Biomedical subjects

Frederick A Connell

Publications and source records attributed to Frederick A Connell.

9 recordsLinked to original sources

PubMed2005

Predicting time to subsequent pregnancy.

OBJECTIVES: Women in poverty may benefit from avoiding closely spaced pregnancies. This study sought to identify predictive factors that could identify women at risk for closely spaced pregnancies. METHODS: We studied 20,028 women receiving welfare (cash assistance) from Washington State. Using Cox proportional hazards methods, we estimated the effects of individual- and community-level variables on time from an index birth until a subsequent pregnancy (between June 1992 and December 1999). Prediction models developed in a random half of our data were validated in the other half. Receiver operator characteristic plots appropriate for proportional hazards models were calculated to compare the sensitivity and specificity of each model. RESULTS: At 5 years of follow-up, the most predictive model contained just individual-level variables (age, education, race, marital status, number of prior pregnancies); the area under the receiver operator characteristic curve was 0.66 (.62-.69). The addition of community-level variables (percent in poverty, with a high school degree or higher, Black, Hispanic, in an urban area; female unemployment rate; income inequality) added little predictive ability. Differences were found between women with different individual- and community-level characteristics, but the results suggest that these factors are not strong predictors of pregnancy spacing. CONCLUSIONS: Individual- and community-level characteristics are associated with interpregnancy intervals; however, we found little evidence that the selected variables predicted pregnancy interval in a useful manner.

Adolescent↗

PubMed2004

Income inequality and pregnancy spacing.

We examined the relationship between county-level income inequality and pregnancy spacing in a welfare-recipient cohort in Washington State. We identified 20,028 welfare-recipient women who had at least one birth between July 1, 1992, and December 31, 1999, and followed this cohort from the date of that first in-study birth until the occurrence of a subsequent pregnancy or the end of the study period. Income inequality was measured as the proportion of total county income earned by the wealthiest 10% of households in that county compared to that earned by the poorest 10%. To measure the relationship between income inequality and the time-dependent risk (hazard) of a subsequent pregnancy, we used Cox proportional hazards methods and adjusted for individual- and county-level covariates. Among women aged 25 and younger at the time of the index birth, the hazard ratio (HR) of subsequent pregnancy associated with income inequality was 1.24 (95% CI: 0.85, 1.80), controlling for individual-level (age, marital status, education at index birth; race, parity) and community-level variables. Among women aged 26 or older at the time of the index birth, the adjusted HR was 2.14 (95% CI: 1.09, 4.18). While income inequality is not the only community-level feature that may affect health, among women aged 26 or older at the index birth it appears to be associated with hazard of a subsequent pregnancy, even after controlling for other factors. These results support previous findings that income inequality may impact health, perhaps by influencing health-related behaviors.

Adolescent↗

PubMed2004

What factors are associated with achieving high continuity of care?

BACKGROUND AND OBJECTIVES: Although continuity of care has been found to be associated with improved health outcomes in children, little is known about what factors predict having consistent contact with a pediatric provider. This study explored what patient, family, provider, and system factors are associated with high continuity of both total and well-child care. METHODS: This cross-sectional study involved 759 patients presenting to a primary care pediatric clinic. Patients completed surveys about demographic variables, attitudes about continuity of care, and family functioning, as well as provider-level information. Outcomes were measured with a continuity of care index that quantified the degree to which a patient experienced continuous care with a provider. RESULTS: In Tobit regression models, the variables associated with increased total continuity of care were continuity belief, higher family control, increased provider availability, and better provider rating. Associated with decreased total continuity of care were: number of visits, patient age, and time at clinic. For well-child care, the variables associated with increased continuity of care were continuity belief, increased provider availability, better provider rating, and greater reported household income. Provider availability was the strongest predictor of total continuity of care, and continuity belief was the strongest predictor of well-child continuity of care. CONCLUSIONS: Increased provider availability may improve overall continuity of care for pediatric patients.

Attitude to Health↗

PubMed2003

The clinical and economic consequences of screening young men for genital chlamydial infection.

BACKGROUND: Wide-scale application of urine-based screening of asymptomatic men for chlamydial infection has not been thoroughly assessed. GOAL: The goal was to compare clinical and economic consequences of three strategies: (1). no screening, (2). screening with ligase chain reaction (LCR) assay of urine, and (3). prescreening urine with a leukocyte esterase test (LE) and confirming positives with LCR. STUDY DESIGN: We used a decision analytic model. RESULTS: At a chlamydia prevalence of 5%, the no screening cost was US dollars 7.44 per man screened, resulting in 522 cases of pelvic inflammatory disease (PID) per 100000 men. LE-LCR was most cost-effective, preventing 242 cases of PID over no screening at an additional cost of US dollars 29.14 per male screened. The LCR strategy prevented 104 more cases of PID than LE-LCR but cost US dollars 22.62 more per male screened. For this to be more efficient than LE-LCR, the LCR assay cost needed to decline to <or=US dollars 18. CONCLUSION: At a chlamydia prevalence of 5%, LE-LCR is the most efficient use of resources. If LCR cost decreases or chlamydia prevalence increases, the LCR strategy is favored.

Bacteriological Techniques↗

PubMed2002

Health care use by children diagnosed as having developmental delay.

BACKGROUND: Although children with developmental delay are known to have increased health care use, it is unclear what proportion of that health care use is related to associated chronic health conditions. OBJECTIVES: To assess the prevalence of isolated developmental delay and to determine the role of developmental delay in health care use controlling for chronic health conditions. DESIGN: Retrospective cohort study using Washington State Medicaid claims records from November 1, 1990, to December 31, 1997, an administrative data set that contains both International Classification of Diseases, Ninth Revision, Clinical Modification codes and billed services. PATIENTS AND SETTING: Children born between November 1, 1990, and December 31, 1992, diagnosed as having developmental delay before the age of 5 years, enrolled in Medicaid within 1 month of birth, and continuously enrolled for at least 12 months. Four control subjects per case were matched on date of birth and duration of continuous enrollment in Medicaid. MAIN OUTCOME MEASURES: Visits to physicians, emergency departments, other practitioners, or hospitals by year of life. RESULTS: One thousand two hundred forty-two children having developmental delay and 5370 children without developmental delay were included. One percent of those who met study criteria had developmental delay without chronic health conditions and 30% of the children with developmental delay had no associated chronic health conditions. Boys were 1.6 times as likely to have a diagnosis of developmental delay. Developmental delay was independently associated with increased health care use by all 4 measures used. CONCLUSION: Developmental delay increases health care use apart from associated chronic health conditions.

Case-Control Studies↗

PubMed2002

Adolescent quality of life, part I: conceptual and measurement model.

Few quality of life instruments exist that focus on the positive aspects of adolescence, incorporate adolescents' perspectives and language, and apply to both general and vulnerable populations. With these goals in mind, a conceptual and measurement model was developed using inductive qualitative methods to guide construction of the Youth Quality of Life Instrument-Research Version (YQOL-R). A conceptual model with four domains-Sense of Self, Social Relationships, Environment, and General Quality of Life-is reported.

Adolescent↗

PubMed2002

Hip fracture incidence in nursing home residents and community-dwelling older people, Washington State, 1993-1995.

OBJECTIVES: To establish and validate a method of linking data from the Minimum Data Set (MDS) and Medicare hospital claims, to estimate hip fracture incidence rates for Medicare beneficiaries aged 65 and older in Washington State, and to compare the incidence rates of hip fractures in nursing home and non-nursing home residents. DESIGN: Retrospective analysis of Medicare population-based enrollment, hospital claims, and nursing home administrative data sets. SETTING: Nursing home and non-nursing home setting. PARTICIPANTS: Medicare beneficiaries in Washington State residing in the community or in skilled nursing facilities. MEASUREMENTS: Crude age- and sex-specific and standardized age- and sex-adjusted hip fracture incidence for persons residing and not residing in nursing homes. RESULTS: From October 1, 1993, through September 30, 1995, 7,812 Medicare beneficiaries aged 65 or older were hospitalized for hip fractures (6,566 fractures for 1,155,234 person-years of exposure in non-nursing home residents and 1,246 fractures for 42,986 person-years of exposure in nursing home residents). The standardized age- and sex-adjusted hip fracture rate of nursing home residents (23.0 per 1,000 person-years) substantially exceeded that of non-nursing home residents (5.7 per 1,000 person-years) (incidence rate ratio = 4.0, 95% confidence interval = 3.7-4.5). CONCLUSION: The incidence of hip fracture in nursing home residents far exceeds that in noninstitutionalized older people. Linkage of MDS and Medicare hospital claims data is a useful tool for epidemiological surveillance regarding events in nursing homes that are likely to result in hospitalization.

Aged↗

PubMed2002

Continuity of care is associated with high-quality careby parental report.

CONTEXT: The benefits of continuity of pediatric care remain controversial. OBJECTIVE: To determine whether there is an association between having a continuous relationship with a primary care pediatric provider and improved quality of care by parental report. DESIGN: Cross-sectional study. SETTING AND POPULATION: Seven hundred fifty-nine patients presenting to a primary care clinic completed surveys, which included validated measures of provider and clinic quality of care from the Consumer Assessment of Health Plan Survey. MAIN EXPOSURE VARIABLE: A continuity of care index that quantifies the degree to which a patient has experienced continuous care with a provider. MAIN OUTCOME MEASURES: The likelihood of parents reporting quality of care as high in several provider- specific items including reporting that providers respected what they had to say, treated them with courtesy and respect, listened to them carefully, explained things in a way they could understand, and spent enough time with their children. In addition, participants were asked to rate the overall quality of the clinic and their child's provider on a 10-point scale. RESULTS: In ordered logistic regression models, continuity of care was associated with statistically significantly higher Consumer Assessment of Health Plan Survey scores for 5 of the 6 items, including feeling that providers respected what parents had to say; listened carefully to them; explained things in a way that they could understand; asked about how their child was feeling, growing, and behaving; and spent enough time with their child. In addition, greater continuity of care was associated with a higher clinic rating, as well as a higher provider rating. CONCLUSIONS: Greater continuity of primary care is associated with higher quality of care as reported by parents. Efforts to improve and maintain continuity may be warranted.

Child Health Services↗

PubMedDate not supplied

Continuity of care is associated with well-coordinated care.

CONTEXT: The importance of continuity of care as a means to promote care coordination remains controversial. OBJECTIVE: To determine if there is an association between having an objective measure of continuity of care and parental perception that care is well coordinated. DESIGN: Cross-sectional study. SETTING AND POPULATION: Seven hundred fifty-nine patients presenting to a primary care clinic completed surveys that included 5 items from the Components of Primary Care Index (CPCI) that relate to care coordination. MAIN PREDICTOR VARIABLE: A continuity of care index (COC) that quantifies the degree of dispersion of care among providers. MAIN OUTCOME MEASURES: Likelihood of parents reporting high scores on the care coordination domain as well as each of the 5 individual CPCI items related to care coordination. RESULTS: Greater continuity of care was associated with higher scores on the CPCI care-coordination domain (P <.001). Continuity of care was also specifically associated with increased odds of agreeing with all 5 individual CPCI items, including reporting that their child's provider "always knows about care my child received in other places" (OR 3.97 [2.11-7.49]), "communicates with the other health care providers my child sees" (OR 2.98 [1.63-5.44]), "knows the results of my child's visits to other doctors" (OR 2.02 [1.08-3.80]), and "always follows up on a problem my child has had, either at the next visit or by phone" (OR 6.20 [2.88-13.35]) and wanting one provider to coordinate all of the health care that the child receives (OR 3.28 [1.48-7.27]). CONCLUSIONS: Greater continuity of primary care is associated with better care coordination as perceived by parents. Efforts to improve and maintain continuity may be justified.

Adult↗