Search PubMed⌕ Search

Biomedical subjects

M McMullan

Publications and source records attributed to M McMullan.

7 recordsLinked to original sources
PubMed1998

A review of cystic fibrosis children born to single mothers.

The purpose of this study was to examine the relationship between single parents and the health of their children with cystic fibrosis. Seventy-five children aged between 0.8 and 6.0 y were identified from our patient register; 20 of these children came from single parent families. Socioeconomic profiles were collated for each family. Retrospective medical data including, gene mutation analysis, were recorded from the hospital notes of all 75 patients. Maternal health was assessed by means of the General Health Questionnaire (28-item version). The results show that maternal age of < or = 19 y and lone parenthood were associated with higher morbidity in CF patients <6 y of age. Predicted values of the Shwachman score being lower by 4.1 and 4.3 points, respectively. A declining Shwachman score of 1.1 points/y was associated with increasing patient's age. In addition, analysis showed that the CF children of teenage mothers were 16 times more likely to have admission rates of > or = 1/y. Single mothers experienced more stress-related symptoms than those from the married group. We concluded that the young CF children of single or teenage mothers have a significantly worse clinical progress and consequently have a higher demand for hospital services. Clearly this population requires extra clinical vigilance and social support.

Adolescent↗
PubMed1997

Improvement in adequacy of delivered dialysis for adult in-center hemodialysis patients in the United States, 1993 to 1995.

The objective of this review is to describe the adequacy of delivered dialysis provided to in-center hemodialysis patients in the United States and to compare the findings with published guidelines. The medical records of random samples of 6,138, 6,919, and 6,861 patients in hemodialysis facilities were studied from all Medicare-eligible adult in-center hemodialysis patients alive on December 31, 1993, 1994, and 1995, respectively. The main clinical measure used was the urea reduction ratio (URR), the mean of which was 0.63 in 1993, 0.64 in 1994, and 0.66 in 1995. The proportion of patients with URR > or = 0.65, as recommended by the Renal Physicians Association and a National Institutes of Health Consensus Development Conference Statement, increased from 43% in 1993 to 49% in 1994 and 59% in 1995. In each of these 3 years, women were more likely than men to have a URR > or = 0.65 (1993: 54% v 31%, odds ratio 2.6; 1994: 61% v 38%, odds ratio 2.5; and 1995: 70% v 50%, odds ratio 24), as were older patients (65+ years) compared with younger patients (18 to 44 years) (1993: 47% v 37%, odds ratio 1.4; 1994: 54% v 45%, odds ratio 1.5; and 1995: 65% v 53%, odds ratio 1.6) and white patients compared with black patients (1993: 46% v 36%, odds ratio 1.5; 1994: 53% v 43%, odds ratio 1.5; and 1995: 63% v 54%, odds ratio 1.4). There was also substantial geographic variation in the proportion of patients receiving hemodialysis with a URR > or = 0.65. In conclusion, marked differences existed in 1993, 1994, and 1995 between observed practice and consensus guidelines for the delivery of adequate dialysis. Nevertheless, notable improvement occurred during this time period. A system to monitor further improvements in hemodialysis care in the United States is in place.

Adult↗
PubMed1996

HCFA's consumer information commitment.

This article provides examples of how the Health Care Financing Administration is providing Medicare and Medicaid beneficiaries with information that will allow them to become more active participants in decisions affecting their health and well-being. The article emphasizes how HCFA has incorporated a beneficiary-centered focus and social marketing techniques in its consumer information activities. The work described in this article represents a cross section of the innovative and excellent work being done by staff throughout the Agency and by our partners and agents in meeting the information needs of beneficiaries.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

Implementing the Health Care Quality Improvement Program in the Medicare ESRD Program: a new era of quality improvement in ESRD.

Improving the quality of health care is a central challenge for America's health care system. The mission of the End-Stage Renal Disease (ESRD) program is to promote the quality, effectiveness, and efficiency of ESRD patient care and program administration. The program provides an ideal opportunity to demonstrate the use of information to help clinicians analyze and improve the care they deliver to patients in an ambulatory setting. This is possible because the program has established regional surveillance systems, called ESRD Networks, that gather information on the occurrence and outcomes of treatment of Medicare beneficiaries with ESRD. The Health Care Financing Administration, which is responsible for the administration of the program, and the renal community have worked together since 1990 to identify ways of incorporating new methods of quality improvement into the program. These methods include statistical evaluation of the processes and outcomes of care in dialysis populations; communicating recommended practices with clinical guidelines and algorithms; regional peer review and feedback (ie, technical assistance and/or collaborations for quality improvement); interventions that focus on the provision of assistance for quality improvement efforts; continuing collection and active feedback of data to providers; and a commitment to continue to evaluate and revise quality improvement activities to reflect lessons learned and newly identified needs. These ideas have been included in the 1994-1997 scope of work for the ESRD Networks and is called the ESRD Health Care Quality Improvement Program (HCQIP). This article describes the background for the ESRD HCQIP and the program's elements.

Humans↗
PubMed1995

A data-driven approach to improving the care of in-center hemodialysis patients.

Health care providers, patients, the end stage renal disease (ESRD) networks, and HCFA have developed the ESRD Health Care Quality Improvement Program (HCQIP) in an effort to assess and improve care provided to ESRD patients. Currently, the ESRD HCQIP focuses on collecting information on quality indicators (QIs) for treatment of anemia, delivery of adequate dialysis, nutritional status, and blood pressure control for adult in-center hemodialysis patients. QIs were measured in a national probability sample of ESRD patients, and interventions and evaluations of the interventions are beginning. The ESRD HCQIP illustrates a way to mobilize the strengths of the public and private sectors to achieve improved care for special populations.

Adult↗
PubMed1984

The Medicare experience with end-stage renal disease: trends in incidence, prevalence, and survival.

This article presents a detailed account of the incidence, prevalence, and survival experience of people with end-stage renal disease (ESRD) covered by Medicare. The number of new entrants into the ESRD program has risen since its inception. This increase is greatest for people whose cause of renal failure is primary hypertensive disease or diabetic nephropathy. The program incidence rates for black people is 2.8 times that of white people. Incidence is highest for persons 65 to 69 years of age. Total patient survival is 44 percent 5 years after renal failure onset. Total Medicare enrollment for ESRD quadrupled between the years 1974 and 1981.

Adolescent↗