Development and Validation of an Immunization Tracking System in a Large Health Maintenance Organization

1993 ◽  
Vol 9 (2) ◽  
pp. 96-100 ◽  
Author(s):  
Thomas Payne ◽  
Susan Kanvik ◽  
Richard Seward ◽  
Doug Beeman ◽  
Angela Salazar ◽  
...  
Keyword(s):  
Tracking System ◽  
Health Maintenance Organization ◽  
Health Maintenance ◽  
Development And Validation

Would Better Adherence to Guidelines Improve Childhood Immunization Rates?

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1062-1068
Author(s):  
Tracy A. Lieu ◽  
Steven B. Black ◽  
Michael E. Sorel ◽  
Paula Ray ◽  
Henry R. Shinefield
Keyword(s):  
Health Plan ◽  
Chart Review ◽  
Tracking System ◽  
Insurance Coverage ◽  
Health Maintenance Organization ◽  
Clinic Visit ◽  
Simultaneous Administration ◽  
Health Maintenance ◽  
Provider Practices ◽  
Second Year

Objective. To evaluate the contribution of three provider practices to underimmunization of children with financial coverage for vaccines. Design. Retrospective cohort study of children in a large health maintenance organization, based on computerized databases and chart review. Setting. Large health maintenance organization in northern California. Patients. The population included 24 268 children who had at least one immunization recorded in the health plan tracking system and had continuous health plan membership between 15 and 24 months of age in 1992 through 1993. The study group (N = 4691) were those who had missed one or more of the immunizations due during their second year. Results. Most (57%) of the underimmunized children had made at least one clinic visit between 15 and 24 months of age. Among those underimmunized children who made well care visits, 90% had been partially immunized at the visit but had not been simultaneously given all vaccines for which they were eligible. When a provider did not give all possible vaccines simultaneously, there was a 9% chance that the child would go on to miss the remaining immunization. Simultaneous administration alone would have achieved full second year coverage of 30% of the underimmunized children in this population. Most underimmunized children (53%), including 35% of those children who had not made any well care visits, had made urgent visits between 15 and 24 months of age. Chart review of randomly sampled patients showed no obstacle or contraindication to immunization at 79% of urgent visits and at 71% of well care visits at which vaccines were withheld. A policy to use weekday urgent visits to promote immunization could potentially reach 27% of the underimmunized children. Conclusions. Provider practices play an important role in underimmunization of children who have insurance coverage for vaccines. Of the three guidelines evaluated, simultaneous administration of all possible vaccines has the greatest potential effectiveness to improve coverage rates in this population. Other guidelines, such as immunizing at urgent visits, are potentially effective but their costs and logistics need further study.

Moral Justice and Legal Justice in Managed Care: The Ascent of Contributive Justice

1995 ◽  
Vol 23 (3) ◽  
pp. 247-265 ◽  
Author(s):  
E. Haavi Morreim
Keyword(s):  
Access To Health Care ◽  
Life Support ◽  
Vegetative State ◽  
Health Maintenance Organization ◽  
Persistent Vegetative State ◽  
Autologous Bone Marrow ◽  
Marrow Transplant ◽  
Health Maintenance ◽  
Access To Health ◽  
Aggressive Care

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state (PVS), cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization (HMO). Similarly, Baby K was an anencephalic infant whose mother, believing that all life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer.

scholarly journals Use of health services by children of smokers and nonsmokers in a health maintenance organization.

1998 ◽  
Vol 88 (6) ◽  
pp. 897-902 ◽  
Author(s):  
C M McBride ◽  
P Lozano ◽  
S J Curry ◽  
D Rosner ◽  
L C Grothaus
Keyword(s):  
Health Services ◽  
Health Maintenance Organization ◽  
Health Maintenance ◽  
Use Of Health Services

Extracting and analyzing ejection fraction values from electronic echocardiography reports in a large health maintenance organization

2016 ◽  
Vol 23 (4) ◽  
pp. 319-328 ◽  
Author(s):  
Fagen Xie ◽  
Chengyi Zheng ◽  
Albert Yuh-Jer Shen ◽  
Wansu Chen
Keyword(s):  
Heart Disease ◽  
Ejection Fraction ◽  
Health Maintenance Organization ◽  
Prognostic Indicator ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Free Text ◽  
Ventricular Ejection Fraction ◽  
Health Maintenance ◽  
Systolic Left Ventricular Function

The left ventricular ejection fraction value is an important prognostic indicator of cardiovascular outcomes including morbidity and mortality and is often used clinically to indicate severity of heart disease. However, it is usually reported in free-text echocardiography reports. We developed and validated a computerized algorithm to extract ejection fraction values from echocardiography reports and applied the algorithm to a large volume of unstructured echocardiography reports between 1995 and 2011 in a large health maintenance organization. A total of 621,856 echocardiography reports with a description of ejection fraction values or systolic functions were identified, of which 70 percent contained numeric ejection fraction values and the rest (30%) were text descriptions explicitly indicating the systolic left ventricular function. The 12.1 percent (16.0% for male and 8.4% for female) of these extracted ejection fraction values are <45 percent. Validation conducted based on a random sample of 200 reports yielded 95.0 percent sensitivity and 96.9 percent positive predictive value.

Genetic information: Special or not? Responses from focus groups with members of a health maintenance organization

2007 ◽  
Vol 143A (6) ◽  
pp. 564-569 ◽  
Author(s):  
Brenda Diergaarde ◽  
Deborah J. Bowen ◽  
Evette J. Ludman ◽  
Julie O. Culver ◽  
Nancy Press ◽  
...  
Keyword(s):  
Focus Groups ◽  
Genetic Information ◽  
Health Maintenance Organization ◽  
Health Maintenance
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