Biomedical subjects

K S Yarnall

Publications and source records attributed to K S Yarnall.

6 recordsLinked to original sources

PubMed1995

Computer-prompted diagnostic codes.

BACKGROUND: The purpose of this study was to develop and evaluate a computer system that would translate patient diagnoses noted by a physician into appropriate International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes and maintain a patient-specific up-to-date problem list. METHODS: The intervention consisted of a computerized list (dictionary) of diagnoses, including practice-specific synonyms and abbreviations, linked to their corresponding ICD-9-CM codes. To record the diagnoses for the office visit before the intervention, physicians used International Classification of Health Problems in Primary Care (ICHPPC-2) codes. After the intervention, physicians used their own words or checked previously identified diagnoses on the computer-generated problem list. The computer then identified the correct ICD-9-CM code. Accuracy of coding was compared before and after the new computerized system was implemented. RESULTS: Visits in which all diagnoses matched increased from 58% to 76% (P < .001) with use of the computer system. Visits in which no computer diagnoses matched the chart decreased from 22% to 8% (P < .001). Errors of omission declined from 38% to 18% (P < .001). Errors of commission decreased from 19% to 11% (P = .006). Overall accuracy increased from 62% to 82% (P < .001). CONCLUSIONS: Outpatient medical diagnosis coding can be simplified and accuracy improved by using a computerized dictionary of practice-specific diagnoses and synonyms linked to appropriate ICD-9-CM codes. Such a system provides a computer-generated problem list that accurately reflects the chart and assists with prompted coding on subsequent visits.

Abstracting and Indexing↗

PubMed1994

Feasibility and potential clinical usefulness of a computerized severity of illness measure.

OBJECTIVE: To assess the feasibility and potential clinical usefulness of the computerized Duke Severity of Illness Checklist (DUSOI). DESIGN: Cross-sectional study of patients whose severity of illness was measured with the DUSOI. Providers assessed the clinical usefulness of the DUSOI and recorded the length of time required for rating severity. Auditors rated severity using progress note information. Demographic and financial data from clinic records were also obtained. SETTING: University-based family practice clinic with 64,621 annual visits. PATIENTS: Convenience sample of ambulatory patients. MAIN OUTCOME MEASURES: Clinical usefulness and time required to rate severity. RESULTS: For 117 patients (63.3% female; mean age, 46.3 years), the mean charge was $105.38, the mean number of health problems was 2.0, the mean overall provider DUSOI score was 33.7, and the mean auditor DUSOI score was 34.0 (scale = 0 to 100). There was excellent agreement between provider and auditor DUSOI scores (intraclass correlation coefficient, .77). Providers required 1.1 minutes to record severity; the principal auditor required 1.6 minutes. Providers found the DUSOI potentially useful in 30.3% of patients. Usefulness was greater in women (38.2% of women vs 18.2% of men), older patients (mean age, 54.5 years in useful group vs 41.9 in nonuseful group), and sicker patients (mean DUSOI score, 55.1 vs 25.9). The DUSOI was more clinically useful in patients with health problems such as type II diabetes mellitus (75.0%) than in those with problems such as tobacco use (25.0%). Higher charges correlated with a higher number of health problems and with female gender but not with severity scores. CONCLUSIONS: The computerized DUSOI is feasible for all patients and is potentially useful for women, older, and sicker patients.

Adolescent↗

PubMed1993

Increasing compliance with mammography recommendations: health assessment forms.

BACKGROUND: Inexpensive reminder systems are needed to ensure that primary care physicians consistently provide health maintenance services to their patients. The purpose of this study was to determine the effectiveness of a simple, inexpensive health assessment form in place of the standard chart note to increase physician compliance with mammography recommendations. METHODS: A health assessment form with a reminder for screening mammography was implemented in a family practice in 1987 and was to be used as the official chart record for health maintenance visits. The charts of all women 50 years of age and older with two or more office visits during the years 1985 through 1988 were audited to determine how many mammograms were completed. Results were compared with mammography completion rates at a similar practice that did not use a health assessment form. RESULTS: The study group showed a significant increase in mammography completion after implementation of the form, with compliance increasing from 7.3% to 32.0% (P < .001). The comparison group had an increase in mammogram completion from 12.0% to 17.8% (P < .001). The difference between the changes in rates of mammography in the two practices was statistically significant (P < .001). Among women in the study group who had a scheduled health maintenance visit during the study period the average rate of mammography completion increased from 21.2% to 65.2% (P < .001). CONCLUSIONS: The addition of a health assessment form with a mammography reminder at the health maintenance visit is an effective and inexpensive method to increase compliance with mammography.

Adolescent↗

PubMed1991

Tricyclic antidepressant prescribing for nonpsychiatric disorders. An analysis based on data from the 1985 National Ambulatory Medical Care Survey.

BACKGROUND: Primary care physicians often do not document a psychiatric diagnosis when prescribing psychotropic medications. Recent literature suggests the potential benefit of tricyclic antidepressants (TCAs) in a number of nonpsychiatric conditions (low back pain, peptic disease, fibrositis, headache, peripheral neuropathy, rheumatoid disease, and irritable colon). METHODS: Data from the 1985 National Ambulatory Medical Care Survey (NAMCS) were used to categorize the primary diagnoses given during office visits in which tricyclic antidepressants were prescribed. Comparisons were made across specialties. RESULTS: Primary care physicians prescribed tricyclic antidepressants in 1% of all visits (an estimated 2,892,000 visits per year). Whereas 50% of these visits at which TCAs were prescribed were for documented psychiatric illnesses or conditions, 15% were for nonpsychiatric TCA-responsive conditions. The majority of visits by patients with these disorders were to primary care physicians. The pattern of TCA prescribing for these disorders by primary care physicians parallels that of other medical specialties except that primary care physicians prescribed TCAs for nonpsychiatric TCA-responsive disorders less frequently than did other medical specialists. CONCLUSIONS: When nonpsychiatric TCA-responsive disorders are included, primary care physicians document with appropriate diagnoses 15% more of their TCA prescriptions than previous studies have indicated. An understanding of the 35% of TCA prescriptions that do not show proper documentation will require further study and information not available from the NAMCS:

Adolescent↗

PubMedDate not supplied

The medical record: a comprehensive computer system for the family physician.

BACKGROUND: Despite the early excitement regarding the possible uses of computers in medical care in the 1980s, the computer has not had much effect on routine outpatient medicine except for billing and accounting. METHODS: An emerging comprehensive ambulatory care computer system, The Medical Record (TMR), is used extensively in a large family practice, the Duke Family Medicine Center. TMR is the central system for accounting, appointments, billing, and reporting of laboratory results, radiographic findings, and medications. TMR also records problem lists and generates prompts to the clinicians for needed health maintenance, laboratory tests, and reminder letters. The most innovative function of TMR is the computerized obstetric patient record, which can be accessed from multiple sites. Cost savings compared with a manual system were found to be in excess of $7 per patient visit or approximately $500,000 per year for the Duke Family Medicine Center. RESULTS AND CONCLUSIONS: A comprehensive computer system in a large family practice is cost effective and facilitates better patient care through improved access to patient data.

Costs and Cost Analysis↗

PubMedDate not supplied

Cancer screening practices among women in a community health center population.

BACKGROUND: Cancer takes a disproportionate toll on disadvantaged Americans. Poverty and low education are risk factors for underuse of cancer screening. METHODS: In this report, we discuss predictors of adherence to cancer screening (mammography, clinical breast exam [CBE], and Pap tests) among 926 women who receive care at a community health center that serves a predominantly low-income and minority population. We examine predictors for each of the tests and for a composite measure of overall cancer screening test compliance. In studying multiple screening behaviors we not only investigate factors associated with each individual behavior, but we also identify consistently effective factors across several behaviors. RESULTS: The analysis indicates consistent effects of age, education, and insurance status on cancer screening. In addition, decisional balance, a measure of a person's beliefs about the pros and cons of complying with the screening test, is associated strongly with adherence. We have extended earlier findings about the positive relationship between decisional balance and mammography to include decisional balance and Pap tests, as well. This finding suggests that behavioral interventions that target decisional balance can effectively promote adherence to cancer screening tests.

Adolescent↗