PubMed Health⌕ Search

Biomedical subjects

J T Badgett

Publications and source records attributed to J T Badgett.

17 recordsLinked to original sources
PubMed1998

Urticaria.

Explore the source record for details and available documents.

Angioedema↗
PubMed1998

General pediatric teaching clinics and managed care.

Academic general pediatric divisions can function as effective primary care providers in a managed care environment. Residents training in these programs are expected to be better equipped to enter a work environment that is increasingly structured in a managed care format. Positive and negative consequences of managed care in an academic setting are discussed. Recommendations for successful implementation of resident training in the world of managed care are shared.

Health Resources↗
PubMed1997

Prepaid capitation versus fee-for-service reimbursement in a Medicaid population.

Utilization of health resources by 37,444 Medicaid recipients enrolled in a capitated health maintenance organization was compared with that of 227,242 Medicaid recipients enrolled in a traditional fee-for-service system over a 1-year period (1983-1984) in the state of Kentucky. Primary care providers in the capitated program had financial incentives to reduce downstream costs like specialist referral, emergency room use, and hospitalizations. The average number of physician visits was similar for both groups (4.47/year in the capitated program; 5.09/year in the fee-for-service system). However, the average number of prescriptions (1.9 versus 4.9 per year), average number of hospital admissions per recipient (0.11 versus 0.22 per year), and average number of hospital days per 1,000 recipients (461 versus 909 per year) were 5% to 60% lower in the capitated group than in the fee-for-service group. The Citicare capitated program resulted in a dramatic reduction in healthcare resource utilization compared with the concurrent fee-for-service system for statewide Medicaid recipients.

Aid to Families with Dependent Children↗
PubMed1997

Subspecialist referrals in an academic, pediatric setting: rationale, rates, and compliance.

Appropriate referrals reduce healthcare costs and enhance patient satisfaction. We evaluated the subspecialty referral pattern of a managed care general pediatric office over a 4-month period. Three-hundred-forty-six referrals (267 meeting inclusion criteria) to 24 subspecialties were generated during 4,219 office visits, with five subspecialties receiving 59% of the referrals. The main objective of each referral was management (100), diagnostic assistance (75), special procedure (63), or a combination (29). Patients kept less than half of the referral appointments, with the highest (80%) and lowest (28%) compliance rates observed in cardiology and ophthalmology, respectively. Appointments made within four weeks of the referral were more likely to be kept than those with greater lag time (P = 0.001). The subspecialists prepared written, post-consultation responses to the referring physician in 73% of cases. Presumptive and post-consultation diagnoses were congruent in 78% of those cases in which both diagnoses were noted. Overall, the managed care format enabled our practice to track referral outcomes. The subspecialists' written responses also allowed for an educational exchange between physicians. Compliance with referral appointments is a substantial problem that needs to be addressed.

Academic Medical Centers↗
PubMed1996

Management of group A streptococcus pharyngitis with a second-generation rapid strep screen: Strep A OIA.

Empirical therapy of presumed group A streptococcus (GAS) pharyngitis leads to unnecessary and inappropriate use of antibiotics and pressure for emergence of resistant strains of common bacteria. Immunoassay technology has produced several rapid tests for GAS. The wide variations in diagnosis and treatment of acute pharyngitis are reviewed including the impact of rapid strep tests. Published studies comparing Strep A OIA to routine agar culture and other rapid strep screens are presented to assess the reliability and applicability of this novel assay. These data suggest that Strep A OIA may be superior to the "gold standard" throat culture and other rapid streptococcal antigen detection assays. Judicious use of Strep A OIA can result in rapid, precise diagnoses and eliminate unnecessary and inappropriate use of antibiotics. Careful antibiotic selection can reduce the pressure for emergence of resistant bacteria. This innovative, effective assay can contribute to a lessening of this serious clinical challenge.

Humans↗
PubMed1994

Evaluation of QBC Autoread performance in an emergency department setting.

The objective of the study was to examine the accuracy and clinical utility of technology using a quantitative buffy coat analysis in determining complete blood cell count results in an emergency department. A prospective observational study was done at an urban pediatric emergency department. One hundred ninety-one patients who had a complete blood cell count (CBC) ordered by the managing emergency physician from 11 AM to 3 AM participated. A blood analysis was performed in the emergency department on the QBC Autoread System for hemoglobin (Hgb), hematocrit (Hct), white blood cell count (WBC), absolute and percent granulocytes (Gr), absolute and percent lymphocytes/monocytes (L/M), and platelets (PTLS). Results were compared with a CBC analysis on the hospital laboratory system (Coulter S-8-80). Time from specimen collection to results were compared for QBC and laboratory CBC. Emergency physicians completed a clinical utility survey after reviewing QBC results. Linear regression curves revealed a high correlation between the two methods for all parameters studied (Hgb: R = 0.911, Hct: R = 0.868, natural log WBC: R = 0.938, % Gr: R = 0.932, % L/M: R = 0.939, and natural log PTLS: R = 0.877). The mean time for collection to QBC result was 17.3 +/- 11.6 minutes compared with 42.2 +/- 17.9 minutes for collection to CBC result. One hundred thirty-five clinical utility forms were completed by the managing physicians after a review of their patient's QBC result. In 20% of cases, physicians felt the QBC result would have shortened the patient's length of stay in the emergency department, and in 85% they felt the result confirmed their clinical impression.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Cell Count↗
PubMed1994

Managed outcomes: a strategy to improve the nation's health.

Current health care delivery systems in the United States have led to high cost, uneven quality, less than universal coverage, undue emphasis on a medical/clinical model, and scant attention to primary care and prevention. In the context of health care reform, a new strategy is introduced that reverses present trends and incentives, called managed outcomes. This strategy is not specific to any particular health care delivery system. Managed outcomes encourages experimentation and flexibility in the design of health care systems and fosters primary care, health promotion, and disease prevention models. It links purchasing decisions to established specific and measurable goals that can provide quality and cost-effective services to improve health.

Health Care Reform↗
PubMed1993

Familial congenital bronchiectasis: Williams-Campbell syndrome.

Williams-Campbell syndrome was first described in 1960 as a rare form of bronchiectasis. Its pathogenesis is characterized by the absence or markedly diminished cartilage around the bronchi. Although the familial nature was postulated early on, only one possible familial occurrence has been reported in the literature. We present two family members in whom respiratory symptoms developed within the first year of life and were found to have histopathologic changes consistent with Williams-Campbell syndrome. This world lend further support of a developmental origin for this type of bronchiectasis.

Bronchi↗
PubMed1987

Acellular pertussis vaccine: immunogenicity and safety of an acellular pertussis vs. a whole cell pertussis vaccine combined with diphtheria and tetanus toxoids as a booster in 18- to 24-month old children.

An acellular pertussis vaccine principally containing two purified pertussis antigens, filamentous hemagglutinin and lymphocytosis-promoting factor, combined with diphtheria and tetanus toxoids was compared to conventional diphtheria-tetanus toxoids-whole cell pertussis for adverse effects and serologic responses in a group of 120 children who were from 18 to 24 months of age. Three vaccinations at 2, 4 and 6 months of age with diphtheria-tetanus toxoids-whole cell pertussis had been administered previously. Adverse effects occurred more frequently with the diphtheria-tetanus toxoids-whole cell pertussis than with diphtheria-tetanus toxoids-acellular pertussis vaccine. Fever occurred significantly more often and to a higher degree in the whole cell pertussis vaccine recipients with a peak difference occurring 6 hours after immunization (P = 0.00008). Local swelling, redness, warmth and tenderness at the injection site also occurred significantly more frequently following whole cell pertussis vaccination. No major sequelae were noted in either group. The antibody responses to lymphocytosis-promoting factor were similar for the two vaccines. The diphtheria-tetanus toxoids-acellular pertussis vaccine produced significantly lower pertussis agglutinin titers (P = 0.00001) but significantly higher antibody to filamentous hemagglutinin (P = 0.05) and to diphtheria (P = 0.03). The protective role of antibody to pertussis agglutinins vs. filamentous hemagglutinin and lymphocytosis-promoting factor continues as a central issue in the quest for a new pertussis vaccine. A clinical efficacy trial is needed.

Agglutinins↗
PubMed1987

Safety and immunogenicity of a diphtheria-tetanus-pertussis vaccine containing an acellular pertussis component.

In an open-label study, we evaluated the safety and immunogenicity of a diphtheria-tetanus-pertussis (DTP) vaccine containing an acellular pertussis component. Thirty-one normal, healthy children 4 to 6 years old received a single dose. All subjects had received their primary DTP series and DTP booster at age 18 months. All but three of the subjects were followed up for one month. Two subjects developed fever (100 F [37.8 C]) during the 24 hours after dosing. Eleven subjects had mild local reactions reported by parents at the 24-hour visit. One subject had a small "sterile abscess." Paired antibody assays revealed enhancement of titers in 19 of 21 for pertussis, 20 of 21 for diphtheria, and 19 of 21 for tetanus. Although the sample is small, the experimental vaccine appears to have been safe and effective in the subjects studied.

Antibodies, Bacterial↗
PubMed1986

Can Medicaid format alter emergency department utilization patterns?

Emergency department utilization by recipients of Aid to Families with Dependent Children (AFDC) in a metropolitan children's hospital was monitored during a 36-month period (July 1982 to June 1985). There were 92,495 emergency department visits recorded in this interval. During 12 months of this period (July 1983 to June 1984) a pilot program (Citicare) for AFDC recipients requiring prior authorization by the primary care physician for emergency department utilization was in effect. Emergency department census dropped dramatically and abruptly upon initiation of this program. Annual census for the targeted years reveals: 35,704 visits for the 12 months preceding this novel program, 25,543 visits for the 12 months of the program, and 31,248 visits for the 12 months following the pilot program. Total emergency department census was decreased by 23% and medical assistance utilization was decreased by 46% during the Citicare program. During the target period, self-pay clients decreased by 25%, and other categories (Champus, Hill-Burton, Crippled Children's Commission, etc.) increased by 6%. There was no corresponding decline in the number of patients admitted to the hospital through the emergency department during the monitoring period with 3,545, 3,555, and 3,922 annualized admissions respectively, for the targeted 12-month periods. These data suggest that the format of Medicaid programs can dramatically alter the utilization of emergency department services. Furthermore, the primary impact of this specific program was to decrease inappropriate emergency department use.

Aid to Families with Dependent Children↗