ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objectives.This study evaluates the effectiveness of telecare, the use of videophones in healthcare for the elderly in communities, and proposes an effective application of telecare in home healthcare.Methods.An intervention study design was applied to evaluate the add-on benefits to home healthcare from a videophone system using Integrated Services Digital Network (ISDN) installed in individual homes of clients and service providers. An intervention group of home healthcare cases were provided with videophones (VHHC group), and it was compared to a reference group of regular healthcare cases (HHC group). Persons from the 2 groups were individually matched according to sex, age, and their independence in activities of daily living. The functional independence of the individuals in the 2 groups was assessed before and 3 months after home healthcare was started, with and without videophones. The effectiveness of videophones was assessed by analyzing the improvements in functional independence using a pairedttest.Results.Improvements in functional independence of 5 pairs of males and 11 pairs of females were analyzed. Improvements in ADL, communication, and social cognition independence of the VHHC group over the 3-month trial period measured by the Functional Independence Measure were 1.5 points, 0.7 points, and 1.9 points, respectively; statistically, these were significantly greater than those of the HHC group (individuallyP< 0.05).Conclusions.The effectiveness of the videophones in home healthcare service was found to be significant. This evidence supports the use of videophones in home healthcare to improve the quality of service.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Pediatric patients' self-report of health-related quality of life (HRQOL) has emerged as an important patient-based health outcome. A practical, validated generic measure of HRQOL facilitates assessing risk, tracking health status, and measuring treatment outcomes in pediatric populations.Methods.The PedsQL is a brief, standardized, generic assessment instrument that systematically assesses patients' and parents' perceptions of HRQOL in pediatric patients with chronic health conditions using pediatric cancer as an exemplary model. The PedsQL is based on a modular approach to measuring HRQOL and consists of a 15-item core measure of global HRQOL and eight supplemental modules assessing specific symptom or treatment domains. The PedsQL was empirically derived from data collected from 291 pediatric cancer patients and their parents at various stages of treatment.Results.Both reliability and validity were determined. Cronbach's alpha coefficients for the core measure (α = .83 for patient and α = .86 for parent) were acceptable for group comparisons. Alphas for the patient self-report modules generally ranged from .70 to .89. Discriminant or clinical validity, using the known-groups approach, was demonstrated for patients on- versus off-treatments. The 11 scales showed small-to-medium positive intercorrelations, supporting the multidimensional measurement model. Further construct validity was demonstrated via a multimethod-multitrait matrix using standardized psychosocial questionnaires.Conclusion.The results support the PedsQL as a reliable and valid measure of HRQOL. The PedsQL core and modular design makes it flexible enough to be used in a variety of research and clinical applications for pediatric chronic health conditions.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Little data exist supporting the association of quality of care and nonfatal adverse outcomes in hospitalized patients, yet those outcomes are routinely scrutinized in quality assessment efforts.Objective.To determine whether measurable differences in quality of care are associated with the occurrence of non-fatal, in-hospital, and treatment-related complications.Design.Retrospective cohort study.Subjects.A total of 2,268 patients who were discharged alive from 9 Southwestern Veterans Affairs Medical Centers with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes mellitus.Measures.Retrospective chart review was performed to collect information on patient severity of illness, in-hospital complication occurrence, and process quality of care. Process quality was assessed as the adherence scores for admission work-up and for treatment during the hospital stay. Process quality represents the proportion of applicable admission or treatment criteria that were met by that patient's care providers. Once severity of illness was taken into account Cox proportional hazards regression was used to assess the independent contribution of process quality of care to complication occurrence.Results.Higher admission work-up adherence scores for COPD patients and higher treatment adherence scores for COPD and diabetes patients were associated with a lower risk of complication occurrence. The adjusted risk ratios of complications for higher versus lower adherence scores (with 95% CI) were 0.64 (0.43, 0.97) and 0.52 (0.33, 0.80) for admission and treatment, respectively, in COPD patients, and 0.51 (0.31, 0.83) for treatment in diabetics. No significant association was found in CHF patients.Conclusion.Better admission work-up and treatment quality in COPD patients, as well as treatment quality in diabetic patients, are associated with lower risk of nonfatal treatment-related complications in the study population.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objectives.In groups of lumbar surgery patients who had different expectations about postoperative pain and recovery, this study investigated disappointment three days and three months after surgery. Our hypothesis was that patients who did not expect any postoperative pain and who expected a fast rate of recovery were at risk of becoming disappointed.Methods.One day before surgery, 120 patients who underwent lumbar surgery were interviewed about their expectations regarding postoperative pain, rate of recovery, and return to work. Levels of postoperative pain and disappointment were measured three days and three months postoperatively.Results.Patients who did not expect to have any postoperative pain reported significantly less disappointment three days and three months after surgery than did patients who expected to have postoperative pain. No significant differences were found in postoperative disappointment between the groups with different expectations regarding the rate of recovery or the return to work.Conclusion.Contrary to our hypothesis, the results suggest that patients who do not expect to experience any postoperative pain will be less disappointed after surgery than patients who expect to be in pain. Implications for the theory of mental preparation and for preoperative intervention strategies aimed at diminishing the stress of surgery are discussed.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective.To explore the relationship between type of initial care as well as the likelihood of recurrence and consequent care seeking behavior.Research Design.Prospective observational cohort recruited from 208 randomly selected North Carolina practices. Cohort study examined the recurrence of low back pain among patients free of back pain 3 months after their index visit to a practitioner for that problem. The following four practitioner strata were examined: primary care providers, chiropractors, orthopedic surgeons, and practitioners in a group model HMO. Patients were interviewed by telephone at 6 and 22 months after the initial visit.Main Outcome Measures.Rates of disabling and non-disabling low back pain; functional status using the Roland back disability scale; and care seeking.Results.Rates of recurrence were substantial; functionally disabling recurrence rates varied between 8% and 14% between 3 to 6 months, and 20% to 35% between 6 to 22 months. Differences in rates among practitioner strata were statistically significant only between 6 to 22 months with higher recurrence rates for HMO patients. Functional status, number of bed days, and time off work were very similar among the practitioner strata. Care seeking, however, was greater among those patients who had initially seen a chiropractor for their back pain. Patients with recurrence saw the same practitioner type they had seen for the index episode 88% of the time. Satisfaction was slightly greater for patients who saw chiropractors when compared with patients seeing allopathic physicians.Conclusions.The recurrence of low back pain is common. Severe disability is rare. Patients who had sought care from chiropractors are more likely to return for recurrences than patients who had initially sought care from MDs.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Current paradigms for conceptualizing alcohol-related problems typically focus on persons who are abusing or dependent on alcohol. These paradigms may not apply to older drinkers whose alcohol use, regardless of consumption-level, can cause problems because of age-related changes in physiology and interactions with increased morbidity, medication use, and functional limitations.Objective.We convened an expert panel# to develop clinical indications of harmful, hazardous, and nonhazardous drinking in persons 65 years of age and older.Research Design and Subjects.Nine panelists with expertise in psychiatry, geriatrics, internal medicine, and alcohol research were provided with epidemiological data and a published explicit literature review of alcohol use in the elderly. The RAND/UCLA two-round panel method was used to develop the indications. After the second round, the authors wrote a draft statement that was circulated to the panelists whose comments were incorporated into a final document.Results.Panelists agreed on 215 scenarios in which older peoples' use of alcohol either alone or in the presence of chronic medical conditions, medication use, symptoms, smoking, and functional limitations are hazardous or harmful. Panelists' ratings of risk did not differ significantly between persons aged 65 to 74 years and those aged 75 years and older.Conclusion.Alcohol use may be hazardous or harmful for older persons, particularly in conjunction with physical or emotional illnesses, medication use, functional limitations, smoking, and driving after drinking. When asking about alcohol use in older persons, clinicians need to be aware of these factors to assist in identifying and managing potential or actual alcohol-related problems.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Although the use of quality of care indicators based on data collected for administrative purposes has become widespread, the relationship between those measures and clinical outcomes has yet to be evaluated.Research Design.This study used hierarchical linear modeling to examine the relationship between 12 performance indicators derived from administrative data sets and 6 clinical outcome measures addressing symptoms, substance abuse, and social functions.Subjects.Patient interviews were conducted with 4,165 veterans 4 months after their discharge from 62 specialized VA inpatient programs for treatment of Posttraumatic Stress disorder.Results.Five of twelve administrative measures were significantly associated with at least one of the clinical outcome measures, which was all in the expected directions. The number of hospital readmissions during the 6 months after the index discharge was significantly related to poor outcomes on all 5 of 6 measures. Measures of readmission and post-discharge hospital use were more strongly and consistently related to outcome than to measures of access, intensity, or continuity of outpatient care.Conclusion.Administrative data, especially measures of hospital readmission, are significantly related to clinical outcomes. Correlations, however, are small to modest in magnitude indicating that these 2 types of performance measures assess different aspects of quality and can not be substituted for one another.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective.A major new survey program, the Medicare Beneficiary Health Status Registry (MBHSR), has been proposed to improve the monitoring of the health status of Medicare beneficiaries. The MBHSR would collect data by mail with telephone follow up of nonrespondents to permit economical assessment of a total Registry of approximately 200,000 Medicare beneficiaries, approximately 54,000 of whom would be surveyed in any given year. (Surveys would be conducted of samples of new enrollees who would be reinterviewed every five years.)Method.To assess the feasibility of that approach, a field test was conducted with a probability sample (n = 1,922) that comprised approximately equal numbers of new Medicare enrollees (aged, 65) and current beneficiaries (age range, 76-80). The field test was designed to assess the quality of the data that this design would produce.Findings.Results indicate that the proposed design of the MBHSR could achieve response rates of approximately 80% among both age cohorts using a survey instrument that took 30 minutes to complete. Internal reliability of Activities of Daily Living, Instrumental Activities of Daily Living, Mobility, Mental Health Index, General Health, and Prostate Symptomatology scales ranged from 0.77 to 0.93. When measurements were repeated approximately 30 days after the initial survey, moderate to high levels of cross temporal correlation (range, 0.64-0.96) were found for most indexes, with the exception of prostate symptomatology. In addition, an earlier comparison of survey responses in the MBHSR field test to Medicare payment records indicated that the MBHSR field test obtained highly accurate reports of most of the major surgeries that were recorded in Medicare claims files.Conclusion.The design proposed for the MBHSR is feasible. If implemented, it should produce acceptably high rates of response and data quality.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Regionalization of high-risk surgical procedures to selected high-volume centers has been proposed as a way to reduce operative mortality. For patients, however, travel to regional centers may be undesirable despite the expected mortality benefit.Objective.To determine the strength of patient preferences for local care.Design.Using a scenario of potentially resectable pancreatic cancer and a modification of the standard gamble utility assessment technique, we determined the level of additional operative mortality risk patients would accept to undergo surgery at a local rather than at a distant regional hospital in which operative mortality was assumed to be 3%. We used multiple logistic regression to identify predictors of willingness to accept additional risk.Subjects.One hundred consecutive patients (95% male, median age 65) awaiting elective surgery at the Veterans Affairs Medical Center in White River Jct., VT.Main Outcome Measure.Additional operative mortality risk patients would accept to keep care local.Results.All patients preferred local surgery if the operative mortality risk at the local hospital were the same as the regional hospital (3%). If local operative mortality risk were 6%, which is twice the regional risk, 45 of 100 patients would still prefer local surgery. If local risk were 12%, 23 of 100 patients would prefer local surgery. If local risk were 18%, 18 of 100 patients would prefer local surgery. Further increases in local risk did not result in large changes in the proportion of patients preferring local care.Conclusions.Many patients prefer to undergo surgery locally even when travel to a regional center would result in lower operative mortality risk. Therefore, policy makers should consider patient preferences when assessing the expected value of regionalizing major surgery.

ISSN:0025-7079    

出版商:OVID    

年代:1999

数据来源: OVID