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At least 289 records · Page 16Linked to original sources

The State Children's Health Insurance Program: a multicenter trial of outreach through the emergency department.

OBJECTIVES: We evaluated emergency department (ED)-based outreach for the State Children's Health Insurance Program (SCHIP). METHODS: We conducted a multicenter trial among uninsured children (< or = 18 years) who presented to 5 EDs in 2001 and 2002. On-site staff enrolled consecutive subjects for a control period followed by an intervention period during which staff handed out SCHIP applications to the uninsured. The primary outcome was state-level confirmation of insured status at 90 days. RESULTS: We followed 223 subjects (108 control, 115 intervention) by both phone interview and state records. Compared to control subjects, those receiving a SCHIP application were more likely to have state health insurance at 90 days (42% vs 28%; P<.05; odds ratio [OR]=3.8; 95% confidence interval [CI]=1.7, 8.6). Although the intervention effect was prominent among 118 African Americans (50% insured after intervention vs 31% of controls, P<.05), lack of family enrollment in other public assistance programs was the primary predictor of intervention success (OR=3.7; 95% CI=1.6, 8.4). CONCLUSIONS: Handing out insurance applications in the ED can be an effective SCHIP enrollment strategy, particularly among minority children without connections to the social welfare system. Adopted nationwide, this simple strategy could initiate insurance coverage for more than a quarter million additional children each year.

Case-Control Studies↗

The Metropolitan Atlanta Congenital Defects Program: 35 years of birth defects surveillance at the Centers for Disease Control and Prevention.

BACKGROUND: The Metropolitan Atlanta Congenital Defects Program (MACDP) is a population-based birth defects surveillance program administered by the Centers for Disease Control and Prevention (CDC) that has been collecting, analyzing, and interpreting birth defects surveillance data since 1967. This paper presents an overview of MACDP current methods and accomplishments over the past 35 years. METHODS: MACDP actively monitors major birth defects among infants born to residents of five counties of metropolitan Atlanta, an area with approximately 50,000 annual births. Cases are ascertained from multiple sources, coded using a modified British Pediatric Association six-digit code, and reviewed and classified by clinical geneticists. RESULTS: MACDP has monitored trends in birth defects rates and has served as a case registry for descriptive, risk factor, and prognostic studies of birth defects, including studies of Agent Orange exposure among Vietnam War veterans, maternal use of multivitamins, diabetes, febrile illnesses, and survival of children with neural tube defects. MACDP has served as a data source for one of the centers participating in the National Birth Defects Prevention Study, and for developing and evaluating neural tube defects prevention strategies related to the periconceptional use of folic acid supplements. CONCLUSIONS: Since its inception, MACDP has served as a resource for the development of uniform methods and approaches to birth defect surveillance across the United States and in many other countries, monitoring birth defects rates, and as a case registry for various descriptive, etiologic, and survival studies of birth defects. MACDP has also served as a training ground for a large number of professionals active in birth defects epidemiology.

2,4,5-Trichlorophenoxyacetic Acid↗

Dental laboratory work authorization forms: a national survey of regulatory agency requirements.

This study reports a survey of the dental licensing agencies in the 50 states, Washington, D.C., and Puerto Rico concerning agency legislation and nomenclature of dental laboratory work orders. Differences in both legislation and nomenclature were found. Dental laboratory work authorization was the title most frequently used by the agencies. Nearly all agencies require a work order written by a licensed dentist to accompany all materials transmitted to a dental laboratory. This along with other sources of information may help to increase uniformity in the content of laboratory work authorization forms, thereby improving quality control in dental restorations made in commercial laboratories.

Dental Technicians↗

Trend reports a tool for efficiently managing materials.

Healthcare organizations reviewing supply and inventory expenses should consider developing monthly trend reports to help financial managers and administrators make accurate appraisals of materials management procedures. The reports are designed to identify purchasing trends, review progress in controlling costs, and stimulate discussions among the parties involved.

Costs and Cost Analysis↗

Plateletapheresis: instrumentation validation.

Plateletapheresis instrumentation validation is required to document that a new or modified instrument or technique is capable of consistently producing acceptable products at the production center using their equipment, personnel, and counting techniques even though the instrument or technique may already have FDA or equivalent approval for use. To pursue the process of validation, several questions need to be addressed: when is it required, what products are validated, what parameters are monitored, and how many products are required. Validation is required when a new instrument or technique (process) is used that could affect the quality of the product. According to the FDA, each apheresis system (e.g., Spectra LRS, Amicus) and each type of product (e.g., single, double, triple) need to be validated separately. Parameters to be validated vary, but usually platelet (plt) yield, white blood cell (WBC) content (if products are labeled "leukoreduced"), and 5-day storage pH are monitored. The number of procedures monitored is also quite variable, but we use 20 samples for highly variable parameters such as platelet yield and WBC content and five samples for less variable parameters such as 5-day storage pH. As an example, we validated the Fenwal Amicus (Baxter Biotech) for single apheresis platelet products. With 20 samples, we found that: 85% of the products contained > or = 3 x 10(11) plt (requirement was at least 75% contain > or = 3 x 10(11) plt); platelet concentration of all products was < or = 1.515 x 10(6) plt/microL (requirement was < or = 2.435 x 10(6) plt/microL), and WBC content was < 1 x 10(6) WBC in all products (requirement was all products contain < 5 x 10(6) WBC). In addition, in five samples, the 5-day storage pH was 6.89-7.25 (requirement was all products should be > or = 6.2 pH). Once validation is complete and acceptable, the process should be monitored on a regular basis using some form of process control. Statistical process control programs are available that can assist in documenting validation and ongoing process control. With the use of process validation and ongoing process control, the plateletapheresis center can assure that acceptable products are consistently being produced.

Forms and Records Control↗

A structured record to implement the national guidelines for diabetes and hypertension care.

BACKGROUND: Guidelines to improve standards of care for hypertension and diabetes were disseminated by the National Department of Health in 1996 but have generally not been implemented by health professional in local primary care. A strategy for the adoption and implementation of the Guidelines was developed in collaboration with health professionals in primary care. OBJECTIVES: The development of a structured record, with prompts for the management of diabetes and hypertension according to the Guidelines. SETTING: Three community health centres (CHCs) in the Western Cape. PARTICIPANTS: Doctors and nurses managing patients with diabetes and hypertension. METHODS: A draft of the structured record was developed at a single-pilot CHC in the Western Cape. Focus group discussions established the core requirements for a structured record. Process, result and structural indicators in line with the national Guidelines were considered for inclusion in the draft record. This draft record was then piloted at two other CHCs. Comments from semi-structured interviews and pre- and post-test evaluation questionnaires were used to compile the final instrument. RESULTS: Eleven doctors and 8 nurses participated in the development of the final instrument. Important considerations in the design were a single-page, user-friendly format, tick-boxes to reduce writing, prompts, provision for sequential recording, target setting, and compatibility with the Guidelines. The final instrument was piloted and elicited a favourable overall response. CONCLUSION: The structured record simplifies the application of the Guidelines and the systematic recording of processes of care. The effectiveness of the Guidelines will be evaluated further in a randomised control trial using the structured record.

Diabetes Mellitus↗

Toward assuring confidentiality of records in large-scale assessment programs.

EPSDT, or any similar national health program, will spawn multiple records on millions of children and adults. Multiple providers will need to share more data to provide quality care. Maintaining privacy of child/parent records, avoiding the dangers of labeling, controlling the life of records and insuring their appropriate demise exacerbate record maintenance problems. Principles of record-keeping confidentiality are proposed.

Attitude of Health Personnel↗

The usefulness of the HCFA form 485 in predicting home healthcare costs.

As prospective pay systems are created, many sources of home care information are being considered. This study examines items on the HCFA Form 485 for their ability to accurately predict home healthcare costs. The researchers deduced that the current information available on the HCFA Form 485 was not useful in anticipating, planning for, and, ultimately, controlling costs.

Aged↗

Find out what's causing unplanned admissions.

Hospitals have seen a tremendous increase in the number of surgical procedures performed in the outpatient setting. This change in practice has implications for patient care quality and hospital resource use. Does ambulatory surgery impair quality? Are strict controls on resource use resulting in unexpected hospital inpatient admissions?

Ambulatory Surgical Procedures↗

Memorial Sloan-Kettering cures paperwork problems with document imaging.

The world's largest cancer center, New York's Memorial Sloan-Kettering, is finding concrete efficiencies--and real savings--by implementing "OSCAR" the Optical System Controlling Administrative Records. The system now handles more than 2.7 million documents, including patient accounts and medical records.

Cancer Care Facilities↗

The priority test request form: a method for improving communication between the physician and the Emergency Clinical Biochemistry Laboratory.

Two forms--a priority test request form and a telephone results form--provide improved communication between the physician and the emergency laboratory of the Clinical Biochemistry Department. The priority test request form contains a list of available tests and it allows the physician to tell the laboratory exactly when emergency test results are required. The telephone results form ensures that the physician will receive a report, by telephone, of a test result although it may not be an urgent test. This allows a greater control of work flow, both routine and emergency, through the laboratory.

Biochemical Phenomena↗