Biomedical subjects

Vijayalaxmi Chandramouli

Publications and source records attributed to Vijayalaxmi Chandramouli.

7 recordsLinked to original sources

PubMed2006

Influenza among healthy young children: changes in parental attitudes and predictors of immunization during the 2003 to 2004 influenza season.

BACKGROUND: In Colorado, the 2003 to 2004 influenza season was unusually early and severe and received substantial media attention. OBJECTIVES: Among parents of healthy young children, to determine how parental knowledge and attitudes regarding influenza infection and immunization changed during the 2003 to 2004 influenza season and to identify factors predictive of influenza immunization. METHODS: The study was conducted in 5 metropolitan Denver pediatric practices. A total of 839 healthy children age 6 to 21 months and their parents were randomly selected for participation. Parents were surveyed by telephone before (August 18 to October 7, 2003) and after (March 31 to June 10, 2004) the influenza season. RESULTS: Among 828 eligible parents, 472 (57%) completed the preseason survey; 316 (67%) of these parents subsequently completed the postseason survey. All analyses were performed for the 316 subjects who completed both preseason and postseason surveys. Compared with their attitudes before the influenza season, 48% of parents interviewed after the season viewed their child as more susceptible to influenza, 58% viewed influenza infections as more severe, and 66% perceived fewer risks associated with influenza vaccine. Ninety-five percent of parents reported hearing in the media about Colorado's influenza outbreak, and having heard about the outbreak in the media was associated with viewing influenza infections as more severe. A total of 258 parents (82%) immunized their child against influenza. In multivariate analyses, positive predictors of immunization included a physician recommendation for immunization and a preseason to postseason increase in the perception that immunization was the social norm. Negative predictors of immunization included high perceived barriers to immunization, less parental education, and preseason intention not to immunize. CONCLUSIONS: Parent attitudes about influenza infection and immunization changed substantially during the 2003 to 2004 influenza season, with changes favoring increased parental acceptance of influenza vaccination for young children. During an intensively publicized influenza outbreak, a physician recommendation of vaccination was an important predictor of influenza immunization.

Colorado↗

PubMed2005

An assessment of pediatric after-hours telephone care: a 1-year experience.

BACKGROUND: Pediatric after-hours telephone triage by call center nurses is an important part of pediatric health care provision. OBJECTIVES: To use a computerized database including the after-hours telephone calls for 90% of the pediatricians in Colorado to examine: (1) the epidemiology of after-hours calls during a 1-year period including the volume, seasonality, and timing of after-hours calls, the age of the patients, the presenting complaint, the triage dispositions, and mean rates of calls per pediatrician; (2) the process of care measures at the call center, including waiting times for nurse telephone call-backs, the length of triage calls, and how these factors varied by season; and (3) the frequency and content of calls requesting information but not requiring triage. DESIGN: Descriptive study. SETTING AND PARTICIPANTS: All telephone calls from the After-Hours Telephone Care Program, Denver, Colo, received between June 21, 1999, and June 20, 2000, were retrieved from a computerized database and categorized by age, season, triage disposition, and algorithm. MAIN OUTCOME MEASURES: The volume, seasonality, timing, age distribution, algorithms used, and triage dispositions of after-hours calls. The reasons for calls requesting information. RESULTS: During the 1-year period 141 922 calls were returned by the call center. Of the total calls, 88% were for a clinical illness; 5%, for information or advice; 5%, for calls in which the parent could not be recontacted; 1%, for duplicate calls, and 1%, for miscellaneous reasons. Listed in rank order for the year, the 10 most common algorithms used for illness calls were vomiting, colds, cough, earache, sore throat, fever, diarrhea, croup, head trauma, and eye infection. Of illness calls, 21% of callers were told to go in for urgent evaluation, 30% were told to contact their primary care physician either the next day or at a later time, 45% were given home care instructions, and 4% were referred to call the on-call physician. CONCLUSIONS: This study describes the epidemiology of after-hours telephone calls regarding children in 90% of the private practices in Colorado. Data provided are useful in guiding the planning of health care provision, providing staffing of after-hours facilities, and planning for the educational training of telephone care staff. They also highlight opportunities for patient education that might decrease unnecessary after-hours calls.

Adolescent↗

PubMed2004

Strategies to improve immunization rates and well-child care in a disadvantaged population: a cluster randomized controlled trial.

OBJECTIVE: To measure the effect of a multimodal intervention on well-child care visit (WCV) and immunization rates in an inner-city population. DESIGN: Cluster randomized controlled trial. SETTING AND PARTICIPANTS: One-year cohort of 2843 infants born at a hospital in an integrated inner-city health care system. INTERVENTIONS: Eleven clinics were randomly allocated to 1 of 3 study arms: WCV intervention (n = 3), immunization intervention (n = 4), and controls (n = 4). Interventions to improve immunization and WCV rates included both patient-based and clinic-based activities. MAIN OUTCOME MEASURES: Up-to-date status with childhood immunizations and WCVs by age 12 months (primary) and health care utilization and charges (secondary). RESULTS: Compared with the control arm, the WCV and immunization arms had 5% to 6% higher immunization rates and 7% to 8% higher WCV rates. In multivariate analyses that accounted for the clustered nature of the data, the number of immunizations received was greater in the WCV arm than in controls. However, neither the WCV nor the immunization intervention increased WCV or immunization up-to-date rates. The WCV arm had slightly higher health care charges. Neither intervention affected emergency, urgent care or inpatient utilization. CONCLUSIONS: This multimodal intervention produced a small increase in the number of childhood immunizations delivered. However, patient- and clinic-based methods did not lead to significant increases in WCV or immunization up-to-date rates after controlling for other factors. Methods found in some settings to increase immunization up-to-date rates may not be as effective in a population of inner-city socioeconomically disadvantaged children.

Child Health Services↗

PubMed2003

Immunization registry accuracy: improvement with progressive clinical application.

BACKGROUND: Healthcare systems have been challenged to ensure the timely administration of immunizations. Immunization registries have been proposed to improve the accuracy and completeness of immunization information and to promote effective practice. METHODS: Comparison of randomly selected samples from two birth cohorts (1993 and 1998) from Denver Health Medical Center. Chart review and immunization registry information for these groups were compared; a composite immunization was recorded and up-to-date (UTD) status established. Registry data were compared with this composite using a sensitivity measure to assess completeness and accuracy. RESULTS: Among 818 children in the 1993 cohort and 1043 children in the 1998 cohort, there were 6386 and 6886 valid immunizations, respectively. The registry recorded 71.4% and 97.7% of these for the 1993 and 1998 cohorts, respectively (p <0.001). The apparent UTD rate, as measured with registry data alone, improved from 37% to 79% between the two time frames (p <0.001). Composite UTD status was 83.1% and 78.9% (1993 vs 1998, respectively). Accurate registry-defined UTD status improved from 44.4% to 100% between the two intervals. CONCLUSIONS: Immunization registry accuracy improved dramatically for recorded immunizations and UTD status. However, after 3 years of registry use, the overall proportion of children who were UTD had not significantly improved. The mere presence of a registry does not ensure more complete vaccination coverage. Other registry-based strategies, including use of the data for reminder, recall, and audit, may further improve immunization coverage.

Child↗

PubMed2002

Managed care for uninsured adults: the rise and fall of a university-based program.

OBJECTIVE: To assess the impact of CU CARE, a managed care program for medically indigent adults developed by University Hospital (UH) in Denver and Kaiser Permanente, on outpatient and inpatient utilization. STUDY DESIGN: Pre-post study with concurrent comparison groups. PATIENTS AND METHODS: Administrative claims from 1994-1996 were analyzed for all enrollees in a state-funded medically indigent program (intervention group) compared with Medicaid patients and uninsured adults rated as "self-pay" who were ineligible for the medically indigent program. RESULTS: In 1994, before initiation of CU CARE, UH provided care to 10,118 medically indigent, 5330 Medicaid, and 7626 self-pay patients; similar numbers received care in 1995-1996, but only 12% of medically indigent patients received care in both time periods. The proportion of medically indigent patients with 1 or more primary care visits increased by 185% (from 10.9% in 1994 to 31.1% in 1995-1996). Medically indigent patients had relative declines of 36% in specialty clinic visits, 25% in emergency department visits, 40% in hospital visits, and 31% in visit costs between 1994 and 1995-1996. All these changes were significant compared with Medicaid and self-pay patients. The impact on acute care utilization was greater for medically indigent patients who used UH in both 1994 and 1995-1996. CONCLUSIONS: This managed care program increased utilization of primary care and reduced specialty and acute care utilization. However, the program was scaled back in 1997 and terminated in 2000 because of problems with care coordination across institutions, increasing costs (particularly pharmacy costs), and competitive pressures.

Adult↗

PubMedDate not supplied

Individually significant risk factors do not provide an accurate clinical prediction rule for infant underimmunization in one disadvantaged urban area.

OBJECTIVE: To define a clinical prediction rule for underimmunization in children of low socioeconomic status. METHODS: We assessed a cohort of 1160 infants born from July 1998 through June 1999 at an urban safety net hospital that received primary care at 4 community health centers. The main outcome measure was up-to-date status with the 3:2:2:2 infant vaccine series at 12 months of age. RESULTS: Latino infants (n = 959, 83% of cohort) had immunization rates of 74%, at least 18% higher than any other racial/ethnic group. Multivariate logistic regression demonstrated the following independent associations (relative risk, 95% confidence interval) for inadequate immunization: non-Latino ethnicity (1.7, 1.4-2.0), maternal smoking (1.3, 1.1-1.7), no health insurance (1.9, 1.4-2.3), late prenatal care (1.9, 1.5-2.3), no pediatric chronic condition (2.1, 1.2-3.1), and no intent to breast-feed (1.3, 1.1-1.6). However, the index of concordance (c-index) for this model was only 0.69. Neither excluding infants who left the health care system nor accounting for infants who were "late starters" for their first vaccines improved the predictive accuracy of the model. CONCLUSIONS: In this predominantly Latino population of low socioeconomic status, Latino infants have higher immunization rates than other infants. However, we were unable to develop a model to reliably predict which infants in this population were underimmunized. Models to predict underimmunization should be tested in other settings. In this population, interventions to improve immunization rates must be targeted at all children without respect to individual risk factors.

Cohort Studies↗

PubMedDate not supplied

Primary-care visits and hospitalizations for ambulatory-care-sensitive conditions in an inner-city health care system.

OBJECTIVE: Hospitalizations for ambulatory-care-sensitive conditions (ACSCs) are a marker for access barriers for children and a possible outcome measure for primary-care interventions. We assessed the relationship between primary-care utilization and subsequent ACSC hospitalization among inner-city children. METHODOLOGY: We conducted a nested, case-control study of children born in 1993 in Denver Health (DH), a "safety-net" delivery system in Denver, Colo. Utilization of preventive care and other primary-care services was compared between children hospitalized for ACSCs and nonhospitalized children, who were matched by age and duration of care. Comparisons were adjusted for demographics, payer, and chronic health conditions. RESULTS: Of 2531 children, 115 (4.5%) were hospitalized for ACSCs. Sixty-eight percent were Hispanic, and 78% were enrolled in Medicaid. Children with ACSC hospitalization and nonhospitalized children made a similar number of preventive-care visits (2.7 +/- 2.0 vs 3.0 +/- 2.1 visits, P =.30) and other primary-care visits (4.4 +/- 4.6 vs 3.6 +/- 4.6, P =.16) between birth and hospitalization (for cases) or the same time period (for controls). After multivariate adjustment, each additional preventive-care visit (odds ratio = 0.87; 95% confidence interval: 0.67-1.12) was associated with a nonsignificant reduction in the risk of hospitalization for ACSC. CONCLUSIONS: Because ACSC hospitalizations are uncommon and the association between primary care and subsequent hospitalization is weak, a reduction in ACSC hospitalizations may not be a feasible outcome measure for interventions to increase the rate of preventive- or primary-care visits for underserved children within individual delivery systems.

Ambulatory Care↗