ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Recent efforts to recruit blood and organ donors have only marginally improved demographic disparities in willingness to donate. Few studies have examined which factors are most important in explaining race and gender disparities in willingness to donate.Objectives.To assess race and gender differences in willingness to donate blood and cadaveric organs, and to determine the extent to which several factors (including sociodemographic characteristics and attitudes about religion and mistrust of hospitals) might explain differences in willingness to donate.Research Design.Cross‐sectional telephone survey of Maryland households contacted via random‐digit dialing.Measures.Past blood donation, organ‐donor status on driver's license, and measures of medical mistrust and religious and spiritual salience.Subjects.Persons age 18 to 75 living in the Baltimore, Maryland metropolitan area.Results.Of 385 respondents (84% of randomized households), 114 were black females, 46 were black males, 110 were white females, and 69 were white males. Before adjustment, black females were least willing to donate blood (41%), and black males were least willing to become cadaveric donors (19%) among all race‐gender groups. Adjustment for respondent concerns about mistrust of hospitals and discrimination in hospitals explained most differences in willingness to donate blood, whereas adjustment for respondents' beliefs regarding the importance of spirituality and religion explained most differences in willingness to donate cadaveric organs.Conclusions.Both race and gender are important identifiers of those less willing to donate. To maximize efficiency, donor recruitment efforts should focus on race‐gender groups with lowest levels of willingness. Potential donor concerns regarding mistrust in hospitals and religion/spirituality may serve as important issues to address when developing programs to improve donation rates.

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Administrative data and ICD‐9‐CM diagnostic codes are frequently used in research efforts to evaluate risk adjusted patient outcomes, particularly mortality. Varying ICD‐9‐CM sampling algorithms have been used to identify stroke patients.Objectives.This study evaluates the effects of different sampling strategies (one high sensitivity and one high specificity) on modeling stroke mortality as a performance indicator.Research Design.Risk adjustment models were developed for two stroke cohorts identified using differing ICD‐9‐CM algorithms. Standard mortality ratios were calculated in a validation sample as network performance measures and compared across the two stroke samples.Subjects.VHA inpatients with stroke during years 1997 (model development) and 1998 (model validation) were selected from the Patient Treatment File based on cerebrovascular diagnostic codes.Measures.Patient mortality within 30 days of admission.Results.The model development and validation for each stroke sampling method produced consistent results: c‐statistics 0.74 to 0.75,R20.07 to 0.09, concordance 73% to 74%. However, ranking differences in network performance varied by 5 or more positions for 7 of the 22 patient networks.Conclusions.These findings highlight a potential problem when using administrative data to assess stroke mortality. In the absence of an agreed upon definition of stroke patients, results of provider profiling will vary depending on the ICD‐9 algorithm used.

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.It is not known if the inclusion of bilinguals affects the results of research using Quality‐of‐Life (QoL) scales.Objective.To determine the influence of bilingualism on responses to a QoL scale.Research Design.In this cross sectional study, a population‐based, disproportionately stratified random sample of monolingual and bilingual ethnic Chinese completed the Short‐Form 36 Health Survey (SF‐36) in English or Chinese (representing an alphabet and pictogram based language respectively). Cumulative logit regression models were used to assess the influence of bilingualism on SF‐36 scores, while adjusting for the influence of questionnaire language and known determinants of QoL.Results.English or Chinese SF‐36 versions were completed by 1331 and 1380 subjects respectively (49% female, aged 21‐65 years, 1366 bilingual, 501 English monolingual, 844 Chinese monolingual), with response rates exceeding 85%. Fifty percent of subjects were bilingual. Bilinguals differed from monolinguals in known determinants of QoL, being younger, better educated, and having fewer chronic medical conditions, and had SF‐36 scores up to 8 points higher than monolinguals. After adjusting for these differences, bilingualism did not influence scores for any of eight SF‐36 scales, whereas questionnaire language influenced scores for four scales. Use of the English SF‐36 was associated with higher scores for General Health, Vitality, Role Emotional and Mental Health Scales (odds ratios 1.35‐1.41), though the magnitude of these odds ratios suggests this association may not be clinically important.Conclusion.Bilingualism did not influence responses to a QoL scale in this large, population‐based study of subjects fluent in an alphabet and/or pictogram based language.

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The Health Utilities Index Mark 3 (HUI3) is a generic multiattribute preference‐based measure of health status and health‐related quality of life that is widely used as an outcome measure in clinical studies, in population health surveys, in the estimation of quality‐adjusted life years, and in economic evaluations. HUI3 consists of eight attributes (or dimensions) of health status: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain with 5 or 6 levels per attribute, varying from highly impaired to normal.Objectives.The objectives are to present a multiattribute utility function and eight single‐attribute utility functions for the HUI3 system based on community preferences.Study Design.Two preference surveys were conducted. One, the modeling survey, collected preference scores for the estimation of the utility functions. The other, the direct survey, provided independent scores to assess the predictive validity of the utility functions.Measures.Preference measures included value scores obtained on the Feeling Thermometer and standard gamble utility scores obtained using the Chance Board.Respondents.A random sample of the general population (≥16 years of age) in Hamilton, Ontario, Canada.Results.Estimates were obtained for eight single‐attribute utility functions and an overall multiattribute utility function. The intraclass correlation coefficient between directly measured utility scores and scores generated by the multiattribute function for 73 health states was 0.88.Conclusions.The HUI3 scoring function has strong theoretical and empirical foundations. It performs well in predicting directly measured scores. The HUI3 system provides a practical way to obtain utility scores based on community preferences.

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background/Objectives.This study compares quality of preventive services between persons with and without mental/substance use disorders for a national sample of medical outpatients.Research Design.Cross‐sectional study.Subjects.A total of 113,505 veterans with chronic conditions and at least three general medical visits to Veterans Health Administration medical providers during 1998 to 1999.Measures.Chart‐derived rates of eight preventive services: two measures of immunization, four measures of cancer screening, and two of tobacco screening and counseling. Multivariable‐generalized estimating equations compared rates of each preventive service among veterans with psychiatric disorders, substance use disorders, both, and neither, adjusting for demographic, health status, and facility‐level characteristics.Results.On average, persons in the sample obtained 64% of the eight preventive procedures for which they were eligible. Overall rates of currency with preventive services were 58% for patients with combined psychiatric/substance use disorders, 60% and 65% for those with psychiatric and substance use disorders alone, and 66% for those with neither psychiatric nor substance use disorders. Each difference remained statistically significant in multivariable models.Conclusions.In this sample of patients in active medical treatment, rates of preventive services were higher than rates reported for population‐based, private‐sector samples. Despite these high‐baseline rates, persons with psychiatric disorders, particularly with comorbid substance use, were at risk for lower rate of receipt of preventive services.

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The influence of continuity of care on outcomes of care for patients with type 2 diabetes is poorly understood.Objective.To examine the relationships between continuity, glucose control, and advancement through stages of change for selfmanagement behaviors.Design.Prospective cohort study.Setting.Five community health centers on the Texas‐Mexico border.Subjects.A random sample of 256 adults, 18 years of age and older with an established diagnosis of type 2 diabetes.Measures.Stage of change for diet and exercise were assessed during two patient interviews, averaging 18.9 months apart. Phlebotomy was performed at each interview to measure glycosolated hemoglobin (HbA1C). Medical records were abstracted for ambulatory care utilization. A continuity score was calculated based on the number of visits and number of providers seen.Results.Patients who advanced one or more stages of change for diet had higher levels of continuity. As continuity improved, the change in HbA1Cwas smaller.(r= –0.25;P<0.001) This relationship remained significant after controlling for number of visits, months since diagnosis, number of days in the study, duration of diabetes, and advancement in stage of change for diet. Advancement through stage of change for diet explained a significant amount of the variance in the relationship between continuity and HbA1C(ttest = –11.33;P<0.01).Conclusions.Continuity of care with a primary care provider is associated with better glucose control among patients with type 2 diabetes. This relationship appears to be mediated by changes in patient behavior regarding diet.

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objectives.The Consumer Assessment of Health Plans Survey (CAHPS) includes an adult version and also a child version for parents or caretakers to rate children's care in health plans. This study examined how adult and child assessments differed in ranking health plans and explored whether the differences justified the additional cost and respondent burden in administering both surveys.Methods.Data were from 136 commercial health plans participating in the National CAHPS Benchmarking Database, with 80,539 adults and 40,003 children. We compared mean assessments for adults and children on four global ratings and five composites, and determined respondent characteristics predictive of these assessments using regression analysis. We calculated correlations of plan mean scores for adults and children and &kgr; statistics for agreement when health plans are ranked as above average, average, or below average performers based on adult and child scores.Results.CAHPS scores for children were significantly (P<0.001) higher than those for adults, except for customer service (lower for children) and specialist ratings. Similar respondent characteristics predicted adult and child scores. Plan‐level correlations between corresponding adult and child mean scores were moderate to high (r= 0.60‐0.85), which translate into fair to moderate agreement (&kgr; = 0.27‐0.61) in ranking health plans.Conclusions.Adult and child CAHPS provide similar scores and plan rankings on many aspects of care. Child reports include information that may be useful for consumer choice and to health plans for targeting quality improvement. Methods should be developed for assessing health care for children that minimize cost and respondent burden.

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Report cards based on various performance measures have become increasingly common for rating hospitals and health care plans. However, little has been done to create report cards at the ambulatory clinic level, nor has there been much comparison of the potential components of report cards.Objectives.To create a report card for ambulatory clinics based on different data collection methods and to assess the correlations of clinic scores across various domains of quality.Research Design.Cross‐sectional chart review (n = 3614), patient (n = 2180), and physician surveys (n = 169).Subjects.Sample of outpatients ages 20 to 75 and their primary care providers in 11 ambulatory clinic sites in the Boston‐area from May 1996 to June 1997.Measures.Performance on various quality indicators for each site.Results.Report card scores for five quality domains (performance on HEDIS‐like measures, clinic function, patient satisfaction, diabetes guideline compliance, asthma guideline compliance) were created for each site. None of the five domain scores were significantly correlated with any of the other domains. In addition, there was substantial intraclinic variation in domain scores when compared with the corresponding mean domain score across all clinics. Additional clinic domain scores were created by limiting measures to those found on chart review or survey alone. The chart review and survey domain scores for each clinic were also not significantly correlated.Conclusions.Report cards that emphasize only one domain of quality or use limited data collection methods may provide incomplete or inconsistent information to health care consumers about the overall quality of an outpatient clinic.

ISSN:0025-7079    

出版商:OVID    

年代:2002

数据来源: OVID