression models examined the influence of recent stress on likelihood of bleeding on each day, controlling for factor level and socioeconomic data. We also determined associations of aggregated previous month's events with bleeding likelihood in the succeeding month. RESULTS: Fifty-eight percent of study participants had severe hemophilia. The sample population averaged nine bleeding episodes per 6 months; of these; two thirds of bleeding incidents occurred into joints and 44% after injury. Factor level strongly predicted bleeding incidence (p < 0.0001). Increased parent stress was associated with increased bleeding in general (odds ratio = 1.37, p < 0.003) and with injury (odds ratio = 1.65, p < 0.001), but not bleeding into joints. Similar findings followed parent reports of positive life events. Increased parent negative life events in 1 month were associated with increased bleeding in the succeeding month (p < 0.05). CONCLUSION: Short- and long-term parental stress may lead to increased bleeding incidence in hemophilia, although factor level much more strongly predicts bleeding.

Adolescent↗
PubMed1996

Does quality of care affect rates of hospitalization for childhood asthma?

BACKGROUND: Hospitalization rates for childhood asthma are three times as high in Boston, Massachusetts, as in Rochester, New York; New Haven, Connecticut, rates are intermediate. We undertook this study to determine how care for children admitted for asthma varies across these communities. METHODS: We performed a community-wide retrospective chart review. We reviewed a random sample of all asthma hospitalizations, from 1988 to 1990, of children 2 to 12 years old living in these communities (n = 614). Abstracted data included demographics, illness severity, and treatment before admission. RESULTS: Compared with Rochester children, Boston children were less likely to have received maintenance preventive therapy (inhaled corticosteroids or cromolyn [odds ratio (OR), 0.4 (0.2, 0.9)]), acute "rescue" therapy (oral corticosteroids [OR, 0.2 (0.1, 0.4)]), or inhaled beta-agonist therapy [OR, 0.5 (0.3, 1.0)]. A larger proportion of admitted asthmatic patients in Boston (34%) were in the least severely ill group-oxygen saturation 95% or above-compared with patients in Rochester (20%). CONCLUSIONS: The quality of ambulatory care, including choice of preventive therapies and thresholds for admission, likely plays a key role in determining community hospitalization rates for chronic conditions such as childhood asthma.

Acute Disease↗
PubMed1996

Monitoring and evaluating managed care for children with chronic illnesses and disabilities.

OBJECTIVE: Children with chronic illnesses and disabilities are increasingly enrolling in managed care arrangements. Yet, the rapid expansion of managed care has unknown consequences for children with chronic conditions and disabilities. As managed care is likely to become the predominant mode of medical practice for children with chronic health problems, information gained from a thorough assessment of existing managed care models could be helpful in indicating adjustments and modifications that could result in improved outcomes for this population. the purpose of this article is to outline a new strategy for collecting needed information on the effects of managed care on children with chronic health problems. METHODS: We reviewed the literature on the effects of managed care on children with chronic conditions and disabilities. We identified key domains relevant to monitoring and evaluating managed care for this population. RESULTS: Two research approaches can provide helpful information for assessing the effects of managed care on children with chronic conditions. First, a monitoring strategy could be pursued in which enrollment trends in managed care, enrollee perceptions of access and satisfaction with care, and other general indicators of outcomes would be tracked over time using inexpensive and rapid turnaround data sources. Second, an evaluative strategy could be pursued using experimental or quasiexperimental designs, in which outcomes across a variety of domains for children with chronic conditions in managed care are compared with: (a) outcomes for the same children before enrollment in managed care; or (b) outcomes for similar children remaining in traditional fee-for-service settings. Evaluation and monitoring strategies should focus on outcomes in a number of domains including: (1) access to care; (2) utilization of services; (3) quality of care; (4) satisfaction with care; (5) expenditures for care; (6) health outcomes; and (7) family impact. CONCLUSION: Assessing outcomes that result from enrollment in managed care for children with chronic health problems presents a formidable challenge. The research strategy outlined in this article presents one approach to meeting that challenge. The monitoring and evaluation strategies described here would require commitment of additional resources on the part of government, private foundations, and/or health plans. Given the paucity of existing information and the stakes for children with chronic conditions and their families, investment of added resources in a comprehensive monitoring and evaluation strategy is essential.

Child↗
PubMed1993

Social and economic consequences of overweight in adolescence and young adulthood.

BACKGROUND AND METHODS: Overweight in adolescents may have deleterious effects on their subsequent self-esteem, social and economic characteristics, and physical health. We studied the relation between overweight and subsequent educational attainment, marital status, household income, and self-esteem in a nationally representative sample of 10,039 randomly selected young people who were 16 to 24 years old in 1981. Follow-up data were obtained in 1988 for 65 to 79 percent of the original cohort, depending on the variable studied. The characteristics of the subjects who had been overweight in 1981 were compared with those for young people with asthma, musculoskeletal abnormalities, and other chronic health conditions. Overweight was defined as a body-mass index above the 95th percentile for age and sex. RESULTS: In 1981, 370 of the subjects were overweight. Seven years later, women who had been overweight had completed fewer years of school (0.3 year less; 95 percent confidence interval, 0.1 to 0.6; P = 0.009), were less likely to be married (20 percent less likely; 95 percent confidence interval, 13 to 27 percent; P < 0.001), had lower household incomes ($6,710 less per year; 95 percent confidence interval, $3,942 to $9,478; P < 0.001), and had higher rates of household poverty (10 percent higher; 95 percent confidence interval, 4 to 16 percent; P < 0.001) than the women who had not been overweight, independent of their base-line socioeconomic status and aptitude-test scores. Men who had been overweight were less likely to be married (11 percent less likely; 95 percent confidence interval, 3 to 18 percent; P = 0.005). In contrast, people with the other chronic conditions we studied did not differ in these ways from the nonoverweight subjects. We found no evidence of an effect of overweight on self-esteem. CONCLUSIONS: Overweight during adolescence has important social and economic consequences, which are greater than those of many other chronic physical conditions. Discrimination against overweight persons may account for these results.

Adolescent↗
PubMed1993

The immunization status of children with spina bifida.

OBJECTIVE: To estimate immunization levels among children with spina bifida and describe factors that may influence immunization completeness. RESEARCH DESIGN: Cross-sectional survey. SETTING: Tertiary care referral center. PATIENTS: One hundred twenty children, from 4 months to 18 years of age, seen in the myelodysplasia clinic of Children's Hospital, Boston, Mass, from February through August 1990. RESULTS: Fifty-eight percent of the children 2 years of age or older and 55% of the children 7 years of age or older had completed the immunization series recommended by the American Academy of Pediatrics. All but one child had an identified primary care provider. Lower immunization levels at 24 months of age occurred in older and in poorer children. Most children (80%) received the first diphtheria and tetanus toxoids and pertussis and oral poliovirus vaccines on time. Immunization delay increased from 20% to 50% through the 18-month diphtheria and tetanus toxoids and pertussis and oral poliovirus vaccines and declined to 24% at school entry. CONCLUSIONS: Many children with spina bifida are underimmunized despite having an identified source of primary care.

Adolescent↗
PubMed1993

Issues involved in the definition and classification of chronic health conditions.

The need for a widely applicable definition of chronic conditions for research, policy, and program development has led to an extensive review of the development of such definitions, the considerations involved in their use, and some recommendations for a new approach. This paper examines some of the methodologic and conceptual issues related to defining and classifying chronic conditions and describes some consequences resulting from decisions made about these issues. While most examples are taken from child health applications, the basic concepts apply to all age groups. The dominant method for identifying and classifying children as having a chronic condition has relied on the presence of an individual health condition of lengthy duration. This condition-specific or "categorical" approach has increasingly seemed neither pragmatically nor conceptually sound. Thus, the development of a "generic" approach, which focuses on elements that are shared by many conditions, children, and families, is recommended. Such a definition might reflect the child's functional status or ongoing use of medical services over a specified time period. In addition, it is suggested that conditions be classified based on the experience of individual children, thus emphasizing the tremendous variability in expression of seemingly similar conditions.

Child↗
PubMed1992

Recent trends in the prevalence and severity of childhood asthma.

OBJECTIVE: To examine changes in the prevalence and distribution of childhood asthma and its relationship with various measures of children's health and functioning between 1981 and 1988. It was hypothesized that there would be an increase in the prevalence of asthma, especially among black children, and that available measures would suggest a deterioration in the health and functioning of children with asthma over this period. DESIGN: Analyses of data from the Child Health Supplements to the National Health Interview Survey. SETTING AND SAMPLE: Nationally representative random sample of 15,224 children aged 0 to 17 years in 1981 and 17,110 in 1988. MAIN OUTCOME MEASURES: Changes in (1) the prevalence and distribution of asthma, and (2) among children with asthma, the percentage of children hospitalized, days spent in bed, school days lost in the year prior to survey, and parent ratings and reports of children's overall health status and behavior problems. RESULTS: The estimated prevalence of childhood asthma increased from 3.1% in 1981 to 4.3% in 1988 (P < .0001), with similar increases for children, adolescents, and both sexes. Increases occurred among white children (2.7% to 4.1%; P < .0001) but not black children (5.3% vs 5.1%; not significant). Among those with asthma in 1988 compared with 1981, there was better overall health status (11% vs 24% fair/poor; P < .0001) and fewer with 30 or more days spent in bed in the last year (3.9% vs 7.2%; P < .04). We also observed trends toward a lower rate of hospitalization in the last year (10% vs 14%; P = .07), fewer school days missed (2% vs 6% with > 30 days; P = .08), and a lower rate of extreme behavior problem scores (13% vs 18%; P = .09) in 1988 compared with 1981. Reductions were similar among both black and white children. CONCLUSIONS: These results indicate that the estimated prevalence of asthma among children in the United States increased by almost 40%, and that although the increase occurred exclusively among white children, the prevalence of asthma still remains higher in black children than in white children. There was no support for increasing asthma severity and functional impact among either black or white children with asthma in 1988 compared with 1981. These findings provide no evidence to support the beliefs that asthma prevalence is increasing largely among black children or that the severity of asthma among most children in the United States is increasing.

Adolescent↗
PubMed1992

Psychological adjustment of children with asthma: effects of illness severity and recent stressful life events.

Although children with chronic illness are at greater risk for decreased psychological adjustment than physically healthy children, little is known about the factors that lead to increased risk. Eighty-one children with asthma between the ages of 6 and 14 years and their parents participated in a study to determine the relative contribution of background variables (age, gender, and socioeconomic status), recent stressful life events, and illness severity to psychological adaptation. Overall 11.5% of the children had CBCL Total Behavior Problems scores above the 98th percentile. Multiple regression revealed that lower SES, negative life change, and high illness severity were predictive of less optimal psychological adjustment. The results highlight the need for interventions to improve coping with both disease and nondisease issues.

Adaptation, Psychological↗
PubMed1992

Improving the psychological status of children with asthma: a randomized controlled trial.

Children with asthma are at special risk for problems in psychological functioning, as are children with other chronic illnesses. We conducted a controlled trial of a combined education and stress management program among children ages 6 to 14 years with asthma. Eighty-one children were randomly assigned to an intervention or a control group; 56 children completed data collection, 29 intervention and 27 control. Psychological status was assessed by the Child Behavior Checklist (CBCL) before and after the intervention, as were children's knowledge of asthma, stress (as measured by children's life events), and functional status (as indicated by such activities as school attendance, time playing with friends, and daily chore performance). Children in the intervention group had a significant improvement in the total Behavior Problems score (p less than .04) and Internalizing scale (p less than .01) on the CBCL and a significant increase in daily chores (p less than .04) compared with the control group. Before intervention, the two groups had statistically significant positive relationships between negative life events and behavior problems scores. After intervention, children in the control group still demonstrated a significant relationship between negative life events and total and Internalizing Behavior Problem scores, although participation in the intervention group negated that relationship. Children in the intervention group whose knowledge of asthma increased were more likely to report an increase in daily chores (p less than .02). We conclude that the intervention had a beneficial effect on psychological status and on children's daily activities. The effect may have occurred in part by decreasing the likelihood that perceived stress from negative life events led to poorer adjustment.

Adaptation, Psychological↗