Biomedical subjects

C Lannon

Publications and source records attributed to C Lannon.

6 recordsLinked to original sources

PubMed2005

Anatomy of a patient safety event: a pediatric patient safety taxonomy.

BACKGROUND: Idiosyncratic terminology and frameworks in the study of patient safety have been tolerated but are increasingly problematic. Agreement on standard language and frameworks is needed for optimal improvement and dissemination of knowledge about patient safety. METHODS: Patient safety events were assessed using critical incident analysis, a method used to classify risks that has been more recently applied to medicine. Clinician interviews and clinician reports to a web based reporting system were used for analysis of hospital based and ambulatory care events, respectively. Events were classified independently by three investigators. RESULTS: A pediatric patient safety taxonomy, relevant to both hospital based and ambulatory pediatric care, was developed from the analysis of 122 hospital based and 144 ambulatory care events. It is composed of four main categories: (1) problem type; (2) domain of medicine; (3) contributing factors in the patient (child-specific), environment (latent conditions) and care providers (human factors); and (4) outcome or result of the event and level of harm. A classification of preventive mechanisms was also developed. Inter-rater reliability of classifications ranged from 72% to 86% for sub-categories of the taxonomy. CONCLUSIONS: This patient safety taxonomy reflects the nature of events that occur in both pediatric hospital based and ambulatory care settings. It is flexible in its construction, permits analysis to begin at any point, and depicts the relationships and interactions of elements of an event.

Ambulatory Care↗

PubMed2001

Improving preventive service delivery through office systems.

OBJECTIVE: Rates of childhood immunizations and other preventive services are lower in many practices than national goals and providers' own estimates. Office systems have been used in adult settings to improve the delivery of preventive care, but their effectiveness in pediatric practices is unknown. This study was designed to determine whether a group of primary care practices in 1 community could implement office-based quality improvement systems that would significantly improve their delivery of childhood preventive services. The study was part of a larger community-wide intervention study reported in a preceding study. METHODS: All the major providers of primary care to children in 1 community were recruited and agreed to participate (N = 8 practices). Project staff worked on-site with improvement teams in each practice to develop tailored systems to assess and improve the delivery of immunizations and screening for anemia, tuberculosis, and lead exposure. Office-based quality improvement systems typically involved some combination of chart prescreening, risk assessment forms, Post-it prompts, flow-sheets, reminder/recall systems, and patient education materials. Office systems also often involved redistributing responsibilities among office staff. RESULTS: All 8 participating practices created improvement teams. Project staff met with the practices 10 to 15 times over 12 months. After the period of office assistance, the overall rates for all preventive services except tuberculosis screening increased by amounts that were both clinically and statistically significant. Absolute percent improvements included: complete immunizations at 12 months, 7%; complete immunizations at 24 months, 12%; anemia screening, 30%; lead screening, 36%. The amount of improvement achieved varied considerably between practices. CONCLUSIONS: Office systems and the principles of quality improvement that underlie them seem to be effective in improving the delivery of childhood preventive services. Important predisposing factors may exist within practices that affect the likelihood that an individual practice will make significant improvements. prevention, immunizations, improvement, office systems, primary care.

Child↗

PubMed1997

Current positions of graduates of internal medicine-pediatrics training programs.

OBJECTIVE: To determine what positions graduates of internal medicine-pediatrics programs currently hold. DESIGN: A survey of the program directors of residencies in internal medicine-pediatrics. PARTICIPANTS: Program directors of the 85 internal medicine-pediatrics training programs listed in the 1993-1994 Graduate Medical Education Directory. MAIN OUTCOME MEASURES: A 1-page survey that described the current positions of trainees graduating between 1987 and 1993. RESULTS: Seventy-four (87%) of the 85 program directors completed the survey. Of the 708 graduates reported on, 68% were practicing as generalists. The generalists of this cohort (n = 480) were primarily in private practice settings (n = 390, 81%) and most were practicing internal medicine-pediatrics (n = 416, 85%). Only 12% of the generalists had chosen to practice either pediatrics or internal medicine. Twenty-one percent of the total graduates had entered subspecialty training. CONCLUSIONS: To our knowledge, the sample of 708 graduates is the largest survey of graduates of internal medicine-pediatrics programs to date and shows that 68% of graduates are practicing in primary care fields. Graduates of internal medicine-pediatrics programs should be considered as an important source of primary care physicians.

Education↗

PubMed1995

What mothers say about why poor children fall behind on immunizations. A summary of focus groups in North Carolina.

OBJECTIVES: To develop a more thorough understanding of the factors that impede poor parents' utilization of health care services for their children and to refine interventions to improve immunization rates. METHODS: We conducted focus group sessions with mothers whose children received care at the health departments in five North Carolina counties. Mothers were uninsured or were receiving Medicaid. A total of 50 women participated; group size varied from three to seven mothers. RESULTS: Socially disadvantaged mothers faced barriers at multiple points in the process of obtaining preventive care for their children. Organizational barriers, such as a lack of flexibility in scheduling and long waiting times, were exacerbated by personal barriers, such as a lack of reliable transportation, chaotic home environments, and employment conflicts. Lack of knowledge regarding the timing of childhood immunizations and misperceptions about the safety of immunizations were also important obstacles. Mothers made several suggestions, such as changes in scheduling, greater assistance with transportation, improved waiting facilities, and increased health education. CONCLUSIONS: Our study suggests that even with improved financing of well-child care, many important barriers to adequate immunization will remain. Many of the changes that mothers in our focus groups advocated are not related to insurance coverage and would be simple and inexpensive to implement. To help with these changes, we developed a checklist for use by health departments to determine which organizational barriers exist at their facility and suggest strategies to overcome the problems. Organizational, personal, and attitudinal barriers pose serious problems for socioeconomically disadvantaged families. To improve vaccination rates for children, new personnel and programs are probably less important than careful strategies to maximize existing resources.

Adolescent↗

PubMed1995

Medicare reimbursement for preventive care. Changes in performance of services, quality of life, and health care costs.

A randomized, controlled trial was conducted to assess the effects of a financial and office systems intervention to increase preventive care in physicians' offices for patients aged 65 years or older. A total of 1,914 patients from 10 primary-care medical practices in central North Carolina were randomized within practices to an intervention and a usual-care control group. The intervention consisted of full Medicare reimbursement to physicians for preventive care and health promotion packages (thus making these services free for patients), regular prompting of physicians to routinely schedule preventive care visits, a new office system in which nurses carried out many preventive procedures, and a form for charting preventive care. The performance of screening tests dramatically increased in the intervention group relative to control (P < 0.001), but there was evidence of lack of follow-up of abnormal findings by physicians. At the 2-year follow-up, there were minimal differences between intervention and control groups in health-related quality-of-life indicators. Relative to the $294 per patient 3-year cost to Medicare for waivered services, the intervention was reimbursed-cost neutral or slightly cost reducing ($190 over 3 years) for Medicare. It is concluded that adding reimbursement for preventive services to Medicare--even with the office systems changes made in this study--will not by itself lead to effective implementation of preventive services in community medical practices. To enhance patient benefit from preventive services, greater attention needs to be focused on an organized approach to patient follow-up.

Aged↗

PubMed1993

Improving clinical breast examination training in a medical school: a randomized controlled trial.

To evaluate a new program for teaching clinical breast examination, a class of 156 second-year medical students were randomized into an experimental group (practice and feedback on silicone breast models and women volunteers) and a control group (lecture only). During a simulated practical clinical examination routinely conducted at the end of the second year, the experimental group students used more suggested palpation techniques during a patient examination (4.6 vs 2.0; p < 0.0001) and found more simulated lumps in a silicone model (4.7 vs 4.4; p < 0.05). Practice with immediate feedback is more effective than lecture alone in teaching clinical breast examination.

Breast Neoplasms↗