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Biomedical subjects

G V Fleming

Publications and source records attributed to G V Fleming.

18 recordsLinked to original sources
PubMed1998

Pediatric research in office settings (PROS): a national practice-based research network to improve children's health care.

OBJECTIVES: To describe the establishment of a national pediatric primary care research network to improve children's health care-Pediatric Research in Office Settings (PROS), and to evaluate the network's progress toward achieving its objectives. SETTING: Pediatric practices in all 50 states and Puerto Rico. PARTICIPANTS: Approximately 1400 pediatric practitioners from more than 470 practices. RESULTS: Beginning in 1986, a core of volunteer pediatrician coordinators from participating American Academy of Pediatrics chapters were identified to oversee local PROS efforts, represent practitioners, and inform the development of proposed research studies. PROS subsequently recruited practitioners from around the country, building a research infrastructure and a system of collaboration between the practitioners, research staff at the AAP, and investigative teams at academic institutions. This PROS collaboration has developed and conducted 10 primary care research studies that have added to the knowledge base of pediatric primary care. CONCLUSIONS: PROS has accomplished two of its initial objectives-development of a structure and process for pediatric practice-based research and provision of research experience to practitioners. Successful and consistent achievement of a third objective-meaningful dissemination of study results to relevant audiences-will depend on meeting several challenges.

Child↗
PubMed1994

Pediatricians' views of access to health services for adolescents.

PURPOSE: The American Academy of Pediatrics (AAP) carried out a member survey to measure pediatricians' views of parental permission and notification for selected health services for two age groups of adolescents, the 13 to 15 year olds and the 16 to 17 year olds. METHODS: Through an AAP Periodic Survey, a sample of 1000 members of the AAP were sent questionnaires to fill out and return. The response rate was 77%. RESULTS: The majority of pediatricians in all groups examined believed parental permission and notification were important for general medical and surgical care. But for most other types of care delineated, related to substance abuse and sexuality, most pediatricians did not believe parental permission should be required, except for requests for abortion for 13-15 year olds. For several types of care most pediatricians believed parental notification should be required for 13-15 year olds. Older pediatricians, male pediatricians, and self-employed pediatricians were more apt to support both parental permission and notification for all types of care. When age, gender and self versus not self-employed were introduced together through a logistic regression procedure differences in views were accounted for by self versus not self-employed, and age and gender had no additional impact. CONCLUSIONS: Most pediatricians supported the right of minors to seek care without parental permission for care related to substance abuse and sexuality. The majority were less likely to grant confidentiality to adolescents, particularly those 13 to 15 years.

Adolescent↗
PubMed1994

Immunization practices of pediatricians and family physicians in the United States.

OBJECTIVE: To assess current practices and attitudes among pediatricians and family physicians across the United States regarding immunizations. DESIGN: Survey of a random sample of pediatricians and family physicians. SUBJECTS: Fellows of the American Academy of Pediatrics (N = 746) and American Academy of Family Medicine (N = 429). SURVEY TOPICS: General immunization practices (eg, types of visits during which vaccinations are provided, mechanisms to identify undervaccinated children); and opinions about perceived barriers to immunizations, acceptance of alternative sites for immunizations, and possible immunization requirements for Medicaid and The Special Supplemental Food Program for Women, Infants, and Children (WIC). RESULTS: Pediatricians and family physicians (combined) reported the following: immunizing children during acute illness visits (28%), follow-up visits (90%), and chronic illness visits (77%); using computer or reminder files to identify undervaccinated children (13%); and simultaneously administering four vaccines (diphtheria-tetanus-pertussis, oral poliovaccine, measles, mumps, and rubella and Haemophilus influenzae type b) to an eligible 18-month-old child (66%). Physicians perceived the following as barriers to immunizations: missed preventive visits (40%), vaccine costs (24%), lack of insurance coverage (24%), inability to track undervaccinated patients (22%), incomplete immunization records (12%), and missed vaccination opportunities (12%). Physicians agreed with offering vaccinations during hospitalizations (51%) or emergency department visits (30%), and with immunization requirements for continued eligibility for Medicaid (66%) or WIC (64%). Pediatricians were more likely to vaccinate during chronic illness and follow-up visits, and were more likely to use systems to track undervaccinated children (P < .05); however, most immunization practices and attitudes of pediatricians and family physicians were similar. Physicians who graduated from medical school more recently and those in high-risk urban practices were more likely to vaccinate during acute illness visits, provide simultaneous vaccinations, and favor vaccinations in hospital settings. CONCLUSIONS: Vaccination rates might be improved by closer adherence to current immunization guidelines regarding vaccinations during all encounters and simultaneous vaccinations, by developing systems to identify undervaccinated children, and by reducing patient costs for vaccinations. Current immunization practices fall short of the immunization guidelines; changes in individual practice styles will be required to conform with these standards.

Acute Disease↗
PubMed1993

Adolescent abortion: views of the membership of the American Academy of Pediatrics.

To identify the positions held by the American Academy of Pediatrics (AAP) membership on a number of issues that may be topics of legislation regarding abortion, the AAP carried out a survey based on a random sample of 1000 active US members. A total of 785 usable questionnaires were returned. The majority of members surveyed (56.7%) favored access to abortion for adolescents for all the reasons identified in the questionnaire; 35.4% believed abortion should clearly be restricted in some circumstances, and 7.0% believed adolescents should not have access to abortion under any circumstances. For each individual reason for abortion, at least 60% of the membership believed adolescents should have access to abortion services. In addition, most pediatricians supported legal positions that would facilitate access to abortion services for adolescents. Urban, female, and non-self-employed pediatricians were slightly more likely to support access to abortion by adolescents than comparison groups. Discussion focuses on the extent to which pediatricians' views reflect medical concerns, the extent to which their views are reflected in the current laws, and implications for practice and for AAP policy.

Abortion, Legal↗
PubMed1992

Prepayment with office-based physicians in publicly funded programs: results from the Children's Medicaid Program.

This paper is a report of the results of a demonstration designed to provide empirical evidence regarding the effects of alternative approaches to paying physicians for serving children in the Medicaid program: (1) visit fees set at twice regular Medicaid fees in return for physician agreement to manage utilization and (2) capitation and financial risk-sharing along with the same physician agreement to manage utilization. Participating physicians were assigned randomly to either of the two payment groups. Comparisons of utilization and expenditures were made between these two plans and the regular Medicaid program (fee-for-service, low fees). Results showed no adverse effect of capitation payments on primary care visits to office-based physicians. Capitation physician referrals to specialists decreased relative to all other groups studied, consistent with the theory that the financial incentives in capitation will lead primary care physicians to reduce referrals to specialists.

Child↗
PubMed1990

Infant care review committees. The response to federal guidelines.

A 1986 survey of hospitals with neonatal intensive care units and/or 1500 or more births indicated (1) which hospitals had established infant care review committees and (2) what hospital and committee characteristics influenced the functioning of infant care review committees. Of the hospitals surveyed, 51.8% had established infant care review committees. This study provides baseline information on the development of infant care review committees.

Ethics Committees, Clinical↗
PubMed1990

Access to office-based physicians under capitation reimbursement and Medicaid case management. Findings from the Children's Medicaid Program.

This study reports the effects of a voluntary Medicaid case-management demonstration on the primary care provided to young children by office-based physicians. The MDs who participated were reimbursed at rates higher than the regular Medicaid fee schedule, either through augmented fees for specific services or through monthly capitation payments. Using the Medicaid Management Information System (MMIS) claims data, we compared the rates at which children in the experimental program and children in the regular Medicaid program were seen by a physician during a one-year period. The majority of experimental children received regular and frequent care from primary care physicians during the demonstration. After controlling for race and prior utilization differences, we found that augmented fee-for-service children received more primary care from office-based physicians than children in the regular Medicaid program. Capitation children received at least the same amount of primary care as children in the regular Medicaid program. We interpret our data to mean that capitation payment, untied to the delivery of services, does not necessarily reduce access to primary care and that higher fees for physicians who treat children may, in fact, increase access.

Capitation Fee↗
PubMed1990

Preventive health care for Medicaid children.

In this article, we measure the extent to which California Medicaid children in 1981 received preventive care services through either the regular or the Early and Periodic Screening, Diagnosis, and Treatment component of Medicaid. On average, 62 percent of children up to 15 years of age who were continuously enrolled for that year had no preventive care visits, with the percentage increasing with age. Forty-five percent of children under 5 had no preventive visits paid by Medicaid. Children outside of urban areas received fewer preventive care visits than did urban children.

Adolescent↗
PubMed1989

Black pediatricians: career concerns and choices.

A survey of black pediatricians and comparison data from surveys of pediatricians as a whole are used to address these study questions: (1) What aspects of black pediatricians' careers are related to career satisfaction? (2) What problems do black pediatricians face in starting their careers? (3) Are the problems black pediatricians face similar to those other pediatricians face? Results show black pediatricians to be generally satisfied with their careers. They are more likely than other pediatricians to experience problems in the financing and business aspects of launching careers, however, and in peer support and role models. A finding that career satisfaction is related to a belief that organizational membership is important to careers is explored. Black pediatricians are still severely underrepresented in the profession compared with the number of blacks in the population.

Academies and Institutes↗
PubMed1987

Impact of municipal health services Medicare waiver program.

A major goal of the municipal health services program (MHSP) was improvement of health services for the elderly while containing Medicare reimbursement. A Health Care Financing Administration financed Medicare waiver program provided some additional benefits to Medicare Part B enrollees who used the MHSP clinics. Disadvantaged and sicker elderly groups were underrepresented in MHSP facilities. However, even after taking these differences between MHSP and other patients into account, analyses of Medicare records showed that participants in this program had lower reimbursement for hospital inpatient, outpatient, and emergency room services. Also, participants had higher reimbursements for physicians' ambulatory and ancillary care. The net result was total Medicare reimbursements were decreased for program participants.

Aged↗
PubMed1986

The Municipal Health Services Program. Improving access to primary care without increasing expenditures.

Under the Municipal Health Services Program (MHSP), five city governments created networks of primary care clinics with a goal of serving populations thought to have poor access to primary medical care. A major concern was fragmented care in public hospitals and other public facilities. The new MHSP clinics were expected to provide care at lower cost than the population's alternative sources of care. Medicare and Medicaid waivers were also provided. This evaluation indicates that MHSP did reach most, but not all, of the targeted groups. MHSP may have successfully replaced some outpatient department and emergency room services. However, it failed to realize the program goals of continuity and high patient satisfaction. Per capita expenditures for medical care for MHSP users were no higher than for others, but also were not significantly lower. However, for Medicare eligible MHSP users, expenditures by Medicare were significantly less.

Consumer Behavior↗
PubMed1984

Self-care. Substitute, supplement, or stimulus for formal medical care services?

This article examines the relationship between selected self-care practices during an episode of illness and the use of formal medical care. Stimulated by conflicting evidence and assertions, the general question addressed is: "Is self-care a substitute, a supplement, or a stimulus for use of formal medical care services?" Multiple Classification Analysis was used in a secondary data analysis of a 1976 nationwide study on access to medical care. The results suggest that self-care users may visit the physician less often and stay fewer days in the hospital, and thus they are expected to have lower expenditures for hospital and physician services. Therefore, the self-care activities examined appear to be substitutes for, rather than supplements or stimuli to, health services utilization. The results must be viewed with some caution due to limitations in the data. However, the results also argue for a greater research emphasis on self-care.

Adolescent↗
PubMed1981

Hospital structure and consumer satisfaction.

This study examines the relationship between hospital structural characteristics and patient satisfaction with hospital care. Teaching hospitals and private hospitals were expected to receive higher ratings of patient satisfaction than were nonteaching and government-controlled hospitals, because they generally are reputed to be technologically superior. Results show that, in general, most patients are satisfied with their hospital stays, but they are clearly more dissatisfied with their stays in teaching hospitals. Although a number of other correlates of patient satisfaction with the hospital stay are identified, no measure succeeds in reducing to insignificance the strong relationship between teaching status and dissatisfaction. Some suggestions are made as to why teaching hospital receive relatively poor evaluations from their patients.

Consumer Behavior↗
PubMed1979

Using consumer evaluations of health care.

Patient evaluation data are valuable to hospital administrators because they indicate what quality of care means to the people the hospital serves and which aspects of care management can alter to avoid patients' negative responses.

Age Factors↗