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Biomedical subjects

P J Maddox

Publications and source records attributed to P J Maddox.

7 recordsLinked to original sources
PubMed2003

Evaluating Medicaid HMOs when encounter data are missing: case of developmentally delayed children.

In evaluating Medicaid Health Maintenance Organizations (HMOs), crucial information regarding severity of illness of patients is often missing--in part because encounter data are not available. If we assume that patients are either in the HMO or in fee-for-service (FFS) plans (i.e., no in or out migration); then severity of HMO patients can be deduced from encounters of FFS patients. We applied this approach to effectiveness of HMO services for developmentally delayed children. Data supported the assumption of a closed system. Data also showed that over 12 months, severity of FFS patients declined. Therefore, we inferred that the HMO was attracting sicker patients. The HMO was paid less than FFS plan, despite the fact that it attracted sicker patients.

Child↗
PubMed2001

Bioterrorism: a renewed public health threat.

In the aftermath of the terrorist attacks of September 11, the United States is coming to terms with new and urgently felt public health and safety concerns related to the threat of bioterrorism. The recent history and the legislative agenda emerging to prevent, monitor, and respond to bioterrorism in the United States are described.

Bioterrorism↗
PubMed1992

Successful implementation of a CQI process.

Managers and CQI facilitators must be equipped to understand both the pain and joy inherent in the organizational change process. The organizational caveats associated with successful implementation of CQI include the following: Expect resistance to change, especially if your current situation is comfortable. Be patient--the change process is an evolution, not a revolution. Plan well in a multidimensional format--you are changing more than policies and procedures when adopting CQI. Shape a culture that will support CQI, actively plan to expand communication opportunities, enhance training programs, and increase recognition modalities. Anticipate and deal with the stress that will accompany change. Don't forget to celebrate successes as transformation occurs!

Hospital Administration↗
PubMedDate not supplied

Patient safety and the need for professional and educational change.

Questionable quality of health care delivered in the United States has become a front-line issue, taking a strong place alongside more traditional concerns such as increasing costs and access to care. Given that nurses comprise the largest component of the health care workforce, safety and error reduction in health care are central concerns for the profession.

Clinical Competence↗
PubMedDate not supplied

HIPAA: update on rule revisions and compliance requirements.

Due to the highly technical requirements for HIPAA compliance and the numerous administrative and clinical functions and processes involved, guidance from experts who are knowledgeable about systems design and use to secure private data is necessary. In health care organizations, this will require individuals who are knowledgeable about clinical processes and those who understand health information technology, security, and privacy to work together to establish an entity's compliance plans and revise operations and practices accordingly. As a precondition of designing such systems, it is essential that covered entities understand the HIPAA's statutory requirements and timeline for compliance. An organization's success in preparing for HIPAA will depend upon an active program of assessment, planning, and implementation. Compliance with security and privacy standards can be expected to increase costs initially. However, greater use of EDI is expected to reduce costs and enhance revenues in the long run if processes and systems are improved. NOTE: Special protection for psychotherapy notes holds them to a higher standard of protection. Notes used only by a psychotherapist are not intended to be shared with anyone and are not considered part of the medical record.

Confidentiality↗
PubMedDate not supplied

Update on patient privacy legislation.

The administrative simplification provisions of HIPAA will establish the first national standards for the electronic transmission of health care transactions with which all federal programs (DOD, Medicare, and Medicaid) and all private health plans must comply. Individuals and organizations should prepare themselves, their systems, and their processes to meet these new administrative and financial data standards and requirements. The benefits of standardized electronic transactions on achieving a single paper-free claims submission to be used by all providers and payers is of obvious benefit. Not so obvious are consequences associated with limiting the access and use of existing data repositories on a variety of clinical, administrative, and research functions. It is critically important in this age of increased accountability for fiscal restraint and improving the outcomes of entire patient populations that clinicians, managers, organizations, and researchers to use data for a variety of clinical, quality improvement/evaluation, and research purposes. Administrative simplification and protecting individual privacy should not be achieved by overly bureaucratic and restrictive responses that impede epidemiologic and health services research, quality improvement activities, and optimization strategies for improving the health of populations. While the health system understands the need for some increased regulation to ensure the privacy of individual patient privacy in the "wired" world solutions must be found and overly restrictive consequences associated with prohibiting access to data must be resolved. More than ever, the entire system requires data to inform every level and type of decision made. Legislation and bureaucratic processes that do not understand and support responsible data-driven decision-making will serve to roll-back, not advance health system improvement. As we prepare ourselves for HIPAA compliance and the expectations of the benefits it will achieve, we must wait to see what impact it will have on clinical, administrative, and research functions concerned with improvement.

Computer Security↗