PubMed Health⌕ Search

Biomedical subjects

Timothy G Ferris

Publications and source records attributed to Timothy G Ferris.

22 records · Page 2Linked to original sources
PubMedDate not supplied

Comparing a diagnosis list with a survey method to identify children with chronic conditions in an urban health center.

OBJECTIVE: To compare a diagnosis list to the Questionnaire for Identifying Children with Chronic Conditions (QuICCC) to assess their relative usefulness as measures for identifying children with chronic conditions. METHODS: Comparison of health encounter data and survey data for a cohort of 304 children aged 0-18 years at an urban health center affiliated with a teaching hospital. We used 2 strategies to identify children with a chronic condition: 1) identification by the existence of an encounter with an International Classification of Diseases, Ninth Revision code indicating a chronic condition and 2) identification by the QuICCC. We compared the characteristics of children identified by the diagnosis list with those of children identified by the QuICCC. RESULTS: This population had high rates of chronic conditions, with 44% identified by the diagnosis list and 36% identified by the QuICCC. These 2 methods jointly identified 66% of children, yet only half (53%) of the children who had a diagnosis of a chronic condition in the encounter data were identified by the QuICCC. Asthma, anorexia, developmental delay, and adjustment reaction were among the common chronic conditions for children identified by the diagnosis list approach only. CONCLUSIONS: We found only moderate concordance among the children identified as having chronic conditions by a diagnosis list and by the QuICCC in this high-risk urban population. These different results indicate that encounter data and survey approaches do not serve as simple substitutes for identifying children with chronic conditions for clinical or monitoring purposes.

Adolescent↗
PubMedDate not supplied

Generalist and subspecialist care for children with chronic conditions.

OBJECTIVE: To determine, among Medicaid-enrolled children with chronic conditions, associations of indicators of morbidity and expenditures with different patterns of generalist, subspecialist, and pediatric subspecialist use. DESIGN AND SETTING: Cross-sectional analysis of Medicaid claims, enrollment, and provider data from 4 states (California, Georgia, Michigan, and Tennessee). SAMPLE: All children enrolled in Supplemental Security Income (aged 0-21 years) and a sample of other Medicaid-enrolled children matched for age and gender. We included 11 chronic conditions, including both uncommon conditions (eg, spina bifida, hemophilia) and common ones (eg, asthma, attention deficit hyperactivity disorder). MAIN OUTCOME MEASURES: We determined the number of visits per year to generalists and subspecialists (pediatric and other), using only subspecialists relevant to that condition. We categorized patterns of care as generalist only, predominantly generalist, or predominantly subspecialist, and examined patterns by condition and an indicator of morbidity. Among children seeing subspecialists, we also compared morbidity by pediatric and other subspecialists. We used linear regression to determine per-year total expenditures, controlling for demographic characteristics and morbidity. RESULTS: Most children (60.7%) saw generalists only. Twenty-eight percent were in predominantly generalist arrangements, and 11% were in predominantly subspecialist arrangements. Children in predominantly generalist arrangements had higher morbidity than children in generalist-only or predominantly subspecialist arrangements. Among children seeing subspecialists, those seeing pediatric subspecialists had generally higher morbidity than those seeing other subspecialists. Mean yearly expenditures varied from 1306 dollars (attention deficit hyperactivity disorder) to 11,633 dollars (acquired immunodeficiency syndrome). Children who saw only generalists had significantly lower expenditures for 6 of the 11 conditions, after adjusting for morbidity. CONCLUSIONS: Medicaid-enrolled children in predominantly generalist arrangements appear to have more complicated conditions than children in generalist-only or predominantly subspecialist arrangements, engendering also higher expenditures. Although children who saw generalists only had lower expenditures than those seeing subspecialists, this finding may reflect unmeasured variations in morbidity.

Adolescent↗
PubMedDate not supplied

Investment, innovation, and disparities: a complex relationship.

Robert Hurley and colleagues find growing disparities in health care. Their methods are rigorous, but key-informant interviews have limitations. Part of their argument rests on observations regarding the diffusion of technological and administrative innovations. The development of disparities will depend on how quickly innovations diffuse to underserved populations. While we look for other supporting data, decreasing public coverage for the poor, medications, and mental health services sends a clear signal from emergency departments. Human suffering reinforces the need to redouble our efforts to patch up coverage holes during good times and keep coverage from unraveling during lean times.

Delivery of Health Care↗