PubMed Health⌕ Search

Biomedical subjects

Brigid K Killelea

Publications and source records attributed to Brigid K Killelea.

4 recordsLinked to original sources
PubMed2007

To what extent do pediatricians accept computer-based dosing suggestions?

OBJECTIVE: Pediatric medication errors occur frequently among hospitalized patients and are often related to dosing. Computerized physician order entry systems with decision support can decrease dosing errors, as well as other types of errors; however, their use in pediatrics has not been extensively studied. Our objective was to determine physician acceptance of dosing and frequency decision support elements in an inpatient pediatric computerized physician order entry system at 1 academic medical center. PATIENTS AND METHODS: We performed a retrospective analysis of all electronic medication orders entered for pediatric inpatients at a large, urban teaching hospital between April 15, 2004, and December 31, 2004. Rates of physician acceptance of computerized physician order entry system-generated dosing and frequency suggestions were determined. RESULTS: We analyzed 54,413 orders in the computerized physician order entry system, of which 27,313 orders had dosing or frequency decision support. Of the orders with decision support, approximately one third (8822) were accepted exactly by prescribers. Of the 18,491 remaining orders, 8708 were changed for dose, 2466 for frequency, and 7317 for both. Among the 18,491 orders that were changed, the majority 11,322 deviated by a substantial amount (>50%) from the total daily dose initially suggested by the decision support feature. Overall, patient weight was missing 31.3% of the time, although patient age alone sometimes was sufficient for the computer to make a dosing suggestion. CONCLUSIONS: Although dosing-decision support systems have the potential to improve care, more work needs to be done to determine and optimize their effectiveness. Commercial vendors of dosing knowledge bases need to deliver effective products, because most health care organizations will not have the resources to customize decision support rules.

Adolescent↗
PubMed2005

Perforated appendicitis presenting as appendicoumbilical fistula.

Perforated appendicitis is one of the most common diagnoses treated by pediatric surgeons. Although rare, a perforated appendix can present with a cutaneous fistula. Here we present the second reported case of perforated appendicitis presenting as an appendicoumbilical fistula.

Adult↗
PubMedDate not supplied

Access to orthopaedic care for children with medicaid versus private insurance: results of a national survey.

BACKGROUND: It has been documented that children insured by Medicaid in California have significantly less access to orthopedic care than children with private insurance. Low Medicaid physician reimbursement rates have been hypothesized to be a major factor. The first objective of this study was to examine whether children insured by Medicaid have limited access to orthopedic care in a national sample. The second objective was to determine if state variations in Medicaid physician reimbursement rates correlate with access to orthopedic care. METHODS: Two-hundred fifty orthopedic surgeon's offices, 5 randomly chosen in each of 50 states, were telephoned. Each office called was asked to answer questions to an anonymous, disclosed survey. The survey asked whether the office accepted pediatric patients, whether they accepted children with Medicaid, and whether they limited the number of children that they accepted with Medicaid, and if so why. Each state sets its own rate of physician reimbursement rates that were collected from individual state Medicaid agencies for 3 different CPT codes. The relationship between acceptance of patients with Medicaid and the individual state's Medicaid reimbursement rate was examined. RESULTS: Children with Medicaid insurance had limited access to orthopedic care in 88 of 230 (38%) offices that treat children, and 18% (41/230) of offices would not see a child with Medicaid under any circumstances. Reimbursement rates for CPT codes widely varied by state: 99243 for an outpatient consultation (range, $20-$176.38), 99213 for an established follow-up outpatient visit (range, $6-$77.76), and 25560 for global treatment of a nondisplaced radius and ulna shaft fracture without manipulation (range, $50-$403.94). There was a statistically significant relationship between access to medical care for Medicaid patients and physician reimbursement rates for all 3 CPT codes. CONCLUSIONS: Children insured with Medicaid have limited access to orthopedic care in this nationwide sample. Medicaid physician reimbursement significantly correlates with patient access to medical care. These data may be of value in the ongoing efforts to improve access to medical care for children on Medicaid. The logical inference from this study is that increasing physician reimbursement rates will improve access. In the authors' opinion, reimbursement rates should be made higher than office overhead to effect meaningful change.

Child↗