FN Thomson Reuters Web of Science™ VR 1.0 PT J AU Meyers, DS Halvorson, H Luckhaupt, S AF Meyers, David S. Halvorson, Heather Luckhaupt, Sara TI Screening for chlamydial infection: An evidence update for the US preventive services task force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID SEXUALLY-TRANSMITTED-DISEASES; TRACHOMATIS; PREVALENCE; HEALTH; PROGRAM; WOMEN AB Background: Chlamydial infection is the most common sexually transmitted bacterial infection in the United States, with an estimated 3 million new cases annually. In 2001, the U.S. Preventive Services Task Force (USPSTF) recommended that clinicians screen all sexually active women at increased risk for infection for Chlamydia trachomatis. Purpose: To summarize a systematic evidence review commissioned by the USPSTF in preparation for an update of its 2001 recommendation. Data Sources: English-language articles identified in PubMed between July 2000 and July 2005. Additional articles were identified by bibliographic reviews and discussions with experts. A total of 452 articles were identified. Study Selection: Explicit inclusion and exclusion criteria were used for each of 3 key questions. For studies of screening in nonpregnant women at increased risk, review was limited to randomized, controlled trials. For other groups, both randomized, controlled studies and nonrandomized, prospective, controlled studies were included. Data Abstraction: Using standardized forms, staff of the Agency for Healthcare Research and Quaity abstracted data on study design, setting, sample, randomization, blinding, results, and harms. Data Synthesis: Only 1 new study met inclusion criteria. This poor-quality study of the effectiveness of screening for chlamydial infection among nonpregnant women at increased risk found that screening was associated with a lower prevalence of chlamydial infection and fewer reported cases of pelvic inflammatory disease at 1-year follow-up. Limitations: No new evidence was found on screening in pregnant women, nonpregnant women not at increased risk, or men. Conclusions: A systematic review found a small amount of new evidence to inform the USPSTF as it updates its recommendations regarding screening for chlamydial infection. There are large gaps in the evidence about screening men to improve health outcomes in women. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Meyers, DS (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 25 TC 51 Z9 55 U1 0 U2 4 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD JUL 17 PY 2007 VL 147 IS 2 BP 135 EP 142 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 192CV UT WOS:000248179300009 PM 17576995 ER PT J AU Ho, K Kelley, E Brady, J Clancy, CM AF Ho, Karen Kelley, Edward Brady, Jeffrey Clancy, Carolyn M. TI Missed opportunities for quality improvement SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Ho, K (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD JUL-AUG PY 2007 VL 22 IS 4 BP 296 EP 299 DI 10.1177/1062860607303605 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 194EF UT WOS:000248326400008 PM 17656734 ER PT J AU Smith, SR Wahed, AS Kelley, SS Conjeevaram, HS Robuck, PR Fried, MW AF Smith, Scott R. Wahed, Abdus S. Kelley, Stephanie S. Conjeevaram, Hari S. Robuck, Patricia R. Fried, Michael W. CA Virahep-C Study Grp TI Assessing the validity of self-reported medication adherence in hepatitis C treatment SO ANNALS OF PHARMACOTHERAPY LA English DT Article DE hepatitis C; measurement; medication adherence ID RIBAVIRIN TREATMENT; THERAPY; PHYSICIAN AB OBJECTIVE: To assess the validity of self-reported medication adherence provided by individuals in treatment for hepatitis C virus (HCV) infection with a regimen of peginterferon and ribavirin. METHODS: Adherence was evaluated prospectively among 196 African American and 205 white subjects enrolled in Virahep-C (Viral Resistance to Antiviral Thearpy of Chronic Hepatitis C), a treatment study for genotype 1 HCV infection. Adherence to the prescribed dose was measured by 2 methods: self-report questions administered during multiple clinic visits, using a touch screen computer; and recordings of bottle openings, using an electronic monitor placed inside the cap of prescription containers. Self-reported responses were compared with the electronic monitor data. Nonparametric tests were used to test the association between adherence measures at 4, 12, 24, 36, and 48 weeks of treatment. RESULTS: The estimated proportion of participants who were adherent prior to a given visit ranged from 85% to 97% (ribavirin) and 97% to 100% (peginterferon) by self report and from 69% to 90% (ribavirin) and 84% to 100% (peginterferon) by electronic monitors. For ribavirin, the percentage of cases in which the 2 measurement methods agreed varied from 68% to 90%; peginterferon agreement was from 84% to 100%. Overall, adherence was higher for peginterferon than for ribavirin but decreased over time for both medications. Self-reported adherence was usually higher than that assessed by electronic measures, and the level of descrepancy increased during the course of treatment. CONCLUTIONS: Adherence to peginterferon and ribavirin decreased gradually during therapy but remained relatively high. Simple self-reported measures can be used to screen for nonadherence to HCV drug therapy, but should be considered as overestimation of the actual amounts taken. C1 Univ N Carolina, Sch Pharm, Chapel Hill, NC USA. Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA USA. Univ Michigan, Ann Arbor, MI 48109 USA. NIDDK, Bethesda, MD USA. Univ N Carolina, Virahep C Study Grp, Chapel Hill, NC 27515 USA. Ctr Outcomes & Evidence, US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Smith, SR (reprint author), Ctr Outcomes & Evidence, US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Scott.Smith@ahrq.hhs.gov RI Wahed, Abdus/A-6441-2008; OI Wahed, Abdus/0000-0001-6911-7221 NR 11 TC 31 Z9 32 U1 0 U2 0 PU HARVEY WHITNEY BOOKS CO PI CINCINNATI PA PO BOX 42696, CINCINNATI, OH 45242 USA SN 1060-0280 J9 ANN PHARMACOTHER JI Ann. Pharmacother. PD JUL-AUG PY 2007 VL 41 IS 7-8 BP 1116 EP 1123 DI 10.1345/aph.1K024 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 193MW UT WOS:000248279100003 PM 17519299 ER PT J AU Buchmueller, TC Cooper, PF Jacobson, M Zuvekas, SH AF Buchmueller, Thomas C. Cooper, Philip F. Jacobson, Mireille Zuvekas, Samuel H. TI Parity for whom? Exemptions and the extent of state mental health parity legislation SO HEALTH AFFAIRS LA English DT Article; Proceedings Paper CT Meeting of the American-Society-of-Health-Economists CY JUN 04-08, 2006 CL Madison, WI SP Amer Soc Hlth Econ ID COVERAGE; CARE AB Between 1997 and 2003, the share of workers subject to mental health parity laws greatly increased. But because of exemptions for self-insured firms and small firms, coverage is much lower than a simple tally of state mandates would suggest. Limits on the types of conditions covered further weaken these laws. This paper summarizes the extent and scope of state parity legislation in terms of the number of insured private-sector employees covered. It explicitly accounts for the Employee Retirement Income Security Act (ERISA) exemption for self-insured plans, exemptions for small employers, and the range of conditions covered by the law. C1 Univ Michigan, Sch Business, Ann Arbor, MI 48109 USA. AHRQ, Ctr Financing Access & Coast Trends, Rockville, MD USA. Univ Calif Irvine, Sch Social Ecol, Irvine, CA 92717 USA. RP Buchmueller, TC (reprint author), Univ Michigan, Sch Business, Ann Arbor, MI 48109 USA. EM tbuch@umich.edu NR 10 TC 29 Z9 29 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JUL-AUG PY 2007 VL 26 IS 4 BP W483 EP W487 DI 10.1377/hlthaff.26.4.w483 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 191GL UT WOS:000248119500048 PM 17556379 ER PT J AU Basu, J Friedman, B AF Basu, Jayasree Friedman, Bernard TI A re-examination of distance as a proxy for severity of illness and the implications for differences in utilization by race/ethnicity SO HEALTH ECONOMICS LA English DT Article; Proceedings Paper CT 1st Conference of the Southeastern-Health-Economics-Study-Group CY NOV 00, 2003-APR 20, 2004 CL Charleston, SC SP SE Hlth Econ Study Grp DE distance; hospital choice; severity of illness; racial/ethnic disparity; elderly ID OF-AREA TRAVEL; SOCIOECONOMIC-STATUS; MEDICARE BENEFICIARIES; HOSPITAL CHOICE; IMPACT; CARE; SERVICES; COUNTIES; DISEASE; RACE AB The study analyzes the hospitalization patterns of elderly residents to examine whether the relation between distant travel and severity of illness is uniform across racial/ethnic subgroups. A hypothesis is made that severity thresholds could be higher for minorities than whites. Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Health Care Research and Quality for New York residents is used, with a link to the Area Resource File and American Hospital Association's survey files. Logistic models compare the association of distant admission with severity corresponding to each local threshold level, race, and type of hospital admission. The study uses four discrete distance thresholds in contrast to recent work. Also, an examination of severity thresholds for distant travel for different types of admission may clarify different sources of disparities in health care utilization. The findings indicate that minorities are likely to have higher severity thresholds than whites in seeking distant hospital care, although these conclusions depend on the type of condition. The study results imply that if costly elective services were regionalized to get the advantages of high volume for both cost and quality of care, some extra effort at outreach may be desirable to reduce disparities in appropriate care. Published in 2006 by John Wiley & Sons, Ltd. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Basu, J (reprint author), 540 Gaither Rd, Rockville, MD 20850 USA. EM Jbasu@ahrq.gov NR 26 TC 13 Z9 13 U1 0 U2 7 PU JOHN WILEY & SONS LTD PI CHICHESTER PA THE ATRIUM, SOUTHERN GATE, CHICHESTER PO19 8SQ, W SUSSEX, ENGLAND SN 1057-9230 J9 HEALTH ECON JI Health Econ. PD JUL PY 2007 VL 16 IS 7 BP 687 EP 701 DI 10.1002/hec.1192 PG 15 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 192FZ UT WOS:000248187500003 PM 17191272 ER PT J AU Josephs, JS Fleishman, JA Gaist, P Gebo, KA AF Josephs, J. S. Fleishman, J. A. Gaist, P. Gebo, K. A. CA HIV Res Network TI Use of complementary and alternative medicines among a multistate, multisite cohort of people living with HIV/AIDS SO HIV MEDICINE LA English DT Article DE alternative therapy; complementary therapy; highly active antiretroviral therapy; HIV Research Network; illicit drug use ID HIV-INFECTED PATIENTS; ACTIVE ANTIRETROVIRAL THERAPY; HEALTH-SERVICES UTILIZATION; UNITED-STATES; CLINICAL-TRIALS; PATTERNS; DISEASE; AIDS; CARE; DETERMINANTS AB Objective The aim of the study was to assess the prevalence of and factors associated with use of complementary or alternative medicine (CAM) in a multistate, multisite cohort of HIV-infected patients. Methods During 2003, 951 adult patients from 14 sites participated in face-to-face interviews. Patients were asked if they received treatment from any alternative therapist or practitioner in the previous 6 months. Logistic regression was performed to examine associations between demographic and clinical variables and CAM use. Results The majority of the participants were male (68%) and African American (52%) with a median age of 45 years (range 20-85 years). Sixteen per cent used any CAM in the 6 months prior to the interview. Factors associated with use of CAM were the HIV risk factor injecting drug use [adjusted odds ratio (AOR) 0.51] compared with men who have sex with men (MSM), former drug use (AOR=2.12) compared with never having used drugs, having a college education (AOR=2.43), and visiting a mental health provider (AOR=2.76). Conclusions This study demonstrated similar rates of CAM use in the current highly active antiretroviral therapy (HAART) era compared with the pre-HAART era. Factors associated with CAM - such as education, use of mental health services, and MSM risk factor - suggest that CAM use may be associated with heightened awareness regarding the availability of such therapies. Given the potential detrimental interactions of certain types of CAM and HAART, all HIV-infected patients should be screened for use of CAM. C1 Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NIH, Bethesda, MD 20892 USA. RP Gebo, KA (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, 1830 E Monument St,Room 435, Baltimore, MD 21287 USA. EM kgebo@jhmi.edu RI Gebo, Kelly/B-9223-2009 FU NIDA NIH HHS [K23-DA00523] NR 28 TC 23 Z9 24 U1 2 U2 2 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 1464-2662 J9 HIV MED JI HIV Med. PD JUL PY 2007 VL 8 IS 5 BP 300 EP 305 DI 10.1111/j.1468-1293.2007.00474.x PG 6 WC Infectious Diseases SC Infectious Diseases GA 177CB UT WOS:000247130100006 PM 17561876 ER PT J AU Mukamel, DB Spector, WD Zinn, JS Huang, L Weimer, DL Dozier, A AF Mukamel, Dana B. Spector, William D. Zinn, Jacqueline S. Huang, Lynn Weimer, David L. Dozier, Ann TI Nursing homes' response to the Nursing Home Compare report card SO JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES LA English DT Article ID WEB SITE; QUALITY; CONSEQUENCES; INFORMATION; PREVALENCE; SURGEONS; OUTCOMES AB Objectives. The Centers for Medicare and Medicaid Services have recently begun publishing the Nursing Home Compare report card. The objective of this study was to examine the initial reactions of nursing homes to publication of the report card and to evaluate the impact of the report card on quality-improvement activities. Methods. We conducted a survey of a random national sample of 1,502 nursing home administrators; 724 responded. We analyzed frequency of responses to questions regarding views of the quality measures and actions taken. Results. A model of nursing homes' behavior predicted that the report card would provide an incentive for facilities to improve quality. A majority of facilities (69%) reported reviewing their quality scores regularly, and many have taken specific actions to improve quality. Homes with poor quality scores were more likely to take actions following the publication of the report card. Discussion. These findings suggest that the Nursing Home Compare report card has the potential to positively affect nursing home quality. C1 [Mukamel, Dana B.; Huang, Lynn] Univ Calif Irvine, Ctr Hlth Policy Res, Dept Med, Irvine, CA 92697 USA. [Spector, William D.] Agcy Healthcare Res & Qual, Washington, DC USA. [Zinn, Jacqueline S.] Temple Univ, Fox Sch Business & Management, Philadelphia, PA 19122 USA. [Weimer, David L.] Univ Wisconsin, LaFollette Sch Publ Affairs, Madison, WI USA. [Dozier, Ann] Univ Rochester, Dept Community & Prevent Med, Rochester, NY USA. RP Mukamel, DB (reprint author), Univ Calif Irvine, Ctr Hlth Policy Res, Dept Med, 111 Acad,Suite 220, Irvine, CA 92697 USA. EM dmukamel@uci.edu RI Dozier, Ann/A-7427-2009 FU NIA NIH HHS [AG023177] NR 33 TC 42 Z9 42 U1 1 U2 4 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 1079-5014 J9 J GERONTOL B-PSYCHOL JI J. Gerontol. Ser. B-Psychol. Sci. Soc. Sci. PD JUL PY 2007 VL 62 IS 4 BP S218 EP S225 PG 8 WC Geriatrics & Gerontology; Gerontology; Psychology; Psychology, Multidisciplinary SC Geriatrics & Gerontology; Psychology GA 272CI UT WOS:000253836100007 PM 17673535 ER PT J AU Fleishman, JA Zuvekas, SH AF Fleishman, John A. Zuvekas, Samuel H. TI Global self-rated mental health: Associations with other mental health measures and with role functioning SO MEDICAL CARE LA English DT Article DE self-rated mental health; role functioning; measurement; K6; SF-12 ID UNITED-STATES; DEPRESSION; DISABILITY; RATINGS; CARE; MORTALITY; ASSESSMENTS; POPULATION; COMMUNITY; SERVICES AB Background: A large body of research shows that global self-rated health is related to important outcome variables. Increasingly, studies also obtain a single global self-rating of mental health, but understanding of what this item measures is limited. Objective: To clarify interpretation of self-reported mental health, we examine its associations with other validated measures of mental health and role functioning. Research Design: We conducted cross-sectional analyses of nationally representative data from the Medical Expenditure Panel Survey. Measures: In-person household interviews obtained data on global self-reported mental health and any limitations in work, school, or housekeeping activities. Adult respondents (N = 11, 109) completed the SF-12 health status survey, the K6 scale of nonspecific psychologic distress, and the Patient Health Questionnaire (PHQ-2) depression screener in a self-administered questionnaire. We used the SF-12 Mental Component Summary and the mental health subscale. Analyses examined associations among mental health measures and regressed activity limitations, and the SF-12 physical and emotional role functioning scales on mental health measures, controlling for demographics and selected chronic conditions. Results: The 4 multi-item mental health measures were strongly correlated with each other (r > 0.69), but correlated less strongly with the self-reported mental health item (r approximate to 0.4). In an exploratory factor analysis, self-reported mental health loaded on both mental and physical health factors. In multivariate analyses, each mental health variable was significantly associated with activity limitations and with role functioning, but the association of self-reported mental health with emotional role functioning was relatively weak. Conclusions: Although global self-rated mental health is related to symptoms of psychologic distress, it cannot be considered to be a substitute for them. C1 Agcy Healthcare Res & Qual, Ctr Financincg Access & Cost Trends, Rockville, MD 20850 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Financincg Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM jfleishm@ahrq.gov NR 30 TC 46 Z9 46 U1 0 U2 12 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2007 VL 45 IS 7 BP 602 EP 609 DI 10.1097/MLR.0b013e31803bb4b0 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 186OR UT WOS:000247788500004 PM 17571008 ER PT J AU Yabroff, KR McNeel, TS Waldron, WR Davis, WW Brown, ML Clauser, S Lawrence, WF AF Yabroff, K. Robin McNeel, Timothy S. Waldron, William R. Davis, William W. Brown, Martin L. Clauser, Steven Lawrence, William F. TI Health limitations and quality of life associated with cancer and other chronic diseases by phase of care SO MEDICAL CARE LA English DT Article DE health status; quality of life; health services research; neoplasms/epidemiology; chronic disease ID SEER-MEDICARE DATA; MAINTENANCE ORGANIZATION; MYOCARDIAL-INFARCTION; UNITED-STATES; COST; POPULATION; VALIDITY; INDEX; COMORBIDITY; UTILITIES AB Objective: To estimate health limitations and health-related quality of life (HRQL) associated with cancer and other chronic conditions in a nationally representative sample within a phase-of-care framework. Study Design and Setting: We used a nested case-control design to assess health limitations and HRQL in individuals reporting a breast, colorectal, prostate, or lung cancer diagnosis, or a diagnosis of arthritis, diabetes, heart disease, or hypertension compared with similar controls without these conditions. All subjects were selected from the 1986-1994 National Health Interview Surveys linked to mortality files in 1995, and classified into the initial, continuing, or last year of life phase of care. Health limitations and HRQL were compared for cases and controls for each condition with 2-sided statistical tests. Results: Across all conditions, individuals in the last year of life phase of care reported greater health limitations and lower HRQL, as measured by the Health Activities and Limitations Index (HALex), than did individuals in the initial and continuing phases of care. Compared with their matched controls, individuals with cancer or other chronic conditions were more likely to report health limitations and lower mean HALex values in the initial, continuing, and last year of life phases of care (P < 0.05). Conclusions: We observed greater health limitations and lower HRQL associated with cancer and other chronic diseases compared with similar individuals without these conditions. The phase-of-care framework used in this study seems to be applicable to the assessment of HRQL for cancer and other chronic diseases. C1 NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. Informat Management Serv Inc, Silver Spring, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Yabroff, KR (reprint author), NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, Execut Plaza N,Room 4005,6130 Execut Blvd,MSC 734, Bethesda, MD 20892 USA. EM yabroffr@mail.nih.gov OI Yabroff, K. Robin/0000-0003-0644-5572 NR 39 TC 24 Z9 24 U1 1 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2007 VL 45 IS 7 BP 629 EP 637 DI 10.1097/MLR.0b013e318045576a PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 186OR UT WOS:000247788500007 PM 17571011 ER PT J AU Berdahl, TA Kirby, JB Stone, RAT AF Berdahl, Terceira A. Kirby, James B. Torres Stone, Rosalie A. TI Access to health care for nonmetro and metro Latinos of Mexican origin in the United States SO MEDICAL CARE LA English DT Article DE race and ethnicity; health care; health disparities; underserved population; Hispanic/Latino ID RURAL-URBAN DIFFERENCES; DISPARITIES; INSURANCE; RACE/ETHNICITY; POPULATION; IMMIGRANTS AB Background: A growing number of Latinos are moving to non-metro areas, but little research has examined how this trend might affect the Latino-disadvantage in access to healthcare. Objective: We investigate health care access disparities between non-Latino whites and Latinos of Mexican origin, and whether the disparities differ between metro and nonmetro areas. Methods: A series of logistic regression models provide insight on whether individuals have a usual source of care and whether they have had any physician visits in the past year. Our analyses focus on the interaction between Mexican origin descent and nonmetro residence. Subjects: Nationally representative data from the 2002-2003 Medical Expenditure Panel Survey are analyzed. The sample consists of working-aged adults age 18-64, yielding a sample size of 29,875. Results: The Mexican disadvantage in having a usual source of care is much greater among nonmetro residents than among those living in metro areas. The Mexican disadvantage in the likelihood of seeing a physician at least I time during the year does not differ across locations. Although general and ethnicity-specific predictors explain the disadvantage of Mexicans in having a usual source of care, they do not explain the added disadvantage of being Mexican and living in nonmetro areas. Conclusions: This study identifies a new challenge to the goal of eliminating health care disparities in the United States. The Latino population living in nonmetro areas is growing, and our findings suggest that Latinos in nonmetro areas face barriers to having a usual source of care that are greater than those faced by Latinos in other areas. C1 Univ Nebraska, Dept Sociol, Lincoln, NE 68583 USA. RP Berdahl, TA (reprint author), Agcy Hlth Care Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd,Suite 5000, Rockville, MD 20850 USA. EM terceira.berdahl@ahrq.hhs.gov NR 25 TC 16 Z9 16 U1 2 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2007 VL 45 IS 7 BP 647 EP 654 DI 10.1097/MLR.0b013e3180536734 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 186OR UT WOS:000247788500009 PM 17571013 ER PT J AU Russell, RB Green, NS Steiner, CA Meikle, S Howse, JL Poschman, K Dias, T Potetz, L Davidoff, MJ Damus, K Petrini, JR AF Russell, Rebecca B. Green, Nancy S. Steiner, Claudia A. Meikle, Susan Howse, Jennifer L. Poschman, Karalee Dias, Todd Potetz, Lisa Davidoff, Michael J. Damus, Karla Petrini, Joann R. TI Cost of hospitalization for preterm and low birth weight infants in the United States SO PEDIATRICS LA English DT Article DE prematurity; newborns; infants; hospital costs; low birth weight; morbidities ID GESTATIONAL-AGE; CARDIOVASCULAR-DISEASE; OUTCOMES; LIFE; PREMATURITY; CHARGES; IMPACT; RATES; CARE AB OBJECTIVE. The objective of this study was to estimate national hospital costs for infant admissions that are associated with preterm birth/low birth weight. METHODS. Infant (< 1 year) hospital discharge data, including delivery, transfers, and readmissions, were analyzed by using the 2001 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project. The Nationwide Inpatient Sample is a 20% sample of US hospitals weighted to approximately > 35 million hospital discharges nationwide. Hospital costs, based on weighted cost-to-charge ratios, and lengths of stay were calculated for preterm/low birth weight infants, uncomplicated newborns, and all other infant hospitalizations and assessed by degree of prematurity, major complications, and expected payer. RESULTS. In 2001, 8% (384 200) of all 4.6 million infant stays nationwide included a diagnosis of preterm birth/low birth weight. Costs for these preterm/low birth weight admissions totaled $5.8 billion, representing 47% of the costs for all infant hospitalizations and 27% for all pediatric stays. Preterm/low birth weight infant stays averaged $15 100, with a mean length of stay of 12.9 days versus $600 and 1.9 days for uncomplicated newborns. Costs were highest for extremely preterm infants (< 28 weeks' gestation/birth weight < 1000 g), averaging $65 600, and for specific respiratory-related complications. However, two thirds of total hospitalization costs for preterm birth/low birth weight were for the substantial number of infants who were not extremely preterm. Of all preterm/low birth weight infant stays, 50% identified private/commercial insurance as the expected payer, and 42% designated Medicaid. CONCLUSIONS. Costs per infant hospitalization were highest for extremely preterm infants, although the larger number of moderately preterm/low birth weight infants contributed more to the overall costs. Preterm/low birth weight infants in the United States account for half of infant hospitalization costs and one quarter of pediatric costs, suggesting that major infant and pediatric cost savings could be realized by preventing preterm birth. C1 March Dimes, Perinatal Data Ctr, White Plains, NY 10605 USA. Albert Einstein Coll Med, Dept Pediat, Bronx, NY 10467 USA. Albert Einstein Coll Med, Dept Obstet & Gynecol & Womens Hlth, Bronx, NY 10467 USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Petrini, JR (reprint author), March Dimes, Perinatal Data Ctr, 1275 Mamaroneck Ave, White Plains, NY 10605 USA. EM jpetrini@marchofdimes.com OI Green, Nancy/0000-0002-9877-1561 NR 40 TC 173 Z9 176 U1 1 U2 18 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JUL PY 2007 VL 120 IS 1 BP E1 EP E9 DI 10.1542/peds.2006-2386 PG 9 WC Pediatrics SC Pediatrics GA 185OC UT WOS:000247719300053 PM 17606536 ER PT J AU Brock, TP Smith, SR AF Brock, Tina Penick Smith, Scott R. TI An interdisciplinary online course in health care Informatics SO AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION LA English DT Article DE informatics; online instruction; interdisciplinary education; internet AB Objectives. To design an interdisciplinary course in health care informatics that enables students to: ( 1) understand how to incorporate technology into the provision of safe, effective and evidence- based health care; ( 2) make decisions about the value and ethical application of specific technologies; and ( 3) appreciate the perspectives and roles of patients and providers when using technology in care. Design. An online, interdisciplinary elective course using a distributive learning model was created. Standard courseware was used to manage teaching and to facilitate student/instructor interactions. Interactive, multimedia lectures were developed using Internet communication software. Assessment. Upon completion of the course, students demonstrated competency in identifying, analyzing, and applying informatics appropriately in diverse health settings. Conclusion. Online education using multimedia software technology is effective in teaching students about health informatics and providing an innovative opportunity for interdisciplinary learning. In light of the growing need for efficient health care informatics training, additional study of this methodology C1 Univ London Sch Pharm, London, England. Dept Practice & Policy, London WC1H 9JP, England. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Brock, TP (reprint author), Univ N Carolina, Chapel Hill, NC 27515 USA. EM tina.brock@pharmacy.ac.uk NR 13 TC 10 Z9 10 U1 0 U2 0 PU AMER ASSOC COLL PHARMACY PI ALEXANDRIA PA 1426 PRINCE STREET, ALEXANDRIA, VA 22314-2815 USA SN 0002-9459 J9 AM J PHARM EDUC JI Am. J. Pharm. Educ. PD JUN 15 PY 2007 VL 71 IS 3 AR 43 PG 5 WC Education, Scientific Disciplines; Pharmacology & Pharmacy SC Education & Educational Research; Pharmacology & Pharmacy GA 200HG UT WOS:000248753900003 PM 17619643 ER PT J AU Basu, J Mobley, LR AF Basu, Jayasree Mobley, Lee R. TI Illness severity and propensity to travel along the urban-rural continuum SO HEALTH & PLACE LA English DT Article; Proceedings Paper CT iHEA Meetings CY 2005 CL Barcelona, SPAIN SP iHEA DE severity of illness; elderly managed care; urban and rural; distance; travel patterns; critical access hospital ID OF-AREA TRAVEL; PREVENTABLE HOSPITALIZATIONS; AVOIDABLE HOSPITALIZATIONS; MEDICARE BENEFICIARIES; SOCIOECONOMIC-STATUS; CARE; CHOICE; IMPACT; DIAGNOSIS; PHYSICIAN AB In this paper, we examine whether the relationship between severity of illness and the propensity to travel greater distance relative to the norm (defined by peers in one's county of residence) is uniform across the urban-rural continuum of geography or over time. We focus on the elderly in New York State who have been admitted to hospital for ambulatory care sensitive conditions (ACSCs), admissions which are presumed to be representative of usual travel patterns. The two periods of time examined span the implementation of the Balanced Budget Act (BBA) of 1997, which established the Medicare Rural Hospital Flexibility Program, a major national initiative to strengthen rural health care with the development of rural Critical Access Hospitals (CAHs). As the number of NY rural hospitals certified as CAH increased with the expanded funding from the BBA, one might expect to see increased distance traveled by more severely ill rural elderly, as their CAHs referred them to their affiliated support hospitals. The logistic regression estimates support this expectation, highlighting an asymmetrical relationship between relative distance and severity across patients in rural and urban areas. Despite a general decline in average propensity to travel further than the norm across the landscape, severity had a larger impact on travel propensity in rural areas, which increased over time. Published by Elsevier Ltd. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Res Triangle Inst, Res Triangle Pk, NC 27709 USA. RP Basu, J (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jbasu@ahrq.gov NR 42 TC 23 Z9 23 U1 0 U2 3 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 1353-8292 J9 HEALTH PLACE JI Health Place PD JUN PY 2007 VL 13 IS 2 BP 381 EP 399 DI 10.1016/j.healthplace.2006.03.002 PG 19 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 138XB UT WOS:000244395500008 PM 16697689 ER PT J AU Hellinger, FJ AF Hellinger, Fred J. TI The changing pattern of hospital care for persons living with HIV - 2000 through 2004 SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE cost; hospital care; length of stay ID ACTIVE ANTIRETROVIRAL THERAPY; UNITED-STATES; INFECTED PATIENTS; MEDICAL-CARE; AIDS; COSTS; ADMISSIONS; IMPACT; SERVICES; TRENDS AB Objective: To compare inpatient utilization and costs by persons living with HIV in 2000 with inpatient utilization and costs in 2004. Data Sources: Data on 91,343 hospital discharge abstracts representing all HIV-related admissions in 6 states (California, Florida, New Jersey, New York, South Carolina, and Washington state) in 2000 and data from 72,829 hospital discharge abstracts representing all HIV-related admissions in the same states in 2004 are used. These data were obtained from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, and they were combined with data on the number of persons living with HIV that were obtained from the Centers for Disease Control and Prevention and 2 state departments of health. Study Design: This study compares the hospital care received by persons living with HIV in 6 states in calendar year 2000 with the hospital care received by persons living with HIV in calendar year 2004 in the same 6 states. This study also compares population-based measures of hospital utilization (ie, to measure the average utilization of hospital care per person living with HIV in each state) across the 6 states. Results: This study found that the average age of a hospitalized patient with HIV rose from 41 to 44 years and that the average number of diagnoses rose from 6.0 to 7.4. Moreover, it was found that the average number of admissions per person living with HIV fell 39% and that the percentages of female and black patients with HIV remained the same. Conclusions: Hospitalized patients living with HIV are getting older and sicker, although the average number of admissions per person living with HIV continues to fall. C1 Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM fhelling@ahrq.gov NR 41 TC 16 Z9 17 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1525-4135 J9 JAIDS-J ACQ IMM DEF JI JAIDS PD JUN 1 PY 2007 VL 45 IS 2 BP 239 EP 246 DI 10.1097/QAI.0b013e3180517407 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 173SD UT WOS:000246891900017 PM 17414928 ER PT J AU Bell, SG Newcomer, SF Bachrach, C Borawski, E Jemmott, JB Morrison, D Stanton, B Tortolero, S Zimmerman, R AF Bell, Stephanie G. Newcomer, Susan F. Bachrach, Christine Borawski, Elaine Jemmott, John B., III Morrison, Diane Stanton, Bonita Tortolero, Susan Zimmerman, Richard TI Challenges in replicating interventions SO JOURNAL OF ADOLESCENT HEALTH LA English DT Article DE adolescents; interventions; sexual behavior; HIV risk ID PREVENTION PROGRAMS; SAFER CHOICES; SUBSTANCE USE; HIV; HEALTH; IMPACT; ADOLESCENTS; CURRICULUM; PREGNANCY; FIDELITY AB Purpose: To describe and reflect on an effort to document, through a set of 6 interventions, the process of adapting effective youth risk behavior interventions for new settings, and to provide insights into how this might best be accomplished. Methods: Six studies were funded by the NIH, starting in 1999. The studies were funded in response to a Request for Applications (RFA) to replicate HIV prevention interventions for youth. Researchers were to select an HIV risk reduction intervention program shown to be effective in one adolescent population and to replicate it in a new community or different adolescent population. This was to be done while systematically documenting those processes and aspects of the intervention hypothesized to be critical to the development of community-based, culturally sensitive programs. The replication was to assess the variations necessary to gain cooperation, implement a locally feasible and meaningful intervention, and evaluate the outcomes in the new setting. The rationale for this initiative and description of the goals and approaches to adaptation of the funded researchers are described. Results: Issues relevant to all interventions are discussed, in addition to those unique to replication. The processes and the consequences of the adaptations are then discussed. The further challenges in taking a successful intervention "to scale" are not discussed. Conclusions: Replications of effective interventions face all of the challenges of implementation design, plus additional challenges of balancing fidelity to the original intervention and sensitivity to the needs of new populations. (c) 2007 Society for Adolescent Medicine. All rights reserved. C1 NICHD, NIH, Bethesda, MD 20892 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Case Western Reserve, Cleveland, OH USA. Univ Penn, Philadelphia, PA 19104 USA. Univ Washington, Seattle, WA 98195 USA. Wayne State Univ, Detroit, MI USA. Univ Texas, Med Ctr Houston, Houston, TX USA. Univ Kentucky, Lexington, KY USA. RP Newcomer, SF (reprint author), NICHD, NIH, Bldg 61E,Room 8B7G, Bethesda, MD 20892 USA. EM newcomes@mail.nih.gov FU NICHD NIH HHS [R01 HD039109, R01 HD038420, R01 HD038420-05S1, R01 HD038456, R01 HD038456-03, R01 HD038457, R01 HD038457-05, R01 HD039109-05, R01-HD038420, R01-HD038456, R01-HD038457, R01-HD039109]; NIMH NIH HHS [R01 MH061187, R01 MH061187-05, R01 MH061761, R01 MH061761-06, R01 MH069229, R01-MH061187, R01-MH061761] NR 38 TC 25 Z9 25 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1054-139X EI 1879-1972 J9 J ADOLESCENT HEALTH JI J. Adolesc. Health PD JUN PY 2007 VL 40 IS 6 BP 514 EP 520 DI 10.1016/j.jadohealth.2006.09.005 PG 7 WC Psychology, Developmental; Public, Environmental & Occupational Health; Pediatrics SC Psychology; Public, Environmental & Occupational Health; Pediatrics GA 174FA UT WOS:000246925900005 PM 17531757 ER PT J AU Allison, RA Manski, RJ AF Allison, R. Andrew Manski, Richard J. TI The supply of dentists and access to care in rural Kansas SO JOURNAL OF RURAL HEALTH LA English DT Article ID ORAL-HEALTH STATUS; UNITED-STATES; RESIDENCE; SERVICES; CHILDREN; ADULTS AB Context: Rural deficits in dental care and oral health are well documented and are typically attributed to the low number of dentists practicing in rural areas, but the relationships between rural residence, dental supply, and access to care have not been firmly established, impeding the development of effective public policy. Purpose: The purpose of this study is to develop a conceptual framework for observed variations in dental supply, oral health, and access to dental care in rural versus nonrural areas, and to test key empirical implications of this framework (eg, whether lower levels of utilization are associated with the lack of dentists and/or other aspects of residence in a rural area). Methods: This study employs descriptive statistics, bivariate analyses, and multiple logistic regression to describe the relationship between oral health, access to care, and the supply of dentists in rural versus nonrural populations. Data analyzed includes Kansas' dental licensure records and the 2002 Behavioral Risk Factor Surveillance System. Findings: Bivariate results confirm that dental supply, access to care, and oral health are lower for populations living in rural areas. Multivariate models indicate that dentist supply has a positive and independent association with utilization, but that rurality is not associated with utilization and oral health after controlling for demographics and dentist supply. Conclusions: Findings are consistent with a conceptual framework linking the geography of rural residence, individual preferences for services such as dental care, and the financial disincentives for dentists to locate in rural areas. C1 Kansas Hlth Policy Author, Topeka, KS USA. Univ Maryland, Sch Dent, Dept Hlth Promot & Policy, Baltimore, MD 21201 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Allison, RA (reprint author), Kansas Hlth Policy Author, Topeka, KS USA. EM Andrew.Allison@khpa.ks.gov NR 17 TC 13 Z9 14 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0890-765X J9 J RURAL HEALTH JI J. Rural Health PD SUM PY 2007 VL 23 IS 3 BP 198 EP 206 DI 10.1111/j.1748-0361.2007.00091.x PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 178FE UT WOS:000247205800002 PM 17565519 ER PT J AU Pine, M Jordan, HS Elixhauser, A Fry, DE Hoaglin, DC AF Pine, Michael Jordan, Harmon S. Elixhauser, Anne Fry, Donald E. Hoaglin, David C. TI Hospital mortality risk adjustment using claims data - In reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Michael Pine & Associates Inc, Chicago, IL USA. ABT Associates Inc, Cambridge, MA 02138 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Pine, M (reprint author), Michael Pine & Associates Inc, Chicago, IL USA. EM mpine@aol.com NR 4 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610-0946 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 9 PY 2007 VL 297 IS 18 BP 1984 EP 1984 DI 10.1001/jama.297.18.1984 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 165JM UT WOS:000246301800019 ER PT J AU Tierney, WM Oppenheimer, CC Hudson, BL Benz, J Finn, A Hickner, JM Lanier, D Gaylin, DS AF Tierney, William M. Oppenheimer, Caitlin C. Hudson, Brenda L. Benz, Jennifer Finn, Amy Hickner, John M. Lanier, David Gaylin, Daniel S. TI A national survey of primary care practice-based research networks SO ANNALS OF FAMILY MEDICINE LA English DT Article; Proceedings Paper CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med DE research networks; primary care; survey research; practice-based research ID HEALTH-CARE; SYMPTOMS AB PURPOSE Increasing numbers of primary care practice-based research networks (PBRNs) are being developed in the United States to perform research relevant to everyday practice. To assess the current status and potential value of this resource, we surveyed US primary care PBRNs in operation from late 2003 to early 2004. METHODS We performed a Web-based survey and structured interviews with PBRN directors and administrative officers, assessing PBRNs' history, size, location, organization, resources, operations, and productivity (funding obtained, studies performed, and articles published). RESULTS Of 111 primary care PBRNs identified, 89 (80%) responded to the survey. The 86 (77%) meeting the criteria for primary care PBRNs contained 1,871 practices, 12,957 physicians (mean 152 per PBRN, median 100), and 14.7 million patients (mean 229,880 per PBRN, median 105,000). Minority and underinsured patients were over-represented. The average PBRN was young (4.4 +/- 5.7 years): one-half had performed 3 or fewer studies. Three-quarters were affiliated with universities. Common research foci included prevention, diabetes, cardiovascular risk factors, and mental health. Respondent PBRNs had published more than 600 articles in peer-reviewed journals. PBRNs studying questions posed by outside researchers had more federal funding (84% vs 27%, P = .006). PBRNs citing funding as a weakness relied more on local resources to fund research projects (70% vs 40%, P = .036). CONCLUSIONS American primary care PBRNs are mainly young, diverse, and pursuing a variety of research foci. Most have university links and provide a dynamic town-gown relationship that could be a vital national resource for improving primary care, translating research into practice, and meeting the National Institutes of Health Roadmap goals. PBRNs merit further attention from both private and public funding agencies and researchers interested in studying the delivery of primary care. C1 Indiana Univ Sch Med, Div Gen Internal Med & Geriatr, Indianapolis, IN USA. Regenstrief Inst Inc, Indianapolis, IN USA. Natl Opinion Res Ctr, Washington, DC USA. Univ Chicago, Dept Family Med, Chicago, IL 60637 USA. Agcy Healthcare Res & Qual, Gaithersburg, MD USA. RP Tierney, WM (reprint author), Room M200 OPW,1001 W Tenth St, Indianapolis, IN 46202 USA. EM wtierney@iupui.edu NR 19 TC 57 Z9 58 U1 0 U2 5 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD MAY-JUN PY 2007 VL 5 IS 3 BP 242 EP 250 DI 10.1370/afm.699 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 183FK UT WOS:000247557900008 PM 17548852 ER PT J AU Lynn, J Baily, MA Bottrell, M Jennings, B Levine, RJ Davidoff, F Casarett, D Corrigan, J Fox, E Wynia, MK Agich, GJ O'Kane, M Speroff, T Schyve, P Batalden, P Tunis, S Berlinger, N Cronenwett, L Fitzmaurice, JM Dubler, NN James, B AF Lynn, Joanne Baily, Mary Ann Bottrell, Melissa Jennings, Bruce Levine, Robert J. Davidoff, Frank Casarett, David Corrigan, Janet Fox, Ellen Wynia, Matthew K. Agich, George J. O'Kane, Margaret Speroff, Theodore Schyve, Paul Batalden, Paul Tunis, Sean Berlinger, Nancy Cronenwett, Linda Fitzmaurice, J. Michael Dubler, Nancy Neveloff James, Brent TI The ethics of using quality improvement methods in health care SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID CLINICAL-RESEARCH; SERVICES RESEARCH; UNITED-STATES; DELIVERY; IMPACT AB Quality improvement (QI) activities can improve health care but must be conducted ethically. The Hastings Center convened leaders and scholars to address ethical requirements for QI and their relationship to regulations protecting human subjects of research. The group defined QI as systematic, data-guided activities designed to bring about immediate improvements in health care delivery in particular settings and concluded that Ql is an intrinsic part of normal health care operations. Both clinicians and patients have an ethical responsibility to participate in QI, provided that it complies with specified ethical requirements. Most QI activities are not human subjects research and should not undergo review by an institutional review board; rather, appropriately calibrated supervision of QI activities should be part of professional supervision of clinical practice. The group formulated a framework that would use key characteristics of a project and its context to categorize it as QI, human subjects research, or both, with the potential of a customized institutional review board process for the overlap category. The group recommended a period of innovation and evaluation to refine the framework for ethical conduct of QI and to integrate that framework into clinical practice. C1 Hastings Ctr, Garrison, NY 10524 USA. RAND Corp, Washington, DC USA. Vet Hlth Adm, Natl Qual Forum, Washington, DC USA. Natl Comm Qual Assurance, Washington, DC USA. Montefiore Med Ctr, Bronx, NY 10467 USA. Vet Hlth Adm, Seattle, WA USA. Yale Univ, New Haven, CT USA. Inst Healthcare Improvement, Cambridge, MA USA. Philadelphia Vet Affairs Med Ctr, Philadelphia, PA USA. Amer Med Assoc, Chicago, IL 60610 USA. Joint Commiss Accreditat Healthcare Org, Oak Brook Terrace, IL USA. Bowling Green State Univ, Bowling Green, OH 43403 USA. Vanderbilt Univ, Ctr Med, Nashville, TN 37232 USA. Dartmouth Coll Sch Med, Hanover, NH USA. Hlth Tech, San Francisco, CA USA. Univ N Carolina, Chapel Hill, NC USA. Agcy Hlth Care Policy & Res, Rockville, MD USA. Intermt Inst Hlth Care Delivery Res, Salt Lake City, UT USA. RP Baily, MA (reprint author), Hastings Ctr, 21 Malcolm Gordan Rd, Garrison, NY 10524 USA. EM bailym@thehastingscenter.org FU AHRQ HHS [1R13HS13369] NR 32 TC 124 Z9 125 U1 3 U2 9 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAY 1 PY 2007 VL 146 IS 9 BP 666 EP 673 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 162EV UT WOS:000246070500006 PM 17438310 ER PT J AU Kourtis, AP Bansil, P Johnson, C Meikle, SF Posner, SF Jamieson, DJ AF Kourtis, Athena P. Bansil, Pooja Johnson, Christopher Meikle, Susan F. Posner, Samuel F. Jamieson, Denise J. TI Children with sickle cell disease and human immunodeficiency virus-1 infection - Use of inpatient care services in the United States SO PEDIATRIC INFECTIOUS DISEASE JOURNAL LA English DT Article DE HIV infection; sickle cell disease; hospitalizations; pediatric; United States ID ACTIVE ANTIRETROVIRAL THERAPY; MORTALITY; CRISES AB Background: The purpose of this study was to describe hospital use patterns of children with sickle cell disease (SCD) and human immunodeficiency virus type-1 (HIV) infection in the United States. Methods: Hospital discharges of children with I or both of the 2 conditions (SCD and HIV infection) were analyzed using nationally weighted data from the 1994 to 2003 Nationwide Inpatient Databases of the Healthcare Cost and Utilization Project. Demographic and hospital characteristics, length of stay, charges and the most frequent diagnoses and procedures performed during the hospitalization were compared. Multivariate logistic regression was used to analyze the effects of age, sex and HIV infection on number of hospitalizations for selected conditions. Results: There were an estimated 686 hospitalizations of children with SCD and HIV infection in the United States in the 10-year period 1994-2003; these hospitalizations aggregated in the South (78.2%) and their expected payer was mostly Medicaid/Medicare (82.0%). Their average length of stay was longer than that of children with SCD alone (8.0 days vs. 4.3 days, respectively), and the mean charges associated with the hospitalization were also higher ($18,291 vs. $9584). Compared with patients with SCD without HIV, HIV infection conferred a higher risk for hospitalizations for bacterial infections and sepsis (odds ratio 2.75; 95% Cl, 1.66-4.6), but less of a risk for vaso-occlusive crises (odds ratio 0.32; 95% CI, 0.22-0.48). Inpatient case-fatality rate of children with SCD and HIV was no different from that of children with SCD alone, but lower than that of the rest of children with HIV infection. Conclusions: Hospitalized children with SCD and HIV infection have higher odds of infection than those with SCD alone. Their inpatient case-fatality rate is lower than that of children with HIV infection alone. These findings should be considered in designing appropriate interventions for this population. C1 Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Reprod Hlth, Atlanta, GA 30341 USA. CONRAD Program, Arlington, VA USA. Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD USA. RP Kourtis, AP (reprint author), Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Reprod Hlth, MS-K34,2900 Woodcock Blvd, Atlanta, GA 30341 USA. EM apk3@cdc.gov OI Posner, Samuel/0000-0003-1574-585X NR 13 TC 8 Z9 8 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0891-3668 J9 PEDIATR INFECT DIS J JI Pediatr. Infect. Dis. J. PD MAY PY 2007 VL 26 IS 5 BP 406 EP 410 DI 10.1097/01.inf.0000259953.79654.d0 PG 5 WC Immunology; Infectious Diseases; Pediatrics SC Immunology; Infectious Diseases; Pediatrics GA 163WH UT WOS:000246193400007 PM 17468650 ER PT J AU Gray, DT AF Gray, Darryl T. TI Outpatient lumbar spine decompression in 233 patients 65 years of age or older - Point of view SO SPINE LA English DT Editorial Material C1 Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Gray, DT (reprint author), Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, 540 Gaither Rd,Room 3353, Rockville, MD 20850 USA. EM darryl.gray@ahrq.hhs.gov NR 5 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0362-2436 J9 SPINE JI SPINE PD MAY 1 PY 2007 VL 32 IS 10 BP 1140 EP 1140 DI 10.1097/01.brs.0000261487.08413.34 PG 1 WC Clinical Neurology; Orthopedics SC Neurosciences & Neurology; Orthopedics GA 164BH UT WOS:000246207100016 ER PT J AU Guirguis-Blake, J Lin, KW Barton, MB AF Guirguis-Blake, Janelle Lin, Kenneth W. Barton, Mary B. TI Is there benefit to coronary calcium screening? SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID RISK PREDICTION; DISEASE EVENTS; HEART-DISEASE; CALCIFICATION; STATEMENT; SCORE C1 Univ Washington, Tacoma Family Med Residency Program, Tacoma, WA 98402 USA. Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. RP Guirguis-Blake, J (reprint author), Univ Washington, Tacoma Family Med Residency Program, Tacoma, WA 98402 USA. EM jguirgui@u.washington.edu NR 9 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD APR 15 PY 2007 VL 75 IS 8 BP 1155 EP 1156 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 160AR UT WOS:000245909700004 PM 17477099 ER PT J AU Fischer, TK Viboud, C Parashar, U Malek, M Steiner, C Glass, R Simonsen, L AF Fischer, Thea Kolsen Viboud, Cecile Parashar, Umesh Malek, Mark Steiner, Claudia Glass, Roger Simonsen, Lone TI Hospitalizations and deaths from diarrhea and rotavirus among children < 5 years of age in the United States, 1993-2003 SO JOURNAL OF INFECTIOUS DISEASES LA English DT Article ID MORBIDITY; GASTROENTERITIS; SURVEILLANCE; INFECTION; MORTALITY; DISEASE; TRENDS; IMPACT; CODE AB Recently a new rotavirus vaccine was licensed in the United States and recommended for universal immunization of American children. The impact of the vaccine on a decrease in hospitalizations will take several years to assess and will be based on the availability of good baseline data on the disease. We used the largest US hospital discharge database available, the Healthcare Cost and Utilization Project (HCUP), to study national rates, trends, and risk factors for diarrhea- and rotavirus-associated hospitalizations and deaths among children < 5 years of age, to establish a baseline against which vaccine implementation can be measured. Rotavirus remained the most important cause of pediatric diarrhea throughout the study period (1993-2003). When the data were extrapolated to the US population, rotavirus was estimated to be the cause of similar to 60,000 hospitalizations and 37 deaths annually. Black infants had a significantly higher risk of being hospitalized with and dying from rotavirus disease early in life, compared with white infants (risk ratio [RR] for hospitalization by 12 months of age was 2.4, with a 95% confidence interval [CI] of 1.2-4.7; RR for death was 2.0, with a 95% CI of 1.7-2.5). Such racial differences in age and risk of rotavirus-associated hospitalization and death highlight the importance of timely and early rotavirus immunization of minority children. The HCUP database serves as a sensitive and robust data source for monitoring the impact of a rotavirus-immunization program in the United States. C1 Statens Serum Inst, Dept Epidemiol Res, DK-2300 Copenhagen, Denmark. Ctr Dis Control & Prevent, Div Viral Dis, Natl Ctr Immunizat & Resp Dis, Atlanta, GA USA. Ctr Dis Control & Prevent, Epidemiol Intelligence Serv, Atlanta, GA USA. NIH, Fogarty Int Ctr, Bethesda, MD USA. NIH, NIAID, Bethesda, MD USA. Agcy Hlth Care Res & Qual, Ctr Delivery Org & Markets, Bethesda, MD USA. RP Fischer, TK (reprint author), Statens Serum Inst, Dept Epidemiol Res, Artillivej 5, DK-2300 Copenhagen, Denmark. EM thf@ssi.dk; LSimonsen@niaid.nih.gov OI Fischer, Thea Kolsen/0000-0003-4812-980X; Simonsen, Lone/0000-0003-1535-8526 NR 27 TC 100 Z9 110 U1 0 U2 3 PU UNIV CHICAGO PRESS PI CHICAGO PA 1427 E 60TH ST, CHICAGO, IL 60637-2954 USA SN 0022-1899 J9 J INFECT DIS JI J. Infect. Dis. PD APR 15 PY 2007 VL 195 IS 8 BP 1117 EP 1125 DI 10.1086/512863 PG 9 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 153AW UT WOS:000245405100007 PM 17357047 ER PT J AU Wun, LM Ezzati-Rice, TM Diaz-Tena, N Greenblatt, J AF Wun, Lap-Ming Ezzati-Rice, Trena M. Diaz-Tena, Nuria Greenblatt, Janet TI On modelling response propensity for dwelling unit (DU) level non-response a ustment in the Medical Expenditure Panel Survey (MEPS) SO STATISTICS IN MEDICINE LA English DT Article; Proceedings Paper CT 10th Biennial Symposium on Statistical Methods CY 2007 CL Washington, DC SP CDC, ATSDR, Washington Statist Soc, Rutgers Univ, Ctr Discrete Math& Comp Sci, SAG, Statist Advisory Grp DE propensity score; weighting; logistic regression; relative total variation ID SUBCLASSIFICATION; BIAS AB Non-response is a common problem in household sample surveys. The Medical Expenditure Panel Survey (MEPS), sponsored by the Agency for Healthcare Research and Quality (AHRQ), is a complex national probability sample survey. The survey is designed to produce annual national and regional estimates of health-care use, expenditures, Sources of payment, and insurance-coverage for the U.S. civilian non-institutionalized population. The MEPS sample is a sub-sample of.,respondents to the prior year's National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics (NCHS). The MEPS, like most sample surveys, experiences unit, or total, non-response despite intensive efforts to maximize response rates. This paper summarizes research on comparing alternative approaches for modelling response propensity to compensate for dwelling unit (DU), i.e. household level non-response in the MEPS. Non-response in sample surveys is usually compensated for by some form of weighting adjustment to reduce the bias in survey estimates. To compensate for potential bias in survey estimates in the MEPS, two separate non-response adjustments are carried out. The first is an adjustment for DU level non-response at the round one interview to account for non-response among those households subsampled from NHIS for the MEPS. The second non-response adjustment is a person level adjustment to compensate for attrition across the five rounds of data collection. This paper deals only with the DU level non-response adjustment. Currently, the categorical search tree algorithm method, the chi-squared automatic interaction detector (CHAID), is used to model the response probability at the DU level and to create the non-response adjustment cells. In this study, we investigate an alternative approach, i.e. logistic regression to model the response probability. Main effects models and models with interaction terms are both evaluated. We further examine inclusion of the base weights as a covariate in the logistic models. We compare variability of weights of the two alternative response propensity approaches as well as direct use of propensity scores. C1 Ctr Financing Access & Cost Trends, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Wun, LM (reprint author), Ctr Financing Access & Cost Trends, Agcy Healthcare Res & Qual, 540 Gaither Rd,Room 5240, Rockville, MD 20850 USA. EM lwun@ahrq.gov NR 14 TC 13 Z9 13 U1 0 U2 2 PU JOHN WILEY & SONS LTD PI CHICHESTER PA THE ATRIUM, SOUTHERN GATE, CHICHESTER PO19 8SQ, W SUSSEX, ENGLAND SN 0277-6715 J9 STAT MED JI Stat. Med. PD APR 15 PY 2007 VL 26 IS 8 BP 1875 EP 1884 DI 10.1002/sim.2809 PG 10 WC Mathematical & Computational Biology; Public, Environmental & Occupational Health; Medical Informatics; Medicine, Research & Experimental; Statistics & Probability SC Mathematical & Computational Biology; Public, Environmental & Occupational Health; Medical Informatics; Research & Experimental Medicine; Mathematics GA 149JI UT WOS:000245142800018 PM 17206601 ER PT J AU Barton, MB Wolff, T Moy, E Burstin, H AF Barton, M. B. Wolff, T. Moy, E. Burstin, H. TI Overuse of pap smear screening in the elderly SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 30th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 25-28, 2007 CL Toronto, CANADA SP Soc Gen Internal Med C1 [Barton, M. B.; Wolff, T.; Moy, E.; Burstin, H.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2007 VL 22 SU 1 BP 7 EP 8 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 240TQ UT WOS:000251610700025 ER PT J AU Hughes, RG Clancy, CM AF Hughes, Ronda G. Clancy, Carolyn M. TI Improving the quality of nursing care using the medical expenditure panel survey data SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID TRENDS C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Hughes, RG (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Ronda.Hughes@ahrq.hhs.gov NR 18 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD APR-JUN PY 2007 VL 22 IS 2 BP 93 EP 96 PG 4 WC Nursing SC Nursing GA 149MI UT WOS:000245150600001 PM 17353742 ER PT J AU Zhan, CL Elixhauser, A Friedman, B Houchens, R Chiang, YP AF Zhan, Chunliu Elixhauser, Anne Friedman, Bernard Houchens, Robert Chiang, Yen-pin TI Modifying DRG-PPS to include only diagnoses present on admission - Financial implications and challenges SO MEDICAL CARE LA English DT Article DE Medicare; diagnosis-related groups; prospective payment system ID ADMINISTRATIVE DATA; ADVERSE EVENTS; COMPLICATIONS; PAYMENT; ACCURACY AB Objective: The inability to distinguish complications acquired in hospital from comorbid conditions that are present on admission (POA) has long hampered the use of claims data in quality and safety research. Now pay-for-performance initiatives and legislation requiring Medicare to reduce payment for acquired infections add imperative for POA coding. This study used data from 2 states currently coding POA to assess the financial impact if Medicare pays based on POA conditions only and to examine the challenges in implementing POA coding. Methods: Medicare payments were calculated based first on all diagnoses and then on POA diagnoses in the Medicare discharge abstracts from California and New York in 2003, using the Diagnosis Related Group (DRG)-based Prospective Payment System (PPS) formula. The potential savings that result from excluding non-POA diagnoses were calculated. Patterns of POA coding were explored. Results: Medicare could have saved $56 million in California, $51 million in New York, and $800 million nationwide in 2003 had it paid hospital claims based only on POA diagnoses. Approximately 15% of the claims had non-POA codes, but only 1.4% of the claims were reassigned to lower-cost DRGs after excluding non-POA diagnoses. Excluding non-POA diagnoses resulted in reduced payment for operating costs, but increased outlier payments because some of the claims were designated as "unusually high cost" in the lower-cost DRGs. POA coding patterns suggest some problems in current POA coding. Conclusions: To be consistent with pay-for-performance principles and make claims data more useful for quality assurance, incorporating POA coding into DRG-PPS could produce sizable savings for Medicare. C1 Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. Thomas Medstat, Santa Barbara, CA USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM Chunliu.zhan@ahrq.hhs.gov NR 17 TC 22 Z9 22 U1 2 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 2007 VL 45 IS 4 BP 288 EP 291 DI 10.1097/01.mlr.0000256969.34461.cf PG 4 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 157EO UT WOS:000245701600004 PM 17496711 ER PT J AU Simpson, L Dougherty, D Krause, D Ku, CM Perrin, JM AF Simpson, Lisa Dougherty, Denise Krause, David Ku, Cindy M. Perrin, James M. TI Measuring children's health care quality SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Article ID MEDICAID C1 Cincinnati Childrens Hosp Med Ctr, Child Policy Res Ctr, Cincinnati, OH 45229 USA. Natl Initiat Childrens Healthcare Qual, Child Hlth Policy, Cincinnati, OH USA. Agcy Healthcare Res & Qual, Child Hlth & Qual Improvement, Rockville, MD USA. Amer Canc Soc, Florida Div, Tampa, FL USA. Harvard Univ, Massachusetts Gen Hosp, Sch Med, Inst Child & Adolescent Hlth Policy, Boston, MA USA. RP Simpson, L (reprint author), Cincinnati Childrens Hosp Med Ctr, Child Policy Res Ctr, 333 Burnet Ave, Cincinnati, OH 45229 USA. EM lisa.simpson@cchmc.org NR 15 TC 9 Z9 9 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD MAR-APR PY 2007 VL 22 IS 2 BP 80 EP 84 DI 10.1177/1062860606298549 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 147TS UT WOS:000245026000002 PM 17395962 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Emergency departments in crisis: Implications for disaster preparedness SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 11 TC 1 Z9 2 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD MAR-APR PY 2007 VL 22 IS 2 BP 123 EP 126 DI 10.1177/1062860606298915 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 147TS UT WOS:000245026000009 PM 17395969 ER PT J AU Ockene, JK Edgerton, EA Teutsch, SM Marion, LN Miller, T Genevro, JL Loveland-Cherry, CJ Fielding, JE Briss, PA AF Ockene, Judith K. Edgerton, Elizabeth A. Teutsch, Steven M. Marion, Lucy N. Miller, Therese Genevro, Janice L. Loveland-Cherry, Carol J. Fielding, Jonathan E. Briss, Peter A. TI Integrating evidence-based clinical and community strategies to improve health SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID SERVICES TASK-FORCE; PREVENTIVE-SERVICES; PHYSICAL-ACTIVITY; TOBACCO CONTROL; PRIMARY-CARE; OBESITY; OVERWEIGHT; ADULTS; INTERVENTIONS; RATIONALE AB Multiple and diverse preventive strategies in clinical and community settings are necessary to improve health. This paper (1) introduces evidence-based recommendations from the U.S. Preventive Services Task Force sponsored by the Agency for Healthcare Research and Quality and the Community Task Force sponsored by the Centers for Disease Control and Prevention, (2) examines, using a social-ecologic model, the evidence-based strategies for use in clinical and community settings to address preventable health-related problems such as tobacco use and obesity, and (3) advocates for prioritization and integration of clinical and community preventive strategies in the planning of programs and policy development, calling for additional research to develop the strategies and systems needed to integrate them. C1 Univ Massachusetts, Sch Med, Div Prevent & Behav Med, Worcester, MA 01655 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Merck & Co Inc, Outcomes Res & Management, West Point, PA USA. Med Coll Georgia, Sch Nursing, Augusta, GA USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. Univ Michigan, Sch Nursing, Ann Arbor, MI USA. Univ Calif Los Angeles, Sch Publ Hlth, Dept Hlth Serv, Los Angeles, CA USA. Ctr Dis Control & Prevent, Community Guide Branch, Atlanta, GA USA. RP Ockene, JK (reprint author), Univ Massachusetts, Sch Med, Div Prevent & Behav Med, 55 Lake Ave N, Worcester, MA 01655 USA. EM Judith.Ockene@umassmed.edu NR 42 TC 47 Z9 49 U1 0 U2 6 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD MAR PY 2007 VL 32 IS 3 BP 244 EP 252 DI 10.1016/j.amepre.2006.11.007 PG 9 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 143NT UT WOS:000244730000010 PM 17296474 ER PT J AU Pezzin, LE Pollak, RA Schone, BS AF Pezzin, Liliana E. Pollak, Robert A. Schone, Barbara S. TI Efficiency in family bargaining: Living arrangements and caregiving decisions of adult children and disabled elderly parents SO CESIFO ECONOMIC STUDIES LA English DT Article; Proceedings Paper CT ASSA Winter Meeting CY JAN, 2003 CL WASHINGTON, DC SP ASSA ID CARE; MARRIAGE; ALLOCATION; RESOURCES; TRANSFERS AB In this article, we use a two-stage bargaining model to analyze the living arrangement of a disabled elderly parent and the assistance provided to the parent by her adult children. The first stage determines the living arrangement: the parent can live in a nursing home, live alone in the community, or live with any child who has invited coresidence. The second stage determines the assistance provided by each child in the family. Working by backward induction, we first calculate the level of assistance that each child would provide to the parent in each possible living arrangement. Using these calculations, we then analyze the living arrangement that would emerge from the first stage game. A key assumption of our model is that family members cannot or will not make binding agreements at the first stage regarding transfers at the second stage. Because coresidence is likely to reduce the bargaining power of the coresident child relative to her siblings, coresidence may fail to emerge as the equilibrium living arrangement even when it is Pareto efficient. That is, the outcome of the two-stage game need not be Pareto efficient. C1 Med Coll Wisconsin, Milwaukee, WI 53226 USA. Washington Univ, Olin Sch, St Louis, MO 63130 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Georgetown Univ, Washington, DC 20057 USA. RP Pezzin, LE (reprint author), Med Coll Wisconsin, Milwaukee, WI 53226 USA. EM lpezzin@mcw.edu; pollak@wustl.edu; bschone@ahrq.gov NR 61 TC 29 Z9 29 U1 4 U2 11 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 1610-241X EI 1612-7501 J9 CESIFO ECON STUD JI CESifo Econ. Stud. PD MAR PY 2007 VL 53 IS 1 BP 69 EP 96 DI 10.1093/cesifo/ifm004 PG 28 WC Economics SC Business & Economics GA 172FG UT WOS:000246788900003 ER PT J AU Slutsky, JR AF Slutsky, Jean R. TI Moving closer to a rapid-learning health care system SO HEALTH AFFAIRS LA English DT Editorial Material AB This Perspective discusses activities that are necessary for developing a rapid-learning health system. Recognition of the central role that patients play in the successful evolution of such a system will help ensure that the goals of the transformation are met. Understanding the trade-offs of using a less controlled form of research to inform health care decision making and making necessary investments in methodology and translation will help secure the success of continuous-learning research. Major public policy interest in promoting health information technology and in getting more value for health care spending creates a framework for moving ahead. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Slutsky, JR (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. EM jean.slutsky@ahrq.hhs.gov NR 6 TC 19 Z9 19 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2007 VL 26 IS 2 BP W122 EP W124 DI 10.1377/hlthaff.26.2.w122 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 143YY UT WOS:000244763500048 PM 17259193 ER PT J AU Zhan, CL Kaczmarek, R Loyo-Berrios, N Sangl, J Bright, RA AF Zhan, Chunliu Kaczmarek, Ronald Loyo-Berrios, Nilsa Sangl, Judith Bright, Roselie A. TI Incidence and short-term outcomes of primary and revision hip replacement in the United States SO JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME LA English DT Article ID ELECTIVE TOTAL HIP; VENOUS THROMBOEMBOLISM; KNEE ARTHROPLASTY; POSTOPERATIVE COMPLICATIONS; DEEP SEPSIS; MORTALITY; VOLUME; RATES; SURGERY; COMORBIDITY AB Background: The purpose of this study was to use 2003 nationwide United States data to determine the incidences of primary total hip replacement, partial hip replacement, and revision hip replacement and to assess the short-term patient outcomes and factors associated with the outcomes. Methods: We screened more than eight million hospital discharge abstracts from the 2003 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and approximately nine million discharge abstracts from five state inpatient databases. Patients who had undergone total, partial, or revision hip replacement were identified with use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes. In-hospital mortality, perioperative complications, readmissions, and the association between these outcomes and certain patient and hospital variables were analyzed. Results: Approximately 200,000 total hip replacements, 100,000 partial hip replacements, and 36,000 revision hip replacements were performed in the United States in 2003. Approximately 60% of the patients were sixty-five years of age or older and at least 75% had one or more comorbid diseases. The in-hospital mortality rates associated with these three procedures were 0.33%, 3.04%, and 0.84%, respectively. The perioperative complication rates associated with the three procedures were 0.68%, 1.36%, and 1.08%, respectively, for deep vein thrombosis or pulmonary embolism; 0.28%, 1.88%, and 1.27% for decubitus ulcer; and 0.05%, 0.06%, and 0.25% for postoperative infection. The rates of readmission, for any cause, within thirty days were 4.91%, 12.15%, and 8.48%, respectively, and the rates of readmissions, within thirty days, that resulted in a surgical procedure on the affected hip were 0.79%, 0.91%, and 1.53%. The rates of readmission, for any cause, within ninety days were 8.94%, 21.14%, and 15.72%, and the rates of readmissions, within ninety days, that resulted in a surgical procedure on the affected hip were 2.15%, 1.61%, and 3.99%. Advanced age and comorbid diseases were associated with worse outcomes, while private insurance coverage and planned admissions were associated with better outcomes. No consistent association between outcomes and hospital characteristics, such as hip procedure volume, was identified. Conclusions: Total hip replacement, partial hip replacement, and revision hip replacement are associated with different rates of postoperative complications and readmissions. Advanced age, comorbidities, and nonelective admissions are associated with inferior outcomes. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. US FDA, Epidemiol Branch, Div Postmarket Surveillance, Off Surveillance & Biomet,Ctr Devices & Radiol Hl, Rockville, MD 20850 USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM chunliu.zhan@ahrq.hhs.gov; rxk@cdrh.fda.gov; nlb@cdrh.fda.gov; judith.sangl@ahrq.hhs.gov; rxb@cdrh.fda.gov RI Bright, Roselie/D-2240-2016 NR 40 TC 116 Z9 118 U1 0 U2 12 PU JOURNAL BONE JOINT SURGERY INC PI NEEDHAM PA 20 PICKERING ST, NEEDHAM, MA 02192 USA SN 0021-9355 J9 J BONE JOINT SURG AM JI J. Bone Joint Surg.-Am. Vol. PD MAR PY 2007 VL 89A IS 3 BP 526 EP 533 DI 10.2106/JBJS.F.00952 PG 8 WC Orthopedics; Surgery SC Orthopedics; Surgery GA 143OG UT WOS:000244731400009 PM 17332101 ER PT J AU Meyerhoefer, CD Zuvekas, SH AF Meyerhoefer, Chad D. Zuvekas, Samuel H. TI How does direct-to-consumer advertising influence the demand for mental health treatment? SO JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS LA English DT Meeting Abstract C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 0 TC 0 Z9 0 U1 1 U2 2 PU INT CENTER MENTAL HEALTH POLICY & ECONOMICS-ICMPE PI MILANO PA VIA DANIELE CRESPI 7, MILANO, 20123, ITALY SN 1091-4358 J9 J MENT HEALTH POLICY JI J. Ment. Health Policy Econ. PD MAR PY 2007 VL 10 SU 1 BP S29 EP S29 PG 1 WC Health Policy & Services; Psychiatry SC Health Care Sciences & Services; Psychiatry GA 166OQ UT WOS:000246388800065 ER PT J AU Spector, W Shaffer, T Potter, DEB Correa-De-Araujo, R Limcangco, MR AF Spector, William Shaffer, Thomas Potter, D. E. B. Correa-de-Araujo, Rosaly Limcangco, M. Rhona TI Risk factors associated with the occurrence of fractures in US nursing homes: Resident and facility characteristics and prescription medications SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE nursing home; fracture; falls; safety; prescription medications; MDS ID BONE-MINERAL DENSITY; MINIMUM DATA SET; HIP FRACTURE; OLDER-PEOPLE; CORTICOSTEROID-USE; FALLS; CARE; QUALITY; COMMUNITY; ANTIDEPRESSANTS AB OBJECTIVES: To determine whether resident and facility characteristics and prescription medications influence the occurrence of fractures in nursing homes (NHs). DESIGN: Panel study with 1-year follow-up. SETTING: A nationally representative sample of NHs from the Medical Expenditure Panel Survey (MEPS). PARTICIPANTS: Residents aged 65 and older who were in sample NHs on January 1, 1996. MEASUREMENTS: Health status measures were collected from facility records and abstracted using a computer-assisted personal interview instrument. Fracture and drug data were updated every 4 months to provide a full year of information. Drug data were obtained from monthly medication administration records. The occurrences of fractures were obtained from medical records. Administered medications were classified using the Department of Veterans Affairs medication classification system. Facility characteristics were based on MEPS survey data collected from NH sources. RESULTS: In 1996, 6% of residents in a NH at the beginning of the year experienced a fracture during their NH stay(s). Resident risk factors included aged 85 and older, admitted from the community, exhibited agitated behaviors, and used both wheelchair and cane or walker. Use of anticonvulsants, antidepressants, opioid analgesics, iron supplements, bisphosphonates, thiazides, and laxatives were associated with fractures. A high certified nurse aide ratio was negatively associated with fractures. CONCLUSION: The findings indicate that fractures are associated with resident and facility characteristics and prescribing practices. It reaffirms the importance of medication review with special attention on opioid analgesics, antidepressants, and anticonvulsants to reduce the risk of fractures. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Maryland, Peter Lamy Ctr Drug Therapy & Aging, Dept Pharmaceut Hlth Serv Res, Sch Pharm, Baltimore, MD 21201 USA. Social & Sci Syst, Silver Spring, MD USA. Dept Hlth & Human Serv, Rockville, MD USA. RP Spector, W (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM William.Spector@ahrq.hhs.gov OI Wu, Lin/0000-0001-7169-3519 NR 49 TC 39 Z9 40 U1 2 U2 6 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD MAR PY 2007 VL 55 IS 3 BP 327 EP 333 DI 10.1111/j.1532-5415.2007.01081.x PG 7 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 140QA UT WOS:000244519400002 PM 17341233 ER PT J AU Uhl, K Trontell, A Kennedy, D AF Uhl, Kathleen Trontell, Anne Kennedy, Dianne TI Risk minimization practices for pregnancy prevention: understanding risk, selecting tools SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Review DE pregnancy; drugs/medications; teratogens; birth defects; risk management; risk minimization; prevention; pregnancy prevention ID CONGENITAL-MALFORMATIONS; DISEASE MANAGEMENT; TUBERCULOSIS; CISAPRIDE; PROGRAM; TRENDS; DRUGS AB According to the March of Dimes, approximately 4% (1/28) of babies are born in the US each year with a birth defect. For the majority of birth defects the etiology is unknown, although chemicals, including drug exposures, probably account for less than 1% of all birth defects. The identification of potential human teratogenicity during drug development is important because drug-induced adverse fetal effects are potentially preventable with the application of risk assessment strategies and risk minimization tools and programs to minimize risk of pregnancy exposure while preserving access to drug benefits; risk assessment and risk minimization together comprise risk management. It is important that risk minimization programs intended to limit fetal exposure use a consistent approach and are tailored to the product-specific risk concerns in order to optimize the benefit-fisk balance for a particular drug. This paper highlights general considerations in developing specific risk minimization programs to prevent fetal drug exposure including the relative advantages and disadvantages of each strategy. Published in 2006 by John Wiley and Sons Ltd. C1 US FDA, Off Womens Hlth, Rockville, MD 20857 USA. US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD 20857 USA. Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Uhl, K (reprint author), US FDA, Off Womens Hlth, 5600 Fishers Lane,PKLN 16-65,HF-8, Rockville, MD 20857 USA. EM kathleen.uhl@fda.hhs.gov NR 24 TC 4 Z9 7 U1 1 U2 1 PU JOHN WILEY & SONS LTD PI CHICHESTER PA THE ATRIUM, SOUTHERN GATE, CHICHESTER PO19 8SQ, W SUSSEX, ENGLAND SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD MAR PY 2007 VL 16 IS 3 BP 337 EP 348 DI 10.1002/pds.1312 PG 12 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 146EV UT WOS:000244918200010 PM 16953517 ER PT J AU Cox, S Johnson, CH Meikle, S Jamieson, DJ Posner, SF AF Cox, Shanna Johnson, Chris H. Meikle, Susan Jamieson, Denise J. Posner, Samuel F. TI Trends in rates of hospitalization with a diagnosis of substance abuse among reproductive-age women, 1998 to 2003 SO WOMENS HEALTH ISSUES LA English DT Article ID UNITED-STATES; USE DISORDERS; SERVICES UTILIZATION; BINGE DRINKING; DRUG-USE; ALCOHOL; PREGNANCY; ADULTS; RISK; CARE AB Objective. To describe trends in hospitalizations with a diagnosis of substance abuse among reproductive-age women from 1998-2003. Methods. Data were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Hospitalizations with a diagnosis of substance abuse were categorized into subgroups by age, primary expected payer, substance-specific diagnoses, concomitance, and hospital location. Trends in hospitalization rates per 100,000 women aged 15-44 were tested using a weighted least-squares method. Results. From 1998-2003, there was no change in the overall rate of hospitalization with a diagnosis of substance abuse among women aged 15-44. Alcohol abuse was the most common substance-specific diagnosis. The rate of hospitalization with a diagnosis of cocaine abuse decreased 22%; for a diagnosis of cannabis abuse, the rate increased 35%. The rate of hospitalization with a diagnosis of amphetamine abuse doubled from 1998-2003. Among women aged 15-24, the rate of hospitalization with a diagnosis of substance abuse increased 23%. Conclusion. Although we did not observe a change in the overall rate of substance-abuse hospitalization among reproductive-age women, there were dramatic changes in the rate of substance-specific diagnoses. These data may be used to quantify emerging trends in substance abuse and promote the use of hospital-based interventions. C1 Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA 30341 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. EM cio8@cdc.gov RI Cox, Shanna/F-4806-2011; OI Posner, Samuel/0000-0003-1574-585X NR 33 TC 5 Z9 5 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2007 VL 17 IS 2 BP 75 EP 83 DI 10.1016/j.whi.2007.02.001 PG 9 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 158IZ UT WOS:000245786500002 PM 17403464 ER PT J AU Lacey, S Hughes, RG AF Lacey, Susan Hughes, Ronda G. TI Is power everything? What can we learn from large data sets SO APPLIED NURSING RESEARCH LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20852 USA. Univ Alabama, Sch Nursing, Birmingham, AL USA. Childrens Hosp, Birmingham, AL USA. RP Hughes, RG (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20852 USA. EM Ronda.Hughes@ahrq.hhs.gov NR 8 TC 1 Z9 1 U1 0 U2 2 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0897-1897 J9 APPL NURS RES JI Appl. Nurs. Res. PD FEB PY 2007 VL 20 IS 1 BP 50 EP 53 DI 10.1016/j.apnr.2006.10.007 PG 4 WC Nursing SC Nursing GA 135IM UT WOS:000244147300011 PM 17259046 ER PT J AU Basu, J AF Basu, Jayasree TI Maladies, preventives and curatives: Debate in public health in India. SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Book Review C1 AHRQ, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Basu, J (reprint author), AHRQ, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jbasu@ahrq.gov NR 1 TC 0 Z9 0 U1 0 U2 0 PU JOHNS HOPKINS UNIV PRESS PI BALTIMORE PA JOURNALS PUBLISHING DIVISION, 2715 NORTH CHARLES ST, BALTIMORE, MD 21218-4363 USA SN 1049-2089 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PD FEB PY 2007 VL 18 IS 1 BP 220 EP 222 DI 10.1353/hpu.2007.0002 PG 3 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 141AL UT WOS:000244548300022 ER PT J AU Martin, BI Mirza, SK Comstock, BA Gray, DT Kreuter, W Deyo, RA AF Martin, Brook I. Mirza, Sohail K. Comstock, Bryan A. Gray, Darryl T. Kreuter, William Deyo, Richard A. TI Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures SO SPINE LA English DT Article CT Western Regional Epidemiology Network Conference CY 2002 CL Ashland, OR DE lumbar; spine; surgery; reoperation; fusion ID LOW-BACK-PAIN; RANDOMIZED CONTROLLED-TRIAL; UNITED-STATES TRENDS; ADMINISTRATIVE DATABASES; SPONDYLOLISTHESIS; HOSPITALIZATION; ARTHRODESIS; STENOSIS; ICD-9-CM; WINNER AB Study Design. Retrospective cohort study using a hospital discharge registry of all nonfederal acute care hospitals in Washington state. Objectives. To determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone. Summary of Background Data. Repeat lumbar spine operations are generally undesirable, implying persistent symptoms, progression of degenerative changes, or treatment complications. Compared to decompression alone, spine fusion is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear. Methods. Adults who underwent inpatient lumbar surgery for degenerative spine disorders in 1990 - 1993 ( n = 24,882) were identified from International Classification of Diseases ninth Revision, Clinical Modification codes and then categorized as having either a lumbar decompression surgery or lumbar fusion surgery. We then compared the subsequent incidence of lumbar spine surgery between these groups. Results. Patients who had surgery in 1990 - 93 had a 19% cumulative incidence of reoperation during the subsequent 11 years. Patients with spondylolisthesis had a lower cumulative incidence of reoperation after fusion surgery than after decompression alone ( 17.1% vs. 28.0%, P = 0.002). For other diagnoses combined, the cumulative incidence of reoperation was higher following fusion than following decompression alone ( 21.5% vs. 18.8%, P = 0.008). After fusion surgery, 62.5% of reoperations were associated with a diagnosis suggesting device complication or pseudarthrosis. Conclusion. Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial. For spondylolisthesis, reoperation is less likely following fusion than following decompression alone. For other degenerative spine conditions, the cumulative incidence of reoperation is higher or unimproved after a fusion procedure compared to decompression alone. C1 Univ Washington, Ctr Cost & Outcomes Res, Seattle, WA 98104 USA. Univ Washington, Dept Med, Seattle, WA 98104 USA. Univ Washington, Dept Orthopaed & Sports Med, Seattle, WA 98104 USA. Univ Washington, Dept Hlth Serv, Seattle, WA 98104 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Seattle, WA USA. RP Martin, BI (reprint author), Univ Washington, Ctr Cost & Outcomes Res, Box 359736,PSB 5073,325 9th Ave, Seattle, WA 98104 USA. EM bim@u.washington.edu NR 24 TC 129 Z9 132 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0362-2436 J9 SPINE JI SPINE PD FEB 1 PY 2007 VL 32 IS 3 BP 382 EP 387 DI 10.1097/01.brs.0000254104.55716.46 PG 6 WC Clinical Neurology; Orthopedics SC Neurosciences & Neurology; Orthopedics GA 132UT UT WOS:000243968600017 PM 17268274 ER PT J AU Smetana, GW Landon, BE Bindman, AB Burstin, H Davis, RB Tjia, J Rich, EC AF Smetana, Gerald W. Landon, Bruce E. Bindman, Andrew B. Burstin, Helen Davis, Roger B. Tjia, Jennifer Rich, Eugene C. TI A comparison of outcomes resulting from generalist vs specialist care for a single discrete medical condition - A systematic review and methodologic critique SO ARCHIVES OF INTERNAL MEDICINE LA English DT Review ID ACUTE MYOCARDIAL-INFARCTION; QUALITY-OF-CARE; CONGESTIVE-HEART-FAILURE; CONVERTING ENZYME-INHIBITORS; HUMAN-IMMUNODEFICIENCY-VIRUS; CORONARY-ARTERY-DISEASE; PHYSICIAN SPECIALTY; UNITED-STATES; ANTIRETROVIRAL THERAPY; PITTSBURGH EPIDEMIOLOGY AB Background: Studies of clinical outcomes for generalist vs specialist care for diagnoses within a specialist's narrow domain have tended to favor specialty care. Methods: A MEDLINE search from January 1, 1980, through April 1, 2005, and a hand search of retrieved bibliographies of English-language studies that compared generalist vs specialist care for individual patients with a single discrete medical condition were performed. Two reviewers determined eligibility for each study and abstracted data onto a standardized instrument. Results: A total of 49 articles met our inclusion criteria: 24 studies favored specialty care, 13 found no difference in outcomes, 7 varied by individual outcome, 1 depended on physician experience, and 4 favored generalist care. Only 8 studies reported integration into health delivery systems, 4 considered physician experience, 3 documented information technology support, and 2 considered the impact of care management programs. Selection bias was adequately addressed in 58% of studies that favored specialty care and in 71% of studies that found no difference or favored generalist care (P=. 52). Studies that favored specialty care were less likely to consider 4 key, potentially confounding physician or practice characteristics compared with studies that found no difference or favored generalist care ( 3% vs 15% of potential instances, respectively; P=. 009). Conclusions: The literature regarding the influence of generalist vs specialist care on outcomes for patients with a single discrete condition suffers from important methodologic shortcomings. Further research is needed to inform health care policy as it pertains to the optimal role of generalists and specialists in the physician marketplace. C1 Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Boston, MA 02215 USA. Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. Univ Calif San Francisco, San Francisco Gen Hosp, Div Gen Internal Med, San Francisco, CA USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. Univ Penn, Sch Med, Div Geriatr Med, Philadelphia, PA 19104 USA. Creighton Univ, Sch Med, Dept Med, Omaha, NE USA. RP Smetana, GW (reprint author), Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, 330 Brookline Ave, Boston, MA 02215 USA. EM gsmetana@bidmc.harvard.edu NR 99 TC 63 Z9 63 U1 1 U2 14 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610-0946 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD JAN 8 PY 2007 VL 167 IS 1 BP 10 EP 20 DI 10.1001/archinte.167.1.10 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 123ZK UT WOS:000243336200002 PM 17210873 ER PT J AU Pine, M Jordan, HS Elixhauser, A Fry, DE Hoaglin, DC Jones, B Meimban, R Warner, D Gonzales, J AF Pine, Michael Jordan, Harmon S. Elixhauser, Anne Fry, Donald E. Hoaglin, David C. Jones, Barbara Meimban, Roger Warner, David Gonzales, Junius TI Enhancement of claims data to improve risk adjustment of hospital mortality SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; HEART-FAILURE; VETERANS-AFFAIRS; CABG SURGERY; MODEL; RATES; SEVERITY; QUALITY; CARE; PREDICTIONS AB Context Comparisons of risk-adjusted hospital performance often are important components of public reports, pay-for-performance programs, and quality improvement initiatives. Risk-adjustment equations used in these analyses must contain sufficient clinical detail to ensure accurate measurements of hospital quality. Objective To assess the effect on risk-adjusted hospital mortality rates of adding present on admission codes and numerical laboratory data to administrative claims data. Design, Setting, and Patients Comparison of risk-adjustment equations for inpatient mortality from July 2000 through June 2003 derived by sequentially adding increasingly difficult-to-obtain clinical data to an administrative database of 188 Pennsylvania hospitals. Patients were hospitalized for acute myocardial infarction, congestive heart failure, cerebrovascular accident, gastrointestinal tract hemorrhage, or pneumonia or underwent an abdominal aortic aneurysm repair, coronary artery bypass graft surgery, or craniotomy. Main Outcome Measures C statistics as a measure of the discriminatory power of alternative risk-adjustment models ( administrative, present on admission, laboratory, and clinical for each of the 5 conditions and 3 procedures). Results The mean (SD) c statistic for the administrative model was 0.79 (0.02). Adding present on admission codes and numerical laboratory data collected at the time of admission resulted in substantially improved risk-adjustment equations ( mean [ SD] c statistic of 0.84 [0.01] and 0.86 [ 0.01], respectively). Modest additional improvements were obtained by adding more complex and expensive to collect clinical data such as vital signs, blood culture results, key clinical findings, and composite scores abstracted from patients' medical records ( mean [ SD] c statistic of 0.88 [ 0.01]). Conclusions This study supports the value of adding present on admission codes and numerical laboratory values to administrative databases. Secondary abstraction of difficult-to-obtain key clinical findings adds little to the predictive power of risk-adjustment equations. C1 Michael Pine & Associates Inc, Chicago, IL USA. Univ Chicago, Pritzker Sch Med, Dept Med, Chicago, IL 60637 USA. Abt Associates Inc, Cambridge, MA 02138 USA. Tufts Univ, Sch Med, Boston, MA 02111 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Pine, M (reprint author), 1210 Chicago Ave,Suite 503, Evanston, IL 60202 USA. EM mpine@aol.com NR 42 TC 185 Z9 185 U1 1 U2 11 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610-0946 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 3 PY 2007 VL 297 IS 1 BP 71 EP 76 DI 10.1001/jama.297.1.71 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 123BS UT WOS:000243271900023 PM 17200477 ER PT J AU Coben, JH Steiner, CA Miller, TR AF Coben, Jeffrey H. Steiner, Claudia A. Miller, Ted R. TI Characteristics of motorcycle-related hospitalizations: Comparing states with different helmet laws SO ACCIDENT ANALYSIS AND PREVENTION LA English DT Article DE motorcycles; injuries; hospitalizations; helmets ID ECONOMIC-IMPACT; UNITED-STATES; TRAUMA; INJURIES; RATES AB This study compares U.S. motorcycle-related hospitalizations across states with differing helmet laws. Cross-sectional analyses of hospital discharge data from 33 states participating in the Healthcare Cost and Utilization Project in 2001 were conducted. Results revealed that motorcyclists hospitalized from states without universal helmet laws are more likely to die during the hospitalization, sustain severe traumatic brain injury, be discharged to long-term care facilities, and lack private health insurance. This study further illustrates and substantiates the increased burden of hospitalization and long-term care seen in states that lack universal motorcycle helmet use laws. (c) 2006 Elsevier Ltd. All rights reserved. C1 W Virginia Univ, Dept Emergency Med, Injury Control Res Ctr, Morgantown, WV 26506 USA. W Virginia Univ, Dept Community Med, Injury Control Res Ctr, Morgantown, WV 26506 USA. US Dept Hlth & Human Serv, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. Pacific Inst Res & Evaluat, Calverton, MD USA. RP Coben, JH (reprint author), W Virginia Univ, Dept Emergency Med, Injury Control Res Ctr, POB 9151, Morgantown, WV 26506 USA. EM jcoben@hsc.wvu.edu OI Miller, Ted/0000-0002-0958-2639 NR 30 TC 34 Z9 35 U1 0 U2 2 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0001-4575 J9 ACCIDENT ANAL PREV JI Accid. Anal. Prev. PD JAN PY 2007 VL 39 IS 1 BP 190 EP 196 DI 10.1016/j.aap.2006.06.018 PG 7 WC Ergonomics; Public, Environmental & Occupational Health; Social Sciences, Interdisciplinary; Transportation SC Engineering; Public, Environmental & Occupational Health; Social Sciences - Other Topics; Transportation GA 130UT UT WOS:000243825200023 PM 16920053 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Commentary - Emergency departments in crisis: Implications for accessibility, quality, and safety SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 10 TC 3 Z9 3 U1 1 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD JAN-FEB PY 2007 VL 22 IS 1 BP 59 EP 62 DI 10.1177/1062860606296900 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 126JM UT WOS:000243509200009 PM 17227879 ER PT J AU Bins, HJ Lanier, D Pace, WD Galliher, JM Ganiats, TG Grey, M Ariza, AJ Williams, R AF Bins, Helen J. Lanier, David Pace, Wilson D. Galliher, James M. Ganiats, Theodore G. Grey, Margaret Ariza, Adolfo J. Williams, Robert CA PRINS TI Describing primary care encounters: The Primary Care Network Survey and the National Ambulatory Medical Care Survey SO ANNALS OF FAMILY MEDICINE LA English DT Article DE practice-based research; health care delivery; health services research; primary care; ambulatory care; office visits; physicians; allied health personnel; prevention; survey methods ID FAMILY PHYSICIANS; CLINICAL-RESEARCH; PRACTITIONERS; PREVALENCE; CHILDREN; TRIALS; VISITS AB PURPOSE The purpose of this study was to describe clinical encounters in primary care research networks and compare them with those of the National Ambulatory Medical Care Survey (NAMCS). METHODS Twenty US primary care research networks collected data on clinicians and patient encounters using the Primary Care Network Survey (PRINS) Clinician Interview (PRINS-1) and Patient Record (PRINS-2), which were newly developed based on NAMCS tools. Clinicians completed a PRINS-1 about themselves and a PRINS-2 for each of 30 patient visits. Data included patient characteristics; reason for the visit, diagnoses, and services ordered or performed. We compared PRINS data with data obtained from primary care physicians during 5 cycles of NAMCS (1997-2001). Data were weighted; PRINS reflects participating networks and NAMCS provides national estimates. RESULTS By discipline, 89% of PRINS clinicians were physicians, 4% were physicians in residency training, 5% were advanced practice nurses/nurse-practitioners, and 2% were physician's assistants. The majority (53%) specialized in pediatrics (34% specialized in family medicine, 9% in internal medicine, and 4% in other specialties). All NAMCS clinicians were physicians, with 20% specializing in pediatrics. When NAMCS and PRINS visits were compared, larger proportions of PRINS visits involved preventive care and were made by children, members of minority racial groups, and individuals who did not have private health insurance. A diagnostic or other assessment service was performed for 99% of PRINS visits and 76% of NAMCS visits (95% confidence interval, 74.9%-78.0%). A preventive or counseling/education service was provided at 64% of PRINS visits and 37% of NAMCS visits (95% confidence interval, 35.1%-38.0%). CONCLUSIONS PRINS presents a view of diverse primary care visits and differs from NAMCS in its methods and findings. Further examinations of PRINS data are needed to assess their usefulness for describing encounters that occur in primary care research networks. C1 Northwestern Univ, Feinberg Sch Med, PPR,Childrens Mem Hosp, Mary Ann & J Milburn Msith Child Hlth Res Program, Evanston, IL 60208 USA. Northwestern Univ, Feinberg Sch Med, Dept Pediat, Evanston, IL 60208 USA. Agcy Healthcare Res & Qual, Qual, Rockville, MD USA. Univ Colorado, Hlth Sci Ctr, Dept Family Med, CaReNet, Aurora, CO USA. Univ Missouri, Dept Sociol, Columbia, MO 65211 USA. Univ Missouri, AAFP NRN, Columbia, MO 65211 USA. Univ Calif San Diego, SURF NET, La Jolla, CA 92093 USA. Yale Univ, Sch Nursing, APRNet, New Haven, CT 06520 USA. RP Bins, HJ (reprint author), 2300 Childrens Plaza,157, Chicago, IL 60614 USA. EM hbinns@northwestern.edu NR 27 TC 0 Z9 0 U1 0 U2 1 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672 USA SN 1544-1709 EI 1544-1717 J9 ANN FAM MED JI Ann. Fam. Med. PD JAN-FEB PY 2007 VL 5 IS 1 BP 39 EP 47 DI 10.1370/afm.620 PG 9 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 139YU UT WOS:000244469700007 ER PT J AU Choi, W Liang, L AF Choi, William Liang, Lan TI Reverse moral hazard of liability insurers: evidence from medical malpractice claims SO APPLIED ECONOMICS LA English DT Article ID SAMPLE SELECTION; LITIGATION; SETTLEMENT; RESOLUTION; DISPUTES AB This study investigates putative differences in the legal defense of medical malpractice claims between liability carriers with distinct ownership forms: doctor-controlled and commercial-stock. The scope of a carrier's legal defense is determined by claim characteristics, such as injury severity and liability, and possibly the doctor's private costs from settling or losing a claim. When a carrier does not internalize the doctor's private costs from losing or settling a claim, then a conflict of interest arises as the carrier provides a lower level of legal defense than preferred by the doctor (i.e., reverse moral hazard). The perception is that doctor-sponsored carriers mitigate such conflicts of interest. If this is the case, we should expect to see differences in the amount spent by the carrier in defense of the doctor and the propensity to settle claims. To test these expectations, we use medical malpractice claims filed in Florida between 1985 and 1990. We indeed find differences in legal defense in terms of amount spent on legal defense and settlement rate between carriers with different ownership. The doctor-sponsored carrier we investigated was less likely to settle out-of-court, and did spend more on a doctor's legal defense than stock carriers. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Econ One Res Inc, Los Angeles, CA USA. RP Liang, L (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM lliang@ahrq.gov NR 28 TC 2 Z9 2 U1 0 U2 1 PU ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD PI ABINGDON PA 4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXFORDSHIRE, ENGLAND SN 0003-6846 J9 APPL ECON JI Appl. Econ. PY 2007 VL 39 IS 18 BP 2331 EP 2340 DI 10.1080/00036840500427080 PG 10 WC Economics SC Business & Economics GA 230NG UT WOS:000250882600004 ER PT S AU Mutter, RL Rosko, MD AF Mutter, Ryan L. Rosko, Michael D. BE Blank, JLT Valdmanis, VG TI THE IMPACT OF OWNERSHIP ON THE COST-EFFICIENCY OF US HOSPITALS SO EVALUATING HOSPITAL POLICY AND PERFORMANCE: CONTRIBUTIONS FROM HOSPITAL POLICY AND PRODUCTIVITY RESEARCH SE Advances in Health Economics and Health Services Research LA English DT Article; Book Chapter ID FOR-PROFIT; MANAGED CARE; TECHNICAL EFFICIENCY; UNCOMPENSATED CARE; HEALTH-CARE; HMO PENETRATION; FRONTIER MODELS; UNITED-STATES; NONPROFIT; CONVERSIONS C1 [Mutter, Ryan L.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Mutter, Ryan L.] Univ Maryland Baltimore Cty, Dept Publ Policy, Baltimore, MD 21228 USA. [Rosko, Michael D.] Widener Univ, Chester, PA 19013 USA. RP Mutter, RL (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. NR 76 TC 3 Z9 3 U1 0 U2 1 PU EMERALD GROUP PUBLISHING LIMITED PI BINGLEY PA HOWARD HOUSE, WAGON LANE, BINGLEY, W YORKSHIRE BD16 1WA, ENGLAND SN 0731-2199 BN 978-0-7623-1453-9 J9 ADV HEALTH ECON HEAL PY 2007 VL 18 BP 113 EP 138 DI 10.1016/S0731-2199(07)00007-6 PG 26 WC Economics; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA BLS56 UT WOS:000270947100008 ER PT J AU Zuvekas, SH Cohen, JW AF Zuvekas, Samuel H. Cohen, Joel W. TI Prescription drugs and the changing concentration of health care expenditures SO HEALTH AFFAIRS LA English DT Article AB Health care expenditures are highly concentrated in the United States, with a small fraction of the population accounting for a large share of total health spending. This concentration has proved remarkably stable over time; however, the degree of concentration has declined over the past decade. Using data from the 1996-2003 Medical Expenditure Panel Survey (MEPS), we explore why. We find that rapid growth in prescription drug spending, which is diffused over a large fraction of the population, versus slower growth in spending for inpatient care largely accounts for the recent change in concentration. We discuss the potential implications for current cost containment and reform efforts. C1 AHRQ, Ctr Financing Access & Cost Trends, Div Social & Econ Res, Rockville, MD USA. RP Zuvekas, SH (reprint author), AHRQ, Ctr Financing Access & Cost Trends, Div Social & Econ Res, Rockville, MD USA. EM szuvekas@ahrq.gov NR 9 TC 38 Z9 38 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2007 VL 26 IS 1 BP 249 EP 257 DI 10.1377/hlthaff.26.1.249 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 136LF UT WOS:000244223200028 PM 17211035 ER PT J AU Zhan, CL AF Zhan, Chunliu TI Adverse events: The authors respond SO HEALTH AFFAIRS LA English DT Letter C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2007 VL 26 IS 1 BP 293 EP 294 DI 10.1377/hlthaff.26.1.293-a PG 2 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 136LF UT WOS:000244223200036 ER PT J AU Merenstein, D Meyers, D Krist, A Delgado, J McCann, J Petterson, S Phillips, RL AF Merenstein, Dan Meyers, David Krist, Alex Delgado, Jose McCann, Jessica Petterson, Stephen Phillips, Robert L., Jr. TI How well do family physicians manage skin lesions? SO JOURNAL OF FAMILY PRACTICE LA English DT Article ID PRIMARY-CARE PHYSICIANS; DERMATOLOGISTS; DISEASE; NONDERMATOLOGISTS; RECOGNIZE; DIAGNOSES; MELANOMA; ABILITY; CANCER C1 Johns Hopkins Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, Baltimore, MD USA. Georgetown Univ, Dept Family Med, Washington, DC USA. US Dept HHS, Agcy Healthcare Res & Qual, Bethesda, MD USA. Virginia Commonwealth Univ, Dept Family Med, Richmond, VA 23284 USA. Robert Graham Ctr Policy Studies Family Med & Pri, Washington, DC USA. RP Merenstein, D (reprint author), 215 Kober Cogan Hall,3750 Reservoir Rd,NW, Washington, DC 20007 USA. EM djm23@georgetown.edu NR 22 TC 1 Z9 1 U1 2 U2 3 PU DOWDEN HEALTH MEDIA PI MONTVALE PA 110 SUMMIT AVE, MONTVALE, NJ 07645-1712 USA SN 0094-3509 J9 J FAM PRACTICE JI J. Fam. Pract. PD JAN PY 2007 VL 56 IS 1 BP 40 EP 45 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 196XS UT WOS:000248517200011 PM 17217897 ER PT J AU Brown, TT Finlayson, TL Scheffler, RM AF Brown, Timothy T. Finlayson, Tracy L. Scheffler, Richard M. TI How do we measure shortages of dental hygienists and dental assistants? Evidence from California: 1997-2005 SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article DE dental hygienists; dental assistants; labor shortage AB Background. The authors examined the labor market for registered dental hygienists;(RDHs) and dental assistants (DAs) in California from 1997 to 2005 to =determine whether there was a shortage in either market. Methods. This analysis used economic indicators interpreted within an economic framework to investigate trends in labor force numbers and market-determined wages for RDHs and DAs. Rising inflation-adjusted mean wages indicated a labor shortage, while declining inflation-adjusted mean wages indicated a labor surplus. , Results. From 1999 to 2002, the wages for RDHs increased 48 percent and then stabilized, indicating a shortage had occurred, after which the market achieved equilibrium. Wages for DAs increased 13.9 percent from 1997 to 2001 but then declined from 2001 to 2005 indicating a shortage that then became a surplus. The market for DAs may not have stabilized: Conclusions. Wages increased for RDHs and DAs, suggesting that. , labor shortages occurred in both markets: The large supply response in the market for DAs resulted in wages declining after their initial rise. Practice Implications. Tracking the local labor markets for RDHs and DAs will enable dental professionals to respond more efficiently to market signals. C1 Univ Calif Berkeley, Sch Publ Hlth, Nicholas C Petris Ctr Hlth Care Markets & Consume, Berkeley, CA 94720 USA. Univ Calif Berkeley, Sch Publ Hlth, Agcy Healthcare Res & Qual, Berkeley, CA 94720 USA. Univ Calif Berkeley, Sch Publ Hlth, Nicholas C Petris Ctr Hlth Care Mkt & Consumer We, Berkeley, CA 94720 USA. RP Brown, TT (reprint author), Univ Calif Berkeley, Sch Publ Hlth, Nicholas C Petris Ctr Hlth Care Markets & Consume, 140 Earl Warren Hall,MC7360, Berkeley, CA 94720 USA. EM tbpetris@berkeley.edu NR 13 TC 2 Z9 2 U1 0 U2 0 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD JAN PY 2007 VL 138 IS 1 BP 94 EP 100 PG 7 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 127PI UT WOS:000243598400023 PM 17197408 ER PT J AU McCormick, KA Delaney, CJ Brennan, PF Effken, JA Kendrick, K Murphy, J Skiba, DJ Warren, JJ Weaver, CA Weiner, B Westra, BL AF McCormick, Kathleen A. Delaney, Connie J. Brennan, Patricia Flatley Effken, Judith A. Kendrick, Kathie Murphy, Judy Skiba, Diane J. Warren, Judith J. Weaver, Charlotte A. Weiner, Betsy Westra, Bonnie L. TI Guideposts to the future - An agenda for nursing informaties SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article AB As new directions and priorities emerge in health care, nursing informatics leaders must prepare to guide the profession appropriately. To use an analogy, where a road bends or changes directions, guideposts indicate how drivers can stay on course. The AMIA Nursing Informatics Working Group (NIWG) produced this white paper as the product of a meeting convened: 1) to describe anticipated nationwide changes in demographics, health care quality, and health care informatics; 2) to assess the potential impact of genomic medicine and of new threats to society; 3) to align AMIA NIWG resources with emerging priorities; and 4) to identify guideposts in the form of an agenda to keep the NIWG on course in light of new opportunities. The anticipated societal changes provide opportunities for nursing informatics. Resources described below within the Department of Health and Human Services (HHS) and the National Committee for Health and Vital Statistics (NCVHS) can help to align AMIA NIWG with emerging priorities. The guideposts consist of priority areas for action in informatics, nursing education, and research. Nursing informatics professionals will collaborate as full participants in local, national, and international efforts related to the guideposts in order to make significant contributions that empower patients and providers for safer health care. C1 SAIC Hlth Solut, Brown Operat, Falls Church, VA 22041 USA. Univ Minnesota, Sch Nursing, Minneapolis, MN 55455 USA. Univ Wisconsin, Coll Engn, Madison, WI USA. Univ Arizona, Coll Nursing, Tucson, AZ 85721 USA. Agcy Healthcare Res & Qual, Off Performance Accountabil Resources & Technol, Rockville, MD USA. Aurora Hlth Care, Milwaukee, WI USA. Univ Colorado, Sch Nursing, Denver, CO 80202 USA. Univ Kansas, Sch Nursing, Kansas City, KS USA. Cerner Corp, Kansas City, MO USA. Vanderbilt Univ, Nashville, TN USA. RP McCormick, KA (reprint author), SAIC Hlth Solut, Brown Operat, 5203 Leesburg Pike,Suite 1477, Falls Church, VA 22041 USA. EM kathleen.a.mccormick@saic.com NR 21 TC 13 Z9 14 U1 1 U2 5 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD JAN-FEB PY 2007 VL 14 IS 1 BP 19 EP 24 DI 10.1197/jamia.M1996 PG 6 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA 127FT UT WOS:000243571400004 PM 17068358 ER PT J AU Zuvekas, SH Rupp, A Norquist, G AF Zuvekas, Samuel H. Rupp, Agnes Norquist, Grayson TI Cost shifting under managed behavioral health care SO PSYCHIATRIC SERVICES LA English DT Article ID LARGE EMPLOYER GROUP; MENTAL-HEALTH; OUT PLAN; MASSACHUSETTS; DEPRESSION; SERVICES; DISORDERS; IMPACTS; PARITY AB Objective: The study examined whether a managed behavioral health care organization (MBHO) shifted treatment costs. Methods: Four years of claims data (1991-1995) from an insurer that introduced an MBHO in 1992 to control treatment costs were analyzed. Although the MBHO was not at direct financial risk for specialty mental health treatment, it faced incentives related to reputation and contract renewal to shift costs to primary care treatment or prescription drugs. it was hypothesized that if cost shifting occurred, an increase would be noted in the use of psychotropic medications without concurrent use of specialty mental health treatment. Simple t tests and a generalized estimating equations probit specification were used to test this hypothesis. Separate tests were performed for use of any psychotropic medication, any newer antidepressant, and any stimulant in a large employer group that simultaneously implemented parity coverage (75,360 enrollees) and a group of smaller employers that did not (9,228 enrollees). Results: The use of any psychotropic medication rose 64% in relative terms (p <.001) over the four-year period among enrollees of the large employer group and by 87% in the smaller groups (p <.001). In general, there were downward secular trends in the use of psychotropic medications without specialty care. Introduction of the MBHO was not significantly associated with the use of psychotropic medication alone. For newer antidepressants, introduction of the MBHO Was associated in the large group with a 2.4 (p=.003) absolute percentage point decrease in medication use alone. Conclusions: No evidence was found to suggest that the MBHO shifted treatment costs. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. NIMH, Div Serv & Intervent Res, Bethesda, MD 20892 USA. Univ Mississippi, Dept Psychiat & Human Behav, Jackson, MS 38677 USA. RP Zuvekas, SH (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM szuvekas@ahrq.gov NR 35 TC 3 Z9 3 U1 0 U2 2 PU AMER PSYCHIATRIC PUBLISHING, INC PI ARLINGTON PA 1000 WILSON BOULEVARD, STE 1825, ARLINGTON, VA 22209-3901 USA SN 1075-2730 J9 PSYCHIAT SERV JI Psychiatr. Serv. PD JAN PY 2007 VL 58 IS 1 BP 100 EP 108 PG 9 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA 124QE UT WOS:000243384200015 PM 17215419 ER PT J AU Teresi, JA Fleishman, JA AF Teresi, Jeanne A. Fleishman, John A. TI Differential item functioning and health assessment SO QUALITY OF LIFE RESEARCH LA English DT Article; Proceedings Paper CT National-Institutes-of-Health Conference on Patient Reported Outcomes CY JUN, 2004 CL Bethesda, MD SP Natl Inst Hlth DE differential item functioning; measurement equivalence; health ID MENTAL-STATE-EXAMINATION; STANDARDIZATION APPROACH; ACHIEVEMENT-TESTS; MANTEL-HAENSZEL; DFIT FRAMEWORK; DIF DETECTION; I ERROR; BIAS; PERFORMANCE; SIMULATION AB Establishing measurement equivalence is important because inaccurate assessment may lead to incorrect estimates of effects in research, and to suboptimal decisions at the individual, clinical level. Examination of differential item functioning (DIF) is a method for studying measurement equivalence. An item (i.e., one question in a longer scale) exhibits DIF if the item response differs across groups (e.g., gender, race), controlling for an estimate of the construct being measured. A distinction between applications in health, as contrasted with other settings such as educational and aptitude testing, is that there are many health-related constructs and multiple measures of each, few of which have received much critical evaluation. Discussed in this article are several methods for detection of differential item functioning (DIF), including non-parametric and parametric methods such as logistic regression, and those based on item response theory. Basic definitions and criteria for DIF detection are provided, as are steps in performing the analyses. Recommendations are presented and future directions discussed. C1 Div Res, Bronx, NY 10471 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. New York State Psychiat Inst & Hosp, Columbia Univ Stroud Ctr, New York, NY 10032 USA. New York State Psychiat Inst & Hosp, Fac Med, New York, NY 10032 USA. RP Teresi, JA (reprint author), Div Res, 5901 Palisade Ave, Bronx, NY 10471 USA. EM Teresimeas@aol.com FU NIA NIH HHS [AG15294]; NIAMS NIH HHS [AR052177] NR 55 TC 90 Z9 91 U1 3 U2 7 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0962-9343 J9 QUAL LIFE RES JI Qual. Life Res. PY 2007 VL 16 SU 1 BP 33 EP 42 DI 10.1007/s11136-007-9184-6 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 194VJ UT WOS:000248371600004 PM 17443420 ER PT J AU Reeve, BB Burke, LB Chiang, YP Clauser, SB Colpe, LJ Elias, JW Fleishman, J Hohmann, AA Johnson-Taylor, WL Lawrence, W Claudia, SM Quatrano, LA Riley, WT Smothers, BA Werner, EM AF Reeve, Bryce B. Burke, Laurie B. Chiang, Yen-Pin Clauser, Steven B. Colpe, Lisa J. Elias, Jeffrey W. Fleishman, John Hohmann, Ann A. Johnson-Taylor, Wendy L. Lawrence, William Claudia, S. Moy Quatrano, Louis A. Riley, William T. Smothers, Barbara A. Werner, Ellen M. TI Enhancing measurement in health outcomes research supported by Agencies within the US Department of Health and Human Services SO QUALITY OF LIFE RESEARCH LA English DT Article DE item response theory; computerized adaptive testing; patient-reported outcomes; health-related quality of life ID CONSUMER ASSESSMENT; OBESITY; CARE; PERCEPTIONS; DIAGNOSIS; CRITERIA; MODELS; PLANS AB Many of the Institutes, Agencies and Centers that make up the US Department of Health and Human Services (DHHS) have recognized the need for better instrumentation in health outcomes research, and provide support, both internally and externally, for research utilizing advances in measurement theory and computer technology (informatics). In this paper, representatives from several DHHS agencies and institutes will discuss their need for better instruments within their discipline and describe current or future initiatives for exploring the benefits of these technologies. Together, the perspectives underscore the importance of developing valid, precise, and efficient measures to capture the full burden of disease and treatment on patients. Initiatives, like the Patient-Reported Outcomes Measurement Information System (PROMIS) to create health-related quality of life item banks, represent a trans-DHHS effort to develop a standard set of measures for informing decision making in clinical research, practice, and health policy. C1 NCI, Outcomes Res Branch, Appl Res Program, Div Canc Control & Populat Sci,NIH, Bethesda, MD 20892 USA. US FDA, Rockville, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NIH, Rockville, MD USA. Natl Inst Aging, Bethesda, MD USA. NIMH, Bethesda, MD 20892 USA. Div Nutr Res Coordinat, Bethesda, MD USA. Natl Inst Neurol Disorders & Stroke, Bethesda, MD USA. Natl Ctr Med Rehabil Res, Bethesda, MD USA. NICHHD, Bethesda, MD 20892 USA. NINR, Bethesda, MD 20892 USA. NHLBI, Bethesda, MD 20892 USA. RP Reeve, BB (reprint author), NCI, Outcomes Res Branch, Appl Res Program, Div Canc Control & Populat Sci,NIH, EPN 4005,6130 Execut Blvd,MSC 7344, Bethesda, MD 20892 USA. EM reeveb@mail.nih.gov NR 51 TC 21 Z9 23 U1 0 U2 5 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0962-9343 J9 QUAL LIFE RES JI Qual. Life Res. PY 2007 VL 16 SU 1 BP 175 EP 186 DI 10.1007/s11136-007-9190-8 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 194VJ UT WOS:000248371600015 PM 17530449 ER PT J AU Kjerulff, KH Frick, KD Rhoades, JA Hollenbeak, CS AF Kjerulff, Kristen H. Frick, Kevin D. Rhoades, Jeffrey A. Hollenbeak, Christopher S. TI The cost of being a woman - A national study of health care utilization and expenditures for female-specific conditions SO WOMENS HEALTH ISSUES LA English DT Article ID UNITED-STATES; GYNECOLOGIC DISORDERS; WOMEN; AGE AB Purpose. An important component of women's health care is for conditions that are exclusive to women, yet little research has addressed the economic impact of health care for these conditions. The purpose of this study was to describe health care utilization for female-specific conditions, the incremental expenditures attributable to these conditions, and the overall incremental expenditures across the lifespan. Methods. We analyzed 3 years of a nationally representative survey of the US noninstitutionalized population, the 2000-2002 National Medical Expenditure Panel Survey, which included 25,361 females aged >= 14, representing 38,170 person-years. Results. More than one fifth of women (21.2%) reported having a female-specific condition during a 1-year period, the most common of which were gynecologic disorders (7.4%); pregnancy-related conditions (6.4%); and menopausal symptoms (5.3%). The mean increment in annual total expenditures attributable to female-specific conditions ranged from $483 for menopausal disorders to $3,896 for female cancers. The annual total health care expenditures of women with female-specific conditions were estimated to be $108 billion, of which > 40% ($43.3 billion) was attributable to female-specific conditions. Women with female-specific conditions who had no health insurance were less likely to have visited a doctor (p = .0002), filled a prescription (p = .001), and been hospitalized (p = .0001) for these conditions, but more likely to have visited an emergency department (p = .02) seeking treatment for these conditions. Conclusions. In this nationally representative sample of American women aged 2:14, female/specific conditions were common and substantially increased costs of health care. C1 Penn State Univ, Coll Med, Dept Hllth Evaluat Sci, Hershey, PA 17033 USA. Penn State Univ, Coll Med, Dept Obstet & Gynecol, Hershey, PA 17033 USA. Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. Penn State Univ, Coll Med, Dept Surg, Hershey, PA 17033 USA. RP Kjerulff, KH (reprint author), Penn State Univ, Coll Med, Dept Hllth Evaluat Sci, A210,600 Centerview Dr,POB 855, Hershey, PA 17033 USA. EM khk2@psu.edu FU AHRQ HHS [R03HS013057] NR 24 TC 23 Z9 23 U1 0 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD JAN-FEB PY 2007 VL 17 IS 1 BP 13 EP 21 DI 10.1016/j.whi.2006.11.004 PG 9 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 145QC UT WOS:000244878600003 PM 17321943 ER PT J AU Banthin, JS Bernard, DM AF Banthin, Jessica S. Bernard, Didem M. TI Changes in financial burdens for health care - National estimates for the population younger than 65 years, 1996 to 2003 SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID EXPENDITURE BURDENS; COVERAGE; ADULTS AB Context Policymakers as well as physicians need to understand how rapidly rising health care costs are affecting specific groups of patients. Objective To estimate the number and characteristics of individuals in the United States faced with very high financial burdens for health care. Design, Setting, and Population Data from a nationally representative sample of civilian, noninstitutionalized US individuals younger than 65 years from the Medical Expenditure Panel Surveys were used to calculate 2 measures of financial burden as a function of tax-adjusted family income. Total burden included all out-of-pocket expenditures for health care services, including premiums. Health care services burden excluded premiums and, when applied to the insured population, was used to identify the underinsured. We defined the underinsured as insured persons with health care service burdens in excess of 10% of tax-adjusted family income. Main Outcome Measures Total and health care services burdens exceeding 10% and 20% of family income in 1996 and 2003. Results In 2003, there were 48.8 million individuals (19.2%) living in families spending more than 10% of family income on health care, an increase of 11.7 million persons since 1996. Of these individuals, about 18.7 million (7.3%) were spending more than 20% of family income. In 2003, individuals with higher-than-average risk of incurring high total burdens included poor and low-income persons and those with non-group coverage, aged 55 to 64 years, living in a non - metropolitan statistical area, in fair or poor health, having any type of limitation, or having a chronic medical condition. Applying our definition of underinsured to the insured population, an estimated 17.1 million persons younger than 65 years were underinsured in 2003, including 9.3 million persons with private employment-related insurance, 1.3 million persons with private nongroup policies, and 6.6 million persons with public coverage. Conclusions Our analysis identifies patients at greatest risk of health-related financial burdens that may adversely affect their access and adherence to recommended treatments. Our study also highlights the high costs associated with nongroup health insurance policies. C1 US Dept HHS, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Banthin, JS (reprint author), US Dept HHS, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jessica.Banthin@ahrq.hhs.gov NR 16 TC 103 Z9 103 U1 0 U2 4 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610-0946 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD DEC 13 PY 2006 VL 296 IS 22 BP 2712 EP 2719 DI 10.1001/jama.296.22.2712 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 115WY UT WOS:000242765700026 PM 17164457 ER PT J AU Genkinger, JM Jehn, ML Sapun, M Mabry, I Young, DR AF Genkinger, JM Jehn, ML Sapun, M Mabry, I Young, DR TI Does weight status influence perceptions of physical activity barriers among African-American women? SO ETHNICITY & DISEASE LA English DT Article DE African-American women; barriers; obesity; physical activity ID NUTRITION EXAMINATION SURVEY; 3RD NATIONAL-HEALTH; US ADULTS; LEISURE-TIME; SOCIAL-CLASS; BLACK-WOMEN; EXERCISE; INACTIVITY; POLICY; RISK AB Background: Many African-American women fail to participate in regular physical activity. Weight status may influence physical activity barriers. This study examined the frequency and type of barriers. Methods: Participants in this study were enrolled in Project EXE-L (Exercising Ladies Excel), a six-month, church-based, randomized trial of moderate-intensity physical activity based in Baltimore city and county in Maryland. Participants were composed of African-American women who attended one of the participating churches, had friends who were church members, or who lived in neighborhoods surrounding one of the churches. individuals who were between the ages of 25 and 70 years, were not regularly physically active (defined as not engaging in moderate-intensity activity more than three times per week), and were able to participate in moderate-intensity activity met eligibility criteria to participate in the trial. Barriers to physical activity were evaluated with the Steinhardt/Dishman Barriers for Habitual Physical Activity Scale at baseline. Results: One hundred twenty women were classified as normal weight (body mass index [BMI]: < 25 kg/m(2)), overweight (BMI: 25-29.9 kg/m(2)), or obese (BMI: >= 30 kg/m(2)). Obese participants were more likely to report "lack of motivation" as a barrier compared with normal-weight participants (63% vs 31%). Normal-weight and overweight participants were more likely to report no barriers compared with the obese (31%, 0%, 5%, respectively, P <.05). Conclusions: Barriers for African-American women may vary by BMI status. By defining these unique barriers, effective physical activity interventions can be developed. C1 Univ Maryland, Dept Kinesiol, College Pk, MD 20742 USA. Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA. Arizona State Univ, Sch Hlth Management & Policy, WP Carey Sch Business, Tempe, AZ USA. Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. RP Young, DR (reprint author), Univ Maryland, Dept Kinesiol, 2312 HHP, College Pk, MD 20742 USA. EM dryoung@umd.edu FU NCRR NIH HHS [5M01RR02715]; NHLBI NIH HHS [R29 HL56968] NR 29 TC 14 Z9 14 U1 4 U2 5 PU INT SOC HYPERTENSION BLACKS-ISHIB PI ATLANTA PA 100 AUBURN AVE NE STE 401, ATLANTA, GA 30303-2527 USA SN 1049-510X J9 ETHNIC DIS JI Ethn. Dis. PD WIN PY 2006 VL 16 IS 1 BP 78 EP 84 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 005RH UT WOS:000234841000012 PM 16599352 ER PT J AU Turner, BJ Fleishman, JA AF Turner, Barbara J. Fleishman, John A. TI Effect of dysthymia on receipt of HAART by minority HIV-infected women SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article; Proceedings Paper CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med DE HIV; AIDS; HAART; dysthymia; disparities; women ID ACTIVE ANTIRETROVIRAL THERAPY; NATIONAL PROBABILITY SAMPLES; LOW-PREVALENCE DISEASES; QUALITY-OF-LIFE; UNITED-STATES; SERVICES UTILIZATION; DEPRESSIVE SYMPTOMS; PRIMARY-CARE; DRUG-USERS; PSYCHIATRIC-DISORDERS AB BACKGROUND: Receipt of highly active antiretroviral therapy (HAART) differs by gender and racial/ethnic group and may reflect an effect of mood disorders. OBJECTIVE: We examined the effects of dysthymia and major depression on HAART use by 6 groups defined by gender and race/ethnicity (white, black, Hispanic). MAIN OUTCOME MEASURE: Self-reported HAART use in the past 6 months. DATA SOURCE: Interview data from the HIV Cost and Services Utilization Study (HCSUS). Independent variables measured in or before the first half of 1997, and HAART use measured in the second half of 1997. ANALYSIS: Multivariate logistic regression of depression and dysthymia on HAART use by 6 patient groups. PARTICIPANTS: One thousand nine hundred and eighty-two HIV-infected adults in HIV care in 1996 and with a CD4 count < 500 in 1997. RESULTS: Highly active antiretroviral therapy receipt was the highest for white men (68.6%) and the lowest for Hispanic women (52.7%) and black women (55.4%). Dysthymia was more prevalent in women (Hispanic, 46%; black, 27%; white, 31%) than men (Hispanic, 23%; black, 18%; white, 15%). The prevalence of major depression was greater in whites (women, 35%; men, 31%) than minorities (women, 26%; men, 21%). Compared with white men without dysthymia, the adjusted odds ratios (AORs) of HAART were significantly lower for black women (0.50 [95% confidence interval [95% CI] 0.29 to 0.87]) and Hispanic women (0.45 [95% CI 0.25, 0.79]). Among patients with depression and no dysthymia, minority women had HAART use (AOR=1.28 [95% CI 0.48 to 3.43]) similar to white men. LIMITATIONS: Self-report data from the early era of HAART use; causation cannot be proven; mental health diagnoses may not meet full DSM IV criteria. CONCLUSIONS: Dysthymia is highly prevalent in minority women and associated with a 50% reduction in the odds of receiving HAART. This underrecognized condition may contribute more than depression to the "gender disparity" in HAART use. C1 Univ Penn, Dept Med, Div, Gen Internal Med, Philadelphia, PA 19104 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Turner, BJ (reprint author), Univ Penn, Dept Med, Div, Gen Internal Med, 1123 Blockley Hall 6021,423 Guardian Dr, Philadelphia, PA 19104 USA. EM bturner@mail.med.upenn.edu FU AHRQ HHS [HS08578, U01 HS008578] NR 41 TC 6 Z9 6 U1 5 U2 7 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD DEC PY 2006 VL 21 IS 12 BP 1235 EP 1241 DI 10.1111/j.1525-1497.2006.00597.x PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 100NI UT WOS:000241675400008 PM 17105522 ER PT J AU Correa-De-Araujo, R AF Correa-De-Araujo, Rosaly TI Serious gaps: How the lack of sex/gender-based research impairs health SO JOURNAL OF WOMENS HEALTH LA English DT Editorial Material ID CORONARY-HEART-DISEASE; ACUTE MYOCARDIAL-INFARCTION; SEX-DIFFERENCES; RISK; WOMEN; DISPARITIES; STROKE; CARE; EPIDEMIOLOGY; CHOLESTEROL C1 US Dept HHS, Off Amer, Washington, DC 20201 USA. US Dept HHS, Off Secretary, Washington, DC 20201 USA. US Dept HHS, Off Global Hlth Affairs, Washington, DC 20201 USA. US Dept HHS, Agcy Healthcare Res & Qual, Washington, DC 20201 USA. RP Correa-De-Araujo, R (reprint author), Dept Hlth & Human Serv, Off Amer, 5600 Fishers Lane, Rockville, MD 20857 USA. EM rosaly.correa@hhs.gov NR 39 TC 16 Z9 17 U1 0 U2 3 PU MARY ANN LIEBERT INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1540-9996 J9 J WOMENS HEALTH JI J. Womens Health PD DEC PY 2006 VL 15 IS 10 BP 1116 EP 1122 DI 10.1089/jwh.2006.15.1116 PG 7 WC Public, Environmental & Occupational Health; Medicine, General & Internal; Obstetrics & Gynecology; Women's Studies SC Public, Environmental & Occupational Health; General & Internal Medicine; Obstetrics & Gynecology; Women's Studies GA 126GB UT WOS:000243499500003 PM 17199452 ER PT J AU Whiteman, MK Kuklina, E Hillis, SD Jamieson, DJ Meikle, SF Posner, SF Marchbanks, PA AF Whiteman, Maura K. Kuklina, Elena Hillis, Susan D. Jamieson, Denise J. Meikle, Susan F. Posner, Samuel F. Marchbanks, Polly A. TI Incidence and determinants of periparturn hysterectomy SO OBSTETRICS AND GYNECOLOGY LA English DT Article ID ASSISTED REPRODUCTIVE TECHNOLOGY; RISK-FACTORS; CESAREAN DELIVERY AB OBJECTIVE: Most studies of peripartum hysterectomy are conducted in single institutions, limiting the ability to provide national incidence estimates and examine risk factors. The objective of this study was to provide a national estimate of the incidence of peripartum hysterectomy and to examine factors associated with the procedure. METHODS: We used data for 1998-2003 from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationally representative survey of inpatient hospitalizations. Peripartum hysterectomy was defined as a hysterectomy and delivery occurring during the same hospitalization. Odds ratios (ORs) and 95% confidence intervals (Cis) were adjusted for maternal and hospital characteristics using logistic regression. RESULTS: During 1998-2003, an estimated 18,339 peripartum hysterectomies occurred in the United States (0.77 per 1,000 deliveries). Compared with vaginal delivery without a previous cesarean delivery, the ORs of peripartum hysterectomy for other delivery types were as follows: repeat cesarean, 8.90 (951% CI 8.09-9.79); primary cesarean, 6.54 (95% CI 5.95-;7.18); and vaginal birth after cesarean, 2.70 (95% CI 2.23-3.26). Multiple birth were associated with an increased risk compared with singleton births (OR 1.41, 95% CI 1.16-1.71). CONCLUSION: Our results suggest that vaginal birth after cesarean, primary and repeat cesarean deliveries, and multiple births are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern, given the increasing rate of both cesarean deliveries and multiple births in the United States. C1 Ctr Dis Control & Prevent, Div Reprod Hlth, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA 30341 USA. Comforce Tech Serv Inc, Los Angeles, CA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Whiteman, MK (reprint author), Ctr Dis Control & Prevent, Div Reprod Hlth, Natl Ctr Chron Dis Prevent & Hlth Promot, 4770 Buford Highway NE,Mailstop K-34, Atlanta, GA 30341 USA. EM acq5@cdc.gov OI Posner, Samuel/0000-0003-1574-585X NR 21 TC 53 Z9 61 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0029-7844 J9 OBSTET GYNECOL JI Obstet. Gynecol. PD DEC PY 2006 VL 108 IS 6 BP 1486 EP 1492 DI 10.1097/01.AOG.0000245445.36116.c6 PG 7 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 171XX UT WOS:000246769800021 PM 17138784 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Gordis, L Gregory, KD Harris, R Kizer, KW LeFevre, ML Loveland-Cherry, C Marion, LN Moyer, VA Ockene, JK Sawaya, GF Siu, AL Teutsch, SM Yawn, BP AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Gordis, Leon Gregory, Kimberly D. Harris, Russell Kizer, Kenneth W. LeFevre, Michael L. Loveland-Cherry, Carol Marion, Lucy N. Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Siu, Albert L. Teutsch, Steven M. Yawn, Barbara P. CA US Preventive Services Task Force TI Screening for elevated blood lead levels in children and pregnant women SO PEDIATRICS LA English DT Article DE lead levels; evidence-based medicine; screening ID PREVALENCE; CHELATION C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. NR 15 TC 8 Z9 8 U1 1 U2 1 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD DEC PY 2006 VL 118 IS 6 BP 2514 EP 2518 DI 10.1542/peds.2006-2352 PG 5 WC Pediatrics SC Pediatrics GA 111TX UT WOS:000242478900030 ER PT J AU Selden, TM AF Selden, Thomas M. TI Compliance with well-child visit recommendations: Evidence from the medical expenditure panel survey, 2000-2002 SO PEDIATRICS LA English DT Article DE well-child care; MEPS ID LOW-INCOME CHILDREN; PEDIATRIC PREVENTIVE CARE; UNITED-STATES; MANAGED CARE; HEALTH-CARE; INSURANCE-COVERAGE; ACCESS; GUIDELINES; QUALITY; EMERGENCY AB OBJECTIVES. This study examines national compliance rates with well-child visit recommendations using the Medical Expenditure Panel Survey. The Medical Expenditure Panel Survey provides nationally representative information on preventative care for children, combining visit-level data over a 2-year period with a rich array of socioeconomic and health status measures. METHODS. Visit-level data from 2000 to 2002 were used to construct a well-child visit "compliance" measure equal to well-child visits as a percentage of age-specific recommendations from the American Academy of Pediatrics. Compliance was examined across age, gender, race/ethnicity, health status, poverty, insurance coverage, eligibility for public coverage, family structure, parent education, insurance, citizenship and country of origin, language, urbanicity, and census division. RESULTS. On average, 56.3% of all children aged 0 to 18 years had no well-child visits during a 12-month period, and 39.4% had no well-child visits over a 2-year period. The average compliance ratio was 61.4%. Large differences in compliance exist among children. High compliance rates were observed among infants (83.2%), children with special health care needs (86.6%), children with college-educated parents (74.3%), children with family incomes > 4 times the poverty level (71.6%), and children in the New England (94.6%) and Middle Atlantic (83.2%) census divisions. Low levels of compliance were observed among uninsured children (35.3%) and especially uninsured children simulated to be eligible for public coverage (28.4%). Other groups with low compliance rates include teenagers (49.2%), noncitizen children (43.9%), and children in the West South Central (44.9%), East South Central (48.8%), and Mountain (49.7%) census divisions. CONCLUSIONS. Well-child visit compliance in the Medical Expenditure Panel Survey is less than found in other househould surveys, yet consistent with or above results based on data from provider and claims data. Although experts dispute the optimal frequency of well-child visits, the disparities observed in compliance rates among population subgroups raise important public health concerns. C1 Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM tselden@ahrq.gov NR 44 TC 52 Z9 53 U1 0 U2 6 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD DEC PY 2006 VL 118 IS 6 BP E1766 EP E1778 DI 10.1542/peds.2006-0286 PG 13 WC Pediatrics SC Pediatrics GA 111TX UT WOS:000242478900072 PM 17142499 ER PT J AU Battles, JB AF Battles, J. B. TI Improving patient safety by instructional systems design SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article AB Education and training are important elements in patient safety, both as a potential contributing factor to risks and hazards of healthcare associated injury or harm and as an intervention to be used in eliminating or preventing such harm. All too often we have relied on training as the only interventions for patient safety without examining other alternatives or realizing that, in some cases, the training systems themselves are part of the problem. One way to ensure safety by design is to apply established design principles to education and training. Instructional systems design (ISD) is a systematic method of development of education and training programs for improved learner performance. The ISD process involves five integrated steps: analysis, development, design, implementation, and evaluation (ADDIE). The application of ISD using the ADDIE approach can eliminate or prevent education and training from being a contributing factor of health associated injury or harm, and can also be effective in preventing injury or harm. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. RP Battles, JB (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gather Rd, Rockville, MD 20850 USA. EM jabattles@ahrq.gov NR 29 TC 6 Z9 6 U1 1 U2 3 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD DEC PY 2006 VL 15 SU 1 BP I25 EP I29 DI 10.1136/qshc.2005.015917 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 112GO UT WOS:000242514000005 PM 17142604 ER PT J AU Battles, JB AF Battles, J. B. TI Quality and safety by design SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article AB Rather than continuing to try to measure the width and depths of the quality chasm, a legitimate question is how does one actually begin to close the quality chasm? One way to think about the problem is as a design challenge rather than as a quality improvement challenge. It is time to move from reactive measurement to a more proactive use of proven design methods, and to involve a number of professions outside health care so that we can design out system failure and design in quality of care. Is it possible to actually design in quality and design out failure? A three level conceptual framework design would use the six quality aims laid out in Crossing the quality chasm. The first or core level of the framework would be designing for patient centered care, with safety as the second level. The third design attributes would be efficiency, effectiveness, timeliness, and equity. Design methods and approaches are available that can be used for the design of healthcare organizations and facilities, learning systems to train and maintain competency of health professionals, clinical systems, clinical work, and information technology systems. In order to bring about major improvements in quality and safety, these design methods can and should be used to redesign healthcare delivery systems. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. RP Battles, JB (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gather Rd, Rockville, MD 20850 USA. EM James.Battles@ahrq.hhs.gov RI Sandall, Jane/D-4146-2009 OI Sandall, Jane/0000-0003-2000-743X NR 12 TC 3 Z9 3 U1 1 U2 1 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD DEC PY 2006 VL 15 SU 1 BP I1 EP I3 DI 10.1136/qshc.2006.020347 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 112GO UT WOS:000242514000001 PM 17142601 ER PT J AU Henriksen, K Dayton, E AF Henriksen, K. Dayton, E. TI Issues in the design of training for quality and safety SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID SCIENCE AB The US healthcare delivery system is in a state of change. Medical science and technology are advancing at an unprecedented rate, while cost containment and productivity pressures on clinicians make the clinical environment less than ideal for training. Training is one of the vehicles for addressing new knowledge requirements and for enhancing human and system based performance. Yet the theoretical underpinnings and design aspects of training have been largely unrecognized and unexamined in health care. This paper first explores changes in the practice of medicine and the healthcare delivery environment. It then describes how healthcare training and education can benefit from findings in the behavioral and cognitive sciences. It describes the systems approach to training and explores the extent to which a systems approach can be applied to the clinical environment. Finally, the paper examines innovative training and education techniques that are already gaining acceptance in health care.. C1 Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. RP Henriksen, K (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM Kerm.Henriksen@ahrq.hhs.gov NR 46 TC 7 Z9 7 U1 2 U2 2 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD DEC PY 2006 VL 15 SU 1 BP I17 EP I24 DI 10.1136/qshc.2005.016774 PG 8 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 112GO UT WOS:000242514000004 PM 17142603 ER PT J AU Wolff, TA Wilson, JE AF Wolff, Tracy A. Wilson, Jane E. TI Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material AB The case study and answers to the following questions on screening for BRCA mutation are based on the recommendations of the U.S. Preventive Services Task Force (USPSTF), an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. More detailed information on the USPSTF Recommendation Statement, the evidence synthesis, and the systematic evidence review is available at http://www. ahrq.gov/clinic/uspstfix. htm. The evidence synthesis and Recommendation Statement are available in print through the AHRQ Publications Clearinghouse (800-358-9295, e-mail: ahrqpubs@ahrq.gov). The practice recommendations in this activity are available at http://www.ahrq. gov/clinic/uspstf/uspsbr-gen.htm. C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, Rockville, MD 20850 USA. Johns Hopkins Bloomberg Sch Publ Hlth, Gen Prevent Med Residency, Baltimore, MD USA. RP Wolff, TA (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, Rockville, MD 20850 USA. NR 5 TC 3 Z9 4 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD NOV 15 PY 2006 VL 74 IS 10 BP 1759 EP 1760 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 107BB UT WOS:000242144600012 PM 17137007 ER PT J AU Marple, AF Antman, EM Hand, MM AF Marple, Amy F. Antman, Elliott M. Hand, Mary M. TI Modern treatment for heart attacks - Opening blocked arteries quickly SO CIRCULATION LA English DT Editorial Material C1 Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA. Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, Rockville, MD USA. RP Hand, MM (reprint author), NHLBI, Hlth Informat Ctr, POB 30105, Bethesda, MD 20824 USA. NR 4 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD NOV 14 PY 2006 VL 114 IS 20 BP E578 EP E580 DI 10.1161/CIRCULATIONAHA.106.648279 PG 3 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 124XQ UT WOS:000243406200018 PM 17101859 ER PT J AU Phillips, S AF Phillips, Sally TI Current status of surge research SO ACADEMIC EMERGENCY MEDICINE LA English DT Article; Proceedings Paper CT Academic Emergency Medicine Consensus Conference on Establishing the Science of Surge CY MAY 17, 2006 CL San Francisco, CA DE surge research; emergency department ID PUBLIC-HEALTH; COMMUNITY; LINKAGES; TRIAGE; TIME AB The dramatic escalation of bioterrorism and public health emergencies in the United States in recent years unfortunately has coincided with an equally dramatic decline in the institutions and services we rely on for emergency preparedness. Hospitals in nearly every metropolitan area in the country have closed; those that remain open have reduced the number of available beds. "Just in time" supplies and health professional shortages have further compromised the nation's overall surge capacity. Emergency departments routinely operate at capacity. These circumstances make evidence-based research on emergency preparedness and surge capacity both more urgently needed and more complex. The Agency for Healthcare Research and Quality and other government and private agencies have been rapidly widening the field of knowledge in this area in recent months and years. This report focuses primarily on the work of the Agency for Healthcare Research and Quality. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Phillips, S (reprint author), Agcy Healthcare Res & Qual, 540 Gaiter Rd, Rockville, MD 20850 USA. EM sally.phillips@ahrq.hhs.gov NR 27 TC 18 Z9 18 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD NOV PY 2006 VL 13 IS 11 BP 1103 EP 1108 DI 10.1197/j.aem.2006.07.007 PG 6 WC Emergency Medicine SC Emergency Medicine GA 104SD UT WOS:000241978400006 PM 17032944 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Care transitions: A threat and an opportunity for patient safety SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 8 TC 23 Z9 23 U1 1 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD NOV-DEC PY 2006 VL 21 IS 6 BP 415 EP 417 DI 10.1177/1062860606293537 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 109FC UT WOS:000242292300008 PM 17077424 ER PT J AU Hughes, RG AF Hughes, Ronda G. TI Research priorities SO APPLIED NURSING RESEARCH LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20852 USA. RP Hughes, RG (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20852 USA. EM ronda.hughes@ahrq.hhs.gov NR 0 TC 3 Z9 3 U1 0 U2 0 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0897-1897 J9 APPL NURS RES JI Appl. Nurs. Res. PD NOV PY 2006 VL 19 IS 4 BP 223 EP 224 DI 10.1016/j.apnr.2006.07.003 PG 2 WC Nursing SC Nursing GA 109OS UT WOS:000242318500010 PM 17098163 ER PT J AU Jatoi, I Zhu, KM Shah, M Lawrence, W AF Jatoi, Ismail Zhu, Kangmin Shah, Mona Lawrence, William TI Psychological distress in US Women who have experienced false-positive mammograms SO BREAST CANCER RESEARCH AND TREATMENT LA English DT Article DE mammography; false-positives; psychological distress ID BREAST-CANCER; SCREENING MAMMOGRAMS; ABNORMAL MAMMOGRAMS; SHORT-TERM; ANXIETY; SATISFACTION AB Background In the United States, approximately 10.7% of all screening mammograms lead to a false-positive result, but the overall impact of false-positives on psychological well-being is poorly understood. Materials and methods Data were analyzed from the 2000 U.S. National Health Interview Survey (NHIS), the most recent national survey that included a cancer control module. Study subjects were 9,755 women who ever had a mammogram, of which 1,450 had experienced a false-positive result. Psychological distress was assessed using the validated K6 questionnaire and logistic regression was used to discern any association with previous false-positive mammograms. Results In a multivariate analysis, women who had indicated a previous false-positive mammogram were more likely to report feeling sad (OR = 1.18, 95% CI, 1.03-1.35), restless (OR = 1.23, 95% CI, 1.08-1.40), worthless (OR = 1.27, 95% CI, 1.04-1.54), and finding that everything was an effort (OR = 1.27, 95% CI, 1.10-1.47). These women were also more likely to have seen a mental health professional in the 12 months preceding the survey (OR = 1.28, 95% CI, 1.03-1.58) and had a higher composite score on all items of the K6 scale (P < 0.0001), a reflection of increased psychological distress. Analyses by age and race revealed that, among women who had experienced false-positives, younger women were more likely to feel that everything was an effort, and blacks were more likely to feel restless. Conclusion In a random sampling of the U.S. population, women who had previously experienced false-positive mammograms were more likely to report symptoms of anxiety and depression. C1 Natl Naval Med Ctr, Dept Surg, Bethesda, MD 20814 USA. Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA. US Mil Canc Inst, Bethesda, MD 20814 USA. Agcy Healthcare Res & Qual, Bethesda, MD 20814 USA. RP Jatoi, I (reprint author), Natl Naval Med Ctr, Dept Surg, 4301 Jones Bridge Rd, Bethesda, MD 20814 USA. EM ismail.jatoi@us.army.mil NR 34 TC 24 Z9 24 U1 2 U2 9 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0167-6806 J9 BREAST CANCER RES TR JI Breast Cancer Res. Treat. PD NOV PY 2006 VL 100 IS 2 BP 191 EP 200 DI 10.1007/s10549-006-9236-6 PG 10 WC Oncology SC Oncology GA 098RY UT WOS:000241541700008 PM 16773439 ER PT J AU Selden, TM Gray, BM AF Selden, Thomas M. Gray, Bradley M. TI Tax subsidies for employment-related health insurance: Estimates for 2006 SO HEALTH AFFAIRS LA English DT Article ID BENEFITS; COVERAGE; MARKET AB Employment-related health insurance is subsidized through exemptions from federal and state income taxes, as well as from taxes for Social Security and Medicare. Proposals to modify this subsidy are a perennial subject of policy debate. We present tax-subsidy projections from a new data resource constructed using a statistical linkage between the establishment and household components of the Medical Expenditure Panel Survey (MEPS). We project that the total federal and state tax subsidy in 2006 for employment-related coverage of active workers will exceed $200 billion. We present per worker tax-subsidy estimates and an analysis of insurance incidence by establishment characteristics. C1 AHRQ, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD USA. CNA Corp, Heatlh Care Operat & Policy Res Ctr, Alexandria, VA USA. RP Selden, TM (reprint author), AHRQ, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD USA. EM tselden@ahrq.gov NR 30 TC 18 Z9 18 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD NOV-DEC PY 2006 VL 25 IS 6 BP 1568 EP 1579 DI 10.1377/hlthaff.25.6.1568 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 105MD UT WOS:000242033300017 PM 17102182 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Perspective - Getting to 'smart' health care SO HEALTH AFFAIRS LA English DT Article AB As the United States struggles with improving the return on its sizable health care investment and consumers become increasingly involved in health care decisions, interest in comparative effectiveness will rise because of its relevance to value, personalized health care, quality, and cost containment. Advances in biomedicine and health information technology present exciting opportunities for providing timely, relevant information about the comparative effectiveness of health care services. Successful growth will require a transparent, participatory approach and new partnerships between the public and private sectors to achieve the goal of producing valid evidence for decision making. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. EM carolyn.clancy@ahrq.hhs.gov NR 1 TC 17 Z9 18 U1 0 U2 4 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD NOV-DEC PY 2006 VL 25 IS 6 BP W589 EP W592 DI 10.1377/hlthaff.25.w589 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 105MD UT WOS:000242033300065 PM 17090557 ER PT J AU Hubbard, HB AF Hubbard, Heddy Bisbop TI A primer on economic evaluations related to expansion of newborn screening for genetic and metabolic disorders SO JOGNN-JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING LA English DT Article DE costs and outcomes; decision modeling; economic evaluations; genetic and metabolic disorders; newborn screening ID TANDEM MASS-SPECTROMETRY; COST-EFFECTIVENESS ANALYSIS; INBORN-ERRORS; HEALTH AB Newborns in every state are screened for genetic/metabolic disorders, but there is no uniform national screening program. Recently, a federal panel concluded that the number of disorders screened should be increased from 9 to Twentynine. In order for state leaders, and for the clinicians who inform them, to make sound decisions about expanding newborn screening programs, they need to be aware of the costs and outcomes of the entire screening program. This paper examines newborn screening from several perspectives: status of state programs, screening technology, and financing. In addition, various types of economic evaluations are defined, and a number of economic studies are explored. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Uniformed Serv Univ Hlth Sci, Grad Sch Nursing, Bethesda, MD 20814 USA. RP Hubbard, HB (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd,Room 3337, Rockville, MD 20850 USA. EM heddy.hubbard@ahrq.hhs.gov NR 38 TC 3 Z9 3 U1 1 U2 1 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0884-2175 J9 JOGNN-J OBST GYN NEO JI JOGNN PD NOV-DEC PY 2006 VL 35 IS 6 BP 692 EP 699 DI 10.1111/J.1552-6909.2006.00098.x PG 8 WC Nursing; Obstetrics & Gynecology SC Nursing; Obstetrics & Gynecology GA 112WT UT WOS:000242559300004 PM 17105633 ER PT J AU Encinosa, WE Bernard, D Steiner, CA AF Encinosa, William E. Bernard, Didem Steiner, Claudia A. TI Response to letter from Harvey J. Sugerman, MID SO MEDICAL CARE LA English DT Letter ID BARIATRIC SURGICAL-PROCEDURES; MORTALITY; SURGERY C1 US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Encinosa, WE (reprint author), US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 10 TC 0 Z9 0 U1 2 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD NOV PY 2006 VL 44 IS 11 BP 1059 EP 1060 DI 10.1097/01.mlr.0000242944.59274.47 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 104KF UT WOS:000241956600015 ER PT J AU McHorney, CA Fleishman, JA AF McHorney, Colleen A. Fleishman, John A. TI Assessing and understanding measurement equivalence in health outcome measures - Issues for further quantitative and qualitative inquiry - Epilogue SO MEDICAL CARE LA English DT Editorial Material ID EXTREME RESPONSE STYLE; DEPRESSION-SCALE; MENTAL-HEALTH; ITEM BIAS; COMMUNITY SAMPLE; AFRICAN-AMERICAN; SYMPTOMS; HISPANICS; CULTURE; ILLNESS C1 Merck & Co Inc, Outcomes Res & Management, West Point, PA 19486 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP McHorney, CA (reprint author), Merck & Co Inc, Outcomes Res & Management, 770 Sunneytown Pike,WP39-166, West Point, PA 19486 USA. EM colleen_mchorney@merck.com NR 75 TC 36 Z9 36 U1 1 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD NOV PY 2006 VL 44 IS 11 SU 3 BP S205 EP S210 DI 10.1097/01.mlr.0000245451.67862.57 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 105IS UT WOS:000242024200026 PM 17060829 ER PT J AU Holman, RC Stoll, BJ Curns, AT Yorita, KL Steiner, CA Schonberger, LB AF Holman, Robert C. Stoll, Barbara J. Curns, Aaron T. Yorita, Krista L. Steiner, Claudia A. Schonberger, Lawrence B. TI Necrotising enterocolitis hospitalisations among neonates in the United States SO PAEDIATRIC AND PERINATAL EPIDEMIOLOGY LA English DT Article DE necrotising enterocolitis; hospital length of stay; mortality; ethnic group ID BIRTH-WEIGHT; INFANT-MORTALITY; EPIDEMIOLOGY AB The objective of this study was to estimate the rate and describe the epidemiology of necrotising enterocolitis (NEC) among neonates (infants < 1 month of age) hospitalised in the United States. Hospital discharge records for neonates with an NEC diagnosis and an in-hospital death or routine discharge were selected for analysis from the 2000 Kids' Inpatient Database. An estimated 4463 (SE = 219) hospitalisations associated with NEC occurred among neonates in the United States during the year 2000, resulting in a hospitalisation rate of 109.9 [95% CI 97.2, 122.6] per 100 000 livebirths. The rate of NEC hospitalisations was highest among non-Hispanic Black neonates. The median hospital length of stay was 49 days. The in-hospital fatality rate was 15.2% (SE = 1.0%). Neonates who underwent a surgical procedure during hospitalisation were more likely to have a longer length of stay and to die than were those who did not have surgical intervention. Low-birthweight (LBW) neonates with NEC were more likely than LBW neonates hospitalised with other diagnoses to be very LBW (VLBW), non-Hispanic Black and male. In addition, compared with LBW neonates hospitalised with other diagnoses, LBW neonates with NEC had higher hospital charges and longer lengths of stay, and were more likely to die during hospitalisation. This study provides the first national estimate of the rate of hospitalisation for NEC among neonates in the United States. During 2000, there was one NEC hospitalisation per 1000 livebirths, with approximately 1 in 7 NEC hospitalisations ending in death. NEC accounts for substantial morbidity; thus, the development of prevention strategies and effective therapies continues to be an important issue. C1 Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Infect Dis, US Dept Hlth & Human Serv, Atlanta, GA 30333 USA. Emory Univ, Sch Med, Dept Pediat, Div Neonatal Perinatal Med, Atlanta, GA USA. US Dept Hlth & Human Serv, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Holman, RC (reprint author), Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Infect Dis, US Dept Hlth & Human Serv, MS A-39, Atlanta, GA 30333 USA. NR 22 TC 132 Z9 137 U1 1 U2 8 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0269-5022 J9 PAEDIATR PERINAT EP JI Paediatr. Perinat. Epidemiol. PD NOV PY 2006 VL 20 IS 6 BP 498 EP 506 DI 10.1111/j.1365-3016.2006.00756.x PG 9 WC Public, Environmental & Occupational Health; Obstetrics & Gynecology; Pediatrics SC Public, Environmental & Occupational Health; Obstetrics & Gynecology; Pediatrics GA 094NL UT WOS:000241246000007 PM 17052286 ER PT J AU Zaloshnja, E Miller, T Jones, P Litovitz, T Coben, J Steiner, C Sheppard, M AF Zaloshnja, Eduard Miller, Ted Jones, Paul Litovitz, Toby Coben, Jeffrey Steiner, Claudia Sheppard, Monique TI The potential impact of poison control centers on rural hospitalization rates for poisoning SO PEDIATRICS LA English DT Article DE poisoning; poison control center; hospitalization rate; rural; benefit; cost-effectiveness ID COSTS AB OBJECTIVE. This study tested the hypothesis that underutilization of poison control centers is associated with increased rates of hospitalizations attributable to poisonings in rural areas. METHODS. To measure the potential impact of poison control centers on hospitalization rates in rural areas among people who visit emergency departments because of poisoning, we estimated the reduction in hospitalization rates associated with increased rates of calls to centers. We used the 2003 State Inpatient Database and State Emergency Department Database from the Healthcare Cost and Utilization Project to calculate the numbers of emergency department visits and hospitalizations for each county in the 12 states analyzed. We used Toxic Exposure Surveillance System data from the American Association of Poison Control Centers to calculate the number of human exposure calls per capita according to county. RESULTS. In rural counties, a 1% higher poison control center human poison exposure call rate was associated with a 0.19% lower hospitalization rate among people who visited emergency departments because of poisoning. If the observed association is causative, then 43.3 calls would prevent 1 hospital admission, yielding $7321 in net cost savings and a return on investment of 5.9:1 (from the health care system perspective). CONCLUSIONS. Our results establish the existence of the hypothesized association between rural poison control center utilization rates and hospitalization rates among emergency department-treated poisoning patients. C1 Pacific Inst Res & Evaluat, Beltsville, MD 20705 USA. Natl Capital Poison Ctr, Washington, DC USA. W Virginia Univ, Injury Control Res Ctr, Morgantown, WV USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Zaloshnja, E (reprint author), Pacific Inst Res & Evaluat, 11710 Beltsville Dr,Suite 125, Beltsville, MD 20705 USA. EM zaloshnja@pire.org OI Litovitz, Toby/0000-0003-0262-5509; Miller, Ted/0000-0002-0958-2639 NR 14 TC 15 Z9 15 U1 0 U2 2 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD NOV PY 2006 VL 118 IS 5 BP 2094 EP 2100 DI 10.1542/peds.2006-1585 PG 7 WC Pediatrics SC Pediatrics GA 101HK UT WOS:000241731700035 PM 17079583 ER PT J AU Sedrakyan, A Wu, AW Parashar, A Bass, EB Treasure, T AF Sedrakyan, Artyom Wu, Albert W. Parashar, Amish Bass, Eric B. Treasure, Tom TI Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting - A meta-analysis of systematically reviewed trials SO STROKE LA English DT Article DE atrial fibrillation; CABG; cardiac surgery; off-pump surgery; outcomes; stroke; systematic review ID ON-PUMP; BEATING-HEART; INFLAMMATORY RESPONSE; ATRIAL-FIBRILLATION; CARDIOPULMONARY BYPASS; CARDIAC-SURGERY; MYOCARDIAL INJURY; RANDOMIZED-TRIAL; REVASCULARIZATION; PREDICTORS AB Background and Purpose-There is growing enthusiasm for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). Although deleterious effects of CPB are known, it remains to be proven that avoiding CPB will result in reduction in morbidity. We sought to determine whether off-pump surgery is associated with reduced occurrence of adverse outcomes as compared with CABG with CPB. Methods-Studies were identified by searching the MEDLINE, EMBASE and the Cochrane Register 1980 to 2006 (February). We also searched the reference lists of randomized clinical trials (RCT) and reviews to look for additional studies. Study selection: RCTs comparing off-pump surgery to CABG with CPB. No restriction applied on the size of the trial or end point reports. Data extraction: 2 reviewers independently searched for studies, read abstracts and abstracted all data. Data synthesis: combined estimates were obtained using fixed or random effect meta-analyses. Relative risks and risk differences were calculated. Heterogeneity was assessed using X, and V values. Results-There were 3996 patients enrolled in 41 RCTs (mean age 62, 22% female). No study reported information on race. Off-pump CABG was associated with a 50% reduction in the relative risk of stroke (95% CI, 7% to 73%), 30% reduction in atrial fibrillation (AF; 95% CI, 16% to 43%) and 48% reduction in wound infection (95% CI, 26% to 63%) with no heterogeneity among RCTs. This translated into avoidance of 10 strokes, 80 cases of AF and 40 infections per 1000 CABG. Fewer distal grafts were performed and there was evidence for > 10 reinterventions per 1000 with off-pump CABG. Long-term follow-up is not yet reported in the trials. Conclusions-Off-pump CABG is associated with reduced risk of stroke, AF and infections as compared with CABG with CPB. Evidence should be generalized taking into account RCT enrollment limitations, drawbacks related to training requirements, propensity to perform fewer grafts and likely reinterventions after off-pump surgery. C1 Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. London Sch Hyg & Trop Med, Dept Publ Hlth & Policy, London WC1, England. Yale Sch Med, Dept Surg, New Haven, CT USA. Johns Hopkins Univ, Hlth Serv Res & Dev Ctr, Baltimore, MD USA. Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. Johns Hopkins Univ, Evidence Based Practice Ctr, Baltimore, MD USA. Guys Hosp, Cardiothorac Unit, London SE1 9RT, England. RP Sedrakyan, A (reprint author), Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM asedraky@ahrq.gov NR 43 TC 117 Z9 118 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD NOV PY 2006 VL 37 IS 11 BP 2759 EP 2769 DI 10.1161/01.STR.0000245081.52877.f2 PG 11 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 102GK UT WOS:000241798800029 PM 17008617 ER PT J AU Chevarley, FM Thierry, JM Gill, CJ Ryerson, AB Nosek, MA AF Chevarley, Frances M. Thierry, JoAnn M. Gill, Carol J. Ryerson, A. Blythe Nosek, Margaret A. TI Health, preventive health care, and health care access among women with disabilities in the 1994-1995 national health interview survey, supplement on disability SO WOMENS HEALTH ISSUES LA English DT Article ID PHYSICAL-DISABILITIES; SERVICES; GENDER AB Objectives. This study presents national estimates on the health, preventive health care, and health care access of adult women with disabilities. We compared women with 1 or 2 functional limitations (FLs) and >= 3 FLs with women with no FLs. Topics covered included demographic characteristics, selected reported health measures, selected clinical preventive services, and selected access to care indicators and health care coverage. Methods. Estimates in this report were based on data from the 1994-1995 National Health Interview Survey, Supplement on Disability (NHIS-D). The sample size for women >= 18 years of age used in producing the estimates from the combined 1994 and 1995 NHIS-D was 77,762. Results. An estimated 16% of women >= 18 years of age had difficulty with at least 1 FL. Women with FLs were less likely to rate their health as excellent or very good and more likely to report their health as fair or poor when compared with women with no FLs. Women with FLs were also more likely to report being a current smoker, having hypertension, being overweight, and experiencing mental health problems. Among women >= 65 years of age, those with FLs were also less likely to have received Pap smear tests within the past year and those with >= 3 FLs were less likely to have received mammograms within the past year than women with no FLs. Women with >= 3 FLs were more likely to report being unable to get general medical care, dental care, prescription medicines, or eyeglasses, regardless of age group, compared with women with no FLs. The main reasons reported for being unable to receive general care were financial problems or limitations in insurance. These findings suggest that increased attention to the health care needs of women with disabilities from researchers, clinicians, and public health professionals is warranted. C1 AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. Ctr Dis Control & Prevent, Atlanta, GA USA. Univ Illinois, Chicago, IL USA. Baylor Coll Med, Houston, TX 77030 USA. RP Chevarley, FM (reprint author), AHRQ, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM Fran.Chevarley@AHRQ.hhs.gov NR 43 TC 106 Z9 107 U1 3 U2 11 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD NOV-DEC PY 2006 VL 16 IS 6 BP 297 EP 312 DI 10.1016/j.whi.2006.10.002 PG 16 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 122RF UT WOS:000243243500003 PM 17188213 ER PT J AU Chou, A Scholle, S Weisman, C Bierman, A Correa-de-Araujo, R Mosca, L AF Chou, Ann Scholle, Sarah Weisman, Carol Bierman, Arlene Correa-de-Araujo, Rosaly Mosca, Lori TI Sex-based differences in the quality of cardiovascular disease (CVD) care in commercial health plans SO CIRCULATION LA English DT Meeting Abstract CT 79th Annual Scientific Session of the American-Heart-Association CY NOV 12-15, 2006 CL Chicago, IL SP Amer Heart Assoc C1 NCQA, Washington, DC USA. Penn State Univ, Hershey, PA USA. Univ Toronto, Toronto, ON, Canada. AHRQ, Rockville, MD USA. Columbia Univ, New York, NY 10027 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD OCT 31 PY 2006 VL 114 IS 18 BP 835 EP 835 PG 1 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 102EC UT WOS:000241792805370 ER PT J AU Lorenz, KA Lynn, J Dy, S Wilkinson, A Mularski, RA Shugarman, LR Hughes, R Asch, SM Rolon, C Rastegar, A Shekelle, PG AF Lorenz, Karl A. Lynn, Joanne Dy, Sydney Wilkinson, Anne Mularski, Richard A. Shugarman, Lisa R. Hughes, Rhonda Asch, Steven M. Rolon, Cony Rastegar, Afshin Shekelle, Paul G. TI Quality measures for symptoms and advance care planning in cancer: A systematic review SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Academy-of-Hospice-and-Palliative-Medicine CY FEB 08-11, 2006 CL Nashville, TN SP Amer Acad Hospice & Palliat Med ID HEALTH-ORGANIZATION GUIDELINES; PAIN MANAGEMENT; OF-LIFE; PALLIATIVE CARE; HOSPICE CARE; VALIDATION; RELIEF; END; IMPLEMENTATION; IMPROVEMENT AB Purpose Measuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps. Methods English-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO ( 1995 to 2005); Internet-based searches; and contact with measure developers. We used terms for each domain to select studies throughout the cancer care continuum. We included measures that expressed a normative relationship to quality, specified the target population, and specified the indicated care. Dual data review and abstraction was performed by palliative care researchers describing populations, testing, and attributes for each measure. Results A total of 4,599 of 5,182 titles were excluded at abstract review. Of 537 remaining articles, 19 contained measures for ACP, six contained measures for depression, five contained measures for dyspnea, and 20 contained measures for pain. We identified 10 relevant measure sets that included 36 fully specified or fielded measures and 14 additional measures ( 16 for pain, five for dyspnea, four for depression, and 25 for ACP). Most measures were unpublished, and few had been tested in a cancer population. We were unable to describe the specifications of all measures fully and did not search for measures for pain and depression that were not cancer specific. Conclusion Measures are available for assessing quality and guiding improvement in palliative cancer care. Existing measures are weighted toward ACP, and more nonpain symptom measures are needed. Additional testing is needed before the measures are used for accountability, and basic research is required to address measurement when self-report is impaired. C1 VA Greater Los Angeles Healthcare Syst, Div Gen Internal Med, Los Angeles, CA 90073 USA. Univ Calif Los Angeles, Geffen Sch Med, Los Angeles, CA USA. RAND, So Calif Evidence Based Practice Ctr, Santa Monica, CA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Johns Hopkins Univ, Sch Publ Hlth, Baltimore, MD USA. RP Lorenz, KA (reprint author), VA Greater Los Angeles Healthcare Syst, Div Gen Internal Med, 11301 Wilshire Blvd,Code 111-G, Los Angeles, CA 90073 USA. EM karl.lorenz@med.va.gov NR 45 TC 49 Z9 50 U1 0 U2 4 PU AMER SOC CLINICAL ONCOLOGY PI ALEXANDRIA PA 330 JOHN CARLYLE ST, STE 300, ALEXANDRIA, VA 22314 USA SN 0732-183X J9 J CLIN ONCOL JI J. Clin. Oncol. PD OCT 20 PY 2006 VL 24 IS 30 BP 4933 EP 4938 DI 10.1200/JCO.2006.06.8650 PG 6 WC Oncology SC Oncology GA 098CF UT WOS:000241497900023 PM 17050878 ER PT J AU Yawn, BP Mabry, IR Ko, S AF Yawn, Barbara P. Mabry, Iris R. Ko, Stephen TI Ultrasonography in the assessment of developmental dysplasia of the hip SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID CONGENITAL DISLOCATION; ULTRASOUND; DIAGNOSIS; RELIABILITY; MANAGEMENT; UK C1 Olmsted Med Ctr, Rochester, MN USA. Agcy Healthcare Res & Qual, Rockville, MD USA. SUNY Stony Brook, Sch Med, Stony Brook, NY 11794 USA. Univ Minnesota, Sch Med, Rochester, MN USA. RP Yawn, BP (reprint author), 826 19th St NE, Rochester, MN 55906 USA. EM yawnx002@umn.edu NR 16 TC 1 Z9 2 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD OCT 15 PY 2006 VL 74 IS 8 BP 1284 EP 1285 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 097ES UT WOS:000241430300003 PM 17087422 ER PT J AU Mabry, IR AF Mabry, Iris R. TI Screening for speech and language delay in preschool children SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Mabry, IR (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 3 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD OCT 15 PY 2006 VL 74 IS 8 BP 1373 EP 1374 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 097ES UT WOS:000241430300011 PM 17087432 ER PT J AU Hand, MM Chesley, FD Ho, KK Clancy, CM AF Hand, Mary M. Chesley, Francis D., Jr. Ho, Karen K. Clancy, Carolyn M. TI The third National Reports on Healthcare Quality and Disparities in the United States - National data for targeting improvements SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Off Director, Rockville, MD 20850 USA. RP Hand, MM (reprint author), Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, 540 Gaither Rd, Rockville, MD 20850 USA. EM mary.hand@ahrq.hhs.gov NR 7 TC 4 Z9 4 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD OCT-DEC PY 2006 VL 21 IS 4 BP 283 EP 289 PG 7 WC Nursing SC Nursing GA 085NJ UT WOS:000240610500001 PM 16985394 ER PT J AU Cox, S Posner, SF McPheeters, M Jamieson, DJ Kourtis, AP Meikle, S AF Cox, Shanna Posner, Samuel F. McPheeters, Melissa Jamieson, Denise J. Kourtis, Athena P. Meikle, Susan TI Influenza and pregnant women: Hospitalization burden, United States, 1998-2002 SO JOURNAL OF WOMENS HEALTH LA English DT Article AB Women in later stages of pregnancy are at increased risk for serious influenza-related morbidity; thus, universal influenza vaccination of pregnant women is recommended. However, vaccine uptake in the United States has been suboptimal. We previously described the burden of severe influenza-related morbidity during pregnancy in the United States by examining hospitalizations of pregnant women with respiratory illness during influenza season. Nondelivery hospitalizations with respiratory illness had significantly longer lengths of stay than those without respiratory illness. Hospitalization characteristics associated with greater likelihood of respiratory illness were the presence of a high-risk condition for which influenza vaccination is recommended, Medicaid/Medicare as primary expected payer, and hospitalization in a rural area. These findings may be explained by these women being at higher risk of influenza-related morbidity or reflect disparities in receipt of influenza immunization. Universal vaccination of pregnant women to decrease influenza-related morbidity should be encouraged. C1 Ctr Dis Control & Prevent, Coordinating Ctr Hlth Promot, Div Reprod Hlth, Atlanta, GA 30341 USA. Oak Ridge Inst Sci & Educ, Oak Ridge, TN USA. Univ Michigan Hlth Syst, Div Gen Pediat, Ann Arbor, MI USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Posner, SF (reprint author), Ctr Dis Control & Prevent, Coordinating Ctr Hlth Promot, Div Reprod Hlth, 4770 Buford Highway,MS K-20, Atlanta, GA 30341 USA. EM shps5@cdc.gov RI Cox, Shanna/F-4806-2011; OI Posner, Samuel/0000-0003-1574-585X NR 10 TC 17 Z9 18 U1 0 U2 0 PU MARY ANN LIEBERT INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1540-9996 J9 J WOMENS HEALTH JI J. Womens Health PD OCT PY 2006 VL 15 IS 8 BP 891 EP 893 DI 10.1089/jwh.2006.15.891 PG 3 WC Public, Environmental & Occupational Health; Medicine, General & Internal; Obstetrics & Gynecology; Women's Studies SC Public, Environmental & Occupational Health; General & Internal Medicine; Obstetrics & Gynecology; Women's Studies GA 104VX UT WOS:000241989800001 PM 17087611 ER PT J AU Luckhaupt, S AF Luckhaupt, Sara TI Screening for developmental dysplasia of the hip SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 US Prevent Serv Task Force Ctr Primary Care Preve, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Michigan, Sch Med, Ann Arbor, MI 48109 USA. RP Luckhaupt, S (reprint author), US Prevent Serv Task Force Ctr Primary Care Preve, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 3 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD SEP 15 PY 2006 VL 74 IS 6 BP 1005 EP 1006 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 086AR UT WOS:000240646000010 ER PT J AU Kourtis, AP Bansil, P McPheeters, M Meikle, SF Posner, SF Jamieson, DJ AF Kourtis, Athena P. Bansil, Pooja McPheeters, Melissa Meikle, Susan F. Posner, Samuel F. Jamieson, Denise J. TI Hospitalizations of pregnant HIV-infected women in the USA prior to and during the era of HAART, 1994-2003 SO AIDS LA English DT Article DE pregnancy; hospitalization; HIV; obstetric complications; maternal; HAART ID COMBINATION ANTIRETROVIRAL THERAPY; IMMUNODEFICIENCY-VIRUS-INFECTION; DRUG-USE; BIRTH; OUTCOMES; INFANTS; RISK; TRANSMISSION; PREVENTION; ZIDOVUDINE AB Background: The literature on whether HIV infection and its complex antiretroviral treatments confer a higher risk for adverse pregnancy outcomes is controversial. Objective: We compared rates of hospitalization for select morbidities among HIV-infected and uninfected pregnant women in the USA. Design and Methods: Using data from the 1994-2003 Nationwide Inpatient Sample, we used descriptive statistics and multivariate logistic regression to examine sociodemographic characteristics, morbidity outcomes and time trends. Results: There were approximately 6000 hospitalizations per year of HIV-infected pregnant women in the USA. HIV-infected women were more likely to be hospitalized in urban hospitals, in the South, have Medicaid as the expected payer, have longer hospitalizations and incur higher charges than uninfected women. Hospitalizations for major puerperal sepsis, genitourinary infections, influenza, bacterial infections, preterm labor/delivery, and liver disorders were more frequent among pregnant HIV-infected women than their uninfected counterparts. However, rates of pre-eclampsia and antepartum hemorrhage were not significantly different. While rates of inpatient mortality and various infectious conditions decreased between 1994 and 2003, the rate of gestational diabetes increased among HIV-infected pregnant women. Conclusions: HIV-infected pregnant women in the USA continue to beat higher risk for morbidity and adverse obstetric outcomes. With the introduction of antiretroviral therapy, rates of most of the conditions examined have either decreased or remained stable, hence current antiretroviral regimens do not seem to be associated with major adverse pregnancy outcomes on a population basis. The increase in gestational diabetes among HIV-infected women may be associated, in part, with antiretroviral therapy and merits further attention. (c) 2006 Lippincott Williams & Wilkins. C1 Ctr Dis Control & Prevent, Div Reprod Hlth, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA. Eastern Virginia Med Sch, Dept Obstet & Gynecol, Norfolk, VA 23501 USA. Michigan Sch Med, Dept Pediat, Ann Arbor, MI USA. Agcy Healthcare Res & Qual, Rockville, MD USA. EM apk3@cdc.gov OI Posner, Samuel/0000-0003-1574-585X NR 28 TC 34 Z9 35 U1 0 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0269-9370 J9 AIDS JI Aids PD SEP 11 PY 2006 VL 20 IS 14 BP 1823 EP 1831 DI 10.1097/01.aids.0000244201.11006.1c PG 9 WC Immunology; Infectious Diseases; Virology SC Immunology; Infectious Diseases; Virology GA 092BK UT WOS:000241071800005 PM 16954723 ER PT J AU Chevarley, FM Owens, PL Zodet, MW Simpson, LA McCormick, MC Dougherty, D AF Chevarley, Frances M. Owens, Pamela L. Zodet, Marc W. Simpson, Lisa A. McCormick, Marie C. Dougherty, Denise TI Health care for children and youth in the United States: Annual report on patterns of coverage, utilization, quality, and expenditures by a county level of urban influence SO AMBULATORY PEDIATRICS LA English DT Article DE geographic area; health care utilization; hospitalization; insurance; poverty; quality; Urban Influence Codes ID INFLUENCE CODES; ACCESS; RESIDENCE; INCOME AB Objective.-To examine child and hospital demographics and children's health care coverage, use, expenditures, and quality by a county-level measure of urban influence. Methods.-Two national health care databases serve as the sources of data for this report: the 2002 Medical Expenditure Panel Survey (MEPS) and the 2002 Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID) from the Healthcare Cost and Utilization Project (HCUP). In both data sets, county urbanicity is defined by use of a collapsed version of the 2003 Urban Influence Codes, to distinguish among children residing in and hospitals located in large metropolitan (metro) counties, small metro counties, micropolitan counties, and noncore counties. Results.-Demographics. In large metro counties, greater percentages of the child population are Hispanic or black non-Hispanic than in small metro, micropolitan, and noncore counties; in micropolitan and noncore counties, higher proporiions of children are below 200% of the federal poverty level than in large metro and small metro counties. Noncore areas have a greater percentage of children in fair or poor health compared with those in small metro and micropolitan counties. Most hospitals are located in large and small metro areas, and large metro areas have a higher proportion of teaching hospitals compared with other areas. Health care. In general, there were no overall differences by place of residence in the proportion of children with and without insurance, although differences emerged in subpopulations within Urban Influence Code types. Hispanic children residing in large metro counties were more likely to be uninsured than those in small metro counties. Overall, the proportion of children with at least one dental visit was larger in small metro areas compared with both large metro and noncore areas. The proportion of children with medicines prescribed was generally lower in large metro areas compared with all other areas both overall and among subpopulations of children. Children in noncore areas were more likely to have a hospital inpatient stay and any emergency department use compared with children in large metro area. Children in large metro counties had longer average inpatient stays and a higher hospital inpatient charge per day compared with children in all other counties. Although most hospitalizations for children from large metro areas occurred in large metro areas, over half of hospitalizations for noncore children occurred outside of noncore counties. Further, children from noncore counties appear to be hospitalized for ambulatory sensitive conditions more than children from all other areas. Conclusions.-County-level data analyses performed using a collapsed version of the Urban Influence Codes with MEPS and HCUP data shed additional light on the health care patterns for children that were not previously evident when only the dichotomous metropolitan/nonmetropolitan geographic schema was used. C1 Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. Univ S Florida, Dept Pediat, St Petersburg, FL 33701 USA. Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA. RP Chevarley, FM (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM Fran.Chevarley@AHRQ.hhs.gov OI McCormmick, Marie/0000-0002-3938-1707 NR 42 TC 21 Z9 21 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD SEP-OCT PY 2006 VL 6 IS 5 BP 241 EP 264 DI 10.1016/j.ambp.2006.06.004 PG 24 WC Pediatrics SC Pediatrics GA 089OE UT WOS:000240889300002 PM 17000414 ER PT J AU Dougherty, D Simpson, LA McCormick, MC AF Dougherty, Denise Simpson, Lisa A. McCormick, Marie C. TI Rural areas and children's health care coverage, use, expenditures, and quality: Policy implications SO AMBULATORY PEDIATRICS LA English DT Article C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ S Florida, Dept Pediat, St Petersburg, FL 33701 USA. Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA. RP Dougherty, D (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Denise.Dougherty@ahrq.hhs.gov OI McCormmick, Marie/0000-0002-3938-1707 NR 27 TC 5 Z9 5 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD SEP-OCT PY 2006 VL 6 IS 5 BP 265 EP 267 DI 10.1016/j.ambp.2006.06.005 PG 3 WC Pediatrics SC Pediatrics GA 089OE UT WOS:000240889300003 PM 17000415 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI The intensive care unit, patient safety, and the agency for healthcare research and quality SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material ID ERRORS C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 17 TC 4 Z9 4 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD SEP-OCT PY 2006 VL 21 IS 5 BP 348 EP 351 DI 10.1177/1062860606291989 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 085VU UT WOS:000240633300013 PM 16973953 ER PT J AU Meyers, DS Mishori, R McCann, J Delgado, J O'Malley, AS Fryer, E AF Meyers, David S. Mishori, Ranit McCann, Jessica Delgado, Jose O'Malley, Ann S. Fryer, Ed TI Primary care physicians' perceptions of the effect of insurance status on clinical decision making SO ANNALS OF FAMILY MEDICINE LA English DT Article DE health insurance; decision making; primary health care; practice-based research network ID HEALTH-INSURANCE; CHILDREN; ACCESS AB PURPOSE Americans who do not have health insurance receive fewer health services and have poorer health status than those who have insurance. To better understand this disparity, in this study we characterize primary care physician's perceptions of what effect, if any, patients' insurance status has on their clinical decision making during office visits. METHODS Twenty-five physician members of CAPRICORN, a primary care practice-based research network in metropolitan Washington, DC, completed a brief paper-card survey instrument immediately after each patient encounter during 2 half-day office sessions. Participants saw patients in their usual manner and were given no additional information about their patients or their insurance. RESULTS Eighty-eight percent of participating physicians reported making at least 1 change in clinical management as a result of a patient's insurance status. They reported altering their management during 99 of 409 patient encounters (24.2%). There was a significant difference in the percentage of visits that involved a change in management for privately insured, publicly insured, and uninsured patients (18.7%, 29.5%, and 43.5% respectively, P = .01). Physicians reported discussing insurance issues with patients during 62.6% of visits during which they made a change in management based on insurance status. CONCLUSION Physicians incorporate their patients' insurance status into their clinical decision making and acknowledge they frequently alter their clinical management as a result. Additional research is needed to understand the effect of these changes on patient health and to assist both physicians and patients in enhancing the quality of care delivered within the constraints of the current insurance system. C1 Georgetown Univ, Med Ctr, Capital Area Primary Care Res Network, CAPRICORN, Washington, DC 20007 USA. Robert Graham Ctr Policy Studies Family Med & Pri, Washington, DC USA. Univ Rochester, Sch Med, Ctr Child Hlth Res, Rochester, NY USA. RP Meyers, DS (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM dmeyers@ahrq.gov NR 14 TC 18 Z9 18 U1 1 U2 4 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD SEP-OCT PY 2006 VL 4 IS 5 BP 399 EP 402 DI 10.1370/afm.574 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 102BV UT WOS:000241786700004 PM 17003138 ER PT J AU Johansson, P Jacobsen, C Buchwald, D AF Johansson, Patrik Jacobsen, Clemma Buchwald, Dedra TI Perceived discrimination in health care among American Indians/Alaska natives SO ETHNICITY & DISEASE LA English DT Article DE Alaska Native; American Indian; health disparities; perceived discrimination ID DETROIT METROPOLITAN-AREA; RACIAL MISCLASSIFICATION; AFRICAN-AMERICAN; BLOOD-PRESSURE; UNFAIR TREATMENT; RISK-FACTORS; LIFE-STYLE; EXPERIENCES; ETHNICITY; WOMEN AB Objectives: We compared the prevalence of, and reasons for, perceived discrimination in health care among American Indian/Alaska Natives (AI/ANs) and persons of AI/AN + White heritage to African Americans, Asian Americans, and Whites. Design: Data on perceived discrimination were collected by the 2001 California Health Interview Survey (CHIS). We used chi-square tests to evaluate the prevalence of perceived discrimination and the reasons for perceived discrimination across racial groups. Setting: The 2001 CHIS, a telephone survey, one of the largest cross-sectional surveys ever conducted in the United States. Participants: Participants in this analysis were adults >= 18 years of age, interviewed from 55,000 households that took part in the survey. Interventions: Participants in the 2001 CHIS were asked "Thinking of your experiences with receiving health care in the past 12 months, have you felt you were discriminated against for any reason?" Respondents who endorsed this item were asked about possible reasons for the discrimination. Main Outcome Measures: 1) Does the prevalence of perceived discrimination in health care differ between AI/ANs, AI/AN + Whites, African Americans, Asian Americans, and Whites? and 2) Do the reasons for perceived discrimination in health care vary by race or ethnicity? Results: Discrimination was perceived by 7.1% of the AI/AN alone group, 8.8% of AI/AN + White respondents, 5.6% of African Americans, 4.3% of Whites, and 2.6% of Asian Americans. After adjusting for covariates, the odds of perceived discrimination were different for AI/AN + White (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.5-2.5) and Asian American (OR=.5, 95% Cl.4-7) when compared to Whites. Conclusions: AI/ANs, and especially those who identify as AI/AN + White, were the most likely among racial groups to report discrimination in health care. C1 Harvard Univ, Sch Med, Cambridge, MA 02138 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Colorado, Hlth Sci Ctr, Amer Indian & Alaska Nat Programs, Denver, CO USA. Univ Washington, Dept Med, Seattle, WA USA. RP Johansson, P (reprint author), Greater SE Community Hosp, 1310 So Ave SE, Washington, DC 20032 USA. EM pjohansson@dc.doctorscommunity.com FU AHRQ HHS [P01 HS10854]; NIA NIH HHS [P30 AG15297] NR 35 TC 14 Z9 14 U1 2 U2 2 PU INT SOC HYPERTENSION BLACKS-ISHIB PI ATLANTA PA 100 AUBURN AVE NE STE 401, ATLANTA, GA 30303-2527 USA SN 1049-510X J9 ETHNIC DIS JI Ethn. Dis. PD FAL PY 2006 VL 16 IS 4 BP 766 EP 771 PG 6 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 094KN UT WOS:000241238400003 PM 17061725 ER PT J AU Zhan, CL Friedman, B Mosso, A Pronovost, P AF Zhan, Chunliu Friedman, Bernard Mosso, Andrew Pronovost, Peter TI Medicare payment for selected adverse events: Building the business case for investing in patient safety SO HEALTH AFFAIRS LA English DT Article ID INJURIES; COSTS AB This study estimates that Medicare extra payments under the hospital prospective payment system (PPS) range from about $700 per case of decubitus ulcer to $9,000 per case of postoperative sepsis in the five types of adverse events identifiable in Medicare claims. Medicare extra payment for the five types of events totals more than $300 million per year, accounting for 0.27 percent of annual Medicare hospital spending. But these extra payments cover less than a third of the extra costs incurred by hospitals in treating these adverse events. We conclude that both Medicare and hospitals gain financially by improving patient safety. C1 AHRQ, Rockville, MD USA. Social & Sci Syst Inc, Silver Spring, MD USA. Johns Hopkins Univ, Ctr Innovat Qual Patient Care, Sch Med, Baltimore, MD USA. RP Zhan, CL (reprint author), AHRQ, Rockville, MD USA. EM czhan@ahrq.gov NR 17 TC 34 Z9 35 U1 2 U2 3 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2006 VL 25 IS 5 BP 1386 EP 1393 DI 10.1377/hlthaff.25.5.1386 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 087MJ UT WOS:000240746200024 PM 16966737 ER PT J AU Sing, M Banthin, JS Selden, TM Cowan, CA Keehan, SP AF Sing, Merrile Banthin, Jessica S. Selden, Thomas M. Cowan, Cathy A. Keehan, Sean P. TI Reconciling medical expenditure estimates from the MEPS and NHEA, 2002 SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The Medical Expenditure Panel Survey (MEPS) and National Health Expenditure Accounts (NHEA) are often used for health care policy analysis and simulations because they contain comprehensive estimates of national health care expenditures. The NHEA are primarily based on aggregate provider revenue data, while MEPS is based on person-level data on health care expenditures. This article compares MEPS and NHEA expenditure estimates for 2002 and discusses the differences. When MEPS and the NHEA are adjusted to be on a consistent basis, their expenditure estimates differ by 13.8 percent. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Sing, M (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM merrile.sing@ahrq.hhs.gov NR 20 TC 52 Z9 52 U1 0 U2 2 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2006 VL 28 IS 1 BP 25 EP 40 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 116OI UT WOS:000242811800003 PM 17290666 ER PT J AU Kelley, ET Arispe, I Holmes, J AF Kelley, Edward T. Arispe, Irma Holmes, Julia TI Beyond the initial indicators: Lessons from the OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report SO INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE LA English DT Article DE indicators; performance reporting; quality ID SYSTEM PERFORMANCE; ORGANIZATION; COUNTRIES AB Interest in comparative quality measurement and evaluation has grown considerably over the past two decades because of factors such as the recognition of widespread variation in clinical practice, the increased availability of evidence about medical effectiveness, and increasing concern about the cost and quality of health care. This article describes and contrasts two current efforts to develop health performance reporting systems: one, an international initiative-the Health Care Quality Indicator (HCQI) Project, sponsored by the Organization for Economic Cooperation and Development (OECD); and the other, a national project-the National Healthcare Quality Report (NHQR), sponsored by the US Agency for Healthcare Quality and Research. There are a number of lessons learned from a comparison of the two efforts that are relevant for the future of each project and for other indicator-based reporting efforts in quality of health care. These lessons are discussed in the article and include: 1. Conceptual frameworks should be established to guide the selection of indicators. 2. Choices should be made early on in the process to focus on a wide range of clinical conditions or to report on a few priority areas. 3. Methods should be developed to add and subtract indicators while maintaining a stable set of indicators to track over time. 4. Resources should be allocated to communication strategies and how best to present data results to diverse audiences. 5. Mechanisms should be put in place to maintain project momentum. C1 Org Econ Cooperat & Dev, Hlth Care Qual Indicators Project, F-75775 Paris 16, France. UD Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. Ctr Dis Control & Prevent, US Dept Hlth & Human Serv, Hyattsville, MD USA. RP Kelley, ET (reprint author), Org Econ Cooperat & Dev, Hlth Care Qual Indicators Project, 2 Rue Andre Pascal, F-75775 Paris 16, France. EM edward.kelley@oecd.org NR 14 TC 20 Z9 21 U1 4 U2 8 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 1353-4505 J9 INT J QUAL HEALTH C JI Int. J. Qual. Health Care PD SEP PY 2006 VL 18 SU 1 BP 45 EP 51 DI 10.1093/intqhc/mzl027 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 086FG UT WOS:000240658600008 PM 16954516 ER PT J AU Zuvekas, SH Meyerhoefer, CD AF Zuvekas, Samuel H. Meyerhoefer, Chad D. TI Coverage for mental health treatment: Do the gaps still persist? SO JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS LA English DT Article ID MANAGED CARE; SERVICES USE; INSURANCE; DEMAND; PARITY; COSTS AB Background: Consumers have long faced high out-of-pocket costs for mental health and substance abuse treatment in private health insurance plans, the predominant form of insurance coverage in the United States. Nominal mental health benefits may have improved from the mid-1990s onwards, as many states passed mental health parity mandates and other employers voluntarily improved coverage. However, the rapid rise of managed behavioral health care organizations (MBHOs) may have effectively offset these gains in nominal coverage. Aims of the Study: We examine how effective mental health benefits, as measured by actual out-of-pocket expenses, compares to coverage for non-mental health treatment and how this has changed in recent years. Methods: We used detailed data on health care use and expenses from the nationally representative, Medical Expenditure Panel Survey (MEPS) to describe the distribution of out-of-pocket expenses for mental health and non-mental health ambulatory visits and prescription drug fills and demonstrate how this changed between 1996 and 2003. In addition, we use two-limit to bit regression models to descriptively examine the factors associated with higher out-of-pocket costs for ambulatory mental health treatment. Results: While out-of-pockets shares generally decreased over the 1996-2003 period, from 39 to 35 percent of total expenses for ambulatory mental health visits and from 3 1 to 26 percent for non-mental health ambulatory visits, the ratio of out-of-pockets costs is still significantly higher for mental health care. Out-of-pocket expenses per visit fell as the number of non-mental health visits increased but out-of-pocket expenses for mental health visits rose with more visits. Out-of-pocket expenses for visits to specialty mental health providers were substantially higher than for non-psychiatrist physicians. Though prescription drug spending increased substantially, the percent paid out-of-pocket did not change for mental health and non-mental health related fills. Discussion: Our results suggest that expenses for ambulatory mental health visits, especially for specialty providers, effectively remain less well covered than other medical visits. Implications for Health Care Provision and Use: Continued high out-of-pocket expenses for mental health treatment may impede access to mental health treatment, especially for those who need greater treatment intensity. Implications for Health Policies: Mental health parity may not ensure that coverage for mental health services is, in actuality, equal. Implications for Further Research: Additional research is needed in understanding relative changes in nominal vs. actual or effective coverage. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Zuvekas, SH (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM szuvekas@ahrq.gov NR 27 TC 11 Z9 11 U1 0 U2 4 PU INT CENTER MENTAL HEALTH POLICY & ECONOMICS-ICMPE PI MILANO PA VIA DANIELE CRESPI 7, MILANO, 20123, ITALY SN 1091-4358 J9 J MENT HEALTH POLICY JI J. Ment. Health Policy Econ. PD SEP PY 2006 VL 9 IS 3 BP 155 EP 163 PG 9 WC Health Policy & Services; Psychiatry SC Health Care Sciences & Services; Psychiatry GA 085BM UT WOS:000240578100005 PM 17031020 ER PT J AU Hubbard, HB AF Hubbard, Heddy Bishop TI Interdisciplinary research: The roel of nursing education SO JOURNAL OF PROFESSIONAL NURSING LA English DT Article; Proceedings Paper CT Conference of the American-Association-of-Colleges-of-Nursing CY JAN, 2005 CL San Diego, CA SP Amer Assoc Coll Nursing ID SCIENCES C1 AHRQ, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Hubbard, HB (reprint author), AHRQ, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. NR 9 TC 0 Z9 0 U1 3 U2 3 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 8755-7223 J9 J PROF NURS JI J. Prof. Nurs. PD SEP-OCT PY 2006 VL 22 IS 5 BP 266 EP 269 DI 10.1016/j.profnurs.2006.07.012 PG 4 WC Nursing SC Nursing GA 089ZR UT WOS:000240920900003 PM 16990117 ER PT J AU Rosen, AK Zhao, SB Rivard, P Loveland, S Montez-Rath, ME Elixhauser, A Romano, PS AF Rosen, Amy K. Zhao, Shibei Rivard, Peter Loveland, Susan Montez-Rath, Maria E. Elixhauser, Anne Romano, Patrick S. TI Tracking rates of patient safety indicators over time - Lessons from the veterans administration SO MEDICAL CARE LA English DT Article DE patient safety; medical errors; administrative data; quality improvement; adverse events ID QUALITY IMPROVEMENT IMPLEMENTATION; HEALTH-SERVICES RESEARCH; ADVERSE EVENTS; UNITED-STATES; VOLUME; CARE; COMPLICATIONS; HOSPITALS; MORTALITY; COSTS AB Background: The Patient Safety Indicators (PSIs), developed by the Agency for Healthcare Research and Quality, are useful screening tools for highlighting areas in which quality should be further investigated and providing useful benchmarks for tracking progress. Objectives: Our objectives were to: 1) provide a descriptive analysis of the incidence of PSI events from 2001 to 2004 in the Veterans Health Administration (VA); 2) examine trends in national PSI rates at the hospital discharge level over time; and 3) assess whether hospital characteristics (eg, teaching status, number of beds, and degree of quality improvement implementation) and baseline safety-related hospital performance predict future hospital safety-related performance. Methods: We examined changes in risk-adjusted PSI rates at the discharge level, calculated the correlation between hospitals' risk-adjusted PSI rates in 2001 with subsequent years, and developed generalized linear models to examine predictors of hospitals' 2004 risk-adjusted PSI rates. Results: Risk-adjusted rates of 2 of the 15 PSIs demonstrated significant trends over time. Rates of iatrogenic pneumothorax increased over time, whereas rates of failure to rescue decreased. Most PSIs demonstrated consistent rates over time. After accounting for patient and hospital characteristics, hospitals' baseline risk-adjusted PSI rates were the most important predictors of their 2004 risk-adjusted rates for 8 PSIs. Conclusions: The PSIs are useful tools for tracking and monitoring patient safety events in the VA. Future research should investigate whether trends reflect better or worse care or increased attention to documenting patient safety events. C1 Bedford VAMC 152, Ctr Hlth Qual Outcomes & Econ Res, Bedford, MA 01730 USA. Boston Univ, Sch Publ Hlth, Dept Hlth Serv, Boston, MA 02215 USA. Boston Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02215 USA. Boston Univ, Sch Med, Dept Family Med, Boston, MA 02215 USA. Boston Coll, Carroll Sch Management, Org Studies Dept, Boston, MA USA. Agcy Healthcare Res & Qual, Ctr Delviery Org & Markets, Rockville, MD USA. Univ Calif Davis, Div Gen Med, Sacramento, CA 95817 USA. RP Rosen, AK (reprint author), Bedford VAMC 152, Ctr Hlth Qual Outcomes & Econ Res, 200 Springs Rd, Bedford, MA 01730 USA. EM akrosen@bu.edu RI Romano, Patrick/N-4225-2014 OI Romano, Patrick/0000-0001-6749-3979 NR 48 TC 32 Z9 32 U1 3 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2006 VL 44 IS 9 BP 850 EP 861 DI 10.1097/01.mlr.0000220686.82472.9c PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 080PV UT WOS:000240260900008 PM 16932137 ER PT J AU Wolff, TA Gutke, GD AF Wolff, Tracy A. Gutke, Gregory D. TI Screening for peripheral arterial disease SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, Rockville, MD 20850 USA. Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA. RP Wolff, TA (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, Rockville, MD 20850 USA. NR 2 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD AUG 15 PY 2006 VL 74 IS 4 BP 635 EP 636 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 077FK UT WOS:000240013300009 PM 16939187 ER PT J AU Calonge, N Carter, C AF Calonge, Ned Carter, Charles CA US Preventive Services Task TI Screening for iron deficiency anemia, including iron supplementations for children and pregnant women: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, USPSTF, Rockville, MD 20850 USA. RP Calonge, N (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force, USPSTF, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 4 TC 5 Z9 5 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD AUG 1 PY 2006 VL 74 IS 3 BP 461 EP 464 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 070NP UT WOS:000239529800011 ER PT J AU Hellinger, FJ Encinosa, WE AF Hellinger, Fred J. Encinosa, William E. TI The impact of state laws limiting malpractice damage awards on health care expenditures SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID FEE-FOR-SERVICE; DEFENSIVE-MEDICINE; MEDICAID; CLAIMS; HOME AB Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care. We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%. C1 Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Room 5319,540 Gaither Rd, Rockville, MD 20850 USA. EM fhelling@ahrq.gov NR 52 TC 24 Z9 25 U1 1 U2 3 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 800 I STREET, NW, WASHINGTON, DC 20001-3710 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD AUG PY 2006 VL 96 IS 8 BP 1375 EP 1381 DI 10.2105/AJPH.2005.077883 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 070NR UT WOS:000239530000012 PM 16809580 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Gordis, L Gregory, KD Harris, R Kizer, KW LeFevre, ML Loveland-Cherry, C Marion, LN Moyer, VA Ockene, JK Sawaya, GF Siu, AL Teutsch, SM Yawn, BP AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Gordis, Leon Gregory, Kimberly D. Harris, Russell Kizer, Kenneth W. LeFevre, Michael L. Loveland-Cherry, Carol Marion, Lucy N. Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Siu, Albert L. Teutsch, Steven M. Yawn, Barbara P. CA US Preventive Serv Task Force TI Screening for hemochromatosis: Recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID LONG-TERM SURVIVAL; HEREDITARY HEMOCHROMATOSIS; POPULATION; IRON AB This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for hemochromatosis and the supporting scientific evidence. The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and on the USPSTF Web site (www.preventiveservices.ahrq.gov). The USPSTF is redesigning its recommendation statement in response to feedback from primary care clinicians. The USPSTF plans to release, later in 2006, a new, updated recommendation statement that is easier to read and incorporates advances in USPSTF methods. The recommendation statement in this paper is an interim version that combines existing language and elements with a new format. Although the definitions of grades remain the same, other elements have been revised. C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 12 TC 20 Z9 21 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD AUG 1 PY 2006 VL 145 IS 3 BP 204 EP 208 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 070MN UT WOS:000239526800006 ER PT J AU Senanayake, P AF Senanayake, Pramilla TI Accountability and good governance are essential to deliver health services SO BULLETIN OF THE WORLD HEALTH ORGANIZATION LA English DT Editorial Material C1 Fdn Council Global Forum Hlth Res, Colombo, Sri Lanka. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Senanayake, P (reprint author), Fdn Council Global Forum Hlth Res, Senanayake 4-8 Hyde Pk Residencies,79 Hyde Pk Cor, Colombo, Sri Lanka. EM pramilla.senanayake@globalforumhealth.org NR 2 TC 0 Z9 0 U1 0 U2 0 PU WORLD HEALTH ORGANIZATION PI GENEVA 27 PA MARKETING AND DISSEMINATION, CH-1211 GENEVA 27, SWITZERLAND SN 0042-9686 J9 B WORLD HEALTH ORGAN JI Bull. World Health Organ. PD AUG PY 2006 VL 84 IS 8 BP 662 EP 662 PG 1 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 071ON UT WOS:000239611600017 ER PT J AU Griffith, DM Moy, E Reischl, TM Dayton, E AF Griffith, Derek M. Moy, Ernest Reischl, Thomas M. Dayton, Elizabeth TI National data for monitoring and evaluating racial and ethnic health inequities: Where do we go from here? SO HEALTH EDUCATION & BEHAVIOR LA English DT Article DE evaluation; data; health disparities; research; program evaluation; health policy; health education; health inequities; health inequalities; monitoring ID PUBLIC-HEALTH; DISPARITIES; PROMOTION; COMMUNITY; RACE; POVERTY; POLICY; CARE; DETERMINANTS; PARTNERSHIP AB The elimination of racial and ethnic health inequities has become a central focus of health education and the national health agenda. The documentation of an increasing gap in life expectancy and other health outcomes suggests the need for more effective strategies to eliminate health inequities, which can be informed by better monitoring and evaluation data. Although the sophistication and volume of health data available have increased dramatically in recent years, this article examines the quality of the current data collected to achieve the goal of eliminating racial and ethnic health inequities. This article explores several key aspects of data to inform addressing inequities including terminology, the role of data, and explanations of the problem. The authors conclude with recommendations for refining data collection to facilitate the elimination of racial and ethnic health inequities and suggest how the Society for Public Health Education can become a more central figure in our national efforts. C1 Univ Michigan, Sch Publ Hlth, Dept Hlth Behav & Hlth Educ, Ann Arbor, MI 48109 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Griffith, DM (reprint author), Univ Michigan, Sch Publ Hlth, Dept Hlth Behav & Hlth Educ, 109 S Observ St,M2525 SPH 2, Ann Arbor, MI 48109 USA. EM derekmg@umich.edu OI Griffith, Derek/0000-0003-0018-9176 NR 70 TC 9 Z9 9 U1 1 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1090-1981 EI 1552-6127 J9 HEALTH EDUC BEHAV JI Health Educ. Behav. PD AUG PY 2006 VL 33 IS 4 BP 470 EP 487 DI 10.1177/1090198106287923 PG 18 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 056QR UT WOS:000238540700005 PM 16769756 ER PT J AU Henriksen, K Dayton, E AF Henriksen, Kerm Dayton, Elizabeth TI Organizational silence and hidden threats to patient safety SO HEALTH SERVICES RESEARCH LA English DT Article DE organizational silence; high reliability organizations; patient safety; organizational learning; communication ID WORK AB Organizational silence refers to a collective-level phenomenon of saying or doing very little in response to significant problems that face an organization. The paper focuses on some of the less obvious factors contributing to organizational silence that can serve as threats to patient safety. Converging areas of research from the cognitive, social, and organizational sciences and the study of sociotechnical systems help to identify some of the underlying factors that serve to shape and sustain organizational silence. These factors have been organized under three levels of analysis: (1) individual factors, including the availability heuristic, self-serving bias, and the status quo trap; (2) social factors, including conformity, diffusion of responsibility, and microclimates of distrust; and (3) organizational factors, including unchallenged beliefs, the good provider fallacy, and neglect of the interdependencies. Finally, a new role for health care leaders and managers is envisioned. It is one that places high value on understanding system complexity and does not take comfort in organizational silence. C1 Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. RP Henriksen, K (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. NR 50 TC 58 Z9 59 U1 2 U2 20 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD AUG PY 2006 VL 41 IS 4 BP 1539 EP 1554 DI 10.1111/j.1475-6773.2006.00564.x PN 2 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 161IT UT WOS:000246008800002 PM 16898978 ER PT J AU Dixon, NM Shofer, M AF Dixon, Nancy M. Shofer, Marjorie TI Struggling to invent high-reliability organizations in health care settings: Insights from the field SO HEALTH SERVICES RESEARCH LA English DT Article DE quality of care; patient safety; high reliability organization; knowledge transfer; diffusion AB The Mission of the Agency for Healthcare Research and Quality (AHRQ) has been to support and conduct health services research and to disseminate those research findings. Recently the Agency has changed its mission to: "Improving the quality, safety, efficiency and effectiveness of health care for all Americans." For agency personnel working with the topic of patient safety, that change has created a need to develop greater awareness of the current patient safety initiatives underway at leading health care systems in order to determine where AHRQ might best play a role in helping these systems more rapidly adopt new practices to improve patient safety. In order to make that determination, AHRQ conducted a customer needs assessment of leaders in selected health care systems, asking them questions about their current implementation initiatives and their perceived needs for continued implementation of patient safety initiatives. Although not designed or conducted as a research study, the hour-long interviews produced rich insights into the implementation efforts of patient safety initiatives. The senior leaders interviewed in each of the health care systems, described implementing patient safety initiatives on multiple fronts-in some systems as many as 15 initiatives were underway. As the number of initiatives attests, there was no lack of knowledge about what patient safety practices should be implemented (CPOE, rapid response teams, reduction in surgical site infections) rather the major struggle these health care systems faced was the "how to" of implementation. Most initiatives were only newly begun, so these leaders were not yet confident about what they had learned from these efforts or whether they could be sustained over time. These health care systems drew many of the ideas for initiatives from outside of health care, for example, the nuclear power industry or aviation. The executives expressed concern about a number of issues including: how patient safety initiatives should be sequenced, the lack of benchmarking data to measure their systems against and the pressing need for IT standardization. The insights from this customer needs assessment revealed a wealth of implementation knowledge in the field and has led AHRQ to create an opportunity for leading edge health care systems to learn from each other via learning networks. C1 Common Knowledge Associates, Dallas, TX 75234 USA. US Dept HHS, Off Commun & Knowledge Transfer, Agcy Healthcare Res & Qual, Washington, DC 20201 USA. RP Dixon, NM (reprint author), Common Knowledge Associates, 2857 Selma Lane, Dallas, TX 75234 USA. NR 7 TC 23 Z9 23 U1 0 U2 12 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD AUG PY 2006 VL 41 IS 4 BP 1618 EP 1632 DI 10.1111/j.1475-6773.2006.00568.x PN 2 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 161IT UT WOS:000246008800006 PM 16898982 ER PT J AU Encinosa, WE Bernard, DM Chen, CC Steiner, CA AF Encinosa, William E. Bernard, Didem M. Chen, Chi-Chang Steiner, Claudia A. TI Healthcare utilization and outcomes after bariatric surgery SO MEDICAL CARE LA English DT Article DE bariatric surgery; obesity; postoperative complications; claims or administrative data ID GASTRIC BYPASS-SURGERY; SURGICAL-PROCEDURES; OBESITY; METAANALYSIS; MORTALITY; TRENDS AB Objective: Bariatric surgery is one of the fastest growing hospital procedures. Our objective is to examine the safety outcomes and utilization of resources in the 6 months after bariatric surgery using a nationwide, population-based sample. Data/Design: We examine insurance claims for 2522 bariatric surgeries, at 308 hospitals, among a population of 5.6 million nonelderly people covered by large employers in the 2001-2002 MarketScan data. Outcomes and costs were risk-adjusted using multivariate regression methods. Principal Findings: Although the complication rate was 21.9% during the initial surgical stay, the rate increased by 81% (P < 0.01) to 39.6% (95% confidence interval, 37.7-41.5%) over the 180 days after discharge. A total of 10.8% of the patients without 30-day complications developed a complication between 30 days and 180 days. Overall, 18.2% of the patients had some type of postoperative visit to the hospital with a complication (through readmission, outpatient hospital visit, or emergency room visit) within 180 days. Although there was no difference between men and women, the near-elderly had a 26% (P < 0.01) higher risk-adjusted complication rate than those age 18 to 39 years. Total 6-month risk-adjusted healthcare payments were $65,031 for those with 180-day readmissions compared with $27,125 for those without readmissions (P < 0.01). Conclusion: In contrast to current bariatric studies, which report a 20% in-hospital complication rate, we find a significantly higher complication rate over the 6 months after surgery, resulting in costly readmissions and emergency room visits. Thus, a clear way to reduce the costs and improve outcomes of bariatric surgery is to address the high rate of postoperative complications. C1 Agcy Healthcare Res & Qual, Ctr Delivery Org & Mkt, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. Univ Maryland, Sch Pharm, Baltimore, MD 21201 USA. RP Encinosa, WE (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Mkt, 540 Gaither Rd,Room 5105, Rockville, MD 20850 USA. EM wencinos@ahrq.gov NR 20 TC 101 Z9 102 U1 3 U2 12 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD AUG PY 2006 VL 44 IS 8 BP 706 EP 712 DI 10.1097/01.mlr.0000220833.89050.ed PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 068FE UT WOS:000239357200002 PM 16862031 ER PT J AU Gray, DT Deyo, RA Kreuter, W Mirza, SK Heagerty, PJ Comstock, BA Chan, L AF Gray, Darryl T. Deyo, Richard A. Kreuter, William Mirza, Sohail K. Heagerty, Patrick J. Comstock, Bryan A. Chan, Leighton TI Population-based trends in volumes and rates of ambulatory lumbar spine surgery SO SPINE LA English DT Article; Proceedings Paper CT Meeting of the American-Academy-of-Health-Services-Research CY JUN 26-28, 2005 CL Boston, MA SP Amer Acad Hlth Serv Res DE lumbar spine surgery; rate trends; ambulatory surgery; outpatient surgery; discectomy; fusion; Nationwide Inpatient Sample (NIS); State Inpatient Database (SID); State Ambulatory Surgery Database (SASD); Healthcare Cost and Utilization Project (HCUP); National Hospital Discharge Survey (NHDS); National Survey of Ambulatory Surgery (NSAS) ID UNITED-STATES TRENDS; LOW-BACK-PAIN; HOSPITALIZATION; ACCURACY; CATARACT; CLAIMS; SAFE AB Study Design. Sequential cross-sectional study. Objectives. To quantify patterns of outpatient lumbar spine surgery. Summary of Background Data. Outpatient lumbar spine surgery patterns are undocumented. Methods. We used CPT-4 and ICD-9-CM diagnosis/procedure codes to identify lumbar spine operations in 20 + year olds. We combined sample volume estimates from the National Hospital Discharge Survey (NHDS), the National Survey of Ambulatory Surgery (NSAS), and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) with complete case counts from HCUP's State Inpatient Databases (SIDs) and State Ambulatory Surgery Databases (SASDs) for four geographically diverse states. We excluded pregnant patients and those with vertebral fractures, cancer, trauma, or infection. We calculated age- and sex-adjusted rates. Results. Ambulatory cases comprised 4% to 13% of procedures performed from 1994 to 1996 (NHDS/NSAS data), versus 9% to 17% for 1997 to 2000 (SID/SASD data). Discectomies comprised 70% to 90% of outpatient cases. Conversely, proportions of discectomies performed on outpatients rose from 4% in 1994 to 26% in 2000. Outpatient fusions and laminectomies were uncommon. NIS data indicate that nationwide inpatient surgery rates were stable ( 159 cases/100,000 in 1994 vs. 162/100,000 in 2000). However, combined data from all sources suggest that inpatient and outpatient rates rose from 164 cases/100,000 in 1994 to 201/100,000 in 2000. Conclusions. While inpatient lumbar surgery rates remained relatively stable for 1994 to 2000, outpatient surgery increased over time. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Univ Washington, Ctr Cost & Outcomes Res, Dept Hlth Serv, Seattle, WA 98195 USA. Univ Washington, Ctr Cost & Outcomes Res, Dept Med, Seattle, WA 98195 USA. Univ Washington, Ctr Cost & Outcomes Res, Dept Orthopaed & Sports Med, Seattle, WA 98195 USA. Univ Washington, Ctr Cost & Outcomes Res, Dept Biostat, Seattle, WA 98195 USA. Univ Washington, Ctr Cost & Outcomes Res, Dept Rehabil, Seattle, WA 98195 USA. RP Gray, DT (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd Room 3353, Rockville, MD 20850 USA. EM darryl.gray@ahrq.hhs.gov FU NIAMS NIH HHS [P60 AR 48093] NR 36 TC 99 Z9 100 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0362-2436 J9 SPINE JI SPINE PD AUG 1 PY 2006 VL 31 IS 17 BP 1957 EP 1963 DI 10.1097/01.brs.0000229148.63418.c1 PG 7 WC Clinical Neurology; Orthopedics SC Neurosciences & Neurology; Orthopedics GA 070KJ UT WOS:000239520800012 PM 16924213 ER PT J AU Smith, SR Clancy, CM AF Smith, Scott R. Clancy, Carolyn M. TI Medication therapy management programs: Forming a new cornerstone for quality and safety in Medicare SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material ID ADVERSE DRUG EVENTS; CONTROLLED TRIAL; PHARMACIST; SERVICES; CARE C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Smith, SR (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. NR 16 TC 18 Z9 18 U1 1 U2 2 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD JUL-AUG PY 2006 VL 21 IS 4 BP 276 EP 279 DI 10.1177/1062860606290031 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 064DJ UT WOS:000239069100009 PM 16849785 ER PT J AU Jiang, HJ Friedman, B Begun, JW AF Jiang, H. Joanna Friedman, Bernard Begun, James W. TI Sustaining and improving hospital performance: The effects of organizational and market factors SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article DE cost; hospital operation; hospital performance; market forces; quality ID MANAGED CARE; QUALITY; COMPETITION; COST AB Using data from hospitals in ten states, this study examines the effects of organizational and market factors on the likelihood of becoming high-quality/low-cost providers during the period of 1997-2001. The findings highlight the important role of previous performance, internal operations, and market competition in hospital performance improvement. Achieving high-quality/low-cost performance is also incidentally found to be associated with improved profit margins. C1 Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. Univ Minnesota, Sch Publ Hlth, Div Hlth Policy & Management, Minneapolis, MN 55455 USA. RP Jiang, HJ (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. EM joanna.jiang@ahrq.gov NR 28 TC 5 Z9 5 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0361-6274 J9 HEALTH CARE MANAGE R JI Health Care Manage. Rev. PD JUL-SEP PY 2006 VL 31 IS 3 BP 188 EP 196 PG 9 WC Health Policy & Services SC Health Care Sciences & Services GA 071MZ UT WOS:000239607600004 PM 16877886 ER PT J AU Coopey, M Nix, MP Clancy, CM AF Coopey, M Nix, MP Clancy, CM TI Translating research into evidence-based nursing practice and evaluating effectiveness SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID CARE C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Coopey, M (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd,Suite 6000, Rockville, MD 20850 USA. EM Salina.Prasad@ahrq.hhs.gov NR 9 TC 11 Z9 11 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD JUL-SEP PY 2006 VL 21 IS 3 BP 195 EP 202 PG 8 WC Nursing SC Nursing GA 055GJ UT WOS:000238437900001 PM 16816597 ER PT J AU Hanmer, J Lawrence, WF Anderson, JP Kaplan, RM Fryback, DG AF Hanmer, Janel Lawrence, William F. Anderson, John P. Kaplan, Robert M. Fryback, Dennis G. TI Report of nationally representative values for the noninstitutionalized US adult population for 7 health-related quality-of-life scores SO MEDICAL DECISION MAKING LA English DT Article DE health-related quality of life; EQ-5D; SF-12; SF-6D; QWB; national norms ID NORMATIVE DATA; INTERVIEW SURVEY; SF-36; EQ-5D; NORMS; SF-12; VALIDITY; RELIABILITY; VALIDATION; SPANISH AB Background. Despite widespread use of generic health-related quality-of-life (HRQoL) scores, few have publicly published nationally representative US values. Purpose. To create current nationally representative values for 7 of the most common HRQoL scores, stratified by age and sex. Methods. The authors used data from the 2001 Medical Expenditures Panel Survey (MEPS) and the 2001 National Health Interview Survey (NHIS), notionally representative surveys of the US noninstitutionalized civilian population. The MEPS was used to calculate 6 HRQoL scores: categorical self-rated health, EuroQoL-5D with US scoring, EuroQoL-5D with UK scoring, EuroQol Visual Analog Scale, mental and physical component summaries from the SF-12, and the SF-6D. The authors estimated Quality of Well-being scale scores from the NHIS. Results. They included 22,523 subjects from MEPS 2001 and 32,472 subjects from NHIS 2001. Most age and sex categories had instrument completion rates above 85%. Females reported lower scores than males across all ages and instruments. In general, those in older age groups reported lower scores than younger age groups, with the exception of the mental component summary from the SF-12. Conclusion, This is one of the first sets of publicly available, nationally representative US values for any standardized HRQoL measure. These values are important for use in both generalized comparisons of health status and in cost-effectiveness analyses. C1 Univ Wisconsin, Dept Populat Hlth Sci, Madison, WI 53726 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif San Diego, La Jolla, CA 92093 USA. Univ Calif Los Angeles, Los Angeles, CA 90024 USA. RP Hanmer, J (reprint author), Univ Wisconsin, Dept Populat Hlth Sci, 644 WARF,610 Walnut St, Madison, WI 53726 USA. EM jehanmer@wisc.edu FU AHRQ HHS [HS000083]; NIA NIH HHS [P01 AG206079-01] NR 26 TC 170 Z9 170 U1 2 U2 14 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0272-989X J9 MED DECIS MAKING JI Med. Decis. Mak. PD JUL-AUG PY 2006 VL 26 IS 4 BP 391 EP 400 DI 10.1177/0272989X06290497 PG 10 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA 066PV UT WOS:000239243500011 PM 16855127 ER PT J AU Kourtis, AP Paramsothy, P Posner, SF Meikle, SF Jamieson, DJ AF Kourtis, AP Paramsothy, P Posner, SF Meikle, SF Jamieson, DJ TI National estimates of hospital use by children with HIV infection in the United States: Analysis of data from the 2000 KIDS inpatient database SO PEDIATRICS LA English DT Article DE HIV; children; hospitalizations; United States; HCUP; diagnosis ID ACTIVE ANTIRETROVIRAL THERAPY; COMBINATION THERAPY; HEALTH-CARE; MORTALITY; RATES; YOUTH AB OBJECTIVES. The purpose of this research was to describe hospital use patterns of HIV-infected children in the United States. STUDY DESIGN. We analyzed a nationwide, stratified probability sample of 2.5 million hospital discharges of children and adolescents during the year 2000, weighted to 7.3 million discharges nationally. We excluded discharges after hospitalizations related to pregnancy/childbirth and their complications and discharges of neonates < 1 month of age and of patients > 18 years of age. Diagnoses were identified through the use of the Clinical Classification Software with grouping of related diagnoses. RESULTS. We estimated that there were 4107 hospitalizations of HIV-infected children in 2000 and that these hospitalizations accounted for similar to$100 million in hospital charges and > 30 000 hospital days. Infections, including sepsis and pneumonia, were among the most frequent diagnoses in such hospitalizations, followed by diagnoses related to gastrointestinal conditions, nutritional deficiencies and anemia, fluid/electrolyte disorders, central nervous system disorders, cardiovascular disorders, and respiratory illnesses. Compared with hospitalizations of nonHIV-infected children, hospitalizations of HIV-infected ones were more likely to be in urban areas, in pediatric/teaching hospitals, and in the Northeast, and the expected payer was more likely to be Medicaid (77.6% vs 37.2%). Compared with children without HIV, those with HIV tended to be older (median age: 9.5 years vs 5.2 years), to have been hospitalized longer (mean: 7.8 days vs 3.9 days), and to have incurred higher hospital costs (mean: $23 221 vs $11 215); HIV-associated hospitalizations ended in the patient's death more frequently than non-HIV ones (1.8% vs 0.4%), and complications of medical care were also more common (10.8% vs 6.2%). CONCLUSIONS. Infections account for the majority of hospitalizations of HIV-infected children in the United States, although nutritional deficiencies, anemia and other hematologic disorders, gastrointestinal and renal disorders, and complications of medical care are also more common among hospitalized children with HIV than among those without HIV. C1 Ctr Dis Control & Prevent, Div Reprod Hlth, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA. Eastern Virginia Med Sch, Norfolk, VA 23501 USA. CONRAD Program, Arlington, VA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Kourtis, AP (reprint author), Koger Ctr, Columbia Bldg,2900 Woodcock Blvd, Atlanta, GA 30341 USA. EM apk3@cdc.gov OI Posner, Samuel/0000-0003-1574-585X NR 20 TC 10 Z9 10 U1 0 U2 5 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JUL PY 2006 VL 118 IS 1 BP E167 EP E173 DI 10.1542/peds.2005-2780 PG 7 WC Pediatrics SC Pediatrics GA 059II UT WOS:000238726100084 PM 16769799 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Serv Task Force TI Screening for developmental dysplasia of the hip: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID MEDIAL OPEN REDUCTION; TERM-FOLLOW-UP; CONGENITAL DISLOCATION; AVASCULAR NECROSIS; CLOSED REDUCTION; NATURAL-HISTORY; PAVLIK HARNESS; RISK-FACTORS; ULTRASOUND; NEWBORNS C1 Univ S Carolina, Family Med Residency, Columbia, SC 29208 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 46 TC 1 Z9 1 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JUN 1 PY 2006 VL 73 IS 11 BP 1992 EP 1996 PG 5 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 051QJ UT WOS:000238175300012 ER PT J AU Coben, JH Steiner, CA Barrett, M Merrill, CT Adamson, D AF Coben, JH Steiner, CA Barrett, M Merrill, CT Adamson, D TI Completeness of cause of injury coding in healthcare administrative databases in the United States, 2001 SO INJURY PREVENTION LA English DT Article AB Objectives: To determine the completeness of external cause of injury coding (E-coding) within healthcare administrative databases in the United States and to identify factors that contribute to variations in E-code reporting across states. Design: Cross sectional analysis of the 2001 Healthcare Cost and Utilization Project (HCUP), including 33 State Inpatient Databases (SID), a Nationwide Inpatient Sample (NIS), and nine State Emergency Department Databases (SEDD). To assess state reporting practices, structured telephone interviews were conducted with the data organizations that participate in HCUP. Results: The percent of injury records with an injury E-code was 86% in HCUP's nationally representative database, the NIS. For the 33 states represented in the SID, completeness averaged 87%, with more than half of the states reporting E-codes on at least 90% of injuries. In the nine states also represented in the SEDD, completeness averaged 93%. Twenty two states had mandates for E-code reporting, but only eight had provisions for enforcing the mandates. These eight states had the highest rates of E-code completeness. Conclusions: E-code reporting in administrative databases is relatively complete, but there is significant variation in completeness across the states. States with mandates for the collection of E-codes and with a mechanism to enforce those mandates had the highest rates of E-code reporting. Nine statewide ED data systems demonstrate consistently high E-coding completeness. C1 W Virginia Univ, Injury Control Res Ctr, Morgantown, WV 26506 USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. ML Barrett Inc, San Diego, CA USA. Medstat, Washington, DC USA. RP Coben, JH (reprint author), W Virginia Univ, Injury Control Res Ctr, POB 9151, Morgantown, WV 26506 USA. EM jcoben@hsc.wvu.edu NR 13 TC 25 Z9 26 U1 0 U2 0 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1353-8047 J9 INJURY PREV JI Inj. Prev. PD JUN PY 2006 VL 12 IS 3 BP 199 EP 201 DI 10.1136/ip.2005.010512 PG 3 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 049PX UT WOS:000238029700015 PM 16751453 ER PT J AU Kirby, JB Kaneda, T AF Kirby, JB Kaneda, T TI Access to health care: Does neighborhood residential instability matter? SO JOURNAL OF HEALTH AND SOCIAL BEHAVIOR LA English DT Article ID LOS-ANGELES-COUNTY; PREVENTABLE HOSPITALIZATIONS; GEOGRAPHIC-VARIATION; COLLECTIVE EFFICACY; SOCIAL INTEGRATION; URBAN COMMUNITIES; MEDICAL-CARE; CRIME; OLDER; MAMMOGRAPHY AB Many Americans do not have access to adequate medical care. Previous research on this problem focuses primarily on individual-level determinants Of access such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed medical care, however, has not received much attention. We address this gap in the literature by investigating the association between neighborhood residential instability and access to health care. Using individual-level data from the 2000 Medical Expenditure Panel Survey and block-group level data from the 2000 decennial census, we find that individuals who live in neighborhoods with high residential turnover have worse health care access than residents of other neighborhoods. This association persists even when the prevalence of poverty, the supply of health care, and a variety of individual characteristics are held constant. We offer explanations for these findings and suggest directions for future research. C1 US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Kirby, JB (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, 540 Gaither Rd,5th Floor, Rockville, MD 20850 USA. NR 52 TC 21 Z9 21 U1 1 U2 8 PU AMER SOCIOLOGICAL ASSOC PI WASHINGTON PA 1307 NEW YORK AVE NW #700, WASHINGTON, DC 20005-4712 USA SN 0022-1465 J9 J HEALTH SOC BEHAV JI J. Health Soc. Behav. PD JUN PY 2006 VL 47 IS 2 BP 142 EP 155 PG 14 WC Public, Environmental & Occupational Health; Psychology, Social SC Public, Environmental & Occupational Health; Psychology GA 056HU UT WOS:000238513800004 PM 16821508 ER PT J AU Cox, S Posner, SF McPheeters, M Jamieson, DJ Kourtis, AP Meikle, S AF Cox, Shanna Posner, Samuel F. McPheeters, Melissa Jamieson, Denise J. Kourtis, Athena P. Meikle, Susan TI Hospitalizations with respiratory illness among pregnant women during influenza season SO OBSTETRICS AND GYNECOLOGY LA English DT Article ID UNITED-STATES AB OBJECTIVE: To examine hospitalizations with respiratory illness among pregnant women in the United States during periods of influenza activity. METHODS: Data were obtained from the Healthcare Cost and Utilization Project National Inpatient Sample (NIS), the largest publicly available all-payer hospital discharge database. Hospitalizations for respiratory illness and pregnancy were classified with International Classification of Diseases, 9th Revision, Clinical Modification codes. Analyses were stratified by delivery status. Discharge characteristics, length of stay, and complications of delivery among hospitalized pregnant women with and those without respiratory illness were compared. RESULTS: During the 1998-2002 influenza seasons, 3.4 per 1,000 hospitalizations of pregnant women included diagnoses of respiratory illness. Characteristics of pregnancy hospitalizations associated with higher odds of respiratory illness were presence of a high-risk condition for which influenza vaccination is recommended (adjusted odds ratio [OR] 3.2, 95% confidence interval [Cl] 3.0-3.5 and OR 6.0, 95% Cl 5.2-6.9 for nondelivery and delivery, respectively), Medicaid/Medicare as primary expected payer of care (OR 1.2, 95% Cl 1.1-1.3 and OR 1.9, 95% Cl 1.7-2.2 for nondelivery and delivery, respectively), and hospitalization in a rural area (OR 1.2, 95% Cl 1.1-1.4 for nondelivery). During influenza season, hospitalized pregnant women with respiratory illness had significantly longer lengths of stay and higher odds of delivery complications than hospitalized pregnant women without respiratory illness. CONCLUSION: Hospitalizations with respiratory illness among pregnant women during influenza season are associated with increased burden for patients and the health care system. Intervention efforts to decrease influenza-related respiratory morbidity among pregnant women should be encouraged. C1 Ctr Dis Control & Prevent, Coordinating Ctr Hlth Promot, Div Reprod Hlth, Atlanta, GA 30341 USA. Oak Ridge Inst Sci & Educ, Oak Ridge, TN USA. Univ Michigan, Hlth Syst, Div Gen Pediat, Ann Arbor, MI 48109 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Posner, SF (reprint author), Ctr Dis Control & Prevent, Coordinating Ctr Hlth Promot, Div Reprod Hlth, 4770 Buford Highway MS K-20, Atlanta, GA 30341 USA. EM shp5@cdc.gov RI Cox, Shanna/F-4806-2011; OI Posner, Samuel/0000-0003-1574-585X NR 14 TC 94 Z9 101 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0029-7844 J9 OBSTET GYNECOL JI Obstet. Gynecol. PD JUN PY 2006 VL 107 IS 6 BP 1315 EP 1322 DI 10.1097/01.AOG.0000218702.92005.bb PG 8 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 095GS UT WOS:000241296800016 PM 16738158 ER PT J AU Malek, MA Curns, AT Holman, RC Fischer, TK Bresee, JS Glass, RI Steiner, CA Parashar, UD AF Malek, Mark A. Curns, Aaron T. Holman, Robert C. Fischer, Thea K. Bresee, Joseph S. Glass, Roger I. Steiner, Claudia A. Parashar, Umesh D. TI Diarrhea- and rotavirus-associated hospitalizations among children less than 5 years of age: United States, 1997 and 2000 SO PEDIATRICS LA English DT Article DE diarrhea; vaccines; gastroenteritis; rotavirus; hospitalization ID SURVEILLANCE; MORTALITY; MORBIDITY; DISEASE; TRENDS; CODE AB OBJECTIVE. A new rotavirus vaccine may be licensed in the United States in early 2006. Estimates of the burden of severe rotavirus disease, particularly hospitalizations, will help evaluate the potential benefits of a national rotavirus immunization program. DESIGN. The Kids' Inpatient Database, a robust sample of 10% of the uncomplicated births and 80% of other pediatric discharges was used to estimate the number and rate of diarrhea- and rotavirus-associated hospitalizations among US children < 5 years of age in 1997 and 2000. RESULTS. In 1997 and 2000, diarrhea was coded in 13% of all childhood hospitalizations, for an estimated cumulative incidence of 1 diarrhea hospitalization per 23 to 27 children by age 5. Most diarrhea-associated hospitalizations (62%) were coded as unspecified etiology, and 35% as viral. Rotavirus was the most common pathogen recorded for 18% and 19% of diarrhea-associated hospitalizations in 1997 and 2000, respectively. Diarrhea-associated hospitalizations coded as unspecified or viral exhibited a marked winter peak similar to that of hospitalizations coded as rotavirus, suggesting that the rotavirus-specific code captures a fraction of all rotavirus hospitalizations. Using indirect methods, we estimated that rotavirus was associated with 51 142-60 155 and 46 839-56 820 hospitalizations in 1997 and 2000, respectively. By these estimates, rotavirus is associated with 4% to 5% of all childhood hospitalizations, and 1 in 67 to 1 in 85 children will be hospitalized with rotavirus by 5 years of age. CONCLUSIONS. Diarrhea is an important cause of hospitalization in US children, and rotavirus is the most important etiology. Disease burden estimates have remained stable during the past decade. An effective rotavirus vaccine will likely reduce substantially the burden of severe rotavirus disease, estimated to account for 4% to 5% of all hospitalizations and similar to 30% of hospitalizations for watery diarrhea among children < 5 years of age. C1 Ctr Dis Control & Prevent, Resp & Enter Viruses Branch, Natl Ctr Infect Dis, Atlanta, GA 30333 USA. Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Infect Dis, Atlanta, GA 30333 USA. US Dept HHS, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Malek, MA (reprint author), Ctr Dis Control & Prevent, Resp & Enter Viruses Branch, Natl Ctr Infect Dis, 1600 E Clifton Rd,NE Bldg 3,Room 108,MS A-34, Atlanta, GA 30333 USA. EM mmalek@cdc.gov OI Fischer, Thea Kolsen/0000-0003-4812-980X NR 19 TC 114 Z9 117 U1 0 U2 4 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JUN PY 2006 VL 117 IS 6 BP 1887 EP 1892 DI 10.1542/peds.2005-2351 PG 6 WC Pediatrics SC Pediatrics GA 048XE UT WOS:000237979000003 PM 16740827 ER PT J AU Stone, RAT Purkayastha, B Berdahl, TA AF Stone, Rosalie A. Torres Purkayastha, Bandana Berdahl, Terceira Ann TI Beyond Asian American: Examining conditions and mechanisms of earnings inequality for Filipina and Asian Indian women SO SOCIOLOGICAL PERSPECTIVES LA English DT Article DE Asian; earnings; ethnicity; gender; race ID US LABOR-MARKETS; IMMIGRANT WOMEN; MEXICAN-AMERICANS; WAGE INEQUALITY; UNITED-STATES; HISPANIC MEN; GENDER; WORK; DISADVANTAGE; ACHIEVEMENT AB Theories of intersectionality encourage scholars to look at how "gender", experiences are forged through race, particularly in the labor market. This study uses data from the 2000 1-percent Public Use Microdata on 23,852 Filipina, Asian Indian, and non-Hispanic white women living ill New York, Chicago. and Los Angeles to examine additive and interactional influences Oil earnings. A detailed analysis of interaction (effects by race-ethnicity reveal several important differences across the three groups of women. The results of this study show that popular stereotypes about Asian-origin groups, such as "model minority." mask significant barriers ill achieving full equality in the labor market. The study also highlights the importance of immigration context and occupational race segregation ill understanding earnings for non-white immigrant women. C1 Univ Nebraska, Dept Sociol, Lincoln, NE 68588 USA. Univ Connecticut, Storrs, CT USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Stone, RAT (reprint author), Univ Nebraska, Dept Sociol, 711 Oldfather Hall, Lincoln, NE 68588 USA. EM rstone2@unlnotes.unl.edu NR 60 TC 12 Z9 12 U1 1 U2 10 PU UNIV CALIFORNIA PRESS PI BERKELEY PA C/O JOURNALS DIVISION, 2000 CENTER ST, STE 303, BERKELEY, CA 94704-1223 USA SN 0731-1214 J9 SOCIOL PERSPECT JI Sociol. Perspect. PD SUM PY 2006 VL 49 IS 2 BP 261 EP 281 PG 21 WC Sociology SC Sociology GA 067PW UT WOS:000239316100006 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Svcs Task Force TI Screening for speech and language delay in preschool children: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID AUDITORY MILESTONE SCALE; CONCURRENT VALIDITY; VALIDATION; POPULATION; HACKNEY; TESTS; CITY C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 29 TC 6 Z9 6 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAY 1 PY 2006 VL 73 IS 9 BP 1605 EP 1610 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 039RL UT WOS:000237324400012 ER PT J AU McNeill, D Moy, E Clancy, CM AF McNeill, D Moy, E Clancy, CM TI The Agency for Healthcare Research and Quality's National Healthcare Quality and Disparities Reports: Action agendas for the nation SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP McNeill, D (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 3 TC 1 Z9 1 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD MAY-JUN PY 2006 VL 21 IS 3 BP 206 EP 209 DI 10.1177/1062860606288003 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 043JZ UT WOS:000237598600008 PM 16679441 ER PT J AU Tan, C Sedrakyan, A Browne, J Swift, S Treasure, T AF Tan, C Sedrakyan, A Browne, J Swift, S Treasure, T TI The evidence on the effectiveness of management for malignant pleural effusion: a systematic review SO EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY LA English DT Review DE malignant effusion; pleurodesis; VATS ID PROSPECTIVE RANDOMIZED-TRIAL; TALC SLURRY; SMALL-BORE; INTRACAVITARY BLEOMYCIN; CORYNEBACTERIUM-PARVUM; TETRACYCLINE PLEURODESIS; BREAST-CANCER; INTRAPLEURAL TETRACYCLINE; PLEUROPERITONEAL SHUNTS; CHEMICAL PLEURODESIS AB The aim of this study was to review systematically the available evidence on pleurodesis for malignant effusion, focusing on the choice of the agents, route of delivery and other strategies to improve outcomes. Four electronic databases (MEDLINE, EMBASE, Web of Science and Cochrane Controlled Trials Register) were searched, reference lists checked and letters requesting details of unpublished trials and data sent to authors of previous trials. Studies of malignant pleural effusion in humans were selected with no language restrictions applied. Criteria for randomised clinical trial (RCT) eligibility were random allocation of patients and non-concurrent use of another experimental medication or device. Methodological quality evaluation of the trials was based on randomisation, blinding, allocation concealment and intention to treat analysis. A random effect model was used to combine the relative risk estimates of the treatment effects whenever pooling for an overall effect was considered appropriate. Forty-six RCTs with a total of 2053 patients with malignant pleural effusions were reviewed for effectiveness of pleurodesis. Talc tended to be associated with fewer recurrences when compared to bleomycin (RR, 0.64; 95% CI, 0.34-1.20) and, with more uncertainty, to tetracycline (RR, 0.50; 95% CI, 0.06-4.42). Tetracycline (or doxycycline) was not superior to bleomycin (RR, 0.92; 95% CI, 0.61-1.38). When compared with bedside talc slurry, thoracoscopic talc insufflation was associated with a reduction in recurrence (RR, 0.21; 95% CI, 0.05-0.93). Strategies such as rolling the patient after instillation of the sclerosing agent, protracted drainage of the effusion and use of larger chest tubes were not found to have any substantial advantages. Talc appears to be effective and should be the agent of choice for pleurodesis. Thoracoscopic talc insufflation is associated with fewer recurrences of effusions compared with bedside talc slurry, but this is based on two small studies. Where thoracoscopy is unavailable bedside talc pleurodesis has a high success rate and is the next best option. Crown Copyright (c) 2005 Published by Elsevier B.V. All rights reserved. C1 Guys Hosp, Thorac Unit, London SE1 9RT, England. Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. Royal Coll Surgeons England, Clin Effectiveness Unit, London WC1E 7HT, England. Univ London London Sch Hyg & Trop Med, Hlth Serv Res Unit, London WC1E 7HT, England. RP Treasure, T (reprint author), Guys Hosp, Thorac Unit, St Thomas St, London SE1 9RT, England. EM Tom.Treasure@gstt.nhs.uk NR 73 TC 105 Z9 113 U1 0 U2 8 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 1010-7940 J9 EUR J CARDIO-THORAC JI Eur. J. Cardio-Thorac. Surg. PD MAY PY 2006 VL 29 IS 5 BP 829 EP 838 DI 10.1016/j.ejcts.2005.12.025 PG 10 WC Cardiac & Cardiovascular Systems; Respiratory System; Surgery SC Cardiovascular System & Cardiology; Respiratory System; Surgery GA 048BS UT WOS:000237923200035 PM 16626967 ER PT J AU Kirby, JB AF Kirby, JB TI From single-parent families to stepfamilies - Is the transition associated with adolescent alcohol initiation? SO JOURNAL OF FAMILY ISSUES LA English DT Article DE stepfamilies; adolescents; alcohol ID YOUNG ADOLESCENTS; DIVORCE; REMARRIAGE; HEALTH; CHILDREN; SOCIALIZATION; DELINQUENCY; RELIGIOSITY; INVOLVEMENT; EXPERIENCES AB This study addresses two questions: Is stepfamily formation associated with the likelihood that adolescents will initiate alcohol use, and if so, does this association differ by the type of single-parent families from which adolescents move or the type of stepfamilies to which they move? The author found that adolescents who moved to stepfamilies from single-parent families had an elevated risk of initiating alcohol use. A transition from a divorced single-parent family to a stepfamily is associated with an increase in alcohol initiation among boys, but a transition from an unwed single-parent family to a stepfamily is not. In contrast, girls who transition from an unwed single-parent family to a stepfamily show an elevated likelihood of initiating alcohol use, whereas those who transition from divorced single-parent families do not. Adolescents who move to cohabiting stepfamilies do not respond differently than do adolescents who move to married stepfamilies regardless of gender. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 48 TC 12 Z9 12 U1 1 U2 13 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0192-513X J9 J FAM ISSUES JI J. Fam. Issues PD MAY PY 2006 VL 27 IS 5 BP 685 EP 711 DI 10.1177/0192513X05284855 PG 27 WC Family Studies SC Family Studies GA 031WQ UT WOS:000236736300005 ER PT J AU Cohen, SB Buchmueller, T AF Cohen, SB Buchmueller, T TI Trends in medical care costs, coverage, use, and access - Research findings from the Medical Expenditure Panel Survey SO MEDICAL CARE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Cohen, SB (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM scohen@ahrq.gov NR 9 TC 7 Z9 7 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 1 EP 3 DI 10.1097/01.mlr.0000208145.39467.6a PG 3 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800001 ER PT J AU Cooper, PF Simon, KI Vistnes, J AF Cooper, PF Simon, KI Vistnes, J TI A closer look at the managed care backlash SO MEDICAL CARE LA English DT Article DE managed care; health plan enrollment ID INSURANCE; COVERAGE; CHOICE; TRENDS AB Background: Much anecdotal evidence exists regarding the managed care backlash of the late 1990s, but limited empirical evidence is available. Objectives: Using a unique series of employer surveys, we examined trends in enrollment rates in health maintenance organizations (HMOs) and other plan types between 1997 and 2003. Research Design: We present enrollment rates in employer-sponsored health plans by plan type. These plan-level enrollment rates are disaggregated by whether or not enrollees had a choice of plan types and by firm size and year. Subjects: Employees who were enrolled in employer-sponsored health insurance in private sector establishments. Results and Conclusions: Although we found evidence of a decline in the popularity of HMOs, it occurred later than indicated in earlier studies. In our data, HMO enrollment rates fell from roughly 32% to 26% between 1997 and 2003, with most of the decline occurring after 2001. Earlier studies reported that the decline in HMO enrollment rates occurred between 1996 and 1998, and between 2000 and 2001. In addition, an interesting story emerged when we examined trends by firm size. We found evidence of a decline in the HMO enrollment rate for large employers starting in 1998. However, this was offset by an increase in the HMO enrollment rate in small employers, which explains the stability in our figures before 2002. Our data also indicated that when workers were given a choice between an HMO and other plan types, workers increasingly opted for the non-HMO plan during this time period. C1 Cornell Univ, Dept Policy Anal & Management, Ithaca, NY 14853 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. Natl Bur Econ Res, Cambridge, MA 02138 USA. RP Simon, KI (reprint author), Cornell Univ, Dept Policy Anal & Management, 106 MVR Hall, Ithaca, NY 14853 USA. EM kis6@cornell.edu NR 20 TC 9 Z9 9 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 4 EP 11 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800002 ER PT J AU Bernard, DM Selden, TM AF Bernard, DM Selden, TM TI Workers who decline employment-related health insurance SO MEDICAL CARE LA English DT Article DE health insurance offers; employer-sponsored health insurance; access to care; financial barriers ID CARE AB Background: Families of workers who decline coverage represent a substantial share of the uninsured and publicly-insured population in the United States. Objective: We examined health status, access to health care, utilization, and expenditures among families that declined health insurance coverage offered by employers using data from the Medical Expenditure Panel Survey for 2001 and 2002. Results: We found differences in insurance status for adults and children among families with offers. We found that among low-income families with offers, children are less likely to have private insurance compared with adults. However, the majority of children who decline private insurance end up with public coverage, whereas most of adults who decline offers remain uninsured. Decliners are more likely to report poor health, yet they are also less likely to have high cost medical conditions. Families declining coverage have weaker preferences for insurance than families that take up. Although access to care is lower among the decliners who remain uninsured, decliners with public insurance have similar access to care as those with private insurance. Families turning down coverage are more likely to face high expenditure burdens as a percentage of income and more likely to have financial barriers to care. Families who decline coverage rely heavily on the safety net. Public sources and uncompensated care account for 72% of total expenditures among adults who decline coverage. Conclusions: Our results suggest that policy initiatives aimed at increasing take up among workers need to take into account the incentives workers face given the availability of care through public sources and uncompensated care. C1 Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Bernard, DM (reprint author), Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM dbernard@ahrq.gov NR 14 TC 7 Z9 7 U1 1 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 12 EP 18 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800003 ER PT J AU Selden, TM Hudson, JL AF Selden, TM Hudson, JL TI Access to care and utilization among children - Estimating the effects of public and private coverage SO MEDICAL CARE LA English DT Article DE access; utilization; children; Medicaid; SCHIP; private insurance ID HEALTH-INSURANCE; MEDICAL-CARE; EXPENDITURES; ELIGIBILITY; EXPANSIONS; QUALITY; IMPACT AB Objectives: We examine the relationship between health insurance coverage and children's access to and utilization of medical care. Access measures we study are having a usual source of care (USC) and lacking a USC for financial or insurance reasons. We also examine indicators for ambulatory visits, well-child visits, dental visits, emergency room use, and inpatient hospital stays. Methods: We pool data from the first 7 years of the Medical Expenditure Panel Survey (MEPS), 1996 to 2002. Pooling yields a large sample of children, enabling us to analyze access and utilization using simple descriptive statistics, multivariate analysis, and instrumental variables estimation (IV). IV estimation is of particular interest given the possibility of bias caused by confounding factors (such as child health or parent attitudes) and measurement error in insurance coverage. We also compare estimates from IV linear probability models to estimates from IV probit with residual inclusion. Results: As previous studies have found, public and private coverage are both associated with large increases in access and utilization. Simple mean comparisons suggest that private coverage has a larger effect than does public coverage. Differences between public and private coverage are reduced (and often reversed) when we control for other characteristics of children and their families. IV coverage effect estimates from both linear probability and residual inclusion probit models are substantially greater than conventional estimates across a wide range of access and utilization measures. Conclusions: Despite concerns that conventional estimates overstate the impact of coverage on access and use, our results suggest that the reverse may be true. One explanation may be that conventional estimates are biased toward zero due to error in the reporting of insurance coverage. The magnitude of the coverage effects we find highlights the importance of reducing uninsurance among children. C1 Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM tselden@ahrq.gov NR 44 TC 33 Z9 33 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 19 EP 26 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800004 ER PT J AU Banthin, JS Miller, GE AF Banthin, JS Miller, GE TI Trends in prescription drug expenditures by Medicaid enrollees SO MEDICAL CARE LA English DT Article DE health care expenditures; prescription drug expenditures; Medicaid pharmacy costs ID MARKET AB Objective: As prescription drug expenditures consume an increasingly larger portion of Medicaid budgets, states are anxious to control drug costs without endangering enrollees' health. In this report, we analyzed recent trends in Medicaid prescription drug expenditures by therapeutic classes and subclasses. Identifying the fastest growing categories of drugs, where drugs are grouped into clinically relevant classes and subclasses, can help policymakers decide where to focus their cost containment efforts. Methods: We used data from the Medical Expenditure Panel Survey linked to a prescription drug therapeutic classification system, to examine trends between 1996/1997 and 2001/2002 in utilization and expenditures for the noninstitutionalized Medicaid population. We separated aggregate trends into changes in population with use and changes in expenditures per user, and percent generic. We also highlighted differences within the Medicaid population, including children, adults, disabled, and elderly. Results: We found rapid growth in expenditures for antidepressants, antipsychotics, antihyperlipidemics, antidiabetic agents, antihistamines, COX-2 inhibitors, and proton pump inhibitors and found evidence supporting the rapid take-up of new drugs. In some cases these increases are the result of increased expenditures per user and in other cases the overall growth also comes from an increase in the population with use. Conclusions: Medicaid programs may want to reassess their cost-containment policies in light of the rapid take-up of new drugs. Our analysis also identifies areas in which more information is needed on the comparative effectiveness of new versus existing treatments. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD 20850 USA. RP Banthin, JS (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, 540 Gauther Rd, Rockville, MD 20850 USA. EM jbanthin@ahrq.gov NR 17 TC 14 Z9 14 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 27 EP 35 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800005 ER PT J AU Miller, GE Hudson, J AF Miller, GE Hudson, J TI Children and antibiotics: Analysis of reduced use, 1996-2001 SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 26th Annual Meeting of the Association-for-Public-Policy-Analysis-and-Management CY OCT 28-30, 2004 CL Atlanta, GA SP Assoc Public Policy Anal & Management DE antibiotic use; child health; logistic regression ID RESPIRATORY-TRACT INFECTIONS; ANTIMICROBIAL AGENTS; JUDICIOUS USE; PRINCIPLES; BRONCHITIS; TRENDS AB Objectives: We investigated trends in antibiotic use by U.S. children, from 1996 to 2001, a period that followed the launch of national campaigns to promote the appropriate use of antibiotics. Data and Methods: We used nationally representative data from the Medical Expenditure Panel Survey for the years 1996-2001 to examine trends in antibiotic use and the contributions of changes in ambulatory visits and prescribing to these trends. We investigated trends in the use of antibiotics overall and for respiratory tract infections and examined these trends within subgroups of children defined by race/ethnicity and income. Results: From 1996 to 2001, the proportion of children with antibiotic use overall and for respiratory tract infections decreased by 8.5 percentage points and 5.1 percentage points, respectively. Overall, the probability of a child having an ambulatory visit did not change. The decrease in overall antibiotic use resulted entirely from an increase in the probability that a child had an ambulatory visit(s) with no antibiotic use. By contrast, a decline in the probability that a child had a visit for a respiratory tract infection accounted for two-thirds of the reduction in antibiotic use for these conditions. The decline in overall use for white-other non-Hispanic children (- 10.2 percentage points) was more than double the decline for black non-Hispanic or Hispanic children. Conclusion: Children's use of antibiotics, overall and for respiratory tract infections, showed significant declines from 1996 to 2001. The apparent response to campaigns to reduce inappropriate antibiotic use was widespread as reductions in use were found in all subgroups of children examined. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD 20850 USA. RP Miller, GE (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, 540 Gaither Rd, Rockville, MD 20850 USA. EM emiller@ahrq.gov NR 20 TC 7 Z9 7 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 36 EP 44 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800006 ER PT J AU Cohen, SB Ezzati-Rice, T Yu, W AF Cohen, SB Ezzati-Rice, T Yu, W TI The utility of extended longitudinal profiles in predicting future health care expenditures SO MEDICAL CARE LA English DT Article DE concentration of expenditures; longitudinal data; MEPS; predictive models ID SERVICES AB Background: Health care spending is highly concentrated. Prediction models that accurately identify the characteristics of individuals most likely to incur high levels of health expenditures in a subsequent year are important analytical and statistical tools. Objectives: This study examined the capacity of alternative models to predict the likelihood of incurring high levels of medical expenditures in a subsequent year. This effort also evaluated the utility of an additional year of longitudinal information. Subjects: A nationally representative sample from the Medical Expenditure Panel Survey (MEPS). Methods: The MEPS longitudinal data are used to examine the persistence of high expenditures during a 2-year period. With the unique linkage of the MEPS to the National Health Interview Survey, the utility of an additional year of data also was examined. Resultant models were evaluated in terms of sensitivity, specificity, and predictive capacity. Results: Only modest marginal gains in discrimination capacity were realized from the use of extended longitudinal profiles from the National Health Interview Survey, relative to information on prior year characteristics. Conclusions: Our results highlight the continuing concentration of health care expenditures during the period 1996 to 2002 and reveal some attenuation in magnitude in the tail of this distribution over time. Further, our results provide evidence of the utility of probabilistic models as prediction tools to identify individuals likely to incur high levels of expenditures in future years. Predictive capacity does not suffer when restricted to a single year of prior information. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Cohen, SB (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM scohen@ahrq.gov NR 21 TC 11 Z9 11 U1 1 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 45 EP 53 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800007 ER PT J AU Fleishman, JA Cohen, JW Manning, WG Kosinski, M AF Fleishman, JA Cohen, JW Manning, WG Kosinski, M TI Using the SF-12 health status measure to improve predictions of medical expenditures SO MEDICAL CARE LA English DT Article DE expenditures; prediction; risk adjustment; MEPS; GLM ID RISK-ADJUSTMENT; CAPITATION RATES; MODELS; RETRANSFORMATION; COSTS; LOG AB Background: Relatively few studies have used self-reported health status in models to predict medical expenditures, and many of these have used the SF-36. Objectives: We sought to examine the ability of the briefer SF-12 measure of health status to predict medical expenditures in a nationally representative sample. Methods: We used data from the 2000-2001 panel of the Medical Expenditure Panel Study. Respondents (n = 5542) completed the SF-12 in a questionnaire. Interviews obtained data on demographics and selected chronic conditions. Data on expenditures incurred subsequent to the interview were obtained in part from provider records. We examined different regression model specifications and compared different statistical estimation techniques. Results: Adding the SF-12 to a regression model improved the prediction of subsequent medical expenditures. In a model with only age and gender, adding the SF-12 increased R-2 from 0.06 to 0.13. The coefficients for the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of the SF-12 for this model were -0.045 (P < 0.01) and -0.012 (P < 0.01), respectively. In a model including demographic characteristics, chronic conditions, and previous expenditures, adding the SF-12 increased the R-2 from 0.26 to 0.29. The coefficients for the PCS and the MCS for this model were -0.025 (P < 0.001) and -0.005 (P = 0.15), respectively. A single general health status question performed almost as well as the full SF-12. Models estimated using ordinary least squares had undesirable properties. In terms of R-2, a generalized linear model (GLM) with a Poisson variance function was consistently superior to a GLM with a gamma variance function. Conclusions: Information on self-reported health status is useful in predicting medical expenditures. The extent to which the SF-12 adds predictive power over a comprehensive array of diagnostic data remains to be examined. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. Univ Chicago, Harris Sch Publ Policy Studies, Chicago, IL 60637 USA. Qual Metr Inc, Lincoln, NE USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM jfleishm@ahrq.gov NR 32 TC 27 Z9 27 U1 1 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 54 EP 63 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800008 ER PT J AU Kirby, JB Taliaferro, G Zuvekas, SH AF Kirby, JB Taliaferro, G Zuvekas, SH TI Explaining racial and ethnic disparities in health care SO MEDICAL CARE LA English DT Article DE health care access; health care utilization; racial/ethnic disparities ID INSURANCE-COVERAGE; MEDICAL-CARE; ACCESS; SATISFACTION; SERVICES; RATES AB Objectives: The substantial racial and ethnic disparities in access to and use of health services are well documented. A number of studies highlight factors such as health insurance coverage and socioeconomic differences that explain some of the differences between groups, but much remains unexplained. We build on this previous research by incorporating additional factors such as attitudes about health care and neighborhood characteristics, as well as separately analyzing different Hispanic subgroups. Methods: We use the Oaxaca-Blinder regression-based method to decompose differences among racial and ethnic groups in 3 measures related to access, quantifying the portion explained by each of a number of underlying characteristics and the differences that remain unexplained. We use data from the 2000 and 2001 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the noninstitutionalized U.S. population. We link these data to detailed neighborhood characteristics from the Census Bureau and local provider supply data from the Health Services Resource Administration (HRSA). Results: Consistent with earlier studies, we find insurance status and socioeconomic differences explain a significant part of the disparities. Additionally, neighborhood racial and ethnic composition account for a large portion of disparities in access, and language differences help explain observed disparities in the use-based access measure. However, much of the differences between racial and ethnic groups remain unexplained. We also found substantial variation in the level of disparities among different groups of Hispanics. Conclusions: Researchers and policymakers may need to broaden the scope of factors they consider as barriers to access if the goal of eliminating disparities in health care is to be achieved. C1 Agcy Healthcare Res & Qual, Ctr Cost Financing & Access Trends, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, Ctr Cost Financing & Access Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM jkirby@ahrq.gov NR 28 TC 52 Z9 52 U1 2 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 64 EP 72 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800009 ER PT J AU Hill, SC Pylypchuk, Y AF Hill, SC Pylypchuk, Y TI Reports of fewer activity limitations - Recovery, survey fatigue, or switching respondent? SO MEDICAL CARE LA English DT Article DE functional status; health trajectories; disability ID OLDER PERSONS; DISABILITY; ADULTS; HEALTH AB Background: Very little is known about the validity and reliability of disability dynamics reported in household surveys, and some researchers argue that measurement error likely plays a large part in reported recovery from disability. Objectives: We assessed the reliability of reported recovery from activity limitations elicited from 2 types of questions. We assessed competing hypotheses explaining reported recoveries from disability: people are less likely to recover from more severe disabilities, switching between self- and proxy-response affects reported recovery, and survey fatigue reduces reported disability. Methods: Using the second panel of the Medical Expenditure Panel Survey, we estimated kappas for 2 types of questions in the same interview about limitations in activities of daily living and instrumental activities of daily living. We estimated multinomial logit models of consistently reported recovery, consistently reported ongoing limitations, and inconsistent responses. Recovery is a function of severity, switching respondent, measures of survey burden (such as family size), age, and education. Results: Within an interview, we found substantial reliability for both instrumental activities of daily living and activities of daily living limitations (kappa = 0.62 and 0.70, respectively). Sample members with more severe disabilities are less likely to report recovery, which is consistent with accurate reporting. Controlling for severity, the type of respondent affects reported recovery. Measures of survey burden did not affect reports. Conclusion: Researchers can be confident in reports of recovery in the Medical Expenditure Panel Survey, especially when disability status was self-reported in both interviews. Researchers may also want to control for proxy respondents and switching respondents in their analyses. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Hill, SC (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM shill@ahrq.gov NR 20 TC 0 Z9 0 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2006 VL 44 IS 5 SU S BP 73 EP 81 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 039CE UT WOS:000237276800010 ER PT J AU Sedrakyan, A Atkins, D Treasure, T AF Sedrakyan, A Atkins, D Treasure, T TI The risk of aprotinin: a conflict of evidence SO LANCET LA English DT Editorial Material ID CARDIAC-SURGERY; CLINICAL-TRIALS; METAANALYSIS C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Guys Hosp, Thorac Unit, London SE1 9RT, England. RP Treasure, T (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM tom.treasure@ukgateway.net NR 13 TC 16 Z9 17 U1 0 U2 0 PU LANCET LTD PI LONDON PA 84 THEOBALDS RD, LONDON WC1X 8RR, ENGLAND SN 0140-6736 J9 LANCET JI Lancet PD APR 29 PY 2006 VL 367 IS 9520 BP 1376 EP 1377 DI 10.1016/S0140-6736(06)68590-5 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 038CI UT WOS:000237195600006 PM 16650632 ER PT J AU Barton, MB AF Barton, MB TI Exploring and crossing the disparity divide in cancer mortality SO ANNALS OF INTERNAL MEDICINE LA English DT Editorial Material ID CERVICAL-CANCER; ETHNIC-DIFFERENCES; WOMEN; SURVIVAL C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, Rockville, MD 20850 USA. RP Barton, MB (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, 540 Gaither Rd, Rockville, MD 20850 USA. EM mbarton@ahrq.gov NR 19 TC 1 Z9 1 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD APR 18 PY 2006 VL 144 IS 8 BP 614 EP 616 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 035QZ UT WOS:000237017900009 PM 16618958 ER PT J AU Atkins, D AF Atkins, D TI New disease: motivational deficiency disorder - Study ignores economic benefits SO BRITISH MEDICAL JOURNAL LA English DT Letter C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Atkins, D (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM david.atkins@comcast.net NR 1 TC 0 Z9 0 U1 0 U2 1 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0959-8146 J9 BRIT MED J JI Br. Med. J. PD APR 15 PY 2006 VL 332 IS 7546 BP 916 EP 916 DI 10.1136/bmj.332.7546.916-c PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 037FK UT WOS:000237132100042 PM 16613982 ER PT J AU Zuvekas, SH Vitiello, B Norquist, GS AF Zuvekas, SH Vitiello, B Norquist, GS TI Recent trends in stimulant medication use among US children SO AMERICAN JOURNAL OF PSYCHIATRY LA English DT Review ID ATTENTION-DEFICIT/HYPERACTIVITY DISORDER; PSYCHOTROPIC MEDICATIONS; PREVALENCE; HYPERACTIVITY; PERSPECTIVE; HEALTH; TRIAL AB Objective: Stimulant medications, such as methylphenidate and amphetamines, are commonly prescribed to treat attention deficit hyperactivity disorder. Stimulant use increased fourfold from 1987 ( 0.6%) to 1996 ( 2.4%) among subjects 18-year- old and younger in the U. S. The aim of this study was to determine whether pediatric use of stimulants continued to rise during the period 1997 - 2002. Method: The Medical Expenditure Panel Survey ( MEPS) database for the years 1997 - 2001 was analyzed. The MEPS is a yearly survey of a nationally representative sample of civilian, noninstitutionalized U. S. households, conducted by the U. S. Agency for Health Care Research and Quality. Previously reported estimates from the 1996 MEPS and the 1987 National Medical Expenditure Survey, the predecessor to MEPS, were also replicated to compare recent trends to changes between 1987 and 1996. Results: The prevalence use of stimulants among subjects under 19 years of age was 2.7% ( 95% C.I. 2.3 - 3.1) in 1997 and 2.9% ( 95% C.I. 2.5 - 3.3) in 2002, with no statistically significant change during these 6 years. Likewise, when pooling data across years and comparing the rate in 1997 - 1998 ( 2.8%) with the rate in 2001 - 2002 ( 3.0%), no statistically significant changes emerged. Use was highest among 6 - 12 year olds ( 4.8% in 2002), as compared with 3.2% among 13 - 19 year olds and 0.3% among children under 6. An estimated 2.2 million ( 95% C.I. 1.9 - 2.6) children received stimulant medication in 2002 as compared to 2.0 million ( 95% C.I. 1.7 - 2.3) in 1997. Conclusions: The steep increase in the utilization of stimulants among children 18 years and younger that occurred over the 1987 - 1996 period attenuated in the following years through 2002, and has remained stable among very young children. C1 NIMH, Div Serv & Intervent Res, Bethesda, MD 20892 USA. Agcy Hlth Care Res & Qual, Div Social & Econ Res, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Vitiello, B (reprint author), NIMH, Div Serv & Intervent Res, 6001 Execut Blvd, Bethesda, MD 20892 USA. EM bvitiell@mail.nih.gov NR 20 TC 105 Z9 106 U1 1 U2 5 PU AMER PSYCHIATRIC PUBLISHING, INC PI ARLINGTON PA 1000 WILSON BOULEVARD, STE 1825, ARLINGTON, VA 22209-3901 USA SN 0002-953X J9 AM J PSYCHIAT JI Am. J. Psychiat. PD APR PY 2006 VL 163 IS 4 BP 579 EP 585 DI 10.1176/appi.ajp.163.4.579 PG 7 WC Psychiatry SC Psychiatry GA 029EF UT WOS:000236541200007 PM 16585430 ER PT J AU Hays, R Johansson, P Weidmer, B Wharton, D Dalpoas, D Darby, C AF Hays, R. Johansson, P. Weidmer, B. Wharton, D. Dalpoas, D. Darby, C. TI Psychometric assessment of an experience with care survey for American Indians SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 Univ Calif Los Angeles, Los Angeles, CA 90024 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RAND Corp, Santa Monica, CA USA. Choctaw Nation Hlth Serv Author, Talihina, OK USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2006 VL 21 SU 4 BP 113 EP 113 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA V43VG UT WOS:000202962000404 ER PT J AU Siegel, JE Clancy, CM AF Siegel, JE Clancy, CM TI Relative value in healthcare - Cost-effectiveness of interventions SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID EQ-5D; SAMPLE; INDEX; SF-12; PART C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Siegel, JE (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd,Room 6026, Rockville, MD 20850 USA. EM jsiegel@abrq.gov NR 18 TC 1 Z9 1 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD APR-JUN PY 2006 VL 21 IS 2 BP 99 EP 103 PG 5 WC Nursing SC Nursing GA 026ZJ UT WOS:000236381900001 PM 16540774 ER PT J AU Simonsen, L Taylor, RJ Elixhauser, A Viboud, C Kapikian, AZ AF Simonsen, L Taylor, RJ Elixhauser, A Viboud, C Kapikian, AZ TI Age dependence of the relation between reassortant rotavirus vaccine (RotaShield) and intussusception - Reply SO JOURNAL OF INFECTIOUS DISEASES LA English DT Letter C1 NIAID, Off Global Affairs, NIH, Bethesda, MD 20892 USA. NIAID, Fogarty Int Ctr, NIH, Bethesda, MD 20892 USA. Agcy Hlth Care Res & Qual, Bethesda, MD USA. RP Simonsen, L (reprint author), NIAID, Off Global Affairs, NIH, 6610 Rockledge Dr,Rm 2033 MSC 7630, Bethesda, MD 20892 USA. EM lsimonsen@niaid.nih.gov OI Simonsen, Lone/0000-0003-1535-8526 NR 7 TC 4 Z9 4 U1 0 U2 0 PU UNIV CHICAGO PRESS PI CHICAGO PA 1427 E 60TH ST, CHICAGO, IL 60637-2954 USA SN 0022-1899 J9 J INFECT DIS JI J. Infect. Dis. PD MAR 15 PY 2006 VL 193 IS 6 BP 898 EP 899 DI 10.1086/500221 PG 2 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 015FB UT WOS:000235536200022 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Services Task Force TI Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Article ID BILATERAL PROPHYLACTIC MASTECTOMY; INTERPRETING FAMILY HISTORIES; ASHKENAZI JEWISH CARRIERS; SURGICAL ADJUVANT BREAST; INHERITED MUTATIONS; PREVENTION TRIAL; COMPUTER SUPPORT; PRIMARY-CARE; WOMEN; PREVALENCE C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 52 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAR 1 PY 2006 VL 73 IS 5 BP 869 EP 874 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 018SM UT WOS:000235785100017 ER PT J AU Darby, C Crofton, C Clancy, CM AF Darby, C Crofton, C Clancy, CM TI Consumer assessment of health providers and systems (CAHPS (R)): evolving to meet stakeholder needs SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Darby, C (reprint author), Ctr Qual Improvement & Patient Safety, Rockville, MD USA. NR 6 TC 16 Z9 16 U1 0 U2 2 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD MAR-APR PY 2006 VL 21 IS 2 BP 144 EP 147 DI 10.1177/1062860606286263 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 027GZ UT WOS:000236404400008 PM 16533906 ER PT J AU Vitiello, B Zuvekas, SH Norquist, GS AF Vitiello, B Zuvekas, SH Norquist, GS TI National estimates of antidepressant medication use among US children, 1997-2002 SO JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY LA English DT Article DE antidepressants; children; adolescents; use; pharmacoepidemiology ID ATTENTION-DEFICIT/HYPERACTIVITY DISORDER; OBSESSIVE-COMPULSIVE DISORDER; CONSENSUS CONFERENCE PANEL; MAJOR DEPRESSIVE DISORDER; OUTPATIENT TREATMENT; ALGORITHM PROJECT; CONTROLLED-TRIAL; ADOLESCENTS; TRENDS; PREVALENCE AB Objective: A threefold increase in the use of antidepressants has been reported among children (18 years old and younger) between 1987 (0.3%) and 1996 (1.0%). The aim of this study was to determine whether pediatric use of antidepressants continued to rise at a national level during the period 1997-2002. Method: The Medical Expenditure Panel Survey (MEPS) database for the years 1997-2002 was analyzed. The MEPS is a yearly survey of a nationally representative sample of civilian, noninstitutionalized U.S. households, conducted by the U.S. Agency for Healthcare Research and Quality. Overall response rate ranged between 64% and 68%. Results: An estimated 1.4 million (95% confidence interval [CI] 1.1-1.7) children received antidepressant medication in 2002 as compared to 0.9 million (95% CI 0.7-1.2) in 1997(p = .01). The percentage of users increased from 1.3% (95% CI 0.9-1.6) in 1997 to 1.8% (95% CI 1.5-2.1) in 2002 (p < .01). Adolescent use (2.1% in 1997 versus 3.9% in 2002 (p < .001) accounted for the increase, with no change among children younger than 13 years. Also among adolescents, the use rate remained stable during the 2000-2002 period. The increase was caused by use of selective serotonin reuptake inhibitors and other newer antidepressants, whereas use of TCAs remained stable in adolescents (p = .84) and declined in prepubertal children (p = .04). Antidepressant use was similar among males and females and higher among whites than blacks and Hispanics. Conclusions: Nationwide, the use of selective serotonin reuptake inhibitor antidepressant medications continued to increase in adolescents in the late 1990s and until the year 2000, with no further increase through 2002, and remained stable in prepubertal children. C1 NIMH, Child & Adolescent Treatment & Prevent Intervent, Bethesda, MD 20892 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Div Social & Econ Res, Ctr Financing Access & Cost Trends, Rockville, MD 20852 USA. Univ Mississippi, Med Ctr, Dept Psychiat & Human Behav, Jackson, MS 39216 USA. RP Vitiello, B (reprint author), NIMH, Child & Adolescent Treatment & Prevent Intervent, Room 7147,6001 Execut Blvd, Bethesda, MD 20892 USA. EM bvitiell@mail.nih.gov NR 33 TC 52 Z9 52 U1 3 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0890-8567 J9 J AM ACAD CHILD PSY JI J. Am. Acad. Child Adolesc. Psychiatr. PD MAR PY 2006 VL 45 IS 3 BP 271 EP 279 DI 10.1097/01.chi.0000192249.61271.81 PG 9 WC Psychology, Developmental; Pediatrics; Psychiatry SC Psychology; Pediatrics; Psychiatry GA 017VZ UT WOS:000235722700002 PM 16540811 ER PT J AU Bernard, DM Banthin, JS Encinosa, WE AF Bernard, DM Banthin, JS Encinosa, WE TI Health care expenditure burdens among adults with diabetes in 2001 SO MEDICAL CARE LA English DT Article DE diabetes; burdens; costs; access; out-of-pocket expenditures ID COSTS; COMPLICATIONS; POOR AB Objective: High out-of-pocket costs can pose a significant burden on patients with chronic conditions such as diabetes and contribute to decreased treatment adherence. We examined financial burdens among adults with diabetes using nationally representative data. Methods: We estimated how frequently adults with diabetes live in families in which spending on health insurance premiums and health care services exceed a specified percentage of family-level after-tax disposable income. Results: We found that adults with diabetes face greater risks of high burdens compared with adults with any other highly prevalent medical condition. Adults with diabetes have lower incomes and pay a higher share of total expenditures out-of-pocket compared with adults with heart disease, hypertension, and cancer. Among adults with diabetes, women, those who live in poverty, and those with coexisting conditions are more likely to bear high burdens. Among nonelderly adults, those with public coverage and the uninsured have greater risk of high burdens compared with those with private insurance. More than 23% of the uninsured and more than 20% of those with public coverage spend more than half of their disposable income on health care. Among the elderly, those with private nonemployment related insurance have the greatest risk of high burdens followed by those with Medicare only, those with private employment-related coverage, and those enrolled in Medicaid. Prescription medications and diabetic supplies account for 63% to 70% of out-of-pocket expenditures among the nonelderly and 62% to 69% among the elderly. Conclusions: Our study identifies the subpopulations among adults with diabetes who are more likely to have high burdens, so that intervention measures can be targeted to help reduce treatment noncompliance. Our analysis also emphasizes the role of medications and diabetic supplies in contributing to high out-of-pocket burdens. C1 Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Bernard, DM (reprint author), Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Cost & Financing Studies, 540 Gaither Rd, Rockville, MD 20850 USA. EM dbernard@ahrq.gov NR 22 TC 30 Z9 30 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2006 VL 44 IS 3 BP 210 EP 215 DI 10.1097/01.mlr.0000199729.25503.60 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 018VJ UT WOS:000235792600003 PM 16501391 ER PT J AU Calonge, N Allan, JD Berg, AO Frame, PS Garcia, J Gordis, L Gregory, KD Harris, R Johnson, MS Klein, JD Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP AF Calonge, N Allan, JD Berg, AO Frame, PS Garcia, J Gordis, L Gregory, KD Harris, R Johnson, MS Klein, JD Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP CA US Prevent Services Task Force TI Screening for developmental dysplasia of the hip: Recommendation statement SO PEDIATRICS LA English DT Article ID MEDIAL OPEN REDUCTION; TERM-FOLLOW-UP; CONGENITAL DISLOCATION; AVASCULAR NECROSIS; CLOSED REDUCTION; NATURAL-HISTORY; PAVLIK HARNESS; RISK-FACTORS; ULTRASOUND; NEWBORNS C1 Agcy Healthcare Res & Qual, USPSTF, Rockville, MD 20850 USA. RP Calonge, N (reprint author), Agcy Healthcare Res & Qual, USPSTF, 540 Gaither Rd, Rockville, MD 20850 USA. NR 47 TC 39 Z9 42 U1 0 U2 3 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD MAR PY 2006 VL 117 IS 3 BP 898 EP 902 DI 10.1542/peds.2005-1995 PG 5 WC Pediatrics SC Pediatrics GA 017QV UT WOS:000235709000064 ER PT J AU Correa-De-Araujo, R AF Correa-De-Araujo, R TI Women, gender, and health care disparities - Introduction SO WOMENS HEALTH ISSUES LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Womens Hlth & Gender Based Res, Rockville, MD 20850 USA. RP Correa-De-Araujo, R (reprint author), Agcy Healthcare Res & Qual, Womens Hlth & Gender Based Res, 540 Gaither Rd, Rockville, MD 20850 USA. EM Rcorrea@ahrq.gov NR 0 TC 1 Z9 1 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2006 VL 16 IS 2 BP 40 EP 40 DI 10.1016/j.whi.2006.02.002 PG 1 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 039HH UT WOS:000237296100001 ER PT J AU Correa-de-Araujo, R Clancy, CM AF Correa-de-Araujo, R Clancy, CM TI Catalyzing quality of care improvements for women SO WOMENS HEALTH ISSUES LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Womens Hlth & Gender Based Res, Rockville, MD 20850 USA. RP Correa-de-Araujo, R (reprint author), Agcy Healthcare Res & Qual, Womens Hlth & Gender Based Res, 540 Gaither Rd, Rockville, MD 20850 USA. EM Rcorrea@ahrq.gov NR 18 TC 3 Z9 3 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2006 VL 16 IS 2 BP 41 EP 43 DI 10.1016/j.whi.2006.02.001 PG 3 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 039HH UT WOS:000237296100002 PM 16638520 ER PT J AU Correa-De-Araujo, R Stevens, B Moy, E Nilasena, D Chesley, F McDermott, K AF Correa-De-Araujo, R Stevens, B Moy, E Nilasena, D Chesley, F McDermott, K TI Gender differences across racial and ethnic groups in the quality of care for acute myocardial infarction and heart failure associated with comorbidities SO WOMENS HEALTH ISSUES LA English DT Article ID CONVERTING ENZYME-INHIBITORS; CORONARY-ARTERY DISEASE; RANDOMIZED-TRIALS; CARDIOVASCULAR-DISEASE; DIABETES-MELLITUS; ELDERLY SURVIVORS; SEX-DIFFERENCES; BETA-BLOCKERS; ASPIRIN USE; RISK AB This paper provides important insights on gender differences across racial and ethnic groups in a Medicare population in terms of the quality of care received for acute myocardial infarction (AMI) and congestive heart failure (CHF) in association with diabetes or hypertension/end-stage renal disease (ESRD). Both race/ethnicity and gender are associated with differences in the diagnostic evaluation and treatment of Medicare recipients with these conditions. In the AMI group, non-Hispanic Black and Hispanic patients of both genders were less likely to receive aspirin or beta-blockers than non-Hispanic Whites. These differences persisted for Hispanic women and men even when they presented with ESRD or diabetes. Rates for smoking cessation counseling were among the lowest among non-Hispanic Blacks and Hispanics with AMI-diabetes and non-Hispanic blacks with AMI-hypertension/ESRD. Gender comparisons within racial groups for the AMI and AMI-diabetes groups show that among non-Hispanic Whites, women were less likely to receive aspirin and P-blockers. No gender differences were noted among non-Hispanic Black and Hispanic Medicare recipients. In the CHF group, Hispanics were the racial/ethnic group least likely to have an assessment of left ventricular function (LVF), even if they had diabetes and had lower rates of angiotensin-converting enzyme inhibitor therapy or even if they had combined CHF-hypertension/ESRD. Gender comparisons in both the CHF and CHF-hypertension/ESRD groups show that non-Hispanic White women were less likely to have an LVF assessment than non-Hispanic White men. Among all subjects, having comorbidities with AMI was not associated with higher markers of quality cardiovascular care. Closing the many gaps in cardiovascular care must target the specific needs of women and men across racial and ethnic groups. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Colorado Fdn Med Care, Englewood, CO USA. RP Correa-De-Araujo, R (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Rcorrea@ahrq.gov NR 60 TC 39 Z9 40 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2006 VL 16 IS 2 BP 44 EP 55 DI 10.1016/j.whi.2005.04.003 PG 12 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 039HH UT WOS:000237296100003 PM 16638521 ER PT J AU Correa-De-Araujo, R McDermott, K Moy, E AF Correa-De-Araujo, R McDermott, K Moy, E TI Gender differences across racial and ethnic groups in the quality of care for diabetes SO WOMENS HEALTH ISSUES LA English DT Article ID GLYCEMIC CONTROL; US; POPULATION; HEALTH; RACE AB High-quality care for diabetes is based on proper prevention, coordination of care among a multidisciplinary team of health care professionals, enhanced patient-provider relationships, and patient self-management skills. This paper discusses gender differences across racial and ethnic groups in the quality of care for type 2 diabetes according to 10 measures defined by the National Healthcare Quality Report and the National Healthcare Disparities Report. These measures include 5 process measures and one composite measure derived from the Medical Expenditure Panel Survey and 4 outcome measures derived from the Healthcare Cost and Utilization Project. National rates for 2 process measures-measurement of HbA1c (women 89.70% versus men 90.10%) and lipid profile (women 92.9% versus men 95.3%)-are high, but only 28.9% of women and 33.9% of men with diabetes received all 5 recommended process measures (HbA1c, lipid profile, eye exam, foot exam, and influenza immunization). Screening rates for retinal and foot exams and influenza immunization should be improved for all, but the need is particularly urgent for Hispanics and non-Hispanic blacks. Women and men have similar rates of hospital admissions for uncontrolled diabetes, but rates for lower extremity amputations were higher for men, particularly non-Hispanic blacks and Hispanics. Avoidable hospitalizations for diabetes decreased as income increased across racial/ethnic groups, but other factors (e.g., quality of primary care, age, relationship with providers, patients' self-management skills) may influence such rates. Moreover, any improvements in the diabetes outcomes measures may lag many years behind any measurable improvements in quality of care. Well-designed interventions that reallocate resources for diabetes self-care should be developed to ensure that gender differences are addressed across racial/ethnic groups. Because much of this care involves the management of risk factors, self-management education should be tailored to the lifestyles and beliefs specific to gender and racial/ethnic groups. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Medstat Grp Inc, Rockville, MD USA. RP Correa-De-Araujo, R (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM Rcorrea@ahrq.gov RI Dalla Zuanna, Teresa/G-3133-2015 NR 30 TC 36 Z9 37 U1 1 U2 9 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2006 VL 16 IS 2 BP 56 EP 65 DI 10.1016/j.whi.2005.08.003 PG 10 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 039HH UT WOS:000237296100004 PM 16638522 ER PT J AU Taylor, AK Larson, S Correa-De-Araujo, R AF Taylor, AK Larson, S Correa-De-Araujo, R TI Women's health care utilization and expenditures SO WOMENS HEALTH ISSUES LA English DT Article ID LOW-INCOME WOMEN; PANEL SURVEY; ACCESS; SERVICES; MEDICAID AB This study examines women's use and expenditures for medical care in the US. In 2000, 91% of women aged 18 years and older used any form of health care services. Overall, 82% of adult women reported an ambulatory care visit, and 11% had an inpatient hospital stay. Mean expense per person with expenses was $3219 for that year. We examined use and expenditures by sociodemographic characteristics. The most notable findings indicate that women with private insurance and those on Medicaid are more likely to use health services than uninsured women. White women, compared to black and Hispanic women, are more likely to have an ambulatory care visit, buy prescription drugs, and use preventive health care services. In addition, white and Hispanic women pay a higher proportion of medical care expenses out-of-pocket than do black women. Finally, nearly 30% of older women in fair or poor health spent 10% or more of their income on medical care. Preventable disparities in access to and receipt of care are unacceptable. To improve the quality of health care for all women, it is important for policymakers to understand the factors that influence their utilization and expenditures for medical care. Data collection, analysis, and reporting by race, ethnicity, and primary language across federally supported health programs are essential to help identify, understand the causes of, monitor, and eventually eliminate disparities. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Substance Abuse & Mental Hlth Serv Adm, Rockville, MD USA. RP Taylor, AK (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM ataylor@ahrq.gov NR 33 TC 15 Z9 15 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2006 VL 16 IS 2 BP 66 EP 79 DI 10.1016/j.whi.2005.11.001 PG 14 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 039HH UT WOS:000237296100005 PM 16638523 ER PT J AU Larson, S Correa-De-Araujo, R AF Larson, S Correa-De-Araujo, R TI Preventive health examinations: A comparison along the rural-urban continuum SO WOMENS HEALTH ISSUES LA English DT Article ID WOMEN; CANCER; CARE AB In this analysis, Medical Expenditure Panel Survey data from 2000 were used to examine differences in reports of preventive health service utilization in 4 types of counties: large metropolitan counties, small metropolitan counties, counties adjacent to metropolitan places, and counties not adjacent to metropolitan areas or with fewer than 10,000 residents. Women from counties with 10,000 or fewer residents and not adjacent to a metropolitan county, classified as rural residents, were less likely to report a number of preventive health examinations during the previous 2 years. Rural women were less likely to obtain blood cholesterol tests, dental exams, and mammograms during the previous 2 years when compared to women from large metropolitan counties. Rural women were more likely to obtain blood pressure checks during the previous year when compared to the metropolitan women. Findings for exams that occurred during the preceding 1- and 2-year periods are reported for blood pressure checks, blood cholesterol checks, physical exams, colon cancer screening, dental exams, breast exams, mammograms, and Pap smears. C1 Substance Abuse & Mental Hlth Serv Adm, Off Appl Studies, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Larson, S (reprint author), Substance Abuse & Mental Hlth Serv Adm, Off Appl Studies, 1 Choke Cherry Rd,Room 7-100, Rockville, MD 20850 USA. EM sharon.larson@samhsa.hhs.gov NR 22 TC 40 Z9 40 U1 2 U2 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2006 VL 16 IS 2 BP 80 EP 88 DI 10.1016/j.whi.2006.03.001 PG 9 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 039HH UT WOS:000237296100006 PM 16638524 ER PT J AU Kosiak, B Sangl, J Correa-De-Araujo, R AF Kosiak, B Sangl, J Correa-De-Araujo, R TI Quality of health care for older women: What do we know? SO WOMENS HEALTH ISSUES LA English DT Article ID CANCER-TREATMENT TRIALS; CORONARY HEART-DISEASE; BREAST-CANCER; RACIAL-DIFFERENCES; CLINICAL-TRIALS; AGE; PARTICIPATION; ADULTS; MORTALITY; KNOWLEDGE AB As the proportion of the population age 65 and over continues to grow-to a projected 20.5% or 77.2 million by the year 2040-tracking the quality, access, and receipt of care for older women becomes more important, since the majority of older citizens are women. This article establishes a rough baseline for the quality of care, primarily preventive care, received by older women compared to older men, using selected measures and data of the 2004 National Healthcare Quality Report and National Healthcare Disparities Report. It highlights significant differences between women and men, as well as differences for racial, ethnic, and educational subgroups. Generally, older non-Hispanic white women frequently score higher than their Hispanic and non-Hispanic black counterparts, and more educated women often score significantly higher than their less-educated peers on several measures of quality of care. Compared to their male counterparts, older women are significantly less likely to have any colorectal screening test, to keep high blood pressure under control, and to receive aspirin or beta-blockers upon hospital admission or discharge for acute myocardial infarction. Results are mixed for the process measures related to diabetes, but improvements are clearly needed toward increased rates of eye and foot examinations. Rates of influenza and pneumococcal vaccinations are low but can be improved through Medicare-covered services. We also found that older women are screened less often for breast cancer than those ages 40 to 64. There is still a pervasive lack of knowledge in the research and clinical communities about the unique health care needs of and appropriate processes of care for older adults. More research needs to focus on the quality of care for this growing population in order to allow the development of geriatric-based quality measures and models of care that will set the standards of healthcare for older adults in general, and older women in particular. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Kosiak, B (reprint author), Amer Urol Assoc, 100 Corp Blvd, Linthicum, MD 21090 USA. EM bkosiak@auanet.org NR 61 TC 22 Z9 22 U1 1 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2006 VL 16 IS 2 BP 89 EP 99 DI 10.1016/j.whi.2005.01.003 PG 11 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 039HH UT WOS:000237296100007 PM 16638525 ER PT J AU Zhan, CL Hicks, RW Blanchette, CM Keyes, MA Cousins, DD AF Zhan, CL Hicks, RW Blanchette, CM Keyes, MA Cousins, DD TI Potential benefits and problems with computerized prescriber order entry: Analysis of a voluntary medication error-reporting database SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article DE computers; databases; dosage; dosage forms; errors, medication; medication orders; physicians; reports; toxicity ID ADVERSE DRUG EVENTS; PREVENTION; INTERVENTION; SYSTEMS; IMPACT AB Purpose. The potential benefits and problems associated with computerized prescriber-order-entry (CPOE) systems were studied. Methods. A national voluntary medication error-reporting database, Medmarx, was used to compare facilities that had CPOE with those that did not have CPOE. The characteristics of medication errors reportedly caused by CPOE were explored, and the text descriptions of these errors were qualitatively analyzed. Results. Facilities with CPCE reported fewer inpatient medication errors and more outpatient medication errors than facilities without CPOE, but the statistical significance of these differences could not be determined. Facilities with CPOE less frequently reported medication errors that reached patients (p < 0.01) or harmed patients (p < 0.01). More than 7000 CPOE-related medication errors were reported over seven months in 2003, and about 0.1% of them resulted in harm or adverse events. The most common CPOE errors were dosing errors (i.e., wrong dose, wrong dosage form, or extra dose). Both quantitative and qualitative analyses indicate that CPCE could lead to medication errors not only because of faulty computer interface, miscommunication with other systems, and lack of adequate decision support but also because of common human errors such as knowledge deficit, distractions, inexperience, and typing errors. Conclusion. A national, voluntary medication error-reporting database cannot be used to determine the effectiveness of a CPOE system in reducing medication errors because of the variability in the number of reports from different institutions. However, it may provide valuable information on the specific types of errors related to CPOE systems. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. USP, Ctr Advancement Patient Safety, Rockville, MD USA. Univ Maryland, Sch Pharm, Baltimore, MD 21201 USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM czhan@ahrq.gov NR 17 TC 60 Z9 63 U1 0 U2 2 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 USA SN 1079-2082 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD FEB 15 PY 2006 VL 63 IS 4 BP 353 EP 358 DI 10.2146/ajhp050379 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 013MD UT WOS:000235412500010 PM 16452521 ER PT J AU Smith, SR Catellier, DJ Conlisk, EA Upchurch, GA AF Smith, SR Catellier, DJ Conlisk, EA Upchurch, GA TI Effect on health outcomes of a community-based medication therapy management program for seniors with limited incomes SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; ADVERSE DRUG EVENTS; PHARMACIST INTERVENTION; CLINICAL PHARMACIST; COST; CARE; PHYSICIAN; TEAM; REDUCTION; CRITERIA C1 Univ N Carolina, Sch Publ Hlth, CH, Dept Biostat, Chapel Hill, NC USA. Hampshire Coll, Amherst, MA 01002 USA. Univ N Carolina, Sch Pharm, CH, Div Pharmacotherapy, Chapel Hill, NC 27515 USA. Univ N Carolina, Sch Publ Hlth, CH, Dept Hlth Behav & Hlth Educ, Chapel Hill, NC 27515 USA. RP Smith, SR (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM ssmith@ahrq.gov NR 36 TC 15 Z9 15 U1 3 U2 5 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 USA SN 1079-2082 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD FEB 15 PY 2006 VL 63 IS 4 BP 372 EP 379 DI 10.2146/ajhp050089 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 013MD UT WOS:000235412500012 PM 16452523 ER PT J AU Douglas, PS Eckel, RH Gray, DT Loeb, JM Straube, BM AF Douglas, PS Eckel, RH Gray, DT Loeb, JM Straube, BM TI Coming together to achieve quality cardiovascular care SO CIRCULATION LA English DT Editorial Material ID MEDICARE BENEFICIARIES C1 Amer Coll Cardiol, Bethesda, MD 20814 USA. Duke Univ, Med Ctr, Durham, NC USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Joint Commiss Accreditat Healthcare Org, Div Res, Oak Brook, IL USA. RP Douglas, PS (reprint author), Amer Coll Cardiol, 9111 Old Georgetown Rd, Bethesda, MD 20814 USA. NR 8 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3261 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD FEB 7 PY 2006 VL 113 IS 5 BP 607 EP 608 DI 10.1161/CIRCULATIONAHA.106.172861 PG 2 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 009ZH UT WOS:000235151800007 PM 16391152 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Serv Task Force TI Screening for peripheral arterial disease: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Article ID POPULATION; CLAUDICATION; ROTTERDAM C1 Agcy Healthcare Res & Qual, USPSTF, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Calonge, N (reprint author), Agcy Healthcare Res & Qual, USPSTF, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 18 TC 12 Z9 12 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD FEB 1 PY 2006 VL 73 IS 3 BP 497 EP 500 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 010GP UT WOS:000235175600019 ER PT J AU Meyerhoefer, CD Trost, RP AF Meyerhoefer, CD Trost, RP TI Tired titanium: A fatigue-based approach to aircraft inventory management and acquisition planning SO DEFENCE AND PEACE ECONOMICS LA English DT Article DE airframe fatigue; aircraft procurement; acquisition planning AB Airframe fatigue has emerged as a primary determinant of tactical aircraft service life. To investigate the impact of various operational scenarios on airframe fatigue and aircraft stocks, we develop an econometric model of fatigue and arrest landing accumulation for US Naval aircraft. Model forecasts suggest that fatigue-related attrition threatens to reduce inventories below the level needed to meet operational commitments before planned replacements are available. Changes to training regimes could mitigate the shortfall, but it is likely that acquisition schedules will have to be accelerated, or current service life extension programs expanded to maintain inventories in the future. C1 George Washington Univ, Dept Econ, Washington, DC 20052 USA. CFACT, DSER, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Trost, RP (reprint author), George Washington Univ, Dept Econ, 1922 F St,NW,Old Main,Room 208, Washington, DC 20052 USA. EM Trost@gwu.edu NR 6 TC 14 Z9 14 U1 2 U2 3 PU TAYLOR & FRANCIS LTD PI ABINGDON PA 4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXON, ENGLAND SN 1024-2694 J9 DEFENCE PEACE ECON JI Def. Peace Econ. PD FEB PY 2006 VL 17 IS 1 BP 1 EP 21 DI 10.1080/10242690500369298 PG 21 WC Economics SC Business & Economics GA 994VU UT WOS:000234060100001 ER PT J AU Meikle, S Orleans, M AF Meikle, S Orleans, M TI Safeguarding the quality and safety of reproductive services for human immunodeficiency virus-positive adults SO FERTILITY AND STERILITY LA English DT Editorial Material ID HIV-DISCORDANT COUPLES; FERTILITY CARE AB Throughout-the world, adults with HIV are living longer, and many are assessing their options for reproduction. The growing body of scientific evidence and commentary concerning the Outcomes of infertility services provided to these adults demands systematic summary and long-term surveillance if safety, quality. and benefit are to be assured. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. Univ Colorado, Hlth Sci Ctr, Dept Prevent Med & Biometr, Denver, CO 80262 USA. RP Meikle, S (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM smeikle@ahrq.gov NR 10 TC 1 Z9 1 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0015-0282 J9 FERTIL STERIL JI Fertil. Steril. PD FEB PY 2006 VL 85 IS 2 BP 293 EP 294 DI 10.1016/j.fertnstert.2005.07.1325 PG 2 WC Obstetrics & Gynecology; Reproductive Biology SC Obstetrics & Gynecology; Reproductive Biology GA 014MF UT WOS:000235483600004 PM 16595200 ER PT J AU Zhan, CL Smith, M Stryer, D AF Zhan, CL Smith, M Stryer, D TI Accidental latrogenic pneumothorax in hospitalized patients SO MEDICAL CARE LA English DT Article DE pneumothorax; iatrogenic disease; medical errors; safety management; ICD-9-CM; hospitals ID IATROGENIC PNEUMOTHORAX; ADMINISTRATIVE DATA; CARDIAC-SURGERY; COMPLICATIONS; INSERTION; DISEASE; CARE AB Objective: Iatrogenic pneumothorax (IP) is an inherent risk to patients who undergo procedures that involve the intentional puncturing of the lung. IP also could occur accidentally to patients who do not undergo such procedures; such accidental IP (AIP) is suggestive of lapses in safe care. This study assessed the risk for AIP in patients hospitalized with specific diagnoses who underwent specific procedures. Research Design: We analyzed 7.5 million discharge abstracts from 994 short-term acute care hospitals across 28 states in 2000 in the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project Nationwide Inpatient Sample. AHRQ Patient Safety Indicators (PSIs) were used to identify AIP. AIP incidences and associated diagnoses and procedures were explored. Results: Patients who were admitted for pleurisy, cancer of the kidney and renal pelvis, or conduction disorders and complications of cardiac devices had the highest rates of developing AIP during hospitalization, with AIP rates at 2.24%, 1.14%, and 0.83% respectively. The procedure-specific rates for AIP varied from 2.68% for patients who underwent thoracentesis to 1.30% for those who underwent nephrectomy, to 0.06% for those who underwent gastrostomy. Thoracentesis appeared to be a high-risk procedure for patients who were admitted for secondary malignancies, pleurisy, or pneumonia, with AIP rates at 3.76%, 3.13%, and 2.28%, respectively. Conclusions: Although AIP is most common after thoracentesis, it is a substantial threat to patients undergoing a wide range of procedures. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Univ Wisconsin, Sch Med, Dept Populat Hlth Sci, Madison, WI USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. EM czhan@ahrq.gov NR 32 TC 15 Z9 15 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3261 USA SN 0025-7079 J9 MED CARE JI Med. Care PD FEB PY 2006 VL 44 IS 2 BP 182 EP 186 DI 10.1097/01.mlr.0000196938.91369.2a PG 5 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 007EE UT WOS:000234950400012 PM 16434918 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Services Task Force TI Screening for speech and language delay in preschool children: Recommendation statement SO PEDIATRICS LA English DT Article DE preventive medicine; speech and language delay; preschool children; screening children ID AUDITORY MILESTONE SCALE; CONCURRENT VALIDITY; VALIDATION; POPULATION; HACKNEY; TESTS; CITY C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 28 TC 18 Z9 20 U1 0 U2 1 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD FEB PY 2006 VL 117 IS 2 BP 497 EP 501 DI 10.1542/peds.2005-2766 PG 5 WC Pediatrics SC Pediatrics GA 014PC UT WOS:000235491100029 ER PT J AU Douglas, PS Eckel, RH Gray, DT Loeb, JM Straube, BM AF Douglas, PS Eckel, RH Gray, DT Loeb, JM Straube, BM TI Coming together to achieve quality cardiovascular care SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Editorial Material ID MEDICARE BENEFICIARIES C1 Amer Coll Cardiol, Bethesda, MD USA. Duke Univ, Med Ctr, Durham, NC USA. Amer Heart Assoc, Dallas, TX USA. Univ Colorado, Hlth Sci Ctr, Denver, CO USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Joint Commiss Accreditat Healthcare Org, Div Res, Oak Brook Terrace, IL USA. Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP Douglas, PS (reprint author), Care of Lora C, Amer Coll Cardiol, 9111 Old Georgetown Rd, Bethesda, MD 20814 USA. NR 8 TC 5 Z9 5 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0735-1097 J9 J AM COLL CARDIOL JI J. Am. Coll. Cardiol. PD JAN 3 PY 2006 VL 47 IS 1 BP 266 EP 267 DI 10.1016/j.jacc.2005.11.019 PG 2 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 000UQ UT WOS:000234488300042 PM 16386698 ER PT J CA US Preventive Services Task Force TI Screening and interventions for overweight in children and adolescents: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID ADULT CHOLESTEROL LEVELS; BODY-MASS INDEX; CHILDHOOD OBESITY; YOUNG ADULTHOOD; BLOOD-PRESSURE; RISK-FACTORS; BOGALUSA; MUSCATINE; ADIPOSITY; THERAPY AB This is one in a series excerpted from the Recommendation Statements released by the U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary care clinical settings, including screening tests, counseling, and chemoprevention. The complete statement is available in HTML and PDF formats through the AFP Web site at http://www.aafp.org/afp/20060101/us.html. C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. NR 35 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X EI 1532-0650 J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JAN 1 PY 2006 VL 73 IS 1 BP 115 EP 119 PG 5 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 999VC UT WOS:000234417800015 ER PT J AU Moy, E Smith, CR Johansson, P Andrews, R AF Moy, E Smith, CR Johansson, P Andrews, R TI Gaps in data for American Indians and Alaska Natives in the National Healthcare Disparities Report SO AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH LA English DT Article AB The aim of this study was to identify and quantify gaps in health care data for American Indians and Alaska Natives. Findings indicate that only 42% of measures of health care quality and access tracked in the National Healthcare Disparities Report could be used to assess disparities among American Indians and Alaska Natives. Patient safety data was especially limited. Data from American Indians and Alaska Natives need to be improved to allow better targeting of interventions to reduce health care disparities and monitoring the success of these activities. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Moy, E (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM emoy@ahrq.gov NR 19 TC 5 Z9 5 U1 0 U2 2 PU UNIVERSITY PRESS COLORADO PI NIWOT PA PO BOX 849, NIWOT, CO 80544 USA SN 0893-5394 J9 AM INDIAN ALASKA NAT JI Am. Indian Alsk. Nativ. Ment. Health Res. PY 2006 VL 13 IS 1 BP 52 EP 69 PG 18 WC Psychology, Clinical SC Psychology GA 034RL UT WOS:000236948200003 PM 17602397 ER PT J AU Bondi, MA Harris, JR Atkins, D French, ME Umland, B AF Bondi, MA Harris, JR Atkins, D French, ME Umland, B TI Employer coverage of clinical preventive services in the United States SO AMERICAN JOURNAL OF HEALTH PROMOTION LA English DT Article DE employer health costs, health insurance, prevention research; workplace; format : research; research purpose : descriptive; study design : nonexperimental; outcome measure : behavior, productivity, other financial/economic; setting : workplace; health focus : smoking control; strategy : incentives, policy; target population age : adults; target population circumstances : employee; other key words : employer health costs, health insurance, prevention, tobacco ID HEALTH; ADULTS; CARE AB Purpose. To characterize employers' coverage of clinical preventive services. Design. Mercer Human Resource Consulting Inc. included questions on clinical preventive services as part of its National Survey of Employer-Sponsored Health Plans, 2001. Setting. A national sample of employers of a large, medium, and small number of employees, including governments. Subjects. Respondents self-identified as most knowledgeable about the organization's health benefits. Measures. Weighted analyses of responses to eight survey questions on health promotion. Results. The survey was completed by 2180 employers, and the response rate was 21%. More than 90% of employers included increased productivity and decreased health care costs among their most important reasons for coverage of clinical preventive services. Within health insurance, coverage of physical examinations, immunizations, and screenings generally exceeded 50%, but coverage of lifestyle modification services was less than 20%. Only 20% of employers covered tobacco cessation services, and only 4% of employers provided an "optimal" benefit. We compared employers' offerings with a published ranking, by impact and value, of clinical preventive services. We found the biggest discrepancy in tobacco cessation services and alcohol problem prevention, which ranked high in terms of impact and value but are offered by only 20% and 18% of employers, respectively. Conclusions. Employers seek financial return from their offerings of clinical preventive services to employees, but they are least likely to offer the services most likely to provide this return. C1 Univ Washington, Sch Publ Hlth & Community Med, Hlth Promot Res Ctr, Seattle, WA 98105 USA. US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. Potoman Hlth Consulting LLC, Arlington, VA USA. Mercer Human Resource Consulting, New York, NY USA. RP Harris, JR (reprint author), Univ Washington, Sch Publ Hlth & Community Med, Hlth Promot Res Ctr, Seattle, WA 98105 USA. EM jh7@u.washington.edu OI Harris, Jeffrey/0000-0001-8728-7195 NR 24 TC 42 Z9 42 U1 1 U2 1 PU AMER J HEALTH PROMOTION INC PI KEEGO HARBOR PA 1660 CASS LAKE RD, STE 104, KEEGO HARBOR, MI 48320 USA SN 0890-1171 J9 AM J HEALTH PROMOT JI Am. J. Health Promot. PD JAN-FEB PY 2006 VL 20 IS 3 BP 214 EP 222 PG 9 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 002BS UT WOS:000234587000010 PM 16422142 ER PT S AU Encinosa, WE Bernard, DM Steiner, CA AF Encinosa, William E. Bernard, Didem M. Steiner, Claudia A. BE Bolin, K Cawley, J TI ADVANCES IN BARIATRIC SURGERY FOR OBESITY: LAPAROSCOPIC SURGERY SO ECONOMICS OF OBESITY SE Advances in Health Economics and Health Services Research LA English DT Article; Book Chapter ID GASTRIC BYPASS-SURGERY; SURGICAL-PROCEDURES; OUTCOMES; METAANALYSIS; MORTALITY AB Context. The most advanced and fastest growing form of bariatric surgery is laparoscopic gastric bypass. Very little is known about population-based 180-day laparoscopic bypass costs, complication rates, readmission rates, and post-operative care. Objective. To examine the 6-month costs and outcomes of laparoscopic vs. open bariatric bypass surgery using a national population-based sample. Design. We use the 1998-2003 Nationwide Inpatient Sample to examine national trends in the rate of laparoscopic bypass. To examine postoperative outcomes, we examine insurance claims for 2,384 bariatric bypass surgeries, at 308 hospitals, among a population of 5.6 million non-elderly people covered by large employers across 49 states in 2001 and 2002. Multivariate logit regression analysis is performed to risk-adjust outcomes. Main Outcome Measures. 180-day outcomes: 12 complications specific to bariatric surgery and 44 general post-operative conditions, readmission rates, ER rates, and expenditures following bariatric surgery. Results. Between 1998 and 2003, the national percentage of bariatric bypass surgeries that were laparoscopic grew from 1.5 to 17.1%. There was no significant difference in in-hospital mortality between laparoscopy and open surgery. With the 2001-2002 claims data, we find that of the patients having bypass surgery, men had 48% lower odds of having laparoscopy and that high bariatric volume hospitals were close to four times more likely to use laparoscopy. Laparoscopic bypass, compared with open bypass, had 34% lower odds of a complication during the initial surgical stay, 27% lower odds of a 30-day complication, but no statistically significant difference in 180-day complications. Laparoscopy had 49% higher odds of having the general 44 post-operative conditions, with 45% higher odds of a readmission and 54% higher odds of an ER visit. However, overall, laparoscopy resulted in a 23% lower number of hospital days and 9% lower 180-day expenditures. Conclusion. The laparoscopic cost-savings during the less invasive initial surgery stay outweigh the increase in post-discharge utilization. Further cost-savings will only emerge from laparoscopy only if its late post-operative complications are reduced. More cost-savings will also emerge as more physicians switch to the use of laparoscopy for bypass surgery. C1 [Encinosa, William E.; Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Bernard, Didem M.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Encinosa, WE (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. NR 23 TC 0 Z9 0 U1 1 U2 1 PU EMERALD GROUP PUBLISHING LIMITED PI BINGLEY PA HOWARD HOUSE, WAGON LANE, BINGLEY, W YORKSHIRE BD16 1WA, ENGLAND SN 0731-2199 BN 978-0-7623-1406-5 J9 ADV HEALTH ECON HEAL PY 2006 VL 17 BP 131 EP 148 DI 10.1016/S0731-2199(06)17006-5 PG 18 WC Economics; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA BLS47 UT WOS:000270940300007 ER PT J AU Bar-Lev, S Harrison, MI AF Bar-Lev, S Harrison, MI TI Negotiating time scripts during implementation of an electronic medical record SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article; Proceedings Paper CT 65th Annual Meeting of the Academy-of-Management CY AUG 05-10, 2005 CL Honolulu, HI SP Acad Management DE EMR; hospital; localization; time ID TECHNOLOGY; ORGANIZATIONS; INFORMATION AB Practitioners renegotiated time use requirements in an electronic medical record (EMR), thereby improving fit between health information technology (HIT) and clinical practices. The study contains important implications for managing HIT implementation. C1 Bar Ilan Univ, Dept Sociol & Anthropol, Ramat Gan, Israel. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Bar-Lev, S (reprint author), Bar Ilan Univ, Dept Sociol & Anthropol, Ramat Gan, Israel. EM shirly.barley@gmail.com NR 25 TC 7 Z9 7 U1 1 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3261 USA SN 0361-6274 J9 HEALTH CARE MANAGE R JI Health Care Manage. Rev. PD JAN-MAR PY 2006 VL 31 IS 1 BP 11 EP 17 PG 7 WC Health Policy & Services SC Health Care Sciences & Services GA 012PT UT WOS:000235352100003 PM 16493268 ER PT J AU Mandelblatt, JS Lawrence, WF Cullen, J Stanton, AL Krupnick, JL Kwan, L Ganz, PA AF Mandelblatt, JS Lawrence, WF Cullen, J Stanton, AL Krupnick, JL Kwan, L Ganz, PA TI Patterns of care in early-stage breast cancer survivors in the first year after cessation of active treatment SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Article ID QUALITY-OF-LIFE; CONTROLLED-TRIAL; HEALTH; SURVEILLANCE; MAMMOGRAPHY; COMORBIDITY; WOMEN; OLDER; COST; AGE AB Purpose Patterns of health care use have not been well described for breast cancer survivors. The purpose of this study was to describe the health service use in a survivor cohort. Patients and Methods Women with stage I or II breast cancer were recruited (n = 558) after primary treatment for a multicenter, randomized trial of psychoeducational interventions for facilitating transition to survivorship; 418 women completed the study. Participants completed calendar diaries detailing health care use for 1 year after treatment. Services were coded using Current Procedural Terminology-Fourth Edition codes; costs were estimated using year 2000 Medicare reimbursements. Results Health care use diary data were available for 391 women (70% of the sample). On average, these survivors reported 30 episodes of health service use in the year after treatment. Total annual costs of care averaged more than $1,800 per survivor; medical off ice visits were the major component of costs. Type of cancer treatment, depression, and physical function and comorbid illness were independent predictors of the costs of services. There were geographic variations in initial local treatment patterns and in post-treatment costs. Notably, all women should have received surveillance mammography in the time period, but only 61.9% did so; the odds of mammogram receipt were higher for women who had a lumpectomy (v mastectomy) and women who were white (v nonwhite). Conclusion Use of health services is frequent and intensive in the first year after treatment for breast cancer. Despite frequent contact with the health care system, there is room for improvement in providing guideline-suggested surveillance mammography for survivors. C1 Georgetown Univ, Ctr Med, Dept Oncol, Lombardi Comprehens Canc Ctr,Canc Control Program, Washington, DC 20057 USA. Georgetown Univ, Ctr Med, Dept Psychiat, Washington, DC 20057 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif Los Angeles, Jonsson Comprehens Canc Ctr, Div Canc Prevent & Control Res, Los Angeles, CA 90024 USA. Univ Calif Los Angeles, Dept Psychiat & Biobehav Sci, David Geffen Sch Med, Los Angeles, CA 90024 USA. Univ Calif Los Angeles, Dept Psychol, Los Angeles, CA 90024 USA. Univ Calif Los Angeles, Sch Med, Los Angeles, CA USA. Univ Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90024 USA. RP Mandelblatt, JS (reprint author), Georgetown Univ, Ctr Med, Dept Oncol, Lombardi Comprehens Canc Ctr,Canc Control Program, 3300 Whitehaven Blve,Ste 4100, Washington, DC 20057 USA. EM mandelbj@georgetown.edu FU NCI NIH HHS [K05-CA96940, R01-CA63028] NR 28 TC 37 Z9 39 U1 0 U2 2 PU AMER SOC CLINICAL ONCOLOGY PI ALEXANDRIA PA 330 JOHN CARLYLE ST, STE 300, ALEXANDRIA, VA 22314 USA SN 0732-183X J9 J CLIN ONCOL JI J. Clin. Oncol. PD JAN 1 PY 2006 VL 24 IS 1 BP 77 EP 84 DI 10.1200/JCO.2005.02.2681 PG 8 WC Oncology SC Oncology GA 998QS UT WOS:000234334700015 PM 16382116 ER PT J AU Nix, MP Coopey, M Clancy, CM AF Nix, MP Coopey, M Clancy, CM TI Quality tools to improve care and prevent errors SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Nix, MP (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd,Room 6361, Rockville, MD 20850 USA. EM mnix@ahrq.gov NR 2 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3261 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD JAN-MAR PY 2006 VL 21 IS 1 BP 1 EP 4 PG 4 WC Nursing SC Nursing GA 995WB UT WOS:000234134100001 PM 16340679 ER PT J AU Jiang, HJ Stocks, C Wong, CJ AF Jiang, HJ Stocks, C Wong, CJ TI Disparities between two common data sources on hospital nurse staffing SO JOURNAL OF NURSING SCHOLARSHIP LA English DT Article DE data collection; nurse staffing; patient outcomes ID ADVERSE EVENTS; PATIENT OUTCOMES; UNITED-STATES; CARE; MORTALITY; QUALITY; RATIOS AB Purpose: To compare nurse staffing measures derived from two widely used data sources: the American Hospital Association (AHA) Annual Survey of Hospitals and the California Office for Statewide Health Planning and Development (OSHPD). Design: Descriptive cross-sectional study with measures of nurse staffing level and skill mix constructed from each database for 372 nonfederal, acute care hospitals in California. Methods: Discrepancies in nurse staffing estimates between the two databases were examined. Relationships of nurse staffing with risk-adjusted patient outcomes (decubitus ulcer, failure to rescue, and mortality) were assessed through multivariate analyses and compared for nursing measures derived from the two databases. Findings: For small, rural, or nonteaching hospitals, AHA reported substantially higher registered nurse (RN) hours per patient day than did OSHPD. RN proportion among licensed nurses matched most closely in the two databases. RN hours per patient day derived from both databases showed significant inverse relationships with decubitus ulcer and mortality, and the association was stronger for the measure based on the OSHPD data. RN proportion derived from the OSHPD data was significantly associated with all three patient outcomes, but the AHA measure had a significant relationship only with decubitus ulcer. Conclusions: Compared with the AHA survey, the OSHPD data on hospital nurse staffing appear to be more complete and also were more closely associated with patient outcomes. Efforts to refine the AHA survey as a national database for nurse staffing will significantly enhance the capacity for monitoring nurse workforce and its effect on quality of care. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Brandeis Univ, Boston, MA USA. RP Jiang, HJ (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM joanna.jiang@ahrq.gov NR 27 TC 22 Z9 22 U1 1 U2 2 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 1527-6546 J9 J NURS SCHOLARSHIP JI J. Nurs. Scholarsh. PY 2006 VL 38 IS 2 BP 187 EP 193 DI 10.1111/j.1547-5069.2006.00099.x PG 7 WC Nursing SC Nursing GA 040QQ UT WOS:000237395900025 PM 16773924 ER PT J AU Hersh, WR Hickam, DH Erlichman, M AF Hersh, William R. Hickam, David H. Erlichman, Martin TI The evidence base of telemedicine: overview of the supplement SO JOURNAL OF TELEMEDICINE AND TELECARE LA English DT Editorial Material C1 Oregon Hlth Sci Univ, Dept Med Informat & Clin Epidemiol, BICC, Portland, OR 97239 USA. VA Med Ctr, Div Hosp & Specialty Med, Portland, OR USA. Agcy Hlth Care Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Hersh, WR (reprint author), Oregon Hlth Sci Univ, Dept Med Informat & Clin Epidemiol, BICC, 3181 SW Sam Jackson Pk Rd, Portland, OR 97239 USA. EM hersh@ohsu.edu NR 11 TC 2 Z9 2 U1 0 U2 1 PU ROYAL SOC MEDICINE PRESS LTD PI LONDON PA 1 WIMPOLE STREET, LONDON W1G 0AE, ENGLAND SN 1357-633X J9 J TELEMED TELECARE JI J. Telemed. Telecare PY 2006 VL 12 SU 2 BP 1 EP 2 DI 10.1258/135763306778393081 PG 2 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 088IN UT WOS:000240805500001 ER PT J AU Pauly, MV AF Pauly, Mark V. BE Sage, WM Kersh, R TI Who Pays When Malpractice Premiums Rise? SO MEDICAL MALPRACTICE AND THE U.S. HEALTH CARE SYSTEM LA English DT Article; Book Chapter C1 [Pauly, Mark V.] Univ Penn, Wharton Sch Management, Philadelphia, PA 19104 USA. [Pauly, Mark V.] Agcy Healthcare Res & Qual, Natl Advisory Council, Rockville, MD USA. [Pauly, Mark V.] Natl Acad Sci, Inst Med, Comm Evaluat Vaccine Purchase Financing US, Washington, DC USA. RP Pauly, MV (reprint author), Univ Penn, Wharton Sch Management, Philadelphia, PA 19104 USA. NR 0 TC 3 Z9 3 U1 0 U2 0 PU CAMBRIDGE UNIV PRESS PI CAMBRIDGE PA THE PITT BUILDING, TRUMPINGTON ST, CAMBRIDGE CB2 1RP, CAMBS, ENGLAND BN 978-0-521-84932-6 PY 2006 BP 71 EP 83 DI 10.1017/CBO9780511617836.005 D2 10.2277/ 0521614112 PG 13 WC Health Policy & Services; Law SC Health Care Sciences & Services; Government & Law GA BXX34 UT WOS:000297343200005 ER PT J AU Owens, PL Kerker, BD Zigler, E Horwitz, SM AF Owens, PL Kerker, BD Zigler, E Horwitz, SM TI Vision and oral health needs of individuals with intellectual disability SO MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS LA English DT Review DE intellectual disability; dental; vision ID MENTALLY-RETARDED CHILDREN; SERVICES-TASK-FORCE; DOWNS-SYNDROME; VISUAL IMPAIRMENT; UNITED-STATES; HANDICAPPED-CHILDREN; PERIODONTAL-DISEASE; REFRACTIVE ERRORS; OCULAR FINDINGS; DENTAL-HEALTH AB Over the past 20 years, there has been an increased emphasis on health promotion, including prevention activities related to vision and oral health, for the general population, but not for individuals with intellectual disability (ID). This review explores what is known about the prevalence of vision problems and oral health conditions among individuals with ID, presents a rationale for the increased prevalence of these conditions in the context of service utilization, and examines the limitations of the available research. Available data reveal a wide range of prevalence estimates for vision problems and oral health conditions, but all suggest that these conditions are more prevalent among individuals with ID compared with the general population, and disparities exist in the receipt of preventive and early treatment for these conditions for individuals with ID. Recommendations for health improvement in these areas include better health planning and monitoring through standardized population-based data collection and reporting and increased emphasis on health promotion activities and early treatment in the healthcare system. (C) 2006 Wiley-Liss, Inc.dagger C1 Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. New York City Dept Hlth & Mental Hyg, New York, NY USA. Yale Univ, Dept Psychol, New Haven, CT 06520 USA. Yale Univ, Sch Med, Ctr Child Study, New Haven, CT 06510 USA. Case Western Reserve Univ, Dept Epidemiol & Biostat, Cleveland, OH 44106 USA. Case Western Reserve Univ, Dept Pediat, Cleveland, OH 44106 USA. Case Western Reserve Univ, Dept Psychiat, Cleveland, OH 44106 USA. RP Owens, PL (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM powens@ahrq.gov FU NIMH NIH HHS [5T32-MH19545, 5T32-MH15783] NR 177 TC 34 Z9 34 U1 2 U2 10 PU WILEY-LISS PI HOBOKEN PA DIV JOHN WILEY & SONS INC, 111 RIVER ST, HOBOKEN, NJ 07030 USA SN 1080-4013 J9 MENT RETARD DEV D R JI Ment. Retard. Dev. Disabil. Res. Rev. PY 2006 VL 12 IS 1 BP 28 EP 40 DI 10.1002/mrdd.20096 PG 13 WC Clinical Neurology; Neurosciences; Pediatrics; Psychiatry SC Neurosciences & Neurology; Pediatrics; Psychiatry GA 010GW UT WOS:000235176600005 PM 16435325 ER PT J AU Hellinger, FJ AF Hellinger, Fred J. TI Economic models of antiretroviral therapy - Searching for the optimal strategy SO PHARMACOECONOMICS LA English DT Article ID HIV-INFECTED PATIENTS; ACQUIRED-IMMUNODEFICIENCY-SYNDROME; HEALTH-SERVICES UTILIZATION; QUALITY-OF-LIFE; COST-EFFECTIVENESS; UNITED-STATES; VIRUS-INFECTION; CARE; DISEASE; ADULTS AB The diffusion of protease inhibitors and non-nucleoside reverse transcriptase inhibitors in the US in 1996 and 1997 reduced the number of deaths attributable to HIV disease and changed the way we think about the illness. Today, HIV disease may be deemed a fairly expensive chronic condition rather than an intolerably expensive fatal illness. Although most studies have found that patients receiving new drug therapies are hospitalised less frequently than patients who received early drug therapies, it is unclear whether the diffusion of new drug therapies has increased or decreased the annual cost of care. However, it is evident that the diffusion of new drug therapies has increased the lifetime cost of care. Analysts rely on models to simulate the course and cost of HIV disease. This study reviews the evolution of these models. paying particular attention to how these models estimate the cost of care. The primary findings of this review are that the economic data used in these models are often too imprecise to accurately identify the cost of each disease stage and are almost always outdated. Moreover. it was found that estimates of drug costs in these models may not accurately reflect actual expenditures. C1 AHRQ, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Hellinger, FJ (reprint author), AHRQ, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM fhelling@ahrq.gov NR 72 TC 8 Z9 10 U1 0 U2 0 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 1311, NEW ZEALAND SN 1170-7690 J9 PHARMACOECONOMICS JI Pharmacoeconomics PY 2006 VL 24 IS 7 BP 631 EP 642 DI 10.2165/00019053-200624070-00002 PG 12 WC Economics; Health Care Sciences & Services; Health Policy & Services; Pharmacology & Pharmacy SC Business & Economics; Health Care Sciences & Services; Pharmacology & Pharmacy GA 062CJ UT WOS:000238921800002 PM 16802839 ER PT J AU Gebo, KA Fleishman, JA Moore, RD AF Gebo, KA Fleishman, JA Moore, RD TI Hospitalizations for metabolic conditions, opportunistic infections, and injection drug use among HIV patients - Trends between 1996 and 2000 in 12 states SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE HIV; hospitalization; highly active antiretroviral therapy; liver disease; injection drug use ID ACTIVE ANTIRETROVIRAL THERAPY; IMMUNODEFICIENCY-VIRUS-INFECTION; CORONARY-HEART-DISEASE; PROTEASE INHIBITORS; MYOCARDIAL-INFARCTION; INPATIENT ADMISSIONS; IMPACT; RATES; MORTALITY; RISK AB Background: Rapid changes in HIV epidemiology and highly active antiretroviral therapy (HAART) may have resulted in recent changes in patterns of inpatient utilization. Objective: To examine trends in inpatient diagnoses and mortality in HIV patients. Design/Setting/Patients: Serial cross-sectional analyses of HIV patients hospitalized in 1996, 1998, and 2000, using hospital discharge data from the Healthcare Costs and Utilization Project for 12 states. Each hospitalization was classified as an opportunistic illness, complication of injection drug use (IDU), liver-related complication, ischemic heart disease, cerebrovascular disease, non-Pneumocytis carinii pneumonia (PCP), diabetes, or chronic hepatitis C virus (HCV). Main Outcome Measures: Number of hospital admissions, inpatient mortality. Results: We evaluated 316,963 admissions that Occurred between 1996 and 2000, with an overall mortality of 7%. Hospitalizations for opportunistic infections significantly decreased from 40% to 27% of all HIV-related admissions. The overall proportion of IDU complications remained relatively stable (6%) each year. Hospitalizations increased for liver-related complications from 8% to 13% and for chronic HCV from 1% to 5% in this period. The number of hospitalizations for cerebrovascular disease and for ischemic heart disease was relatively negligible in all years. Overall, inpatient mortality decreased between 1996 and 2000. Relatively higher mortality was observed among African Americans, Hispanics, those with Medicaid, those with Medicare, and the uninsured, however. Opportunistic infections and liver-related complications were associated with greater inpatient mortality. Conclusion: Results do not show a significant recent rise in HIV-related inpatient utilization. Admissions to treat opportunistic infections have declined precipitously, consistent with the effects of HAART. Although not dramatic, liver-related disease is an increasing cause Of hospitalization in HIV+ patients. C1 Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Moore, RD (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, 1830 E Monument St,Room 442, Baltimore, MD 21287 USA. EM kgebo@jhmi.edu RI Gebo, Kelly/B-9223-2009 FU NIAID NIH HHS [P30 AI42855]; NIDA NIH HHS [K 23 DA 00523, K24 DA 00432] NR 47 TC 68 Z9 71 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3261 USA SN 1525-4135 J9 JAIDS-J ACQ IMM DEF JI JAIDS PD DEC 15 PY 2005 VL 40 IS 5 BP 609 EP 616 DI 10.1097/01.qai.0000171727.55553.78 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 989SR UT WOS:000233694600016 PM 16284539 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Services Task Force TI Screening for HIV: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID HUMAN-IMMUNODEFICIENCY-VIRUS; ACTIVE ANTIRETROVIRAL THERAPY; SERVICES-TASK-FORCE; COST-EFFECTIVENESS; INFECTION; RISK; DIAGNOSIS; METAANALYSIS; TRANSUDATE; PREVENTION C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 51 TC 2 Z9 2 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD DEC 1 PY 2005 VL 72 IS 11 BP 2287 EP 2292 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 990ZC UT WOS:000233780900015 ER PT J AU Zinn, J Spector, W Hsieh, L Mukamel, DB AF Zinn, J Spector, W Hsieh, L Mukamel, DB TI Do trends in the reporting of quality measures on the nursing home compare web site differ by nursing home characteristics? SO GERONTOLOGIST LA English DT Article DE nursing home compare; medicare; consumer information; quality measures ID OWNERSHIP TYPE; CARE; RESIDENTS; INDICATORS; IMPACT; PAIN AB Purpose: This study examines the relationship between the first set of quality measures (QMs) published by the Centers for Medicare and Medicaid Services on the Nursing Home Compare Web site and five nursing home structural characteristics: ownership, chain affiliation, size, occupancy, and hospital-based versus freestanding status. Design and Methods: Using robust linear regressions, we examined the values of the QMs at first publication and their change over the first five reporting periods, in relation to facility characteristics. Results: There were significant baseline differences associated with these facility characteristics. Pain, physical restraints, and delirium exhibit a clear downward trend, with differences between the first QM reporting period and the fifth ranging from 12.7% to 46.0%. However, there were only minimal differences in trends associated with facility characteristics. This suggests that the relative position of facilities on these measures did not change much within this time period. The variation by facility type was larger for the short-stay QMs than for the long-stay measures. Implications: Those QMs that show an improvement exhibit it across all types of facilities, irrespective of initial quality levels. Although a number of alternatives may explain this positive trend, the trend itself suggests that report cards, to the extent that they are effective, are so for all facility types but only some QMs. C1 Temple Univ, Fox Sch Business & Management, Dept Risk Management & Healthcare Management, Philadelphia, PA 19122 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif Irvine, Ctr Hlth Policy Res, Irvine, CA 92717 USA. RP Zinn, J (reprint author), Temple Univ, Fox Sch Business & Management, Dept Risk Management & Healthcare Management, 413 Ritter Annex, Philadelphia, PA 19122 USA. EM Jacqueline.Zinn@temple.edu NR 42 TC 36 Z9 36 U1 0 U2 1 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD DEC PY 2005 VL 45 IS 6 BP 720 EP 730 PG 11 WC Gerontology SC Geriatrics & Gerontology GA 989UN UT WOS:000233699500001 PM 16326653 ER PT J AU Goldstein, E Farquhar, M Crofton, C Darby, C Garfinkel, S AF Goldstein, E Farquhar, M Crofton, C Darby, C Garfinkel, S TI Measuring hospital care from the patients' perspective: An overview of the CAHPS (R) Hospital Survey development process SO HEALTH SERVICES RESEARCH LA English DT Article DE patient reports of hospital care; patient satisfaction instruments; hospital quality; patient care AB To describe the developmental process for the CAHPS((R)) Hospital Survey. A pilot was conducted in three states with 19,720 hospital discharges. A rigorous, multi-step process was used to develop the CAHPS Hospital Survey. It included a public call for measures, multiple Federal Register notices soliciting public input, a review of the relevant literature, meetings with hospitals, consumers and survey vendors, cognitive interviews with consumer, a large-scale pilot test in three states and consumer testing and numerous small-scale field tests. The current version of the CAHPS Hospital Survey has survey items in seven domains, two overall ratings of the hospital and five items used for adjusting for the mix of patients across hospitals and for analytical purposes. The CAHPS Hospital Survey is a core set of questions that can be administered as a stand-alone questionnaire or combined with a broader set of hospital specific items. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Amer Inst Res, Chapel Hill, NC 27514 USA. RP Goldstein, E (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. NR 7 TC 91 Z9 91 U1 1 U2 8 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2005 VL 40 IS 6 BP 1977 EP 1995 DI 10.1111/j.1475-6773.2005.00477.x PN 2 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 984GB UT WOS:000233289500002 PM 16316434 ER PT J AU Sofaer, S Crofton, C Goldstein, E Hoy, E Crabb, J AF Sofaer, S Crofton, C Goldstein, E Hoy, E Crabb, J TI What do consumers want to know about the quality of care in hospitals? SO HEALTH SERVICES RESEARCH LA English DT Article DE hospital quality; patient experience surveys; performance reporting; consumer information ID HEALTH-CARE; SATISFACTION; SERVICES AB To guide the development of the Consumer Assessments of Healthcare Providers and Systems (CAHPS((R))) Hospital Survey by identifying which domains of hospital quality included in a survey of recent hospital patients, and which survey items within those domains, would be of greatest interest to consumers and patients. Primary data were collected in four cities (Baltimore, Los Angeles, Phoenix, and Orlando), from a demographically varied mix of people of whom most, but not all, had recently been hospitalized or had a close loved one hospitalized. A total of 16 focus groups were held in these four cities. Groups were structured to be homogeneous with respect to type of health care coverage (Medicare, non-Medicare), and type of recent hospital experience (urgent admission, elective admission, maternity admission, no admission). They were heterogeneous with respect to race/ethnicity, gender, and educational attainment. In addition to moderated discussions, focus group participants completed a pregroup questionnaire and various paper and pencil exercises during the groups. A wide range of features were identified by participants as being relevant to hospital quality. Many were consonant with domains and items in the CAHPS Hospital Survey; however, some addressed structural features of hospitals and hospital outcomes that are not best derived from a patient experience survey. When shown the domains and items being considered for inclusion in the CAHPS Hospital Survey, participants were most interested in items relating to doctor communication with patients, nurse and hospital staff communication with patients, responsiveness to patient needs, and cleanliness of the hospital room and bathroom. Findings were quite consistent across groups regardless of location and participant characteristics. Consumers and patients have a high degree of interest in hospital quality and found a very high proportion of the items being considered for the CAHPS Hospital Survey to be so important they would consider changing hospitals in response to information about them. Hospital choice may well be constrained for patients, but publicly reported information from a patient perspective can also be used to support patient discussions with facilities and physicians about how to ensure patients have the best hospital experience possible. C1 CUNY Bernard M Baruch Coll, Sch Publ Affairs, New York, NY 10010 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Westat Corp, Rockville, MD USA. RP Sofaer, S (reprint author), CUNY Bernard M Baruch Coll, Sch Publ Affairs, 17 Lexington Ave,Box D615, New York, NY 10010 USA. NR 22 TC 63 Z9 63 U1 2 U2 16 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2005 VL 40 IS 6 BP 2018 EP 2036 DI 10.1111/j.1475-6773.2005.00473.x PN 2 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 984GB UT WOS:000233289500004 PM 16316436 ER PT J AU Miller, GE Moeller, JF Stafford, RS AF Miller, GE Moeller, JF Stafford, RS TI New cardiovascular drugs: Patterns of use and association with non-drug health expenditures SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID PRESCRIPTION DRUGS; SERVICES; HOSPITALS; BENEFITS; OUTCOMES; PEOPLE; AGENTS; WORTH; COST; RISK AB The potential role of new drugs in reducing expenditures for non-drug health services has received considerable attention in recent policy debates. We estimate expenditure models to determine whether the use of newer drugs to treat cardiovascular conditions is of associated with lower (or higher) non-drug expenditures for these conditions. We fail to substantiate the findings of previous research that newer drugs are associated with reductions in non-drug expenditures. We find, however, that increases in the number of drugs used, or the mix of drugs of different ages, are associated with increased non-drug expenditures and find that the number or mix of drugs used are important confounders in the estimated association between drug age and non-drug expenditures. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD 20850 USA. Stanford Univ, Program Prevent Outcomes & Practices, Stanford Prevent Res Ctr, Stanford, CA 94305 USA. RP Miller, GE (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD 20850 USA. EM emiller@ahrq.gov NR 32 TC 8 Z9 8 U1 0 U2 2 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD WIN PY 2005 VL 42 IS 4 BP 397 EP 412 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 023JS UT WOS:000236123500007 PM 16568931 ER PT J AU Larson, SL Hill, SC AF Larson, SL Hill, SC TI Rural-urban differences in employment-related health insurance SO JOURNAL OF RURAL HEALTH LA English DT Article ID ACCESS AB Context: Rural residents are disproportionately represented among the uninsured in the United States. Purpose: We compared nonelderly adult residents in 3 types of nonmetropolitan areas with metropolitan workers to evaluate which characteristics contribute to lack of employment-related insurance. Research Design and Analysis: Data were obtained from the Medical Expenditure Panel Survey, pooled across 3 panels (1996-1998) to enhance the rural sample size. Econometric decomposition was used to quantify the contribution of employment structure to differences in the probability of being offered employment-related health insurance. Findings: The most rural workers are 10.4 percentage points less likely to be offered insurance compared with urban workers; the difference is smaller for residents of other rural areas. In rural counties not adjacent to urban areas, lower wages and smaller employers each account for about one-third of the total difference. Conclusions: Health insurance disparities associated with rural residence are related to the structure of employment. Major factors include smaller employers, lower wages, greater prevalence of self-employment, and sociodemographic characteristics. C1 Agcy Healthcare Res & Qual, CFACT, DSER, Rockville, MD 20850 USA. RP Larson, SL (reprint author), Agcy Healthcare Res & Qual, CFACT, DSER, 540 Gaither Rd,Suite 5000, Rockville, MD 20850 USA. EM slarson@ahrq.gov NR 39 TC 29 Z9 29 U1 0 U2 4 PU NATL RURAL HEALTH ASSOC PI KANSAS CITY PA ONE WEST ARMOUR BLVD, STE 301, KANSAS CITY, MO 64111 USA SN 0890-765X J9 J RURAL HEALTH JI J. Rural Health PD WIN PY 2005 VL 21 IS 1 BP 21 EP 30 DI 10.1111/j.1748-0361.2005.tb00058.x PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 966JU UT WOS:000232016800004 PM 15667006 ER PT J AU Calonge, N AF Calonge, N CA U S Preventive Services Task Forc TI Screening for testicular cancer: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Article C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 3 TC 1 Z9 2 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD NOV 15 PY 2005 VL 72 IS 10 BP 2069 EP 2070 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 990QY UT WOS:000233759500015 PM 16342838 ER PT J AU Calonge, N AF Calonge, N CA U S Preventative Serv Task Force TI Screening for gonorrhea: Recommendation statement - US Preventive Services Task Force SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID DISEASES C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 6 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD NOV 1 PY 2005 VL 72 IS 9 BP 1783 EP 1786 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 984BS UT WOS:000233278100016 ER PT J AU Slutsky, JR Clancy, CM AF Slutsky, JR Clancy, CM TI The agency for healthcare research and quality's effective health care program: Creating a dynamic system for discovering and reporting what works in health care SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Ctr Outcomes & Evidence, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Slutsky, JR (reprint author), Ctr Outcomes & Evidence, Rockville, MD 20850 USA. NR 0 TC 8 Z9 8 U1 0 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD NOV-DEC PY 2005 VL 20 IS 6 BP 358 EP 360 DI 10.1177/1062860605281608 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 985UL UT WOS:000233404100010 PM 16280400 ER PT J AU Zuvekas, SH Rupp, AE Norquist, GS AF Zuvekas, SH Rupp, AE Norquist, GS TI Update: Special report - The impacts of mental health parity and managed care in one large employer group: A reexamination SO HEALTH AFFAIRS LA English DT Editorial Material ID LONGITUDINAL DATA-ANALYSIS; NATIONAL TRENDS; MODELS AB Although the impacts of carve-outs to managed behavioral health care organizations (MBHOs) and parity mandates on costs are largely settled in the literature, their impacts on access are less clear. Here we reexamine a study published by Samuel Zuvekas and colleagues in this journal, which found that the number of people receiving mental health/substance abuse treatment increased by almost 50 percent after the introduction of mental health parity and an MBHO. Using multivariate panel data methods, we now suggest that secular trends were largely responsible for this increase. C1 AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD USA. NIMH, Mental Hlth Econ Res Program, Bethesda, MD 20892 USA. Univ Mississippi, Med Ctr, Dept Psychiat & Human Behav, Jackson, MS 39216 USA. RP Zuvekas, SH (reprint author), AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM szuvekas@ahrq.gov NR 10 TC 7 Z9 7 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD NOV-DEC PY 2005 VL 24 IS 6 BP 1668 EP 1671 DI 10.1377/hlthaff.24.6.1668 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 008IM UT WOS:000235033500033 PM 16284042 ER PT J AU Monheit, AC Vistnes, JP AF Monheit, AC Vistnes, JP TI The demand for dependent health insurance: How important is the cost of family coverage? SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE employment-based health insurance; medicaid; out-of-pocket premium costs ID MEDICAID EXPANSIONS; PRIVATE INSURANCE; CHILDREN; DECLINE AB From the mid-1980s to the mid-1990s, the proportion of non-elderly Americans with employment-based health insurance declined. Roughly 80% of this decline was due to the loss of coverage by dependent family members. During this period, workers became increasingly responsible for the costs of family coverage, while expanded Medicaid coverage provided low-income working families with an alternative to employment-based insurance. We examine the role of out-of-pocket premiums and expanded Medicaid eligibility in households' demand for employment-based family coverage. Cross-sectional results reveal that demand is affected by both factors. We find that between 1987 and 1996, the increase in out-of-pocket premium costs accounted for nearly half of the decline in dependent coverage while expanded Medicaid eligibility represented 14% of the decline. (c) 2005 Elsevier B.V. All rights reserved. C1 Univ Med & Dent New Jersey, Sch Publ Hlth, Piscataway, NJ 08554 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Monheit, AC (reprint author), Univ Med & Dent New Jersey, Sch Publ Hlth, 683 Hoes Lane W, Piscataway, NJ 08554 USA. EM monheiac@umdnj.edu; jvistnes@ahrq.gov NR 31 TC 9 Z9 9 U1 1 U2 3 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD NOV PY 2005 VL 24 IS 6 BP 1108 EP 1131 DI 10.1016/j.jhealeco.2005.04.005 PG 24 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 982SN UT WOS:000233182000003 PM 16183158 ER PT J AU Clancy, C Sharp, BAC Hubbard, HB AF Clancy, C Sharp, BAC Hubbard, HB TI Guest Editorial: Intersections for mutual success in nursing and health services research SO NURSING OUTLOOK LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Sharp, BAC (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD USA. EM bcsharp@ahrq.gov NR 11 TC 1 Z9 1 U1 0 U2 0 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0029-6554 J9 NURS OUTLOOK JI Nurs. Outlook PD NOV-DEC PY 2005 VL 53 IS 6 BP 263 EP 265 DI 10.1016/j.outlook.2005.06.006 PG 3 WC Nursing SC Nursing GA 999SD UT WOS:000234409900001 PM 16360691 ER PT J AU Atkins, D Moy, EM AF Atkins, D Moy, EM TI Left behind: the legacy of hurricane Katrina SO BRITISH MEDICAL JOURNAL LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Outcome & Effectiveness, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. RP Atkins, D (reprint author), Agcy Healthcare Res & Qual, Ctr Outcome & Effectiveness, Rockville, MD 20850 USA. EM datkins@ahrq.gov NR 11 TC 27 Z9 27 U1 0 U2 2 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0959-8146 J9 BRIT MED J JI Br. Med. J. PD OCT 22 PY 2005 VL 331 IS 7522 BP 916 EP 918 DI 10.1136/bmj.331.7522.916 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 979UR UT WOS:000232970900002 PM 16239669 ER PT J AU Calonge, N AF Calonge, N TI Screening for genital herpes: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID SIMPLEX-VIRUS TYPE-2; PLACEBO-CONTROLLED TRIAL; NEONATAL HERPES; LATE PREGNANCY; ACYCLOVIR PROPHYLAXIS; CESAREAN DELIVERY; ORAL FAMCICLOVIR; UNITED-STATES; INFECTION; SUPPRESSION C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 31 TC 2 Z9 2 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD OCT 15 PY 2005 VL 72 IS 8 BP 1557 EP 1561 PG 5 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 979IV UT WOS:000232936500009 ER PT J AU Guirguis-Blake, J AF Guirguis-Blake, J TI Rationale for the USPSTF recommendation on screening for glaucoma SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID PRIMARY OPEN-ANGLE; PROGRESSION; TRIAL C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Guirguis-Blake, J (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM jg247@georgetown.edu NR 6 TC 3 Z9 3 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD OCT 1 PY 2005 VL 72 IS 7 BP 1184 EP + PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 969OS UT WOS:000232244300005 PM 16225022 ER PT J AU Kerner, JF Guirguis-Blake, J Hennessy, KD Brounstein, PJ Vinson, C Schwartz, RH Myers, BA Briss, P AF Kerner, JF Guirguis-Blake, J Hennessy, KD Brounstein, PJ Vinson, C Schwartz, RH Myers, BA Briss, P TI Translating research into improved outcomes in comprehensive cancer control SO CANCER CAUSES & CONTROL LA English DT Article; Proceedings Paper CT Conference on Comprehensive Approaches to Cancer Control CY SEP, 2003 CL Atlanta, GA DE dissemination; implementation; knowledge transfer; comprehensive cancer control ID PREVENTIVE-SERVICES; INTERVENTIONS; CHALLENGES; PROGRAM; CARE AB A key question in moving comprehensive cancer control (CCC) plans into action is, to what extent should the knowledge gained from investments in cancer prevention and control research influence the actions taken by states, tribes, and territories during implementation? Underlying this 'should' is the assumption that evidence-based approaches (i.e., a public health or clinical intervention or policy that has resulted in improved outcomes when scientifically tested), when implemented in a real-world setting, will increase the likelihood of improved outcomes. This article elucidates the barriers and opportunities for integrating science with practice across the cancer control continuum. However, given the scope of CCC and the substantial investment in generating new knowledge through science, it is difficult for any one agency, on its own, to make a sufficient investment to ensure new knowledge is translated and implemented at a national, state, or local level. Thus, if greater demand for evidence-based interventions and increased resources for adopting them are going to support the dissemination initiatives described herein, new interagency partnerships must be developed to ensure that sufficient means are dedicated to integrating science with service. Furthermore, for these collaborations to increase both in size and in frequency, agency leaders must clearly articulate their support for these collaborative initiatives and explicitly recognize those collaborative efforts that are successful. In this way, the whole (in this context, comprehensive cancer control) can become greater than the sum of its parts. C1 NCI, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Subst Abuse & Mental Hlth Serv Adm, Rockville, MD USA. Amer Canc Soc, Framingham, MA USA. Ctr Dis Control & Prevent, Atlanta, GA USA. RP Kerner, JF (reprint author), NCI, Div Canc Control & Populat Sci, 6130 Execut Blvd,EPN 6144, Bethesda, MD 20892 USA. EM kernerj@mail.nih.gov OI Kerner, Jon/0000-0002-8792-3830 NR 30 TC 49 Z9 50 U1 0 U2 2 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0957-5243 J9 CANCER CAUSE CONTROL JI Cancer Causes Control PD OCT PY 2005 VL 16 SU 1 BP 27 EP 40 DI 10.1007/s10552-005-0488-y PG 14 WC Oncology; Public, Environmental & Occupational Health SC Oncology; Public, Environmental & Occupational Health GA 990GP UT WOS:000233731500004 PM 16208572 ER PT J AU Mukamel, D Spector, W Zinn, J Huang, L Weimer, D AF Mukamel, D Spector, W Zinn, J Huang, L Weimer, D TI The impact of the CMS "Nursing Home Compare" report card on nursing homes SO GERONTOLOGIST LA English DT Meeting Abstract C1 Univ Calif Irvine, Dept Med, Irvine, CA 92717 USA. Agcy Hlth Care Res & Qual, Rockville, MD USA. Temple Univ, Philadelphia, PA 19122 USA. Univ Calif Irvine, Irvine Ctr Hlth Policy Res, Irvine, CA USA. Univ Wisconsin, Madison, WI USA. LaFollette Sch Publ Affairs, Madison, WI USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2005 VL 45 SI 2 BP 172 EP 172 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 988QF UT WOS:000233615000446 ER PT J AU Hughes, RG Clancy, CM AF Hughes, RG Clancy, CM TI Working conditions that support patient safety SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID INTENSIVE-CARE; MORTALITY; OUTCOMES; QUALITY C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Hughes, RG (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd,Room 6052, Rockville, MD 20850 USA. EM rhughes@ahrq.gov NR 28 TC 18 Z9 19 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3261 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD OCT-DEC PY 2005 VL 20 IS 4 BP 289 EP 292 PG 4 WC Nursing SC Nursing GA 967KB UT WOS:000232089000001 PM 16177577 ER PT J AU Calonge, N AF Calonge, N TI Screening for Rh(D) incompatibility: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 US Prevent Serv Task Forces, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), US Prevent Serv Task Forces, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 3 TC 0 Z9 0 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD SEP 15 PY 2005 VL 72 IS 6 BP 1087 EP 1088 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 967WL UT WOS:000232121800009 ER PT J AU Berg, AO Allan, JD Calonge, N Frame, PS Gordis, L Gregory, KD Harris, R Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP AF Berg, AO Allan, JD Calonge, N Frame, PS Gordis, L Gregory, KD Harris, R Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP CA US Prevent Serv Task Force TI Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: Recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID BILATERAL PROPHYLACTIC MASTECTOMY; INTERPRETING FAMILY HISTORIES; ASHKENAZI JEWISH CARRIERS; SURGICAL ADJUVANT BREAST; INHERITED MUTATIONS; PREVENTION TRIAL; COMPUTER SUPPORT; PRIMARY-CARE; WOMEN; PREVALENCE AB This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility, along with the supporting scientific evidence. The complete information on which this statement is based, including evidence tables and references, is included in the evidence synthesis available through the USPSTF Web site (www.preventiveservices.ahrq.gov). The recommendation is also posted on the Web site of the National Guideline Clearinghouse (www.guideline.gov). C1 Agcy Healthcare & Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. RP Berg, AO (reprint author), Agcy Healthcare & Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. NR 58 TC 233 Z9 235 U1 1 U2 11 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD SEP 6 PY 2005 VL 143 IS 5 BP 355 EP 361 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 961TE UT WOS:000231683900005 ER PT J AU Miller, MR Gergen, P Honour, M Zhan, CL AF Miller, MR Gergen, P Honour, M Zhan, CL TI Burden of illness for children and where we stand in measuring the quality of this health care SO AMBULATORY PEDIATRICS LA English DT Article DE adolescent; child; emergency medicine; health care; hospitals; infant; inpatients; outpatients; quality indicators; quality of health care AB Context.-Measures of health care quality for children are not as well developed as those for adults. It is also unclear the extent to which the current pool of measures address common causes of illness and health care utilization for children. Objective.-The goal of this study was to create lists of high-priority conditions for children based on different vantage points for defining burden relative to both inpatient and outpatient care for children. These high-priority conditions were then cross-tabulated with all known existing quality measures for pediatric health care. Data.-High-prevalence conditions for children were identified by using the 2000 National Ambulatory Medical Care Survey, 2000 National Hospital Ambulatory Medical Care Survey, 1999 Medical Expenditure Panel Survey, 2000 Healthcare Cost and Utilization Project's State Inpatient Databases, and 2000 Healthcare Cost and Utilization Project's State Ambulatory Surgery Databases. Burden assessments were done using frequencies of visits, charges, in-hospital deaths. Existing quality measures for children were identified from a recent compendium of such measures and a search of the National Quality Measures Clearinghouse. Results.-There are numerous and large gaps in existing quality-of-care measures for children relative to high-burden conditions in both the inpatient and outpatient setting. With the ever increasing efforts to measure and even publicly report on health care, efforts for children need to include focus on building a representative repertoire of quality measures for the high-burden conditions children experience. C1 Johns Hopkins Univ, Childrens Ctr, Dept Pediat, Baltimore, MD 21287 USA. NIH, Bethesda, MD 20892 USA. Brigham & Womens Hosp, Boston, MA 02115 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Miller, MR (reprint author), Johns Hopkins Univ, Childrens Ctr, Dept Pediat, 600 N Wolfe St, Baltimore, MD 21287 USA. EM mmille21@jhmi.edu NR 15 TC 13 Z9 13 U1 0 U2 0 PU ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS PI LAWRENCE PA 810 EAST 10TH STREET, LAWRENCE, KS 66044 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD SEP-OCT PY 2005 VL 5 IS 5 BP 268 EP 278 DI 10.1367/A04-229R.1 PG 11 WC Pediatrics SC Pediatrics GA 967VJ UT WOS:000232119000003 PM 16167849 ER PT J AU Miller, MR Pronovost, P Donithan, M Zeger, S Zhan, CL Morlock, L Meyer, GS AF Miller, MR Pronovost, P Donithan, M Zeger, S Zhan, CL Morlock, L Meyer, GS TI Relationship between performance measurement and accreditation: Implications for quality of care and patient safety SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Article DE safety; quality of health care/statistics and numerical data; medical error; inpatients; hospitals ID HOSPITALS AB This study examined the association between the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation scores and the Agency for Healthcare Research and Quality's Inpatient Quality Indicators and Patient Safety Indicators (IQIs/PSIs). JCAHO accreditation data from 1997 to 1999 were matched with institutional IQL/PSI performance from 24 states in the Healthcare Cost and Utilization Project. Most institutions scored high on JCAHO measures despite IQL/PSI performance variation with no significant relationship between them. Principal component analysis found 1 factor each of the IQIs/PSIs that explained the majority of variance on the IQIs/PSIs. Worse performance on the PSI factor was associated with worse performance on JCAHO scores (P = .02). No significant relationships existed between JCAHO categorical accreditation decisions and IQL/PSI performance. Few relationships exist between JCAHO scores and IQI/PSI performance. There is a need to continuously reevaluate all measurement tools to ensure they are providing the public with reliable, consistent information about health care quality and safety. C1 Johns Hopkins Univ, Sch Med, Qual & Safety Initiat, Baltimore, MD USA. Johns Hopkins Univ, Bloomberg Sch Publ Hlth & Hyg, Baltimore, MD USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Massachusetts Gen Phys Org, Boston, MA USA. RP Miller, MR (reprint author), Johns Hopkins Childrens Ctr, CMSC 2-125,600 N Wolfe St, Baltimore, MD 21287 USA. EM mmille21@jhmi.edu NR 34 TC 44 Z9 45 U1 19 U2 30 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD SEP-OCT PY 2005 VL 20 IS 5 BP 239 EP 252 DI 10.1177/1062860605277076 PG 14 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 968PF UT WOS:000232173800003 PM 16221832 ER PT J AU Clancy, CM AF Clancy, CM TI Training health care professionals for patient safety SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 6 TC 5 Z9 5 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD SEP-OCT PY 2005 VL 20 IS 5 BP 277 EP 279 DI 10.1177/1062860605279798 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 968PF UT WOS:000232173800007 PM 16221836 ER PT J AU Jiang, HJ Andrews, R Stryer, D Friedman, B AF Jiang, HJ Andrews, R Stryer, D Friedman, B TI Racial/ethnic disparities in potentially preventable readmissions: The case of diabetes SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID HEALTH-CARE ACCESS; ETHNIC-DIFFERENCES; AFRICAN-AMERICANS; MEXICAN-AMERICANS; HOSPITALIZATION; COMPLICATIONS; MELLITUS; ADULTS; RISK; INSURANCE AB Objectives. Considerable differences in prevalence of diabetes and management of the disease exist among racial/ethnic groups. We examined the relationship between race/ethnicity and hospital readmissions for diabetes-related conditions. Methods. Nonmaternal adult patients with Medicare, Medicaid, or private insurance coverage hospitalized for diabetes-related conditions in 5 states were identified from the 1999 State Inpatient Databases of the Healthcare Cost and Utilization Project. Racial/ethnic differences in the likelihood of readmission were estimated by logistic regression with adjustment for patient demographic, clinical, and socioeconomic characteristics and hospital attributes. Results. The risk-adjusted likelihood of 180-day readmission was significantly lower for non-Hispanic Whites than for Hispanics across all 3 payers or for non-Hispanic Blacks among Medicare enrollees. Within each payer, Hispanics from low-income communities had the highest risk of readmission. Among Medicare beneficiaries, Blacks and Hispanics had higher percentages of readmission for acute complications and microvascular disease, while Whites had higher percentages of readmission for macrovascular conditions. Conclusions. Racial/ethnic disparities are more evident in 180-day than in 30-day readmission rates, and greatest among the Medicare population. Readmission diagnoses vary by race/ethnicity, with Blacks and Hispanics at higher risk for those complications more likely preventable with effective postdischarge care. C1 Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Jiang, HJ (reprint author), Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM jjiang@ahrq.gov NR 37 TC 60 Z9 61 U1 1 U2 3 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 800 I STREET, NW, WASHINGTON, DC 20001-3710 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD SEP PY 2005 VL 95 IS 9 BP 1561 EP 1567 DI 10.2105/AJPH.2004.044222 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 959VZ UT WOS:000231548700017 PM 16118367 ER PT J AU Lee, J Cain, C Young, S Chockley, N Burstin, H AF Lee, J Cain, C Young, S Chockley, N Burstin, H TI The adoption gap: Health information technology in small physician practices SO HEALTH AFFAIRS LA English DT Editorial Material AB Health information technology (HIT) can promote higher quality, lower costs, and increased patient and clinician satisfaction. Yet small practice settings (where the vast majority of patient care is provided) have been slow to adopt HIT products and services. Successful adoption requires close attention to office workflow, or how tasks are organized and resources used to achieve outcomes. HIT improvements in the small physician office setting are achieved through strong leadership, strategic planning, process reengineering, change management, and customizing IT systems to match and support desired office workflows and health care outcomes. C1 Natl Inst Hlth Care Management Fdn, Washington, DC USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. RP Lee, J (reprint author), Natl Inst Hlth Care Management Fdn, Washington, DC USA. EM jlee@nihcm.org NR 7 TC 24 Z9 24 U1 0 U2 3 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2005 VL 24 IS 5 BP 1364 EP 1366 DI 10.1377/hlthaff.24.5.1364 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 008IL UT WOS:000235033400037 PM 16162585 ER PT J AU Buchmueller, T Cooper, P Simon, K Vistnes, J AF Buchmueller, T Cooper, P Simon, K Vistnes, J TI The effect of SCHIP expansions on health insurance decisions by employers SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article; Proceedings Paper CT AcademyHealth Annual Meeting CY JUN, 2004 CL San Diego, CA ID MEDICAID EXPANSIONS; PRIVATE INSURANCE; COVERAGE; CHILDREN; DEMAND; CROWD; SIPP AB This study uses repeated cross-sectional data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC), a large nationally representative survey of establishments, to investigate the effiect of the State Children's Health Insurance Program (SCHIP) on health insurance decisions by employers. The data span the years 1997 to 2001, the period when states were implementing SCHIP. We exploit cross-state variation in the timing of SCHIP implementation and the extent to which the program increased eligibility for public insurance. We find evidence suggesting that employers whose workers were likely to have been affected by these expansions reacted by raising employee contributions for family coverage options, and that take-up of any coverage, generally, and family coverage, specfically, dropped in these establishments. We find no evidence that employers stopped offering single or family coverage outright. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. Univ Calif Irvine, Paul Merage Sch Business, Irvine, CA USA. Natl Bur Econ Res, Cambridge, MA 02138 USA. Cornell Univ, Dept Policy Anal & Management, Ithaca, NY 14853 USA. RP Cooper, P (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM pcooper@ahrq.gov NR 27 TC 12 Z9 12 U1 0 U2 2 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 2005 VL 42 IS 3 BP 218 EP 231 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 990HW UT WOS:000233734800004 PM 16353760 ER PT J AU Hudson, JL Selden, TM Banthin, JS AF Hudson, JL Selden, TM Banthin, JS TI The impact of SCHIP on insurance coverage of children SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID HEALTH-INSURANCE; MEDICAID EXPANSIONS; PRIVATE INSURANCE; ELIGIBILITY; PROGRAM; CARE; ENROLLMENT; ACCESS; CROWD; COST AB In this paper we use the Medical Expenditure Panel Survey between 1996 and 2002 to investigate the impact of the State Children's Health Insurance Program (SCHIP) on insurance coverage for children. We explore a range of alternative estimation strategies, including instrumental variables and difference-in-trends models. We find that SCHIP had a significant impact in decreasing uninsurance and increasing public insurance for both children targeted by SCHIP and those eligible for Medicaid. With respect to changes in private coverage our results are less conclusive: some specfications resulted in no significant effect of SCHIP on private insurance coverage, while others showed significant decreases in private insurance. Associated estimates of SCHIP crowd-out had wide confidence intervals and were sensitive to estimation strategy. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD 20850 USA. RP Hudson, JL (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, 540 Gaither Rd, Rockville, MD 20850 USA. EM JHudson@ahrq.gov NR 65 TC 34 Z9 34 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 2005 VL 42 IS 3 BP 232 EP 254 PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 990HW UT WOS:000233734800005 PM 16353761 ER PT J AU Sing, M Stevens, B AF Sing, M Stevens, B TI The value of experience: Differences in knowledge among Medicare beneficiaries SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID INFORMATION; CONSUMERS; LESSONS; CHOICES AB The Medicare Advantage program gives Medicare beneficiaries the opportunity to choose from an array of insurance options instead of receiving prescribed benefits. In 2006, beneficiaries who want prescription drug benefits will need to enroll in a Medicare managed care plan or a private prescription drug plan. To examine awareness and use of Medicare information programs, and the extent to which these programs are associated with beneficiary knowledge about Medicare and managed care, we conducted a national survey of Medicare beneficiaries six to 12 months after the nationwide mailing of the Medicare & You 2000 handbook. Beneficiary information-gathering behavior and experience with Medicare managed care were more highly associated with knowledge about Medicare managed care than formal education, age, income, or membership in a managed care plan before enrolling in Medicare. Practical life experience appears to outweigh traditional factors in beneficiary knowledge of Medicare and managed care. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Sing, M (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM msing@ahrq.gov NR 30 TC 2 Z9 2 U1 0 U2 1 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 2005 VL 42 IS 3 BP 266 EP 280 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 990HW UT WOS:000233734800007 PM 16353763 ER PT J AU Simonsen, L Viboud, C Elixhauser, A Taylor, RJ Kapikian, AZ AF Simonsen, L Viboud, C Elixhauser, A Taylor, RJ Kapikian, AZ TI More on RotaShield and intussusception: The role of age at the time of vaccination SO JOURNAL OF INFECTIOUS DISEASES LA English DT Article; Proceedings Paper CT 6th International Rotavirus Symposium CY JUL 07-09, 2004 CL Mexico City, MEXICO ID NATIONAL IMMUNIZATION SURVEY; ORAL ROTAVIRUS VACCINE; YOUNG-CHILDREN; INFECTION; ASSOCIATION; INFANTS; PROGRAM AB Background. RotaShield, a vaccine intended to prevent severe rotavirus diarrhea, was withdrawn in July 1999, 9 months after it became available in the United States, because of a temporal association with intussusception events that occurred in vaccinated infants. We explore here the effect of age on the risk of intussusception. Methods. We reanalyzed a case-control database of the Centers for Disease Control and Prevention by use of a 21-day window, to define vaccine-associated events. We obtained data on vaccine use from the National Immunization Survey and estimated the age-stratified background incidence of intussusception by use of Healthcare Cost and Utilization Project data. We combined these data to estimate how absolute risk varies with age and to model the projected population-attributable risk associated with 3 different vaccination schedules. Results. We found that the incidence of intussusception associated with the first dose of vaccine increased with age. Infants >= 90 days old accounted for 80% of cases of intussusception associated with a first dose but had received only 38% of first doses. Modeling of the recommended schedule of vaccination at ages 2, 4, and 6 months projected 1 intussusception event/11,000-16,000 vaccine recipients; modeling of a 2-dose schedule beginning in the neonatal period projected 1 intussusception event/38,000-59,000 vaccine recipients. Conclusions. The practice of initiating immunization after age 90 days, which we call "catch-up" vaccination, contributed disproportionately to the occurrence of intussusception associated with the use of RotaShield. A fully implemented 2-dose vaccination schedule begun during the neonatal period would lead to, at most, a 7% increase in the incidence of intussusception above the annual background incidence. C1 NIAID, Off Global Affairs, NIH, Bethesda, MD 20892 USA. NIH, Fogarty Int Ctr, Bethesda, MD 20892 USA. Agcy Hlth Care Res & Qual, Bethesda, MD 20892 USA. RP Simonsen, L (reprint author), NIAID, Off Global Affairs, NIH, 6610 Rockledge Dr,Rm 2033, Bethesda, MD 20892 USA. EM Lsimonsen@niaid.nih.gov OI Simonsen, Lone/0000-0003-1535-8526 NR 26 TC 92 Z9 100 U1 0 U2 2 PU UNIV CHICAGO PRESS PI CHICAGO PA 1427 E 60TH ST, CHICAGO, IL 60637-2954 USA SN 0022-1899 J9 J INFECT DIS JI J. Infect. Dis. PD SEP 1 PY 2005 VL 192 SU 1 BP S36 EP S43 DI 10.1086/431512 PG 8 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 953WX UT WOS:000231113500006 PM 16088803 ER PT J AU Smith, SR Brock, TP Howarth, SM AF Smith, Scott R. Brock, Tina Penick Howarth, Shannon M. TI Use of personal digital assistants to deliver education about adherence to antiretroviral medications SO JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION LA English DT Article C1 [Smith, Scott R.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. [Brock, Tina Penick] Univ London, Sch Pharm, London WC1N 1AX, England. [Howarth, Shannon M.] Univ Utah, Hlth Sci Ctr, Salt Lake City, UT USA. RP Smith, SR (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM ssmith@ahrq.gov FU NIAID NIH HHS [9P30 AI50410] NR 10 TC 5 Z9 5 U1 0 U2 0 PU AMER PHARMACEUTICAL ASSOC PI WASHINGTON PA 2215 CONSTITUTION AVE NW, WASHINGTON, DC 20037 USA SN 1544-3191 J9 J AM PHARM ASSOC JI J. Am. Pharm. Assoc. PD SEP-OCT PY 2005 VL 45 IS 5 BP 625 EP 628 DI 10.1331/1544345055001292 PG 4 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA V47JN UT WOS:000203201900015 PM 16295649 ER PT J AU Korst, LM Gregory, KD Lu, MC Reyes, C Hobel, CJ Chavez, GF AF Korst, LM Gregory, KD Lu, MC Reyes, C Hobel, CJ Chavez, GF TI A framework for the development of maternal quality of care indicators SO MATERNAL AND CHILD HEALTH JOURNAL LA English DT Article; Proceedings Paper CT 7th Annual Maternal and Child Health Epidemiology Conference CY DEC 12-13, 2001 CL Clearwater Beach, FL SP State Calif, Maternal Child Hlth Branch, Agcy Hlth Care Res & Qual DE quality indicators; health care; maternal health services; pregnancy ID NEURAL-TUBE DEFECTS; NEONATAL INTENSIVE-CARE; CESAREAN DELIVERY RATES; HEALTH-CARE; PRENATAL-DIAGNOSIS; UNITED-STATES; CERVICAL-CANCER; ELECTIVE TERMINATION; RISK ADJUSTMENT; URINARY-INCONTINENCE AB Background: In collaboration with the California Department of Health Maternal and Child Health Branch, the authors formed a Working Group to identify potential clinical indicators that could be used to inform decision making regarding maternal health care quality. Objective: To develop potential indicators for the assessment of maternal health care quality. Materials and Methods: A Working Group was convened to review information from the published literature and expert opinion. Selection of potential indicators was guided by the following goals: 1) To identify key areas for routine aggregate monitoring; 2) To include perspectives of relevant stakeholders in maternal health care services 3) To include measures that are comprehensive and reflect a balance between maternal and fetal interests; and 4) To develop measures that would be valid, generalizable, mutable, and feasible. Results: Ninety potential indicators were identified. Each underwent a thorough review based on: its definition, objective, and validity; its contribution to innovation; the cost and timeliness of implementation; its feasibility, acceptability, and potential effectiveness; and its compatibility with ethics, values, and social policy. This process yielded 24 final indicators from the following categories: Health Status and Access (e.g., availability of 24 h inpatient anesthesia); Preconception and Interconception Care (e.g., Pap smear use); Antenatal Care (e.g., hospitalization for uncontrolled diabetes or pyelonephritis); Labor and Delivery Care (e.g., chorioamnionitis or obstetrical hemorrhage), and Postpartum Care (e.g., rate of postpartum visits). Conclusions: These potential indicators, representative of the women's health continuum, can serve as a foundation to structure the development of consensus and methods for maternal health care quality assessment. C1 Childrens Hosp Los Angeles, Saban Res Inst, Los Angeles, CA USA. Univ So Calif, Keck Sch Med, Dept Pediat, Los Angeles, CA USA. Univ So Calif, Keck Sch Med, Div Res Children Youth & Families, Los Angeles, CA USA. Univ So Calif, Keck Sch Med, Div Neonatal Med, Los Angeles, CA USA. Univ So Calif, Keck Sch Med, Dept Obstet & Gynecol, Los Angeles, CA USA. Cedars Sinai Med Ctr, Burns & Allen Res Inst, Los Angeles, CA 90048 USA. Univ So Calif, David Geffen Sch Med, Dept Obstet & Gynecol, Los Angeles, CA USA. Univ Calif Los Angeles, David Geffen Sch Med, Div Maternal Fetal Med, Los Angeles, CA USA. Univ Calif Los Angeles, David Geffen Sch Med, Div Womens Hlth Serv Res & Policy, Los Angeles, CA USA. Univ Calif Los Angeles, David Geffen Sch Med, Dept Pediat, Los Angeles, CA USA. Univ Calif Los Angeles, Sch Publ Hlth, Dept Community Hlth Serv, Los Angeles, CA 90024 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Korst, LM (reprint author), LAC & Womens & Childrens Hosp, 1240 N Miss Rd,5K40, Los Angeles, CA 90033 USA. EM korst@use.edu NR 250 TC 10 Z9 10 U1 5 U2 7 PU SPRINGER/PLENUM PUBLISHERS PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1092-7875 J9 MATERN CHILD HLTH J JI Matern. Child Health J. PD SEP PY 2005 VL 9 IS 3 BP 317 EP 341 DI 10.1007/s10995-005-0001-y PG 25 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 993VD UT WOS:000233982600011 PM 16160758 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI The delivery of health care services to persons with HIV disease - New empirical studies SO MEDICAL CARE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Delievery Org & Markets, Rockville, MD 20850 USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, Ctr Delievery Org & Markets, 540 Gaither Rd,5th Floor, Rockville, MD 20850 USA. EM fhelling@ahrq.gov NR 4 TC 1 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2005 VL 43 IS 9 SU S BP 1 EP 2 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 959UU UT WOS:000231545600001 ER PT J AU Betz, ME Gebo, KA Barber, E Sklar, P Fleishman, JA Reilly, ED Mathews, WC AF Betz, ME Gebo, KA Barber, E Sklar, P Fleishman, JA Reilly, ED Mathews, WC CA HIV Res Network TI Patterns of diagnoses in hospital admissions in a multistate cohort of HIV-positive adults in 2001 SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 42nd Annual Meeting of the Infectious-Diseases-Society-of-America CY SEP 30-OCT 03, 2004 CL Boston, MA SP Infect Dis Soc Amer DE HIV; hospitalization; mental health; HAART ID ACTIVE ANTIRETROVIRAL THERAPY; IMMUNODEFICIENCY-VIRUS-INFECTION; CORONARY-HEART-DISEASE; PROTEASE INHIBITORS; MYOCARDIAL-INFARCTION; INPATIENT ADMISSIONS; SERVICES UTILIZATION; UNITED-STATES; IMPACT; RATES AB Background: Admissions for AIDS-related illnesses decreased soon after the introduction of highly active antiretroviral therapy (HAART), but it is unclear if the trends have continued in the current HAART era. An understanding of healthcare utilization patterns is important for optimization of care;and resource allocation. We examined the diagnoses-for hospitalizations of patients with HIV in 2001. Methods: Demographic and healthcare data were collected for 8376 patients from 6 U.S. HIV care sites in 2001. We categorized diagnoses into 18 disease groups and used Poisson regression to analyze the number of admissions for each of the 4 most common groups. We also compared patients with admissions for AIDS-defining illnesses (ADI) with patients admitted for other diagnoses Results: Twenty-one percent of patients had at feast I hospitalization. Among patients hospitalized at least once;,;28% were hospitalized for an ADI. Comparing diagnosis categories, the most common hospitalizations were AIDS-defining illnesses (21.6%), gastrointestinal (GI) diseases (9.5%), mental illnesses (9.0%), and circulatory diseases (7.4%). In multivariate analysis, women had higher hospitalization. rates than men for ADI (incidence rate ratio [IRR], 1.50; 95% confidence interval.[CI], 1.25-1.79) and GI diseases (IRR, 1.52; 95% Cl, 1. 15-2.00). Compared with whites, blacks had higher admission rates for mental illnesses (IRR, 1.70; 95% Cl, 1.22-2.36), but. not for ADI. As expected, CD4 count and viral load were associated with ADI admission rates; CD4 counts were also related to hospitalizations for GI and circulatory conditions. Conclusions: Five years after the introduction of HAART, AIDS-defining illnesses continue to have the highest hospitalization rate among the diagnosis categories examined. This result emphasizes the importance of vaccination for pneumonia and influenza, as well as prophylaxis for Pneumocystis jiroveci pneumonia. The relatively large. number of mental illness admissions highlights, the need for comanagement of psychiatric disease, substance abuse, and HIV. Overall,the majority of patients were hospitalized for reasons other. than ADI, illustrating the importance of managing comorbid conditions in this population. Data from this cobort of patients with HIV may help guide the allocation of healthcare resources by enhancing our understanding of factors associated with variation in inpatient utilization rates. C1 Johns Hopkins Univ, Sch Med, Baltimore, MD 21287 USA. Univ Calif San Diego, Dept Med, San Diego, CA USA. Drexel Univ, Div HIV AIDS Med Partnership Comprehens Care Prac, Philadelphia, PA USA. Agcy Healthcare Res & Qual, Ctr Financing Access, Rockville, MD USA. RP Gebo, KA (reprint author), Johns Hopkins Univ, Sch Med, 1830 E Monument St,Rm 442, Baltimore, MD 21287 USA. EM kgebo@jhmi.edu RI Mathews, William/E-4451-2010 OI Mathews, William/0000-0002-2352-0725 NR 43 TC 26 Z9 26 U1 2 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2005 VL 43 IS 9 SU S BP 3 EP 14 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 959UU UT WOS:000231545600002 ER PT J AU Rutstein, RM Gebo, KA Flynn, PM Fleishman, JA Sharp, VL Siberry, GK Spector, SA AF Rutstein, RM Gebo, KA Flynn, PM Fleishman, JA Sharp, VL Siberry, GK Spector, SA TI Immunologic function and virologic suppression among children with perinatally acquired HIV infection on highly active antiretroviral therapy SO MEDICAL CARE LA English DT Article DE pediatric HIV infection; virologic suppression; antiretroviral therapy ID IMMUNODEFICIENCY-VIRUS TYPE-1; PROTEASE-INHIBITOR; COMBINATION THERAPY; VIRAL LOAD; HIV-1-INFECTED CHILDREN; DISEASE PROGRESSION; PREDICTIVE-VALUE; MORTALITY; SURVIVAL; INFANTS AB Background: The goal of highly active antiretroviral therapy (HAART) has been to stabilize and reconstitute immune function and suppress viral replication to the greatest degree possible. Suppression of HIV viral replication has been associated with improved long-term and short-term prognosis. Limited data are available on the level of virologic suppression and immune function of pediatric patients followed in clinical settings in the HAART era., Objective: The objective of this study was to assess the level of virologic suppression and immune function in a cohort-of children with perinatally acquired HIV infection followed at dedicated HIV specialty care sites. Research Design: This study comprised a. cohort study of HIV-infected children and adolescents. Subjects: Study subjects consisted of 263, HIV-positive children (<= 17 years old), on HAART, with at least one outpatient, visit and CD4 test recorded in 2001 seen at 4 U.S. HIV primary pediatrics and specialty care sites (2 eastern, I southern, and I western). Measures: Measures consisted of all plasma HIV-1 RNA levels <= 400 during calendar year 2001. Results: Two hundred sixty-three patients received HIV-related treatment during 2001, with a mean age of 8.5 years. Sixty-eight percent were black, 54% Were females, and the majority (85%) was insured by Medicaid. A total of 28.6% had a class C AIDS diagnosis. A total of 23.5% and 34% of patients maintained viral suppression at < 50 copies per milliliter (cpm), or < 400 cpm, respectively, for the calendar year; 32.5% and 38.8%, respectively, fulfilled the, criteria if one "blip,", to < 5000 cpm was allowed. Forty-eight percent maintained all viral loads < 5000 cpm, and 74.9% overall had HIV-1 RNAs :51,5,000 cpm. Eighty-seven percent of patients had CD4%, > 25; only 4.2% had CD4 < 15%. Overall, 12.5% of patients had either CD4% < 15 or severely decreased absolute CD4 counts (adjusted for age). A total of 4.6% of patients had HIV-1 RNAs > 100,006 cpm and severe immunosuppression. Patients who. were, less likely to achieve virologic suppression to < 400 cpm included those with CD4 count < 200 cells/mm(3) (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.007-0.46), those with AIDS (OR, 0.5; 95% Cl, 0.28-0.94), and those with moderate (OR, 0.42; 95% Cl, 0.22-0.79), or severe immunologic suppression (OR, 0.14; 95% Cl, 0.046-0.43) based on CD4%. Conclusion: In this multisite, pediatric cohort, the rate of near-complete, virologic suppression (< 50. or < 400 cpm) was low. However,,the majority of patients have near-normal CD4 counts and viral loads < 15,000 cpm., Follow up will be critical to assess the implications of ongoing low-level viral replication with near-normal CD4 values. C1 Childrens Hosp Philadelphia, Div Gen Pediat, Philadelphia, PA 19104 USA. Johns Hopkins Univ, Sch Med, Baltimore, MD USA. Univ Tennessee, Hlth Sci Ctr, Memphis, TN USA. St Jude Childrens Res Hosp, Dept Infect Dis, Memphis, TN USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. St Lukes Roosevelt Hosp, Ctr Comprehens Care, New York, NY USA. Univ Calif San Diego, Dept Pediat, La Jolla, CA USA. RP Rutstein, RM (reprint author), Childrens Hosp Philadelphia, Div Gen Pediat, Room 2419,36th & Civic Ctr Blvd, Philadelphia, PA 19104 USA. EM Rutstein@email.chop.edu RI Gebo, Kelly/B-9223-2009 NR 36 TC 9 Z9 9 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2005 VL 43 IS 9 SU S BP 15 EP 22 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 959UU UT WOS:000231545600003 ER PT J AU Gebo, KA Fleishman, JA Reilly, ED Moore, RD AF Gebo, KA Fleishman, JA Reilly, ED Moore, RD CA HIV Res Network TI High rates of primary Mycobacterium avium complex and Pneumocystis jiroveci prophylaxis in the united states SO MEDICAL CARE LA English DT Article DE HIV; opportunistic illness prophylaxis; Pneumocystis jiroveci; Mycobacterium avium complex; gender; disparities ID HIV-INFECTED PATIENTS; SOCIETY-USA PANEL; ANTIRETROVIRAL THERAPY; UPDATED RECOMMENDATIONS; RACIAL-DIFFERENCES; MEDICAL-CARE; ACCESS; AIDS; DRUG; PRESCRIPTION AB Background: National data from the mid-1990s demonstrated that many eligible patients with HIV infection do, not receive prophylaxis for opportunistic infections (OIs) and that racial and gender disparities existed in 01 prophylaxis receipt. Objective: We examined whether demographic disparities in use of 01 prophylaxis persist in 2001 and if outpatient care is associated with 01 prophylaxis utilization. Research Design: Demographic, clinical, and pharmacy utilization data were collected from 10 U.S. HIV primary care sites in the HIV Research Network. Subjects: This study consisted of adult patients ( 18 years old) in longitudinal HIV primary care. Measures: Indications for Pneumocystis jiroveci pneumonia (PCP) or Mycobacterium avium complex (MAC) prophylaxis were 2 or more CD4 counts less than 200 or 50 cells/mm(3) during calendar year (CY) 2001, respectively. Using multivariate logistic regression, we examined demographic and clinical characteristics associated with receipt of PCP or MAC prophylaxis and the association of outpatient utilization with appropriate 01 prophylaxis. Results: Among eligible patients, 88.1% received PCP prophylaxis and 87.6% received MAC prophylaxis. Approximately 80% had 4 or more outpatient visits during CY 2001. Adjusting for care site, male gender (odds ratio [OR], 1.47), Medicare coverage (OR, 1.60), and having 4 or more outpatient visits in a year (OR, 2.34) were significantly associated with increased likelihood of PCP prophylaxis. Adjusting for care site, having 4 or more outpatient visits in a year (OR, 1.85) was associated with increased likelihood of receipt of MAC prophylaxis. There were no demographic or insurance characteristics associated with receipt of MAC prophylaxis. Conclusions: The overall prevalence of 01 prophylaxis has increased since the mid-1990s, and previous racial and HIV risk factor disparities in receipt of 01 prophylaxis have waned. Integration into the healthcare system is an important correlate of receiving 01 prophylaxis. C1 Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Gebo, KA (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, 1830 E Monument St,Room 442, Baltimore, MD 21287 USA. EM kgebo@jhmi.edu RI Gebo, Kelly/B-9223-2009 NR 29 TC 20 Z9 22 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2005 VL 43 IS 9 SU S BP 23 EP 30 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 959UU UT WOS:000231545600004 ER PT J AU Rutstein, RM Gebo, KA Siberry, GK Flynn, PM Spector, SA Sharp, VL Fleishman, JA AF Rutstein, RM Gebo, KA Siberry, GK Flynn, PM Spector, SA Sharp, VL Fleishman, JA TI Hospital and outpatient health services utilization among HIV-infected children in care 2000-2001 SO MEDICAL CARE LA English DT Article DE resource use; HIV; children; hospital admission; antiretroviral therapy ID ACTIVE ANTIRETROVIRAL THERAPY; ACQUIRED-IMMUNODEFICIENCY-SYNDROME; COMBINATION THERAPY; HIV-1-INFECTED CHILDREN; PROTEASE INHIBITORS; VIRUS-INFECTION; UNITED-STATES; MEDICAL-CARE; MORTALITY; COHORT AB Background: The aging of the pediatric HIV cohort and advances in antiretroviral therapy for children may have resulted in recent changes in patterns of healthcare utilization. Objectives: The objectives of this study were to examine inpatient and outpatient HIV-related health service utilization in a multistate sample of HIV-infected children, and to assess sociodemographic and clinical correlates of utilization. Design: Cohort study of pediatric patients with HIV. Demographic, clinical, and resource utilization data were collected from medical records for 2000 and 2001. Setting: This study was conducted at 4 U.S. HIV primary pediatric and specialty care sites in different geographic regions. Patients: Three hundred three HIV-positive children with at least one outpatient visit or CD4 test in either 2000 or 2001 were studied. Main Outcome Measures: Mean outcome measures were number of hospital admissions, mean length of hospital stay, and number of outpatient clinic/office visits. Results: Hospitalization rates decreased significantly from 39.2 (95% confidence interval [CI], 28.4-50.1) to 25.3 (95% Cl, 16.4-34.3) admissions per 100 patients between 2000 and 2001. Hospitalizations were higher among patients with greater immunosuppression, those 2 years and under, and those with AIDS, but were not significantly related to receipt of highly active antiretroviral therapy. Mean outpatient visits did not change significantly between 2000 and 2001 from 9.09 (95% Cl, 8.3-9.9) to 9.06 (95% Cl, 8.4-9.7) visits per child per year. Children 2 years and under, those on highly active antiretroviral therapy, those with AIDS, and those with Medicaid had significantly higher outpatient utilization. Those with higher HIV-1 RNA had higher outpatient utilization than those with less advanced disease. Conclusion: Inpatient utilization significantly decreased between 2000 and 2001, but outpatient utilization did not change over time. Compared with prior studies, utilization rates appear to be declining over time. Unlike, adults, racial/ethnic or gender disparities in healthcare utilization are less pronounced for HIV-infected children. C1 Johns Hopkins Univ, Sch Med, Baltimore, MD 21287 USA. Childrens Hosp Philadelphia, Div Gen Pediat, Philadelphia, PA USA. St Jude Childrens Res Hosp, Dept Infect Dis, Memphis, TN USA. Univ Calif San Diego, Dept Pediat, La Jolla, CA 92093 USA. St Lukes Roosevelt Hosp, Ctr Comprehens Care, New York, NY USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Gebo, KA (reprint author), Johns Hopkins Univ, Sch Med, 1830 E Monument St,Room 442, Baltimore, MD 21287 USA. EM kgebo@jhmi.edu RI Gebo, Kelly/B-9223-2009 NR 33 TC 3 Z9 3 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2005 VL 43 IS 9 SU S BP 31 EP 39 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 959UU UT WOS:000231545600005 ER PT J AU Fleishman, JA Gebo, KA Reilly, ED Conviser, R Mathews, WC Korthuis, PT Hellinger, J Rutstein, R Keiser, P Rubin, H Moore, RD AF Fleishman, JA Gebo, KA Reilly, ED Conviser, R Mathews, WC Korthuis, PT Hellinger, J Rutstein, R Keiser, P Rubin, H Moore, RD CA HIV Res Network TI Hospital and outpatient health services utilization among HIV-infected adults in care 2000-2002 SO MEDICAL CARE LA English DT Article DE resource use; health services; cost of care; hospital admission; antiretroviral therapy; gender; race; disparities; female; injection drug use; black ID COMBINATION ANTIRETROVIRAL THERAPY; IMMUNODEFICIENCY-VIRUS-INFECTION; INJECTION-DRUG USERS; PROTEASE INHIBITORS; UNITED-STATES; MEDICAL-CARE; DISEASE; COHORT; COSTS; AIDS AB Background: Rapid changes in HIV epidemiology and antiretroviral therapy may have resulted in recent changes in patterns of healthcare utilization. Objective: The objective of this study was to examine sociodemographic and clinical correlates of inpatient and outpatient HIV-related health service utilization in a multistate sample of patients with HIV. Design: Demographic, clinical, and resource utilization data were collected from medical records for 2000, 2001, and 2002. Setting:,,This study. was,conducted at 11 U.S. HIV primary and specialty care sites in different geographic regions. Patients: In each year, HIV-positive patients with at least one CD4 count and any use of inpatient, outpatient, or emergency room services. Sample sizes were 13,392 in 2000, 15,211 in 2001, and 14,403 in 2002. Main Outcome Measures: Main outcome measures were number of hospital admissions, total days in hospital, and number of outpatient clinic/office visits per year. Inpatient and outpatient costs were estimated by applying unit costs to numbers of inpatient days and outpatient visits. Results: Mean numbers of admissions per person per year decreased from 2000 (0.40) to 2002 (0.35), but this difference was not significant in multivariate analyses. Hospitalization rates were significantly higher among,patients with-greater inummosuppression, women, blacks, patients who acquired HIV through drug use, those 50 years of age and over, and those with Medicaid or Medicare. Mean annual outpatient visits decreased significantly between 2000 and 2002, from 6.06 to 5.66 visits per person per year. Whites, Hispanics, those 30 years of age and over, those on highly active antiretroviral therapy (HAART), and those with Medicaid or Medicare had significantly higher outpatient utilization. Inpatient costs per patient per month (PPPM) were estimated to be $514 in 2,000, $472 in 2001, and $424 in 2002; outpatient costs - PPPM were estimated at $108 in 2000, $100 in 2001, and $101 in 2002. Conclusion: Changes in utilization over this 3-year period, although statistically significant in some cases, were not substantial. Hospitalization rates remain relatively high among minority or disadvantaged groups, suggesting persistent disparities in care. Combined inpatient and outpatient costs for patients on HAART were not significantly lower than for patients not on HAART. C1 Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. HIV AIDS Bur, Hlth Resources & Serv Adm, Rockville, MD USA. Univ Calif San Diego, Dept Med, San Diego, CA 92103 USA. Oregon Hlth Sci Univ, Dept Med, Portland, OR USA. Childrens Hosp Philadelphia, Philadelphia, PA USA. Community Med Alliance, Boston, MA USA. Parkland Hlth & Hosp Syst, Dallas, TX USA. RP Gebo, KA (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, 1830 E Monument St,Room 442, Baltimore, MD 21287 USA. EM kgebo@jhmi.edu RI Gebo, Kelly/B-9223-2009; Mathews, William/E-4451-2010 OI Mathews, William/0000-0002-2352-0725 NR 41 TC 102 Z9 103 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2005 VL 43 IS 9 SU S BP 40 EP 52 PG 13 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 959UU UT WOS:000231545600006 ER PT J AU Rosen, AK Rivard, P Zhao, SB Loveland, S Tsilimingras, D Christiansen, CL Elixhauser, A Romano, PS AF Rosen, AK Rivard, P Zhao, SB Loveland, S Tsilimingras, D Christiansen, CL Elixhauser, A Romano, PS TI Evaluating the Patient Safety Indicators - How well do they perform on Veterans Health Administration data? SO MEDICAL CARE LA English DT Article; Proceedings Paper CT AcademyHealth Annual Meeting CY JUN 06-08, 2004 CL San Diego, CA DE patient safety; medical errors; administrative data; quality indicators; adverse events ID IN-HOSPITAL COMPLICATIONS; MEDICAL INJURIES; IDENTIFYING COMPLICATIONS; PROGRAM; AFFAIRS; QUALITY; CARE; VA; EVENTS; COSTS AB Background: The Patient Safety Indicators (PSIs), an administrative data-based tool developed by the Agency for Healthcare Research and Quality, are increasingly being used to screen for potential in-hospital patient safety problems. Although the Veterans Health Administration (VA) is a national leader in patient safety, accurate information on the epidemiology of patient safety events in the VA is still unavailable. Objectives: Our objectives were to: (1) apply the AHRQ PSI software to VA administrative data to identify potential instances of compromised patient safety; (2) determine occurrence rates of PSI events in the VA; and (3) examine the construct validity of the PSIs. Methods: We examined differences between observed and riskadjusted PSI rates in the VA, compared VA and non-VA PSI rates, and investigated the construct validity of the PSIs by examining correlations of the PSIs with other outcomes of VA hospitalizations. Results: We identified 11,411 PSI events in the VA nationwide in FY'01. Observed PSI rates per 1000 discharges ranged from 0.007 for "transfusion reaction" to 155.5 for "failure to rescue." There were significant, although small, differences between VA and non-VA risk-adjusted PSI rates. Hospitalizations with PSI events had longer lengths of stay, higher mortality, and higher costs than those without PSI events. Conclusions: Our results suggest that the PSIs may be useful as a patient safety screening tool in the VA. Our PSI rates were consistent with the national incidence of low rates; however, differences between VA and non-VA rates suggest that inadequate case-mix adjustment may be contributing to these findings. C1 VAMC 152, Ctr Hlth Qual Outcomes & Econ Res, Bedford, MA 01730 USA. Boston Univ, Sch Publ Hlth, Dept Hlth Serv, Boston, MA 02215 USA. Boston Univ, Carroll Sch Management, Org Studies Dept, Boston, MA 02215 USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. Univ Calif Davis, Div Gen Med, Sacramento, CA 95817 USA. RP Rosen, AK (reprint author), VAMC 152, Ctr Hlth Qual Outcomes & Econ Res, 200 Springs Rd, Bedford, MA 01730 USA. EM akrosen@bu.edu RI Romano, Patrick/N-4225-2014 OI Romano, Patrick/0000-0001-6749-3979 NR 40 TC 71 Z9 71 U1 3 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2005 VL 43 IS 9 BP 873 EP 884 DI 10.1097/01.mlr.0000173561.79742.fb PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 959BU UT WOS:000231492700005 PM 16116352 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Services Task Force TI Screening for pancreatic cancer: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. NR 4 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD AUG 15 PY 2005 VL 72 IS 4 BP 665 EP 666 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 956XQ UT WOS:000231333800012 ER PT J AU Meyerhoefer, CD Ranney, CK Sahn, DE AF Meyerhoefer, CD Ranney, CK Sahn, DE TI Consistent estimation of censored demand systems using panel data SO AMERICAN JOURNAL OF AGRICULTURAL ECONOMICS LA English DT Article DE almost ideal demand system; censoring; generalized method of moments; panel data ID NON-NEGATIVITY CONSTRAINTS; PRICE ELASTICITIES; EQUATIONS; QUANTITY; MODELS AB We derive a joint continuous/censored commodity demand system for panel data applications. Unobserved heterogeneity is controlled for using a correlated random effects specification and a generalized method of moments framework used to estimate the model. While relatively small differences in elasticity estimates are found between a flexible random effects specification and one that restricts the random effect coefficient to be time invariant, larger differences are observed when comparing the flexible model to a pooled cross-sectional estimator. The results suggest the limited ability of such estimators to control for preference heterogeneity and unit-value endogeneity leads to parameter bias. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. Cornell Univ, Dept Appl Econ & Management, Ithaca, NY 14853 USA. Cornell Univ, Ithaca, NY 14853 USA. Cornell Univ, Dept Econ, Ithaca, NY 14853 USA. Cornell Univ, Div Nutr Sci, Ithaca, NY 14853 USA. RP Meyerhoefer, CD (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 36 TC 25 Z9 25 U1 1 U2 8 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0002-9092 J9 AM J AGR ECON JI Am. J. Agr. Econ. PD AUG PY 2005 VL 87 IS 3 BP 660 EP 672 DI 10.1111/j.1467-8276.2005.00754.x PG 13 WC Agricultural Economics & Policy; Economics SC Agriculture; Business & Economics GA 942RX UT WOS:000230300900009 ER PT J AU Mukamel, DB Spector, WD Bajorska, A AF Mukamel, DB Spector, WD Bajorska, A TI Nursing home spending patterns in the 1990s: The role of nursing home competition and excess demand SO HEALTH SERVICES RESEARCH LA English DT Article DE nursing homes; costs; competition; excess demand ID QUALITY; CARE; COSTS AB Objective. To examine nursing home expenditures on clinical, hotel, and administrative activities during the 1990s and to determine the association between nursing home competition and excess demand on expenditures. Data Sources/Study Setting. Secondary data sources for 1991, 1996, and 1999 for 500 free-standing nursing homes in New York State. Study Design. A retrospective statistical analysis of nursing homes' expenditures. The dependent variables were clinical, hotel, and administrative costs in each year. Independent variables included outputs (inpatient and outpatient), wages, ownership, New York City location, and measures of competition and excess demand. Data Collection/Extraction Method. Variables were constructed from annual financial reports submitted by the nursing homes, the Patient Review Instrument and Medicare enrollment data. Principal Findings. Clinical and administrative costs have increased over the decade, while hotel expenditures have declined. Increased competition was associated with higher clinical and administrative costs while excess demand was associated with lower clinical and hotel expenditures. Conclusions. Nursing home expenditures are sensitive to competition and excess demand conditions. Policies that influence competition in nursing home markets are therefore likely to have an impact on expenditures as well. C1 Univ Calif Irvine, Ctr Hlth Policy Res, Dept Med, Div Gen Internal Med & Primary Care, Irvine, CA 92717 USA. Agcy Healthcare Res & Qual, Washington, DC USA. Univ Rochester, Rochester, NY 14627 USA. RP Mukamel, DB (reprint author), Univ Calif Irvine, Ctr Hlth Policy Res, Dept Med, Div Gen Internal Med & Primary Care, 111 Acad Way,Suite 220, Irvine, CA 92717 USA. FU NIA NIH HHS [AG-15965] NR 17 TC 17 Z9 17 U1 0 U2 2 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD AUG PY 2005 VL 40 IS 4 BP 1040 EP 1055 DI 10.1111/j.1475-6773.2005.00394.x PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 942OT UT WOS:000230292400006 PM 16033491 ER PT J AU McNamara, P AF McNamara, P TI Quality-based payment: six case examples SO INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE LA English DT Article DE incentive payments for patient safety; incentive payments for quality; pay for performance; quality-based payment; value-based purchasing ID HEALTH-SERVICES; CARE AB Introduction. The logic of paying more for high-quality care and less for low-quality resonates. Increasingly health system leaders worldwide acknowledge that payment reforms are needed to do just that, prompted no doubt by the growing body of evidence indicating that quality is not what it should be. Purpose. This review was undertaken to explore contexts in which quality-based payment appears feasible. The ultimate intent is to provoke thoughtful debate about whether and how quality-based payment might fit within a particular developing country's framework of policies to ensure and promote quality of care. Methods. With guidance from key informants with first-hand knowledge of international quality- based payment schemes, a purposive sample of six quality- based payment schemes was assembled. Schemes were examined to identify environmental contexts and design features. Results. Examples illustrate a variety of approaches and a breadth of contexts in which quality- based payment has been implemented. Contrary to what might be expected, implementation does not appear to be constrained to private-sector purchasers, private-sector providers, hospital settings, nor to any particular type of underlying payment system. Further, quality- based payment pioneers are using a variety of incentive structures, and are tapping a rich mix of structural, process, and outcome standards to benchmark quality. Conclusion. Despite significant operational challenges, quality- based payment has been implemented in developing as well as developed countries, albeit not frequently in either instance. What we do not know - what the literature is nearly silent on relates to the sustainability and ultimate impact of alternative incentive schemes. C1 Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP McNamara, P (reprint author), Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM pmcnamar@ahrq.gov NR 25 TC 23 Z9 23 U1 2 U2 5 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 1353-4505 J9 INT J QUAL HEALTH C JI Int. J. Qual. Health Care PD AUG PY 2005 VL 17 IS 4 BP 357 EP 362 DI 10.1093/intqhc/mzi033 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 948OJ UT WOS:000230725300011 PM 15879011 ER PT J AU Harris, KM Edlund, MJ Larson, S AF Harris, KM Edlund, MJ Larson, S TI Racial and ethnic differences in the mental health problems and use of mental health care SO MEDICAL CARE LA English DT Article DE mental health care; utilization; unmet need; racial and ethnic disparities ID NATIONAL-COMORBIDITY-SURVEY; PSYCHIATRIC-DISORDERS; MEXICAN-AMERICANS; UNITED-STATES; LIFETIME PREVALENCE; LOS-ANGELES; DRUG-ABUSE; SERVICES; ILLNESS; POPULATION AB Objectives: We compared rates of mental health problems and use of mental health care across multiple racial and ethnic groups using secondary data from a large, nationally representative survey. Methods: We pooled cross-sectional data from the 2001-2003 National Surveys on Drug Use and Health. Our sample included 134,875 adults classified as white, African American, American Indian/Alaskan Native, Asian, Mexican, Central and South American, Puerto Rican, other Hispanic-Latino, or those with multiple race and ethnicities. For each group, we estimate the past year probability of. (1) having I or more mental health symptoms in the past year, (2) having serious mental illness in the past year, (3) using mental health care, (4) using mental health care conditional on having mental health problems, (5) reporting unmet need for mental health care, and (6) reporting unmet need for mental health care conditional on having mental health problems. Results: We found significantly higher rates of mental health problems and higher self-reported unmet need relative to whites among American Indian/Alaskan Natives and lower rates of mental health problems and use of mental health care among African American, Asian, Mexican, Central and South American, and other Hispanic-Latino groups. These differences generally were robust to the inclusion of clinical and socio demographic covariates. Conclusions: Overall, our study shows wide variation in mental health morbidity and use of mental health care across racial and ethnic groups in the United States. These results can help to focus efforts aimed at understanding the underlying causes of the differences we observe. C1 Subst Abuse & Mental Hlth Serv Adm, Off Appl Studies, Rockville, MD 20856 USA. Univ Arkansas Med Sci, Cent Arkansas Vet Healthcare Syst, Ctr Mental Healthcare & Outcomes Res, Little Rock, AR 72205 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Harris, KM (reprint author), Subst Abuse & Mental Hlth Serv Adm, Off Appl Studies, 5600 Fishers Lane,Room 16-105, Rockville, MD 20856 USA. EM kharris@samhsa.gov NR 40 TC 83 Z9 83 U1 1 U2 15 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD AUG PY 2005 VL 43 IS 8 BP 775 EP 784 DI 10.1097/01.mlr.0000170405.66264.23 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 949ON UT WOS:000230798100005 PM 16034291 ER PT J AU Reynolds, MG Holman, RC Curns, AT O'Reilly, M McQuiston, JH Steiner, CA AF Reynolds, MG Holman, RC Curns, AT O'Reilly, M McQuiston, JH Steiner, CA TI Epidemiology of cat-scratch disease hospitalizations among children in the United States SO PEDIATRIC INFECTIOUS DISEASE JOURNAL LA English DT Article DE Bartonella; cat-scratch disease; epidemiology; Healthcare Cost and Utilization Project; hospitalization AB Background: Cat-scratch disease (CSD), caused by infection with Bartonella henselae, affects both children and adults but is principally a pediatric disease. Typical CSD is generally benign and self-limited and is characterized by regional lymphadenopathy with fever. Infections can, however, be accompanied by focal or diffuse inflammatory responses (atypical CSD) involving neurologic, organ (liver/spleen), lymphatic or skeletal systems. Methods: Pediatric hospitalizations with CSD listed as a diagnosis were examined using the Kids' Inpatient Database for the year 2000. National estimates of CSD-associated hospitalizations, hospitalization rates and various hospitalization statistics were examined for patients younger than 18 years of age. Results: During 2000, an estimated 437 (SE 43) pediatric hospitalizations associated with CSD occurred among children younger than 18 years of age in the United States. The national CSD-associated hospitalization rate was 0.60/100,000 children younger than 18 years of age (95% confidence interval, 0.49-0.72) and 0.86/100,000 children younger than 5 years of age (95% CI 0.64-1.07). Accompanying diagnoses included neurologic complications (12%), organ (liver/spleen) involvement (7%) and "other" (5%). Atypical CSD accounted for similar to 24% of the CSD-associated hospitalizations. The median charge for a CSD-associated hospitalization was $6140 with total annual hospital charges of similar to$3.5 million among children in the United States. Conclusions: The CSD-associated hospitalization rate among children during 2000 appeared similar to those estimated for the 1980s in the United States, despite significant increases in cat ownership in the intervening time. Early serologic and molecular testing for CSD in children is suggested to minimize unnecessary interventions and promote optimally effective care when supportive measures are required. C1 Ctr Dis Control & Prevent, Viral & Rickettsial Zoonoses Branch, US Dept Hlth & Human Serv, Atlanta, GA 30333 USA. Ctr Dis Control & Prevent, Off Director, Div Viral & Rickettsial Dis, Natl Ctr Infect Dis,US Dept Hlth & Human Serv, Atlanta, GA 30333 USA. Minist Publ Hlth, Field Epidemiol Training Program Thailand, Nonthaburi, Thailand. US Dept Hlth & Human Serv, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Reynolds, MG (reprint author), Ctr Dis Control & Prevent, Viral & Rickettsial Zoonoses Branch, US Dept Hlth & Human Serv, MS G-18, Atlanta, GA 30333 USA. EM nzr6@cdc.gov NR 12 TC 25 Z9 29 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0891-3668 J9 PEDIATR INFECT DIS J JI Pediatr. Infect. Dis. J. PD AUG PY 2005 VL 24 IS 8 BP 700 EP 704 DI 10.1097/01.inf.0000172185.01939.fc PG 5 WC Immunology; Infectious Diseases; Pediatrics SC Immunology; Infectious Diseases; Pediatrics GA 958EQ UT WOS:000231427900008 PM 16094224 ER PT J AU Fink, KS AF Fink, KS TI Systematic reviews provide more accurate assessments SO AMERICAN FAMILY PHYSICIAN LA English DT Letter C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Fink, KS (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. NR 2 TC 0 Z9 0 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JUL 15 PY 2005 VL 72 IS 2 BP 226 EP 226 PG 1 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 947ZX UT WOS:000230686900003 PM 16050448 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Services Task Force TI Hormone therapy for the prevention of chronic conditions in postmenopausal women: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID CONJUGATED EQUINE ESTROGENS; RANDOMIZED CONTROLLED-TRIAL; HEALTH INITIATIVE MEMORY; SERVICES TASK-FORCE; REPLACEMENT THERAPY; BREAST-CANCER; ESTROGEN/PROGESTIN REPLACEMENT; PLUS PROGESTIN; OVARIAN-CANCER; FOLLOW-UP C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 32 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JUL 15 PY 2005 VL 72 IS 2 BP 311 EP 316 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 947ZX UT WOS:000230686900010 ER PT J AU Harrison, MI Young, S AF Harrison, MI Young, S TI Computers and clinical work SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter ID STILL C1 Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Hlth Informat Technol Res & Programs, Rockville, MD USA. RP Harrison, MI (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. EM mharriso@ahrq.gov NR 4 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 13 PY 2005 VL 294 IS 2 BP 181 EP 181 DI 10.1001/jama.294.2.181-a PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 944DO UT WOS:000230406100017 PM 16014591 ER PT J AU Stuart, B Briesacher, BA Shea, DG Cooper, B Baysac, FS Limcangco, MR AF Stuart, B Briesacher, BA Shea, DG Cooper, B Baysac, FS Limcangco, MR TI Riding the rollercoaster: The ups and downs in out-of-pocket spending under the standard medicare drug benefit SO HEALTH AFFAIRS LA English DT Article ID BENEFICIARIES; COVERAGE; POPULATION AB This study projects how much Medicare beneficiaries who sign up for the standard Part D drug benefit in 2006 will pay in quarterly out-of-pocket payments through 2008. In the first year we estimate that about 38 percent of enrollees will hit the benefit's no-coverage zone, known as the "doughnut hole," and that 14 percent will exceed the catastrophic threshold. Because drug spending is highly persistent over time, beneficiaries who experience the biggest gaps in coverage are likely to do so year after year, with potentially serious financial consequences. C1 Univ Maryland, Ctr Drug Therapy & Aging, Baltimore, MD 21201 USA. Univ Massachusetts, Sch Med, Div Geriatr Med, Worcester, MA 01003 USA. Penn State Univ, Dept Hlth Policy & Adm, University Pk, PA 16802 USA. Commonwealth Fund, Program Medicares Future, New York, NY USA. Univ Maryland, Dept Pharmaceut Hlth Serv Res, Baltimore, MD 21201 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Stuart, B (reprint author), Univ Maryland, Ctr Drug Therapy & Aging, Baltimore, MD 21201 USA. EM BStuart@rx.umaryland.edu NR 18 TC 30 Z9 30 U1 0 U2 3 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JUL-AUG PY 2005 VL 24 IS 4 BP 1022 EP 1031 DI 10.1377/hlthaf.24.4.1022 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 947CV UT WOS:000230621600016 PM 16012142 ER PT J AU Encinosa, WE Hellinger, FJ AF Encinosa, WE Hellinger, FJ TI Have state caps on malpractice awards increased the supply of physicians? SO HEALTH AFFAIRS LA English DT Article ID CLAIMS AB Twenty-seven states have laws that cap payments for noneconomic damages in malpractice cases. In this study we examined whether these laws have increased the supply of physicians, using county-level data from all fifty states from 1985 to 2000. Counties in states with a cap had 2.2 percent more physicians per capita because of the cap, and rural counties in states with a cap had 3.2 percent more physicians per capita. Rural counties in states with a $250,000 cap had 5.4 percent more obstetrician-gynecologists and 5.5 percent more surgical specialists per capita than did rural counties in states with a cap above $250,000. C1 AHRQ, Ctr Delivery Org & Markets, Rockville, MD USA. RP Encinosa, WE (reprint author), AHRQ, Ctr Delivery Org & Markets, Rockville, MD USA. EM wencinos@ahrq.gov NR 34 TC 3 Z9 3 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JUL-AUG PY 2005 VL 24 IS 4 BP W250 EP W258 DI 10.1377/hlthaff.W5.250 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 947CV UT WOS:000230621600048 ER PT J AU Clancy, CM Farquhar, MB Sharp, BAC AF Clancy, CM Farquhar, MB Sharp, BAC TI Patient safety in nursing practice SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID NURSES C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Farquhar, MB (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM mfarquha@ahrq.gov NR 13 TC 12 Z9 13 U1 1 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD JUL-SEP PY 2005 VL 20 IS 3 BP 193 EP 197 PG 5 WC Nursing SC Nursing GA 936TK UT WOS:000229878100001 PM 15965381 ER PT J AU Siegel, JE AF Siegel, JE TI Cost-effectiveness analysis in US healthcare decision-making - Where is it going? SO MEDICAL CARE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Res Initiat Clin Econ, Ctr Outcones & Evidence, Rockville, MD 20850 USA. RP Siegel, JE (reprint author), Agcy Healthcare Res & Qual, Res Initiat Clin Econ, Ctr Outcones & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM jsiegel@AHRQ.gov NR 12 TC 7 Z9 7 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2005 VL 43 IS 7 SU S BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 942ZX UT WOS:000230322500001 PM 16056002 ER PT J AU Sullivan, PW Lawrence, WF Ghushchyan, V AF Sullivan, PW Lawrence, WF Ghushchyan, V TI A national catalog of preference-based scores for chronic conditions in the United States SO MEDICAL CARE LA English DT Article DE health-related quality of life; cost-utility analysis; utility; chronic disease ID HEALTH UTILITIES INDEX; QUALITY-OF-LIFE; POPULATION HEALTH; CLINICAL-TRIAL; EUROQOL EQ-5D; MARK 3; VALIDITY; MODEL; INSTRUMENTS; DISEASE AB Background: The variability in preferences used in quality-adjusted life-years estimation jeopardizes the comparability of cost-effectiveness analyses and has led the Panel on Cost-Effectiveness in Health and Medicine (the PCEHM) to call for a catalog of "off-the-shelf' preference weights associated with conditions that can be used by health researchers without the burden of collecting primary data. Objective: The current research responds to the call by developing a nationally representative catalog of preference-based scores for chronic conditions and associated sociodemographic characteristics. Methods: The authors report the EQ-5D(index) scores of chronic conditions and associated sociodemographic characteristics in the nationally representative Medical Expenditure Panel Survey (MEPS). Chronic conditions were coded using "quality priority conditions" (QPC) and clinical classification categories (CCC). OLS, Tobit, and censored least absolute deviations (CLAD) regression models were used to provide condition estimates adjusted for age, comorbidity, gender, race, ethnicity, income, and education. Results: Unadjusted and adjusted EQ-5D(index) scores for each QPC and CCC code are presented. EQ-5D(index) scores for older age categories were lower than younger categories, female scores were lower than males, certain racial groups had lower scores than others, and EQ-5D(index) scores were higher for individuals with higher education and income levels. Conclusion: The preference-based chronic condition scores reported in this research are nationally representative and may be useful to researchers to calculate quality-adjusted life-years for cost-effectiveness analyses and population-based burden of illness studies without the difficulty of primary data collection. Further research is necessary to validate these scores in condition-specific studies. C1 Univ Colorado, Sch Pharm, Pharmaceut Outcomes Res Program, Denver, CO 80262 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Sullivan, PW (reprint author), Univ Colorado, Sch Pharm, Pharmaceut Outcomes Res Program, 4200 E 9th Ave,Box C238, Denver, CO 80262 USA. EM Patrick.Sullivan@UCHSC.edu NR 43 TC 196 Z9 197 U1 2 U2 13 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2005 VL 43 IS 7 BP 736 EP 749 DI 10.1097/01.mlr.0000172050.67085.4f PG 14 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 940QJ UT WOS:000230158700014 PM 15970790 ER PT J AU Moyer, VA Klein, JD Ockene, JK Teutsch, SM Johnson, MS Allan, JD AF Moyer, VA Klein, JD Ockene, JK Teutsch, SM Johnson, MS Allan, JD CA Childhood Obesity Working Grp US TI Screening for overweight in children and adolescents: Where is the evidence? A commentary by the childhood obesity working group of the US preventive services task force SO PEDIATRICS LA English DT Editorial Material C1 Univ Texas, Hlth Sci Ctr, Dept Pediat, Houston, TX 77030 USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Univ Massachusetts, Sch Med, Div Prevent & Behav Med, Worcester, MA 01655 USA. Merck & Co Inc, Oucomes Res & Management, West Point, PA 19486 USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Family Med, Newark, NJ 07103 USA. Univ Maryland Baltimore Cty, Sch Nursing, Baltimore, MD 21250 USA. RP Moyer, VA (reprint author), USPSTF, Agcy Hlth Care Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 7 TC 20 Z9 20 U1 0 U2 3 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JUL PY 2005 VL 116 IS 1 BP 235 EP 238 PG 4 WC Pediatrics SC Pediatrics GA 941IC UT WOS:000230207500061 PM 15995061 ER PT J AU Atkins, D Fink, K Slutsky, J AF Atkins, D Fink, K Slutsky, J TI Better information for better health care: The evidence-based practice center program and the agency for healthcare research and quality SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID IMPLEMENTATION; GUIDELINE; STRENGTH; OUTCOMES AB To provide decision makers with the best available evidence, the Agency for Healthcare Research and Quality established a network of Evidence-based Practice Centers across North America. The centers perform systematic reviews on important questions posed by partner organizations about clinical, organizational, and policy interventions in health care. The Agency works closely with partners and other decision makers to help translate that evidence into practice or policy. In this paper, we review important lessons we have learned over the past 7 years about how to increase the efficiency and impact of systematic reviews. Lessons concern selecting the right topics and scope, working effectively with partners, and balancing consistency and flexibility in methods. We examine continuing evolutions of the program and the impact of planned work on comparative effectiveness performed as part of the Medicare Modernization Act of 2003. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Atkins, D (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM datkins@ahrq.gov NR 28 TC 45 Z9 46 U1 0 U2 1 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD JUN 21 PY 2005 VL 142 IS 12 SU S BP 1035 EP 1041 PN 2 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 938CN UT WOS:000229977600002 PM 15968027 ER PT J AU Tatsioni, A Zarin, DA Aronson, N Samson, DJ Flamm, CR Schmid, C Lau, J AF Tatsioni, A Zarin, DA Aronson, N Samson, DJ Flamm, CR Schmid, C Lau, J TI Challenges in systematic reviews of diagnostic technologies SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID PUBLICATION BIAS; TEST ACCURACY; TESTS; METAANALYSIS; LESSONS; QUALITY; CURVE AB Diagnostic tests are critical components of effective health care. They help determine treatments that are most beneficial for a given patient. Their assessment is a complex process that includes such challenges as a dearth of studies that evaluate clinical outcomes and lack of data on use of the test in realistic clinical settings. The methodologic quality of studies of diagnostic tests also lags behind the quality of studies of therapeutic interventions. Statistical methods to combine diagnostic accuracy data are more complex and not as well developed, leading to difficulties in the interpretation of results. The Agency for Healthcare Research and Quality Technology Assessment Program has adopted a 6-level framework for evaluating diagnostic technologies. The model emphasizes the need for systematic reviews of diagnostic test studies to go beyond the assessment of technical feasibility and accuracy to examine the impact of the test on health outcomes. In this paper, we use examples from 3 Evidence-based Practice Center reports to illustrate 3 challenges reviewers may face when reviewing diagnostic test literature: finding relevant studies, assessing methodologic quality of diagnostic accuracy studies, and synthesizing studies that evaluate tests in different patient populations or use different outcomes. C1 Tufts New England Med Ctr, Evidence Based Pract Ctr, Boston, MA 02111 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Blue Cross & Blue Shield Assoc Technol Evaluat Ct, Chicago, IL USA. RP Lau, J (reprint author), Tufts New England Med Ctr, Evidence Based Pract Ctr, 750 Washington St, Boston, MA 02111 USA. OI Schmid, Christopher/0000-0002-0855-5313 FU AHRQ HHS [R01 HS13328] NR 47 TC 113 Z9 115 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD JUN 21 PY 2005 VL 142 IS 12 SU S BP 1048 EP 1055 PN 2 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 938CN UT WOS:000229977600004 PM 15968029 ER PT J AU Norris, SL Atkins, D AF Norris, SL Atkins, D TI Challenges in using nonrandomized studies in systematic reviews of treatment interventions SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID CONTROLLED-TRIALS; CLINICAL-TRIALS; QUALITY AB Randomized, controlled trials (RCTs) are firmly established as the standard for determining which medical treatments are effective. in some areas of health care, however, among them surgery, public health, and the organization of health care delivery, most evidence addressing the effectiveness of clinical or policy interventions rests on nonrandomized studies. We examine the use of study designs other than RCTs in Evidence-based Practice Center reports addressing questions of the effectiveness of treatment interventions. These reports offer the opportunity to examine the approaches used and the challenges faced by reviewers when nonrandomized studies are included and their quality assessed. We then offer recommendations for using these studies in systematic reviews of treatment interventions. C1 Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Norris, SL (reprint author), Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, Room 6325,540 Gaither Rd, Rockville, MD 20850 USA. EM snorris@ahrq.gov NR 36 TC 63 Z9 68 U1 0 U2 1 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD JUN 21 PY 2005 VL 142 IS 12 SU S BP 1112 EP 1119 PN 2 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 938CN UT WOS:000229977600011 PM 15968036 ER PT J AU Deyo, RA Gray, DT Kreuter, W Mirza, S Martin, BI AF Deyo, RA Gray, DT Kreuter, W Mirza, S Martin, BI TI United States trends in lumbar fusion surgery for degenerative conditions SO SPINE LA English DT Article DE fusion; surgery rates; trends; surgical implants ID LOW-BACK-PAIN; GEOGRAPHIC VARIATIONS; SPINAL-FUSION; HOSPITALIZATION; COMPLICATIONS; REOPERATIONS; RATES AB Study Design. Retrospective cohort study using national sample administrative data. Objectives. To determine if lumbar fusion rates increased in the 1990s and to compare lumbar fusion rates with those of other major musculoskeletal procedures. Summary of Background Data. Previous studies found that lumbar fusion rates rose more rapidly during the 1980s than did other types of lumbar surgery. Methods. We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1988 through 2001 to examine trends. U. S. Census data were used for calculating age and sex-adjusted population-based rates. We excluded patients with vertebral fractures, cancer, or infection. Results. In 2001, over 122,000 lumbar fusions were performed nationwide for degenerative conditions. This represented a 220% increase from 1990 in fusions per 100,000. The increase accelerated after 1996, when fusion cages were approved. From 1996 to 2001, the number of lumbar fusions increased 113%, compared with 13 to 15% for hip replacement and knee arthroplasty. Rates of lumbar fusion rose most rapidly among patients aged 60 and above. The proportion of lumbar operations involving a fusion increased for all diagnoses. Conclusions. Lumbar fusion rates rose even more rapidly in the 90s than in the 80s. The most rapid increases followed the approval of new surgical implants and were much greater than increases in other major orthopedic procedures. The most rapid increases in fusion rates were among adults aged 60 and above. These increases were not associated with reports of clarified indications or improved efficacy, suggesting a need for better data on the efficacy of various fusion techniques for various indications. C1 Univ Washington, Ctr Cost & Outcomes Res, Seattle, WA 98104 USA. Univ Washington, Dept Med, Seattle, WA 98104 USA. Univ Washington, Dept Hlth Serv, Seattle, WA 98104 USA. Univ Washington, Dept Orthopaed & Sports Med, Seattle, WA 98104 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement &Patient Safety, Rockville, MD USA. RP Deyo, RA (reprint author), Univ Washington, Ctr Cost & Outcomes Res, 325 9th Ave,Box 359736, Seattle, WA 98104 USA. EM deyo@u.washington.edu FU NIAMS NIH HHS [P60 AR 48093] NR 15 TC 384 Z9 396 U1 4 U2 21 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0362-2436 J9 SPINE JI SPINE PD JUN 15 PY 2005 VL 30 IS 12 BP 1441 EP 1445 DI 10.1097/01.brs.0000166503.37969.8a PG 5 WC Clinical Neurology; Orthopedics SC Neurosciences & Neurology; Orthopedics GA 936YC UT WOS:000229890500015 PM 15959375 ER PT J AU Calonge, N AF Calonge, N CA US Prevent Serv Task Force TI Screening for abdominal aortic aneurysm: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID RANDOMIZED CONTROLLED-TRIAL; ENDOVASCULAR REPAIR; UNITED-STATES; RISK-FACTORS; SINGLE SCAN; AGE 65; POPULATION; MORTALITY; EPIDEMIOLOGY; SURVEILLANCE C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 34 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JUN 1 PY 2005 VL 71 IS 11 BP 2144 EP 2148 PG 5 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 931XD UT WOS:000229517900014 ER PT J AU Guirguis-Blake, J Wolff, TA AF Guirguis-Blake, J Wolff, TA TI Screening for abdominal aortic aneurism SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. Johns Hopkins Univ, Baltimore, MD 21218 USA. RP Guirguis-Blake, J (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. NR 4 TC 3 Z9 3 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JUN 1 PY 2005 VL 71 IS 11 BP 2154 EP 2155 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 931XD UT WOS:000229517900016 PM 15952445 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI Commentary - Assessing the impact of managed care patient protection laws: Problems and pitfalls SO HEALTH SERVICES RESEARCH LA English DT Editorial Material ID HEALTH-INSURANCE C1 AHRQ, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Hellinger, FJ (reprint author), AHRQ, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. NR 18 TC 5 Z9 5 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 2005 VL 40 IS 3 BP 669 EP 674 DI 10.1111/j.1475-6773.2005.00379.x PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 928NX UT WOS:000229279700004 PM 15960685 ER PT J AU McKibben, L Horan, TC Tokars, JI Fowler, G Cardo, DM Pearson, ML Brennan, PJ AF McKibben, L Horan, TC Tokars, JI Fowler, G Cardo, DM Pearson, ML Brennan, PJ CA Healthcare Infection Control TI Guidance on public reporting of healthcare-associated infections: Recommendations of the healthcare infection control practices advisory committee SO INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY LA English DT Article ID BLOOD-STREAM INFECTIONS; NOSOCOMIAL INFECTIONS; SURVEILLANCE SYSTEM; UNITED-STATES; PREVENTION; RATES C1 Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Infect Dis, Atlanta, GA 30330 USA. Ctr Dis Control & Prevent, Healthcare Otucomes Branch, Natl Ctr Infect Dis, Div Healthcare Qual Promot, Atlanta, GA 30330 USA. Ctr Dis Control & Prevent, Prevent & Evaluat Branch, Natl Ctr Infect Dis, Div Healthcare Qual Promot, Atlanta, GA 30330 USA. Univ Penn, Sch Med, Div Infect Dis, Philadelphia, PA 19104 USA. Vanderbilt Univ, Med Ctr, Nashville, TN USA. Sharp Mem Hosp & Rehabil Ctr, San Diego, CA USA. Univ Washington, Sch Med, Seattle, WA 98195 USA. Amer Hosp Assoc, Washington, DC USA. Cleveland Clin Fdn, Cleveland, OH 44195 USA. Duke Univ, Ctr Med, Durham, NC 27706 USA. Univ Minnesota, Minneapolis, MN 55455 USA. Texas Dept Hlth, Austin, TX 78756 USA. Long Beach Mem Med Ctr, Long Beach, CA USA. Wake Forest Univ, Sch Med, Winston Salem, NC 27109 USA. Childrens Natl Med Ctr, Washington, DC 20010 USA. Qualis Hlth Boise, Boise, ID USA. Univ Nebraska, Med Ctr, Omaha, NE 68583 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Assoc PeriOperat Registered Nurses, Denver, CO USA. Assoc Proffes Infect Control & Epidemiol In, Washington, DC USA. Amer Healthcare, Washington, DC USA. Natl Inst Hlth, Bethesda, MD USA. Hlth Serv Resources Adm, Atlanta, GA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Food & Drug Adm, Rockville, MD USA. Amer Coll Occupat & Environm Med, Arlington Hts, IL USA. CDC, Advisory Comm Eliminat TB, Atlanta, GA 30333 USA. Soc Healthcare Epidemiol Amer Inc, Alexandria, VA USA. Joint Comm Accreditat Healthcare Org, Oak Brook, IL USA. RP Pearson, ML (reprint author), Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Infect Dis, Mailstop E-68,1600 Clifton Rd,NE, Atlanta, GA 30330 USA. EM mpearson@cdc.gov NR 42 TC 60 Z9 60 U1 0 U2 1 PU SLACK INC PI THOROFARE PA 6900 GROVE RD, THOROFARE, NJ 08086 USA SN 0899-823X J9 INFECT CONT HOSP EP JI Infect. Control Hosp. Epidemiol. PD JUN PY 2005 VL 26 IS 6 BP 580 EP 587 DI 10.1086/502585 PG 8 WC Public, Environmental & Occupational Health; Infectious Diseases SC Public, Environmental & Occupational Health; Infectious Diseases GA 973QW UT WOS:000232538700015 PM 16018435 ER PT J AU Weinick, RM Byron, SC Bierman, AS AF Weinick, RM Byron, SC Bierman, AS TI Who can't pay for health care? SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article; Proceedings Paper CT AcademyHealth Annual Meeting CY JUN, 2004 CL San Diego, CA DE health care affordability; insurance coverage; low-income populations; functional impairment ID PREVALENCE; RISK AB BACKGROUND: In an era of rising health care costs, many Americans experience difficulty paying for needed health care services. With costs expected to continue rising, changes to private insurance plans and public programs aimed at containing costs may have a negative impact on Americans' ability to afford care. OBJECTIVES: To provide estimates of the number of adults who avoid health care due to cost, and to assess the association of income, functional status, and type of insurance with the extent to which people with health insurance report financial barriers. RESEARCH DESIGN: Cross-sectional observational study using data from the Commonwealth Fund 2001 Health Care Quality Survey, a nationally representative telephone survey. PARTICIPANTS: U. S. adults age 18 and older (N=6,722). MEASURES: Six measures of avoiding health care due to cost, including delaying or not seeking care; not filling prescription medicines; and not following recommended treatment plan. RESULTS: The proportion of Americans with difficulty affording health care varies by income and health insurance coverage. Overall, 16.9% of Americans report at least 1 financial barrier. Among those with private insurance, the poor (28.4%), near poor (24.3%), and those with functional impairments (22.9%) were more likely to report avoiding care due to cost. In multivariate models, the uninsured are more likely (OR, 2.3; 95% CI, 1.7 to 3.0) to have trouble paying for care. Independent of insurance coverage and other demographic characteristics, the poor (OR, 3.6; 95% CI, 2.1 to 4.6), near poor (OR, 2.1; 95% CI, 1.9 to 3.7), and middle-income (OR, 1.8; 95% CI, 1.3 to 2.5) respondents as well as those with functional impairments (OR, 1.6; 95% CI, 1.3 to 2.0) are significantly more likely to avoid care due to cost. CONCLUSIONS: Privately and publicly insured individuals who have low incomes or functional impairments encounter significant financial barriers to care despite having health insurance. Proposals to expand health insurance will need to address these barriers in order to be effective. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Massachusetts Gen Hosp, Boston, MA 02114 USA. Univ Toronto, St Michaels Hosp, Toronto, ON M5B 1W8, Canada. Univ Toronto, Fac Nursing, Toronto, ON M5B 1W8, Canada. Univ Toronto, Fac Med, Toronto, ON M5B 1W8, Canada. RP Byron, SC (reprint author), Agcy Healthcare Res & Qual, 540 Gatther Rd, Rockville, MD 20850 USA. EM sbyron@ahrq.gov NR 29 TC 16 Z9 16 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2005 VL 20 IS 6 BP 504 EP 509 DI 10.1111/j.1525-1497.2005.0087.x PG 6 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 940KG UT WOS:000230142800003 PM 15987324 ER PT J AU Battles, JB AF Battles, JB TI Computerized surveillance of adverse drug events in hospital patients - Commentary SO QUALITY & SAFETY IN HEALTH CARE LA English DT Editorial Material C1 CQuIPS, AHRQ, Rockville, MD 20850 USA. RP Battles, JB (reprint author), CQuIPS, AHRQ, Rockville, MD 20850 USA. EM jbattles@ahrq.gov NR 7 TC 1 Z9 1 U1 0 U2 1 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD JUN PY 2005 VL 14 IS 3 BP 225 EP 226 DI 10.1136/qshc.2005.014522 PG 2 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 932GX UT WOS:000229543300016 ER PT J AU Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP AF Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP CA US Preventive Serv Task Force TI Hormone therapy for the prevention of chronic conditions in postmenopausal women: Recommendations from the US Preventive Services Task Force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID CONJUGATED EQUINE ESTROGENS; RANDOMIZED CONTROLLED-TRIAL; HEALTH INITIATIVE MEMORY; REPLACEMENT THERAPY; BREAST-CANCER; ESTROGEN/PROGESTIN REPLACEMENT; PLUS PROGESTIN; OVARIAN-CANCER; FOLLOW-UP; RISK AB This statement summarizes the U.S. Preventive Services Task Force recommendations on hormone therapy for the prevention of chronic conditions in postmenopausal women and the supporting scientific evidence, and updates the Task Force's 2002 recommendations on hormone replacement therapy. The updated statement is based on the results of the Women's Health Initiative randomized, controlled trial, as well as the information in the 2002 summary of the evidence on this topic, which is available on the USPSTF Web site (www.preventiveservices.ahrq.gov). C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Johnson, MS (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 30 TC 66 Z9 67 U1 1 U2 1 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAY 17 PY 2005 VL 142 IS 10 BP 855 EP 860 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 926CE UT WOS:000229099600007 ER PT J AU Calonge, N AF Calonge, N TI Screening for idiopathic scoliosis in adolescents: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 4 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAY 15 PY 2005 VL 71 IS 10 BP 1975 EP 1976 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 927PO UT WOS:000229206400010 ER PT J AU Cain, C Clancy, C AF Cain, C Clancy, C TI Commentary: Patient-centered health information technology SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material ID QUALITY C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Cain, C (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 6 TC 1 Z9 1 U1 0 U2 1 PU AMER COLLEGE MEDICAL QUALITY PI BETHESDA PA 4334 MONTGOMERY AVE, 2ND FL, BETHESDA, MD 20814-4402 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD MAY-JUN PY 2005 VL 20 IS 3 BP 164 EP 166 DI 10.1177/1062860605275994 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 929FC UT WOS:000229326500009 PM 15951523 ER PT J AU Hughes, RG Edgerton, EA AF Hughes, RG Edgerton, EA TI Reducing pediatric medication errors SO AMERICAN JOURNAL OF NURSING LA English DT Editorial Material ID ADVERSE DRUG EVENTS; PHYSICIAN ORDER ENTRY; INTENSIVE-CARE; PREVENTION; INPATIENTS; EMERGENCY; CHILDREN; ABILITY; IMPACT; UNIT C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. RP Hughes, RG (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. EM rhughes@ahrq.gov NR 60 TC 22 Z9 23 U1 1 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD MAY PY 2005 VL 105 IS 5 BP 79 EP + PG 8 WC Nursing SC Nursing GA 921AB UT WOS:000228735500037 PM 15867545 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Serv Task Force TI Screening for gonorrhea: Recommendation statement SO ANNALS OF FAMILY MEDICINE LA English DT Review DE gonorrhea; mass screening; practice guidelines ID DISEASES C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Colorado Dept Publ Hlth & Environm, Denver, CO USA. Kaiser Permanente So Calif, Reg Adm, Pasadena, CA USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Tricty Family Med, Cohocton, NY USA. Univ Rochester, Rochester, MN USA. Pan Amer Hlth Org, Washington, DC USA. Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA. Cedars Sinai Med Ctr, Dept Obstet & Gynecol, Womens Hlth Serv Res & Maternal Fetal Med, Los Angeles, CA USA. Univ N Carolina, Sch Med, Sheps Ctr Hlth Serv Res, Chapel Hill, NC USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Family Med, Newark, NJ 07103 USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Univ Michigan, Sch Nursing, Off Acad Affairs, Ann Arbor, MI 48109 USA. Univ Texas, Hlth Sci Ctr, Dept Pediat, Houston, TX 77225 USA. Univ Massachusetts, Sch Med, Div Prevent & Behav Med, Worcester, MA USA. Mt Sinai Med Ctr, Brookdale Dept Geratr & Adult Dev, New York, NY USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Olmstead Res Ctr, Rochester, MN USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 13 TC 44 Z9 47 U1 0 U2 0 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD MAY-JUN PY 2005 VL 3 IS 3 BP 263 EP 267 DI 10.1370/afm.337 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 934MR UT WOS:000229713400013 ER PT J AU Basu, J AF Basu, J TI Severity of illness, race, and choice of local versus distant hospitals among the elderly SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Article DE patient flow; travel pattern; racial difference; distant hospitalization; hospital choice; severity of illness; elderly; healthcare cost and utilization project; state inpatient database ID RURAL MEDICARE BENEFICIARIES; OF-AREA TRAVEL; PREVENTABLE HOSPITALIZATIONS; SOCIOECONOMIC-STATUS; CARE; PHYSICIAN; COUNTIES; DISEASE; IMPACT AB This study examines travel patterns for hospitalization among elderly patients to address whether there are differences by age and race/ethnicity, and whether the differences persist even when a severe illness occurs. Using the Healthcare Cost and Utilization Project (HCUP) State Inpatient database (SID) of the Agency for Healthcare Research and Quality, the study focuses on New York residents in the 65-and-over age group who are hospitalized in New York or neighboring states. Two types of hospital admissions are used: referral-sensitive admissions (fairly discretionary, high-technology procedures) and ambulatory care-sensitive admissions (avoidable with appropriate primary care). The study found that, after adjusting for other covariates, travel progressively declines with age among the elderly. Travel patterns across elderly age cohorts were not significantly different when patients were more severely ill. Members of racial/ethnic minority groups were less likely to travel than whites, and this gap persisted even when a severe illness occurred. C1 AHRQ, Rockville, MD 20850 USA. RP Basu, J (reprint author), AHRQ, 540 Gaither Rd,Room 6048, Rockville, MD 20850 USA. EM Jbasu@ahrq.gov RI Dalla Zuanna, Teresa/G-3133-2015 NR 25 TC 21 Z9 21 U1 0 U2 4 PU JOHNS HOPKINS UNIV PRESS PI BALTIMORE PA JOURNALS PUBLISHING DIVISION, 2715 NORTH CHARLES ST, BALTIMORE, MD 21218-4363 USA SN 1049-2089 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PD MAY PY 2005 VL 16 IS 2 BP 391 EP 405 DI 10.1353/hpu.2005.0023 PG 15 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 932RS UT WOS:000229571700023 PM 15937400 ER PT J AU Holman, RC Curns, AT Belay, ED Steiner, CA Effler, PV Yorita, KL Miyamura, J Forbes, S Schonberger, LB Melish, M AF Holman, RC Curns, AT Belay, ED Steiner, CA Effler, PV Yorita, KL Miyamura, J Forbes, S Schonberger, LB Melish, M TI Kawasaki syndrome in Hawaii SO PEDIATRIC INFECTIOUS DISEASE JOURNAL LA English DT Article; Proceedings Paper CT 8th International Kawasaki Disease Symposium CY FEB, 2005 CL San Diego, CA DE Kawasaki syndrome; hospitalizations; epidemiology; children; infants; Hawaii ID LYMPH-NODE SYNDROME; UNITED-STATES; SYNDROME HOSPITALIZATIONS; DISEASE; CHILDREN; JAPAN; RISK AB Objective: To describe the incidence and epidemiology of Kawasaki syndrome (KS) in Hawaii. Methods: Retrospective analysis of the State Inpatient Database for Hawaii residents hospitalized with KS during 1996 through 2001. Results: During 1996 through 2001, 267 persons younger than 18 years of age living in Hawaii were hospitalized with KS; 226 (84.6%) were younger than 5 years of age. The average annual incidence for KS was 45.2 per 100,000 children younger than 5 years of age. The incidence was higher for children younger than 1 year of age than for those 1-4 years of age (74.3 and 37.5 per 100,000). The KS incidence for Asian and Pacific Islander children and for White children was 70.9 and 35.3 per 100,000, respectively. Incidence was highest among Japanese American children living in Hawaii (197.7 per 100,000). Honolulu County had the most KS patients (85.0%) and the highest incidence (53.1 per 100,000) among Hawaii counties. For children younger than 5 years of age hospitalized with KS, the median length of stay was 2 days, and the median hospital charge was $9379. Conclusion: During 1996 through 2001, the annual incidence rate for KS among children younger than 5 years of age in Hawaii was the highest in the United States. The incidence among Japanese American children in Hawaii was higher than that among other racial groups in the state and when compared with children living in Japan. C1 CDCP, US Dept HHS, Off Director, Div Viral & Rickettsial Dis,Natl Ctr Infect Dis, Atlanta, GA USA. US Dept HHS, Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Healthcare Cost & Utilizat Project, Rockville, MD USA. Hawaii Hlth Informat Corp, Hawaii Dept Hlth, Honolulu, HI USA. Kapiolani Med Ctr Women & Children, Honolulu, HI USA. RP Holman, RC (reprint author), CDCP, US Dept HHS, Off Director, Div Viral & Rickettsial Dis,Natl Ctr Infect Dis, Atlanta, GA USA. RI Belay, Ermias/A-8829-2013 NR 36 TC 47 Z9 52 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0891-3668 J9 PEDIATR INFECT DIS J JI Pediatr. Infect. Dis. J. PD MAY PY 2005 VL 24 IS 5 BP 429 EP 433 DI 10.1097/01.inf.0000160946.05295.91 PG 5 WC Immunology; Infectious Diseases; Pediatrics SC Immunology; Infectious Diseases; Pediatrics GA 927UQ UT WOS:000229226400006 PM 15876942 ER PT J AU Siegel, JE Byron, SC Lawrence, WF AF Siegel, JE Byron, SC Lawrence, WF TI Federal sponsorship of cost-effectiveness and related research in health care: 1997-2001 SO VALUE IN HEALTH LA English DT Article DE cost-effectiveness; federal funding; federal health agencies; health economics; research priorities ID UNITED-STATES; TRANSMISSION; HIV-1; DEATH AB Objectives: To describe recent federal sponsorship of cost-effectiveness and related health economics research to provide insight into the functioning of existing research support systems and assess the roles of federal health agencies. Methods: Using the PubMed database, we identified cost-effectiveness and related publications citing support from a US government entity and published during the period of 1997 through 2001, and audited them for information on funding sources, study type, and content focus. Results: Five Department of Health and Human Services agencies and centers and the Veterans Administration are cited as funders in 74% of 520 federally supported health economics publications we identified. Three-fourths of federally supported publications address five areas of high disease burden: infections, cancer, HIV/AIDS, cardiovascular disease, and substance abuse. Other high burden diseases, including mental health, diabetes, and injuries, receive less attention. Federal support of health economics studies of health education and care delivery-intervention types underexamined in the field-is relatively strong but most often focuses on substance abuse or mental health services. Each of the top federal funders has a distinct funding pattern, but there are substantial areas of overlap within which we could not identify content domains specific to one funder or another. Conclusions: Federal support of health economics research has paralleled growth in the field. Federal funders support projects consistent with their mission and focus on high-burden disease areas. However, overlapping funding areas, ambiguity concerning agency interests within overlapping content areas, and gaps in some disease and intervention areas suggest that the coordination of health economics research funding could be improved. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Res Initiat Clin Econ, Rockville, MD 20850 USA. RP Siegel, JE (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Res Initiat Clin Econ, 540 Gaither Rd, Rockville, MD 20850 USA. EM jsiegel@AHRQ.gov NR 26 TC 6 Z9 6 U1 0 U2 5 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2005 VL 8 IS 3 BP 223 EP 236 DI 10.1111/j.1524-4733.2005.04037.x PG 14 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 918PE UT WOS:000228559300006 PM 15877594 ER PT J AU Beaton, SJ Gunter, MJ Paez, KA Chilton, L Dougherty, D AF Beaton, SJ Gunter, MJ Paez, KA Chilton, L Dougherty, D TI Evaluation of an otitis media education intervention in an integrated delivery system SO VALUE IN HEALTH LA English DT Meeting Abstract C1 Lovelace Clin Fdn, Albuquerque, NM USA. Lovelace Sandia Hlth Syst, Albuquerque, NM USA. AHRQ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2005 VL 8 IS 3 BP 366 EP 367 PG 2 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 918PE UT WOS:000228559300417 ER PT J AU Gunter, MJ Beaton, SJ Paez, KA Chilton, L Dougherty, D AF Gunter, MJ Beaton, SJ Paez, KA Chilton, L Dougherty, D TI Process evaluation of the implementation of otitis media guidelines in an integrated delivery system SO VALUE IN HEALTH LA English DT Meeting Abstract C1 Lovelace Clin Fdn, Albuquerque, NM USA. Lovelace Sandia Hlth Syst, Albuquerque, NM USA. AHRQ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2005 VL 8 IS 3 BP 367 EP 367 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 918PE UT WOS:000228559300418 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Services Task Force TI Screening for asymptomatic bacteriuria: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 4 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD APR 15 PY 2005 VL 71 IS 8 BP 1575 EP 1576 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 918WV UT WOS:000228579300011 ER PT J AU Zhang, XP Norris, SL Gregg, EW Cheng, YLJ Beckles, G Kahn, HS AF Zhang, XP Norris, SL Gregg, EW Cheng, YLJ Beckles, G Kahn, HS TI Depressive symptoms and mortality among persons with and without diabetes SO AMERICAN JOURNAL OF EPIDEMIOLOGY LA English DT Article DE depression; diabetes mellitus; mortality ID PITUITARY-ADRENAL AXIS; MYOCARDIAL-INFARCTION; GLYCEMIC CONTROL; FOLLOW-UP; AFFECTIVE-DISORDER; MAJOR DEPRESSION; INCREASED RISK; UNITED-STATES; OLDER-ADULTS; HEALTH AB Although people with diabetes mellitus have a high risk of depression and depression may increase mortality among people with other conditions, the impact of depression on mortality risk among people with diabetes needs further examination. Using survival analysis, the authors analyzed longitudinal data from the NHANES I Epidemiologic Follow-up Study (1982-1992). The findings showed that the presence of severe depressive symptoms significantly elevated mortality risk among US adults with diabetes; the same pattern was not observed among people without diabetes. After results were controlled for sociodemographic, lifestyle, and health-status variables, diabetic persons with Centers for Epidemiologic Studies Depression (CES-D) Scale scores of 16 or more had 54% greater mortality than those with scores under 16 (p = 0.004). After exclusion of participants who died during the first year of follow-up, mortality remained higher among those with CES-D scores greater than or equal to 22 as compared with those with CES-D scores less than 16, but not among those with CES-D scores between 16 and 21. No significant relation between depression and mortality was found in the nondiabetic population. This analysis indicates that diabetes modifies the effect of depression on mortality. It also demonstrates the importance of observing subgroups, rather than aggregated populations, when examining the effect of depression on mortality. C1 Ctr Dis Control & Prevent, Div Diabet Translat, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA 30341 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness, Rockville, MD USA. RP Zhang, XP (reprint author), Ctr Dis Control & Prevent, Div Diabet Translat, Natl Ctr Chron Dis Prevent & Hlth Promot, 4770 Buford Highway NE,Mail Stop K-10, Atlanta, GA 30341 USA. EM xbz2@cdc.gov OI Kahn, Henry/0000-0003-2533-1562 NR 72 TC 170 Z9 179 U1 2 U2 11 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0002-9262 J9 AM J EPIDEMIOL JI Am. J. Epidemiol. PD APR 1 PY 2005 VL 161 IS 7 BP 652 EP 660 DI 10.1093/aje/kwi089 PG 9 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 910TH UT WOS:000227954600006 PM 15781954 ER PT J AU Mabry, IR Clark, SJ Kemper, A Fraser, K Kileny, S Cabana, MD AF Mabry, IR Clark, SJ Kemper, A Fraser, K Kileny, S Cabana, MD TI Variation in establishing a diagnosis of obesity in children SO CLINICAL PEDIATRICS LA English DT Article ID PEDIATRIC NURSE PRACTITIONERS; ADOLESCENT OBESITY; REGISTERED DIETITIANS; MANAGEMENT; CARE; PHYSICIANS; OVERWEIGHT; GENDER AB Consensus guidelines provide recommendations for the diagnosis and management of obesity. We conducted a medical record review of children initially diagnosed with obesity at a general pediatrics visit. The diagnosis was made most often at health maintenance visits (46%). Body mass index was documented in 5% of initial visits; 74% had documentation of obesity-related history; 64% had documentation of counseling. In multivariate analysis, male patients were more likely to have diet history documentation; female patients were more likely to have weight loss program referrals. Future research should assess pediatricians' perceptions about obesity to better understand clinical practice patterns. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Michigan Hlth Syst, Child Hlth Evaluat & Res CHEAR Unit, Div Gen Pediat, Ann Arbor, MI USA. Loma Linda Univ, Childrens Hosp, Dept Pediat, Loma Linda, CA 92350 USA. RP Mabry, IR (reprint author), Agcy Healthcare Res & Qual, 540 Galther Rd,Suite 6105, Rockville, MD 20850 USA. NR 13 TC 21 Z9 22 U1 0 U2 2 PU WESTMINSTER PUBL INC PI GLEN HEAD PA 708 GLEN COVE AVE, GLEN HEAD, NY 11545 USA SN 0009-9228 J9 CLIN PEDIATR JI Clin. Pediatr. PD APR PY 2005 VL 44 IS 3 BP 221 EP 227 DI 10.1177/000992280504400305 PG 7 WC Pediatrics SC Pediatrics GA 919CH UT WOS:000228595400005 PM 15821846 ER PT J AU Phillips, CD Holan, S Sherman, M Spector, W Hawes, C AF Phillips, CD Holan, S Sherman, M Spector, W Hawes, C TI Medicare expenditures for residents in assisted living: Data from a national study SO HEALTH SERVICES RESEARCH LA English DT Article DE long-term care; assisted living; medicare utilization; medicare expenditures ID CARE; BENEFICIARIES AB To provide preliminary data on Medicare expenditures for assisted living facility (ALF) residents and to investigate whether ALF characteristics were related to Medicare expenditures for ALF residents. Data from the National Study of Assisted Living for the Frail Elderly conducted in 1998-1999. This analysis was restricted to the 40 percent of ALFs in that sample that adhered to the assisted living (AL) philosophy by offering more than minimal levels of services and privacy. This study involved the approximately 1,200 residents who remained in an ALF from baseline to follow-up data collection. Six months of postbaseline Medicare claims were acquired for 545 of these residents, who did not differ significantly from the larger sample. Baseline individual and facility data were collected in personal interviews with residents and a combination of personal and telephone interviews with facility staff. Medicare claims data were acquired from the Centers for Medicare and Medicaid Services. Cross-sectional analyses using logistic and ordinary least squares regression techniques were used to determine the relationships among individual and facility characteristics and Medicare utilization and expenditures. On an annualized basis, AL residents incurred Medicare costs of approximately $4,800. Just less than 15 percent of AL residents accounted for over 75 percent of total Medicare costs. Both the likelihood of utilizing Medicare-covered services and the intensity of service use were largely unaffected by the characteristics of the ALF in which residents lived. Utilization was largely a function of individual characteristics. The only exception to this general finding was that those individuals who utilized services and resided in smaller ALFs had significantly lower average expenditures than did individuals in larger ALFs. These preliminary data imply that both the level and distribution of Medicare expenditures among ALF residents were similar to those among the general community-dwelling Medicare beneficiary population. No significant relationships were observed between ALF characteristics and Medicare expenditures, except the effect of facility size. This result may imply that how the AL industry eventually defines itself in terms of services and amenities, other than size, may have little impact on Medicare expenditures for ALF residents. However, this is a single, initial study, so caution must be exercised when considering the implications of these results. C1 Texas A&M Univ, Hlth Sci Ctr, Sch Rural Publ Hlth, Bryan, TX 77803 USA. Univ Missouri, Dept Stat, Columbia, MO 65211 USA. Agcy Healthcare Res & Qual, Ctr Delivery Organ & Markets, Rockville, MD USA. RP Phillips, CD (reprint author), Texas A&M Univ, Hlth Sci Ctr, Sch Rural Publ Hlth, 3000 Briarcrest Dr,Suite 310, Bryan, TX 77803 USA. FU AHRQ HHS [HHS-100-98-0013, HHS-100-94-0024, R01 HS010606, R01-HS-10606] NR 25 TC 6 Z9 6 U1 1 U2 2 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2005 VL 40 IS 2 BP 373 EP 388 DI 10.1111/j.1475-6773.2005.0s363.x PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 015ZK UT WOS:000235590000006 PM 15762897 ER PT J AU Johansson, P Buchwald, D Jacobsen, C AF Johansson, P Buchwald, D Jacobsen, C TI Perceived discrimination in healthcare; the California health interview survey SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 28th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 11-14, 2005 CL New Orleans, LA SP Soc General Internal Med C1 Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Washington, Seattle, WA 98195 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2005 VL 20 SU 1 BP 122 EP 122 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 922IQ UT WOS:000228831000337 ER PT J AU Meikle, SF Owens, PL Remus, D Elixhauser, A AF Meikle, SF Owens, PL Remus, D Elixhauser, A TI Neonatal birth trauma: Does type of delivery matter? SO OBSTETRICS AND GYNECOLOGY LA English DT Meeting Abstract CT 53rd Annual Clinical Meeting of the American-College-of-Obstetricians-and-Gynecologists CY MAY 07-11, 2005 CL San Francisco, CA SP Amer Coll Obstetricans & Gynecol, Organon Pharmaceut US Inc, Novo Nordisk Pharmaceut C1 Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0029-7844 J9 OBSTET GYNECOL JI Obstet. Gynecol. PD APR PY 2005 VL 105 IS 4 SU S BP 1S EP 2S PG 2 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 912GP UT WOS:000228065900005 ER PT J AU Meikle, SF Steiner, CA Zhang, J Lawrence, WL AF Meikle, SF Steiner, CA Zhang, J Lawrence, WL TI A national estimate of the elective primary cesarean delivery rate SO OBSTETRICS AND GYNECOLOGY LA English DT Article ID IDENTIFY INDICATIONS AB OBJECTIVE: We describe national trends for elective primary cesarean delivery from 1994 to 2001, with attention to changes in indications. METHODS: We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Cesarean deliveries were identified by International Classification of Diseases, 9th Revision, Clinical Modification procedure and diagnostic codes; V codes identified all types of deliveries for denominators. Twelve indications for elective primary cesarean delivery were targeted. International Classification of Diseases, 9th Revision, Clinical Modification coding changes were also evaluated. RESULTS: After excluding women who had labored and previous cesarean deliveries, elective primary cesarean deliveries rose from 19.7% of all cesarean deliveries in 1994 to 28.3% in 2001, an increase of approximately 43.6%. The use of the identified indications for elective primary cesarean delivery increased for codes representing malpresentation, antepartum bleeding, hypertension and severe hypertension, macrosomia, unengaged head, preterm gestation, and maternal soft tissue disorders. Coding for herpes, multiple gestation, other uterine scar, and congenital central nervous system remained the same. Additionally, a new 1998 code for fetal heart rate abnormalities was rapidly adopted during the study period. CONCLUSION: A national estimate of the elective primary cesarean delivery rate shows a rising trend. Additionally, coded indications for these procedures are shifting. Further examination into the use and clinical implications of indications through national surveillance for elective primary cesarean delivery is important for future obstetric practice. A revision of the terminology classification used to identify indications for cesarean delivery procedures would aid in this effort. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NICHHD, NIH, Rockville, MD USA. RP Meikle, SF (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM smeikle@ahrq.gov NR 15 TC 65 Z9 66 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0029-7844 J9 OBSTET GYNECOL JI Obstet. Gynecol. PD APR PY 2005 VL 105 IS 4 BP 751 EP 756 DI 10.1097/01.AOG.0000157435.67138.78 PG 6 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 910WK UT WOS:000227962700011 PM 15802401 ER PT J AU Atkins, D Briss, PA Eccles, M Flottorp, S Guyatt, GH Harbour, RT Hill, S Jaeschke, R Liberati, A Magrini, N Mason, J O'Connell, D Oxman, AD Phillips, B Schunemann, H Edejer, TTT Vist, GE Williams, JW AF Atkins, D Briss, PA Eccles, M Flottorp, S Guyatt, GH Harbour, RT Hill, S Jaeschke, R Liberati, A Magrini, N Mason, J O'Connell, D Oxman, AD Phillips, B Schunemann, H Edejer, TTT Vist, GE Williams, JW CA GRADE Working Grp TI Systems for grading the quality of evidence and the strength of recommendations II: Pilot study of a new system SO BMC HEALTH SERVICES RESEARCH LA English DT Article ID METAANALYSIS; INTERVENTIONS; REVIEWS AB Background: Systems that are used by different organisations to grade the quality of evidence and the strength of recommendations vary. They have different strengths and weaknesses. The GRADE Working Group has developed an approach that addresses key shortcomings in these systems. The aim of this study was to pilot test and further develop the GRADE approach to grading evidence and recommendations. Methods: A GRADE evidence profile consists of two tables: a quality assessment and a summary of findings. Twelve evidence profiles were used in this pilot study. Each evidence profile was made based on information available in a systematic review. Seventeen people were given instructions and independently graded the level of evidence and strength of recommendation for each of the 12 evidence profiles. For each example judgements were collected, summarised and discussed in the group with the aim of improving the proposed grading system. Kappas were calculated as a measure of chance-corrected agreement for the quality of evidence for each outcome for each of the twelve evidence profiles. The seventeen judges were also asked about the ease of understanding and the sensibility of the approach. All of the judgements were recorded and disagreements discussed. Results: There was a varied amount of agreement on the quality of evidence for the outcomes relating to each of the twelve questions (kappa coefficients for agreement beyond chance ranged from 0 to 0.82). However, there was fair agreement about the relative importance of each outcome. There was poor agreement about the balance of benefits and harms and recommendations. Most of the disagreements were easily resolved through discussion. In general we found the GRADE approach to be clear, understandable and sensible. Some modifications were made in the approach and it was agreed that more information was needed in the evidence profiles. Conclusion: Judgements about evidence and recommendations are complex. Some subjectivity, especially regarding recommendations, is unavoidable. We believe our system for guiding these complex judgements appropriately balances the need for simplicity with the need for full and transparent consideration of all important issues. C1 Norwegian Hlth Serv Res Ctr, Informed Choice Res Dept, N-0130 Oslo, Norway. Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. Ctr Dis Control & Prevent, Community Guide Branch, Atlanta, GA 30341 USA. Newcastle Univ, Ctr Hlth Serv Res, Newcastle Upon Tyne NE2 4AA, Tyne & Wear, England. McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada. McMaster Univ, Dept Med, Hamilton, ON L8N 3Z5, Canada. Scottish Intercollegiate Guidelines Network, Edinburgh EH2 1JQ, Midlothian, Scotland. Univ Newcastle, Newcastle Mater Hosp, Fac Med & Hlth Sci, Dept Clin Pharmacol, Waratah, NSW 2298, Australia. McMaster Univ, Dept Med, Hamilton, ON L8N 3Z5, Canada. Univ Modena & Reggio Emilia, Azienda Osped Policlin, Dept Hematol & Oncol, I-41100 Modena, Italy. NHS Ctr Evaluat Effectiveness Hlth Care, CeVEAS, I-41100 Modena, Italy. NSW Canc Council, Canc Res & Registers Div, Canc Epidemiol Res Unit, Kings Cross, NSW 1340, Australia. Univ Oxford, Warneford Hosp, Dept Psychiat, Ctr Evidence Based Med, Oxford OX3 7JX, England. SUNY Buffalo, Dept Med, Buffalo, NY 14215 USA. SUNY Buffalo, Dept Social & Prevent Med, Buffalo, NY 14215 USA. WHO, Global Programme Evidence Hlth Policy, CH-1211 Geneva, Switzerland. Dept Vet Affairs Med Ctr, Ctr Hlth Serv Res Primary Care, HSR&D, Durham, NC 27705 USA. Duke Univ, Med Ctr, Durham, NC 27705 USA. RP Vist, GE (reprint author), Norwegian Hlth Serv Res Ctr, Informed Choice Res Dept, Pb 7004 St Olavs Plass, N-0130 Oslo, Norway. EM DAtkins@AHRQ.GOV; pxb5@cdc.gov; Martin.Eccles@newcastle.ac.uk; signe.flottorp@nhsrc.no; guyatt@mcmaster.ca; r.harbour@sign.ac.uk; hillsu@mail.newcastle.edu.au; jaeschke@mcmaster.ca; alesslib@tin.it; n.magrini@ausl.mo.it; jmason123@orange.net; dianneo@nswcc.org.au; oxman@online.no; bob.phillips@doctors.org.uk; hjs@buffalo.edu; tantorrest@who.ch; gev@nhsrc.no; jw.williams@duke.edu RI Mason, James/D-9904-2011 OI Mason, James/0000-0001-9210-4082 NR 17 TC 142 Z9 154 U1 1 U2 8 PU BIOMED CENTRAL LTD PI LONDON PA 236 GRAYS INN RD, FLOOR 6, LONDON WC1X 8HL, ENGLAND SN 1472-6963 J9 BMC HEALTH SERV RES JI BMC Health Serv. Res. PD MAR 23 PY 2005 VL 5 AR 25 DI 10.1186/1472-6963-5-25 PG 12 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 918IL UT WOS:000228535400001 PM 15788089 ER PT J CA US Preventive Services Task Force TI Lung cancer screening: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID SPIRAL COMPUTED-TOMOGRAPHY; BASE-LINE; FOLLOW-UP; JAPAN; PREFECTURE; PROGRAM; MORTALITY; PROJECT; SCANNER; DESIGN C1 USPSTF, US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 25 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAR 15 PY 2005 VL 71 IS 6 BP 1165 EP 1168 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 908FO UT WOS:000227773000009 ER PT J AU Clancy, CM AF Clancy, CM TI Untitled - Commentary SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 3 TC 0 Z9 0 U1 0 U2 0 PU AMER COLLEGE MEDICAL QUALITY PI BETHESDA PA 4334 MONTGOMERY AVE, 2ND FL, BETHESDA, MD 20814-4402 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD MAR-APR PY 2005 VL 20 IS 2 BP 104 EP 106 DI 10.1177/1062860605274800 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 908TK UT WOS:000227812900008 PM 15851389 ER PT J AU Chen, FM Fryer, GE Wilson, E Pathman, DE AF Chen, FM Fryer, GE Wilson, E Pathman, DE TI Patients' beliefs about racism, preferences for physician race, and satisfaction with care SO ANNALS OF FAMILY MEDICINE LA English DT Article ID HEALTH-CARE; DISPARITIES; RACE/ETHNICITY; PERCEPTIONS; SERVICES; QUALITY; RECEIPT; DISEASE; GENDER AB PURPOSE Few studies have attempted to link patients' beliefs about racism in the health care system with how they use and experience health care. METHODS Using telephone survey data from a national sample of 1,479 whites, 1,189 African Americans, and 983 Latinos, we explored patients' beliefs about racism, their preferences for the race and ethnicity of their physician, and their satisfaction with that physician. A scale was developed to reflect patients' beliefs about racism. Race-stratified analyses assessed associations between patients' beliefs, racial preferences for physicians, choice of physician, and satisfaction with care. RESULTS Among African Americans, stronger beliefs about racial discrimination in health care were associated with preferring an African American physician (P <.001). Whereas only 22% of African Americans preferred an African American physician,those who preferred a African American physician and had an African American physician were more likely to rate their physician as excellent than did African Americans who preferred a African American physician but had a non-African American physician (57% vs 20%, P <.001). Latinos with stronger beliefs about discrimination in health care were more likely to prefer a Latino physician (P <.001). One third of Latinos preferred a Latino physician. Though not statistically significant, those who preferred and had a Latino physician rated their physician higher than Latinos who preferred a Latino physician but had a non-Latino physician (40% vs 29%). CONCLUSIONS Many African Americans and Latinos perceive racism in the health care system, and those who do are more likely to prefer a physician of their own race or ethnicity. African Americans who have preferences are more often satisfied with their care when their own physicians match their preferences. C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, Rockville, MD USA. Robert Graham Ctr Policy Studies Family Practice, Washington, DC USA. Univ Calif San Francisco, Dept Family & Community Med, San Francisco, CA 94143 USA. Univ N Carolina, Dept Family Med, Chapel Hill, NC 27514 USA. Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC USA. RP Chen, FM (reprint author), Univ Washington, Dept Family Med, Box 354982, Seattle, WA 98195 USA. EM fchen@u.washington.edu NR 24 TC 67 Z9 67 U1 0 U2 3 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD MAR-APR PY 2005 VL 3 IS 2 BP 138 EP 143 DI 10.1370/afm.282 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 912OX UT WOS:000228090000009 PM 15798040 ER PT J AU Calonge, N Allan, JD Berg, AO Frame, PS Garcia, J Gordis, L Gregory, KD Harris, R Johnson, MS Klein, JD Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP AF Calonge, N Allan, JD Berg, AO Frame, PS Garcia, J Gordis, L Gregory, KD Harris, R Johnson, MS Klein, JD Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP CA US Preventive Services Task Force TI Screening for glaucoma: Recommendation statement SO ANNALS OF FAMILY MEDICINE LA English DT Review C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 3 TC 11 Z9 11 U1 0 U2 0 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD MAR-APR PY 2005 VL 3 IS 2 BP 171 EP 172 DI 10.1370/afm.294 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 912OX UT WOS:000228090000014 ER PT J AU McClellan, MB Loeb, JM Clancy, CM Francis, GS Jacobs, AK Kizer, KW O'Kane, ME Wolk, MJ AF McClellan, MB Loeb, JM Clancy, CM Francis, GS Jacobs, AK Kizer, KW O'Kane, ME Wolk, MJ TI Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in chronic heart failure SO ANNALS OF INTERNAL MEDICINE LA English DT Letter ID MYOCARDIAL-INFARCTION C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Joint Commiss Accreditat Healthcare Org, Oak Brook Terrace, IL 60181 USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Heart Failure Soc Amer, St Paul, MN 55114 USA. Amer Heart Assoc, Dallas, TX 75231 USA. Natl Qual Forum, Washington, DC 20005 USA. Natl Comm Qual Assurance, Washington, DC 20036 USA. Amer Coll Cardiol, Bethesda, MD 20814 USA. RP McClellan, MB (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 7 TC 5 Z9 5 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAR 1 PY 2005 VL 142 IS 5 BP 386 EP 387 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 902BB UT WOS:000227325100012 PM 15738459 ER PT J AU Moy, E Dayton, E Clancy, CM AF Moy, E Dayton, E Clancy, CM TI Compiling the evidence: The National Healthcare Disparities Reports - These important reports contribute to the infrastructure needed to track progress toward eliminating disparities. SO HEALTH AFFAIRS LA English DT Article ID QUALITY AB Disparities in health care have been described extensively in the literature. The next step in resolving this national problem is to develop the necessary infrastructure for monitoring and tracking disparities. The congressionally mandated National Healthcare Disparities Report begins to build this infrastructure. The 2003 report addressed many of the methodological challenges inherent in measuring disparities. The recently released 2004 report continues the process by summarizing the status of U.S. health care disparities and beginning to track changes over time. Both reports emphasize the need to integrate activities to reduce disparities and to improve the quality of health care. C1 AHRQ, Ctr Qual Improvement & Patient Safety, Natl Healthcare Disparities Report Project, Rockville, MD USA. RP Moy, E (reprint author), AHRQ, Ctr Qual Improvement & Patient Safety, Natl Healthcare Disparities Report Project, Rockville, MD USA. EM emoy@ahrq.gov NR 21 TC 30 Z9 30 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2005 VL 24 IS 2 BP 376 EP 387 DI 10.1377/hlthaff.24.2.376 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 909CE UT WOS:000227835700012 PM 15757921 ER PT J AU Brach, C Fraser, I Paez, K AF Brach, C Fraser, I Paez, K TI Crossing the language Chasm - An in-depth analysis of what language-assistance programs look like in practice. SO HEALTH AFFAIRS LA English DT Article ID HEALTH-CARE; INTERPRETER SERVICES; SPEAKING PATIENTS; PHYSICIANS AB The quality of communication between patients and clinicians can have a major impact on health outcomes, and limited English proficiency can interfere with effective communication. More than ten million U.S. residents speak English poorly or not at all, constituting a language chasm in the health care system. This paper reviews the evidence on the link between linguistic competence and health care quality and the impact of particular language-assistance strategies. Drawing on the experiences of fourteen health plans that have been at the forefront of linguistic competence efforts, we identify lessons for plans, purchasers, policymakers, and researchers on ways to improve the availability and quality of interpreter services. C1 AHRQ, Ctr Delivery Org & Markets, Rockville, MD USA. Lovelace Clin Fdn, Columbia, MD USA. RP Brach, C (reprint author), AHRQ, Ctr Delivery Org & Markets, Rockville, MD USA. EM cbrach@ahrq.gov FU Intramural AHRQ HHS [HS999999] NR 31 TC 59 Z9 60 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2005 VL 24 IS 2 BP 424 EP 434 DI 10.1377/hlthaff.24.2.424 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 909CE UT WOS:000227835700019 PM 15757927 ER PT J AU Selden, TM Hudson, JL AF Selden, TM Hudson, JL TI How much can really be saved by rolling back SCRIP? The net cost of public health insurance for children SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID MEDICAID EXPANSIONS; ADVERSE SELECTION; COVERAGE; CARE; ELIGIBILITY; TRACKING; PROGRAM; MODEL AB A growing body of research demonstrates the many benefits of expanded public coverage for Children. Expansions in Medicaid and the State Children's Health Insurance Program (SCRIP) have helped to increase insurance coverage increase access to care, and reduce the financial burdens facing low-income families. Less attention has been forcused oil the cost of expanding public coverage. We argue that budgetary data may, exaggerate the net costs of these expansions because many of the highest-cost children would have received publicly funded care even if the expansions had riot taken place. Using data from the 2000 Medical Expenditure Panel Surrey, we simulate the net cost of SCIIIP. finding that the true cost of this program-both to states and to the federal government-is substantially less than average spending per enrollee would suggest. Our results strengthen the benefit-cost argument against implementing rollbacks in SCRIP. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM tselden@AHRQ.gov NR 31 TC 8 Z9 8 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SPR PY 2005 VL 42 IS 1 BP 16 EP 28 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 936PO UT WOS:000229868100003 PM 16013584 ER PT J AU Zuvekas, SH Rupp, AE Norquist, GS AF Zuvekas, SH Rupp, AE Norquist, GS TI Spillover effects of benefit expansions and carve-outs on psychotropic medication use and costs SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID MENTAL-HEALTH; MODELS AB This paper extends the previous literature examining the impacts of managed behavioral health care carve-opts and mental health parity mandates on mental health and substance abuse (MH/SA) specialty treatment use and costs by considering the effects on psychotropic prescription medication costs. We use multivariate panel data methods to remove underlying secular growth trends, driven by increased demand for improved MH/SA treatment related to pharmaceutical innovations. We find that psychotropic medication costs continued to increase after the introduction of a substantial benefit expansion and carve-out to a managed behavioral health organization (MBHO), offsetting large declines in inpatient specialty MH/SA costs. However, we find evidence that the MBHO may have restrained growth in prescription medication spending. C1 Agcy Healthcare Res & Qual, Ctr Cost Financing & Access Trends, Rockville, MD 20850 USA. Univ Mississippi, Med Ctr, Dept Psychiat & Human Behav, University, MS 38677 USA. RP Zuvekas, SH (reprint author), Agcy Healthcare Res & Qual, Ctr Cost Financing & Access Trends, Rockville, MD 20850 USA. EM szuvekas@ahrq.gov NR 18 TC 5 Z9 5 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SPR PY 2005 VL 42 IS 1 BP 86 EP 97 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 936PO UT WOS:000229868100008 PM 16013588 ER PT J AU Kirby, JB Kaneda, T AF Kirby, JB Kaneda, T TI If neighborhood socioeconomic disadvantage and access to health care SO JOURNAL OF HEALTH AND SOCIAL BEHAVIOR LA English DT Article; Proceedings Paper CT Annual Meeting of the Population-Association-of-America CY APR 01-03, 2004 CL Boston, MA SP Populat Assoc Amer ID UNITED-STATES; MEDICAL-CARE; BEHAVIORAL-MODEL; CERVICAL-CANCER; MENTAL-HEALTH; CONTEXT; DEPRESSION; MORTALITY; DISORDER; IMPACT AB Most research on access to health care focuses on individual-level determinants such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed care, however, has not received much attention. We address this gap in the literature by examining how neighborhood socioeconomic disadvantage is associated with access to health care. We find that living in disadvantaged neighborhoods reduces the likelihood of having a usual source of care and of obtaining recommended preventive services, while it increases the likelihood of having unmet medical need. These associations are not explained by the supply of health care providers. Furthermore, though controlling for individual-level characteristics reduces the association between neighborhood disadvantage and access to health care, a significant association remains. This suggests that when individuals who are disadvantaged are concentrated into specific areas, disadvantage becomes an "emergent characteristic" of those areas that predicts the ability of residents to obtain health care. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd,5th Floor, Rockville, MD 20850 USA. NR 50 TC 93 Z9 93 U1 4 U2 12 PU AMER SOCIOLOGICAL ASSOC PI WASHINGTON PA 1307 NEW YORK AVE NW #700, WASHINGTON, DC 20005-4712 USA SN 0022-1465 J9 J HEALTH SOC BEHAV JI J. Health Soc. Behav. PD MAR PY 2005 VL 46 IS 1 BP 15 EP 31 PG 17 WC Public, Environmental & Occupational Health; Psychology, Social SC Public, Environmental & Occupational Health; Psychology GA 933CF UT WOS:000229600900004 PM 15869118 ER PT J AU Clancy, CM Slutsky, JR AF Clancy, CM Slutsky, JR TI Advancing excellence in health care: Getting to effectiveness SO JOURNAL OF INVESTIGATIVE MEDICINE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD USA. Ctr Outcomes & Evidence, Rockville, MD USA. RP Clancy, CM (reprint author), Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 1 TC 1 Z9 1 U1 0 U2 0 PU B C DECKER INC PI HAMILTON PA 20 HUGHSON ST SOUTH, PO BOX 620, L C D 1, HAMILTON, ONTARIO L8N 3K7, CANADA SN 1081-5589 J9 J INVEST MED JI J. Invest. Med. PD MAR PY 2005 VL 53 IS 2 BP 65 EP 66 PG 2 WC Medicine, General & Internal; Medicine, Research & Experimental SC General & Internal Medicine; Research & Experimental Medicine GA 909FU UT WOS:000227846600013 PM 15810491 ER PT J AU Blake, I Teach, S Edgerton, E AF Blake, I Teach, S Edgerton, E TI Management of female adolescent sexual assault victims in the pediatric emergency department: Does quality of care vary by provider type? SO JOURNAL OF INVESTIGATIVE MEDICINE LA English DT Meeting Abstract CT Joint Annual Meeting of the Central-Society-for-Clinical-Research/Midwestern American-Federation-for-Medical-Research CY APR, 2005 CL Chicago, IL SP Cent Soc Clin Res, Midwestern Amer Federat Med Res C1 Childrens Natl Med Ctr, Emergency Med & Trauma Ctr, Washington, DC USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU B C DECKER INC PI HAMILTON PA 20 HUGHSON ST SOUTH, PO BOX 620, L C D 1, HAMILTON, ONTARIO L8N 3K7, CANADA SN 1081-5589 J9 J INVEST MED JI J. Invest. Med. PD MAR PY 2005 VL 53 IS 2 BP S389 EP S389 PG 1 WC Medicine, General & Internal; Medicine, Research & Experimental SC General & Internal Medicine; Research & Experimental Medicine GA 909FU UT WOS:000227846600102 ER PT J AU Yabroff, KR Lawrence, WF King, JC Mangan, P Washington, KS Yi, B Kerner, JF Mandelblatt, JS AF Yabroff, KR Lawrence, WF King, JC Mangan, P Washington, KS Yi, B Kerner, JF Mandelblatt, JS TI Geographic disparities in cervical cancer mortality: What are the roles of risk factor prevalence, screening, and use of recommended treatment? SO JOURNAL OF RURAL HEALTH LA English DT Review ID HUMAN-PAPILLOMAVIRUS INFECTION; PREVENTIVE HEALTH-CARE; ABNORMAL PAPANICOLAOU SMEARS; RURAL AMERICAN-INDIANS; CORONARY HEART-DISEASE; UNITED-STATES; FOLLOW-UP; UTERINE CERVIX; NEW-MEXICO; INTRAEPITHELIAL NEOPLASIA AB Context: Despite advances in early detection and prevention of cervical cancer, women living in rural areas, and particularly in Appalachia, the rural South, the Texas/Mexico border, and the central valley of California, have had consistently higher rates of cervical cancer mortality than their counterparts in other areas during the past several decades. Methods: This paper reviews the published literature from 1966 to July 2002 to assess three potential pathways underlying this excess mortality-high human papilloma virus (HPV) prevalence, lack of or infrequent screening and advanced disease at diagnosis, and tinder-use of recommended treatment and shorter survival. Findings: Living in rural areas may impose barriers to cervical cancer control, including lack of transportation and medical care infrastructures. Population characteristics that place women at greater risk for developing and dying from cervical cancer, such as low income, lack of health insurance, and physician availability, are concentrated in rural areas. Published data, however, are insufficient to identify the key reasons for the observed mortality patterns. Conclusions: At this time, given the lack of definitive evidence in the published literature, decisions about priorities in areas with high rates of cervical cancer mortality will depend on knowledge of current levels of screening, incidence, and stage distribution; and service delivery infrastructures, resources, and acceptability of interventions to the target population. C1 NCI, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. Georgetown Univ, Canc Control Program, Vincent T Lombardi Canc Res Ctr, Sch Med, Washington, DC 20007 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. SUNY Stony Brook, Stony Brook, NY 11794 USA. RP Yabroff, KR (reprint author), NCI, Div Canc Control & Populat Sci, Execut Pl N,Room 4005,6130 Execut Blvd,MSC 7344, Bethesda, MD 20892 USA. EM yabroffr@mail.nih.gov OI Yabroff, K. Robin/0000-0003-0644-5572 FU NIA NIH HHS [R01-AG15340] NR 123 TC 79 Z9 79 U1 9 U2 21 PU NATL RURAL HEALTH ASSOC PI KANSAS CITY PA ONE WEST ARMOUR BLVD, STE 301, KANSAS CITY, MO 64111 USA SN 0890-765X J9 J RURAL HEALTH JI J. Rural Health PD SPR PY 2005 VL 21 IS 2 BP 149 EP 157 DI 10.1111/j.1748-0361.2005.tb00075.x PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 966JV UT WOS:000232016900007 PM 15859052 ER PT J AU Doshi, JA Shaffer, T Briesacher, BA AF Doshi, JA Shaffer, T Briesacher, BA TI National estimates of medication use in nursing homes: Findings from the 1997 Medicare Current Beneficiary Survey and the 1996 Medical Expenditure Survey SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE nursing homes; long-term care; medication use; national estimates; elderly AB OBJECTIVES: To provide the first nationwide estimates of medication use in nursing homes (NHs) and to introduce a new data set for examining drug use in long-term care facilities. DESIGN: Cross-sectional comparison. SETTING: NH medication files from two nationally representative data sets, the 1997 Medicare Current Beneficiary Survey (MCBS) and the 1996 Medical Expenditure Panel Survey-Nursing Home Component (MEPS-NHC). PARTICIPANTS: NH residents in the MCBS (n=929, weighted n=2.0 million) and MEPS-NHC (n=5,899, weighted n=3.1 million). MEASUREMENTS: Estimates include characteristics of facilities and residents, average number of drugs used per person per month, and the prevalence and duration of use by select therapeutic drug classes. RESULTS: NH residents received, on average, seven to eight medications each month (7.6 MCBS, 7.2 MEPS-NHC). About one-third of residents had monthly drug regimens of nine or more medications (31.8% MCBS, 32.4% MEPS-NHC). The most commonly used medications in NHs, in descending order, were analgesics and antipyretics, gastrointestinal agents, electrolytic and caloric preparations, central nervous system agents, anti-infective agents, and cardiovascular agents. CONCLUSION: These estimates serve as examples of the first national benchmarks of prescribing patterns in NHs. This study highlights the usefulness of the MCBS as an important new resource for examining medication use in NHs. C1 Univ Penn, Sch Med, Philadelphia, PA 19104 USA. Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Massachusetts, Sch Med, Worcester, MA USA. RP Doshi, JA (reprint author), 1214 Blockley Hall, Philadelphia, PA 19104 USA. EM jdoshi@mail.med.upenn.edu NR 13 TC 60 Z9 63 U1 0 U2 1 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD MAR PY 2005 VL 53 IS 3 BP 438 EP 443 DI 10.1111/j.1532-5415.2005.53161.x PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 900BG UT WOS:000227189800011 PM 15743286 ER PT J AU Rector, TS Spector, WD Shaffer, TJ Finch, MD AF Rector, TS Spector, WD Shaffer, TJ Finch, MD TI Pneumonia in nursing home residents: Factors associated with in-home care of EverCare enrollees SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE long-term care; managed care; nurse practitioners; pneumonia ID ACQUIRED PNEUMONIA; HOSPITALIZATION; FACILITY; RISK; MANAGEMENT; INFECTION; PROJECT; RATES AB OBJECTIVES: To identify determinants of whether nursing home (NH) residents enrolled in EverCare were admitted to in-home intensive service days (ISDs) rather than a hospital when they were thought to have pneumonia. DESIGN: Retrospective cross-sectional. SETTING: EverCare operations in five metropolitan areas. PARTICIPANTS: EverCare enrollees admitted to ISDs or a hospital for suspected pneumonia in 2002. MEASUREMENTS: Member, nurse practitioner, physician, and NH characteristics extracted from EverCare's administrative data and Online Survey Certification and Reporting NH data. RESULTS: Multivariable logistic regression indicated that admission to ISDs (65% of cases) was positively associated with age (odds ratio (OR)=1.04. 95% confidence interval (CI) 1.03-1.04), advance directives not to hospitalize (OR=2.88, 95% CI=1.76-4.72), or perform cardiopulmonary resuscitation, 3.09 (2.44-3.91), and hours worked by the NH's registered nurses (OR=4.34, 95% CI=1.74-10.8). Admission to ISD was less likely on weekends (OR=0.30, 95% CI=0.21-0.43), when residents had renal insufficiency (OR=0.61, 95% CI=0.49-0.76), and when the resident was covered by Medicaid (OR 0.87, 95% CI=0.82-0.93). CONCLUSION: Exploration of ways to extend services to weekends, increased availability of registered nurse staff, attention to advance directives, and a better understanding of the role of Medicaid might increase the likelihood of caring for EverCare enrollees with suspected pneumonia in their NH. C1 Vet Affairs Med Ctr, Ctr Chron Dis Outcomes Res, Minneapolis, MN 55417 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Finch & King Inc, Minneapolis, MN USA. RP Rector, TS (reprint author), Vet Affairs Med Ctr, Ctr Chron Dis Outcomes Res, 152-2E 1 Vet dr, Minneapolis, MN 55417 USA. EM Thomas.Rector@med.va.gov FU PHS HHS [2900-00-0012] NR 25 TC 7 Z9 7 U1 2 U2 2 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD MAR PY 2005 VL 53 IS 3 BP 472 EP 477 DI 10.1111/j.1532-5415.2005.53167.x PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 900BG UT WOS:000227189800017 PM 15743292 ER PT J AU Kelley, E Moy, E Dayton, E AF Kelley, E Moy, E Dayton, E TI Health care quality and disparities - Lessons from First National Reports SO MEDICAL CARE LA English DT Editorial Material C1 US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. EM edayton@ahrq.gov NR 0 TC 9 Z9 9 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 1 EP 2 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300001 ER PT J AU Kelley, E Moy, E Stryer, D Burstin, H Clancy, C AF Kelley, E Moy, E Stryer, D Burstin, H Clancy, C TI The National Healthcare Quality and Disparities Reports - An overview SO MEDICAL CARE LA English DT Article DE health care quality; health care trends; health care safety AB Background: Congress directed the Agency for Healthcare Research and Quality (AHRQ) to lead an effort for the US Department of Health and Human Services (DHHS) to develop 2 annual reports: a National Healthcare Quality Report (NHQR) and a National Healthcare Disparities Report (NHDR). Objectives: This article lays out key concepts, definitions, statistical methods, and findings from these first ever national reports on quality and disparities. We also summarize some possible future directions for the reports. Research Design: The NHQR and NHDR rely on secondary analysis of available data from over 40 established, national databases. The NHQR presents data at the national level, by sociodemographic characteristics, and at the state level. The NHDR presents data broken out by race/ethnicity and by socioeconomic status. Measures: The 2003 NHQR presented data on approximately 140 quality measures and the NHDR presented data on these same measures plus approximately 100 measures of access to care. Results: The reports found that high healthcare quality is not a given and that disparities are pervasive throughout the US healthcare system. In addition, they found the quality and disparities issues are particularly apparent in preventive care, but that greater improvement is possible. Conclusions: As these reports evolve for the 2004 version and beyond, they will be a vital step in the effort to improve healthcare quality for all populations in the United States. C1 US Dept Hlth & Human Serv, Natl Healthcare Qual Report, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Kelley, E (reprint author), US Dept Hlth & Human Serv, Natl Healthcare Qual Report, Agcy Healthcare Res & Qual, 540 Gaither Rd,Suite 300, Rockville, MD 20850 USA. EM ekelley@ahrq.gov NR 12 TC 31 Z9 31 U1 0 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 3 EP 8 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300002 ER PT J AU Moy, E Arispe, IE Holmes, JS Andrews, RM AF Moy, E Arispe, IE Holmes, JS Andrews, RM TI Preparing the National Healthcare Disparities Report - Gaps in data for assessing racial, ethnic, and socioeconomic disparities in health care SO MEDICAL CARE LA English DT Article DE health care disparities; data collection; quality of care; access to care ID CENTERS; ACCESS AB Background: Efforts to quantify, monitor, understand, and reduce disparities in health care are critically dependent on the collection of high-quality data that support such analyses. In producing the first National Healthcare Disparities Report (NHDR), a number of gaps in data were encountered that limited the ability to assess racial, ethnic, and socioeconomic disparities in health care. Objectives: The objectives of this study were to identify and quantify gaps in data related to disparities in health care and discuss efforts to fill these gaps in future NHDRs. Findings: Data on specific racial, ethnic, and socioeconomic groups were often not collected or collected in formats that differed from federal standards. When collected, data were often insufficient to generate reliable estimates for specific racial, ethnic, and socioeconomic groups. These effects were magnified when attempting to assess disparities within many of the agency's priority populations such as women, children, the elderly, low-income populations, and rural residents. Future NHDRs begin to fill some of these gaps in data, but some gaps will likely persist and new gaps will likely arise as the availability of data for specific populations vary from year to year. Conclusions: Gaps in data limit the ability to address racial, ethnic, and socioeconomic disparities in health care. Although many federal efforts are underway to improve data collection, some groups and populations pose unique challenges for data collection that will be difficult to overcome. C1 Ctr Qual Improvement & Patient Safety, US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Ctr Dis Control & Prevent, Natl Ctr Hlth Stat, US Dept Hlth & Human Serv, Hyattsville, MD 20782 USA. RP Moy, E (reprint author), Ctr Qual Improvement & Patient Safety, US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM emoy@ahrq.gov NR 29 TC 14 Z9 14 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 9 EP 16 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300003 ER PT J AU Arispe, IE Holmes, JS Moy, E AF Arispe, IE Holmes, JS Moy, E TI Measurement challenges in developing the National Healthcare Quality Report and the National Healthcare Disparities Report SO MEDICAL CARE LA English DT Article DE NHQR; NHDR; race and ethnicity data; federal data systems; disparities ID RACE; INFORMATION; ETHNICITY; VALIDITY; RATES AB Objectives: The objective of this study was to describe 2 measurement challenges faced in the development of the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR): the use of federal data on race and ethnicity and the selection of measures of socioeconomic status (SES). Methods: Over 30 federal and nonfederal data systems were examined to identify measures of race, ethnicity, and SES and to evaluate the characteristics and relative quality of the data. Results: The availability and quality of data on race, ethnicity, and SES vary by factors such as the type of data (population or establishment based-survey, administrative/claims data, or vital statistics), the source of information (self, proxy, other, or some combination), and the transition to new federal standards. No single measure of SES could be identified, so a mix of measures is presented, including income, education, and expected source of payment (ESOP). Income relative to federal poverty level was used as the preferred SES measure from person-based surveys. Selected analyses linking hospital discharge data to annual median household income from US census data were presented for data derived from administrative data systems. Educational attainment was the variable used for examining SES using data from the Vital Statistics System. Conclusions: The first NHQR and NHDR maximized the presentation of data by accommodating the variation among data systems while at the same time imposing some standardization in the coding and classification of data on race, ethnicity, and SES. C1 Natl Ctr Hlth Stat, Div Hlth Care Stat, Ctr Dis Control & Prevent, US Dept Hlth & Human Serv, Hyattsville, MD 20782 USA. US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Arispe, IE (reprint author), Natl Ctr Hlth Stat, Div Hlth Care Stat, Ctr Dis Control & Prevent, US Dept Hlth & Human Serv, 3311 Toledo Rd,Rm 3315, Hyattsville, MD 20782 USA. EM laa9@cdc.gov NR 21 TC 4 Z9 4 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 17 EP 23 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300004 ER PT J AU Sangl, J Saliba, D Gifford, DR Hittle, DF AF Sangl, J Saliba, D Gifford, DR Hittle, DF TI Challenges in measuring nursing home and home health quality - Lessons from the First National Healthcare Quality Report SO MEDICAL CARE LA English DT Article DE nursing home quality; home health quality; quality measures ID MINIMUM DATA SET; PRESSURE ULCER PREVENTION; INDICATORS; PAIN; MDS AB Background: The availability of patient assessment data collected by all Medicare- and Medicaid-certified nursing homes (NHs) (the Minimum Data Set [MDS]) and home health agencies (HHAs) (the Outcome and Assessment Information Set [OASIS]) provides an opportunity to measure quality of care in these settings. Objective: The objective of this study was to examine methodologic issues encountered as these datasets are used to report the nation's health care in the National Healthcare Quality Report (NHQR) at national and state levels. Findings: Although the reliability of most data elements from MDS and OASIS are considered acceptable in research studies, mixed evidence exists for the reliability and validity of the quality measures themselves. Detection bias can affect the quality measures, particularly for pain and pressure ulcers. Although risk adjustment is used for all measures, effectiveness varies among measures and methods. Additional quality measures such as patient satisfaction, quality of life, and structural measures would be desirable but will require additional data collection efforts. Although the NH measures represent most NH residents, the HHA measures only apply to Medicare and Medicaid patients served by Medicare-certified agencies. Finally, the absence of clinical benchmarks limits the interpretation of the NHQR HHA and NH measures. Conclusions: Further developmental work is needed to address many of these issues to improve the usefulness of these quality measures in future NHQR reports. C1 US Dept Hlth & Human Serv, Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif Los Angeles, Dept Med, VA HSR&D, Santa Monica, CA USA. RAND Corp, Santa Monica, CA USA. Brown Univ, Qual Partners Rhode Isl, Ctr Gerontol & Healthcare Res, Providence, RI 02912 USA. Univ Colorado, Hlth Sci Ctr, Ctr Hlth Serv Res, Div Hlth Care Policy & Res, Aurora, CO USA. RP Sangl, J (reprint author), 540 Gaither Rd, Rockville, MD 20850 USA. EM jsangl@ahrq.gov NR 45 TC 9 Z9 9 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 24 EP 32 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300005 PM 15746587 ER PT J AU Holmes, JS Arispe, IE Moy, E AF Holmes, JS Arispe, IE Moy, E TI Heart disease and prevention - Race and age differences in heart disease prevention, treatment, and mortality SO MEDICAL CARE LA English DT Article DE racial disparities; heart disease; health promotion; screening and prevention; cardiac procedures ID RACIAL-DIFFERENCES; CORONARY REVASCULARIZATION; CARDIAC-CATHETERIZATION; UNITED-STATES; CARE; RECOMMENDATIONS; RACE/ETHNICITY; APPROPRIATE; SERVICES; RECEIPT AB Objective: The objective of this study was to analyze race and age differences in the distribution of health promotion and cardiovascular screening tests, and the prevalence of serious heart disease and cardiovascular mortality in the United States. Data Sources/Study Population: Data are from 7 federal datasets represented in the first National Healthcare Quality Report and the National Healthcare Disparities Report, and include surveys, administrative and vital statistics data systems. The study analyzes blacks and whites. Measures: Counseling on diet and nutrition, exercise, and tobacco during an outpatient visit indicate the availability of health promotion services, and screening for high blood pressure and cholesterol represent preventive services. Hospitalizations for heart-related conditions and use of certain cardiac procedures identify serious heart disease. Deaths from coronary artery disease and stroke are the heart-related mortality measures. Principal Findings: Counseling and education services tend to occur more on outpatient visits by individuals aged 45 to 64 years than in younger age groups. Screening rates among individuals aged 45 to 64 years of approximately 90% for hypertension and 80% for high cholesterol suggest progress in early detection of cardiac risk factors. However, blacks aged 45 to 64 years are 5.6 times more likely than their white counterparts to be hospitalized for hypertension, approximately one third less likely to receive a cardiac procedure, and almost twice as likely to die of coronary heart disease. Conclusions: Although findings indicate few racial differences in health promotion services in ambulatory care or screening for cardiac risk factors, the prevalence of serious cardiovascular disease, use of cardiac procedures, and heart-related mortality suggest continuing racial disparities in heart disease. C1 Natl Ctr Hlth Stat, Div Hlth Care Stat, Ctr Dis Control & Prevent, US Dept Hlth & Human Serv, Hyattsville, MD 20782 USA. US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Holmes, JS (reprint author), Natl Ctr Hlth Stat, Div Hlth Care Stat, Ctr Dis Control & Prevent, US Dept Hlth & Human Serv, 3311 Toledo Rd,Rm 3314, Hyattsville, MD 20782 USA. EM zbv3@cdc.gov NR 29 TC 18 Z9 18 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 33 EP 41 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300006 ER PT J AU Zhan, CL Kelley, E Yang, HP Keyes, M Battles, J Borotkanics, RJ Stryer, D AF Zhan, CL Kelley, E Yang, HP Keyes, M Battles, J Borotkanics, RJ Stryer, D TI Assessing patient safety in the United States - Challenges and opportunities SO MEDICAL CARE LA English DT Article DE National Healthcare Quality Report; patient safety ID ADVERSE EVENTS; MEDICAL INJURIES; ADMINISTRATIVE DATA; HOSPITALIZED-PATIENTS; COMPLICATIONS; ERRORS; SURVEILLANCE; COLORADO; RATES; FOCUS AB Background: In 1999, the US Congress mandated the Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services (DHHS), to report annually to the nation about healthcare quality. One chapter in the National Healthcare Quality Report (NHQR) is focused on patient safety. Objectives: The objectives of this study were to describe the challenges in reporting the national status on patient safety for the first NHQR and discuss emerging opportunities to improve the comprehensiveness and reliability of future reporting. Research Design: This study is a selective review of definitions, frameworks, data sources, measures, and emerging developments for assessing patient safety in the United States. Results: Available data and measures for patient safety assessment in the nation are inadequate, especially for comparing regions and subpopulations and for trend analysis. However, many opportunities are emerging from the recently increased investments in patient safety research and many ongoing safety improvement efforts in the private sector and at the federal, state, and local government levels. Conclusion: There are many challenges in assessing national performance on patient safety today. Ongoing developments on multiple fronts will provide data and measures for more accurate and more comprehensive assessments of patient safety for future NHQRs. C1 Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, US Dept Hlth & Human Serv, Rockville, MD 20850 USA. US Hlth Resources & Serv Adm, Bur Hlth Profess, Rockville, MD 20857 USA. RP Zhan, CL (reprint author), Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, US Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM czhan@ahrq.gov NR 46 TC 11 Z9 11 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 42 EP 47 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300007 ER PT J AU Coffey, RM Andrews, RM Moy, E AF Coffey, RM Andrews, RM Moy, E TI Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators SO MEDICAL CARE LA English DT Article DE racial/ethnic disparities; socioeconomic disparities; patient safety; adverse events ID QUALITY-OF-CARE; ACUTE MYOCARDIAL-INFARCTION; HEART-FAILURE; PERINEAL LACERATIONS; MEDICARE PATIENTS; CARDIAC-SURGEONS; HEALTH-CARE; RACE; THERAPY; SEX AB Background: Patient safety events that result from the happen-stance of mistakes and errors should not occur systematically across racial, ethnic, or socioeconomic subgroups. Objective: To determine whether racial and ethnic differences in patient safety events disappear when income (a proxy for socioeconomic status) is taken into account. Research Design: This study analyzes administrative data from community hospitals in 16 states with reliable race/ethnicity measures in the 2000 Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality (AHRQ), using the publicly available AHRQ patient safety indicators (PSIs). Results: Different indicators show different results for different racial/ethnic subgroups. Many events with higher rates for non-Hispanic blacks (compared with non-Hispanic whites) remain higher when income is taken into account, although such differences for Hispanics or Asian/Pacific Islanders (APIs) tend to disappear. Many events with lower rates for Hispanics and APIs remain lower than whites when income is taken into account, but for blacks, they disappear. Discussion: The higher rates for minorities that reflect the way health care is delivered raise troubling questions about potential racial/ethnic bias and discrimination in the US health care system, problems with cultural sensitivity and effective communication, and access to high-quality health care providers. Conclusions: The AHRQ PSIs are a broad screen for potential safety events that point to needed improvement in the quality of care for specific populations. C1 Medstat Grp Inc, Washington, DC 20008 USA. US Dept Hlth & Human Serv, Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, Rockville, MD USA. US Dept Hlth & Human Serv, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Coffey, RM (reprint author), Medstat Grp Inc, 4301 Conncecticut Ave NW,Suite 330, Washington, DC 20008 USA. EM rosanna.coffey@thomson.com NR 48 TC 30 Z9 30 U1 3 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 48 EP 57 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300008 ER PT J AU Dougherty, D Meikle, SF Owens, P Kelley, E Moy, E AF Dougherty, D Meikle, SF Owens, P Kelley, E Moy, E TI Children's health care in the first National Healthcare Quality Report and National Healthcare Disparities Report SO MEDICAL CARE LA English DT Article ID OF-THE-LITERATURE; ETHNIC DISPARITIES; PATIENT SAFETY; US CHILDREN; ADOLESCENTS; PROGRAM; EVENTS AB Background: The first National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) are landmark events for children's health care quality and are expected to stimulate local measurement, benchmarking, and quality improvement efforts. Method: The authors select findings from the NHQR and NHDR, focusing on topics reflecting a range of health care and health care settings affecting children. They highlight disparities by race/ethnicity, socioeconomic status, and insurance source. They critique the first NHQR and NHDR from a child health perspective. Select NHQR/DR Findings: Quality-of-care issues in the effectiveness domain were identified for black infant mortality, low and very low birth weight rates, antibiotic use for the common cold, and childhood hospitalizations for asthma. Immunization rates have improved. Patient centeredness and timeliness results vary by race, ethnicity and income. The NHDR found that Hispanic and low-income children are most likely to be uninsured for part of the year. Groups of children most likely to have public coverage are American Indian/Alaska native, black, and Hispanic. Critique of Reports: The structure and criteria used for the first reports limit their usefulness from a child health perspective. A basic problem is that the conceptualizations of health and health care that are driving national initiatives on quality are based largely on an adult chronic care model focused on conditions with high expenditures as treated in the mainstream health care delivery system. Conclusion: NHQR and NHDR provide essential information on children's health care quality. Future reports can be improved by including child-relevant perspectives in priority-setting and data-gathering efforts. C1 US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Dougherty, D (reprint author), US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, John M Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20850 USA. EM ddougher@ahrq.gov NR 46 TC 11 Z9 11 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 58 EP 63 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300009 ER PT J AU Sharp, BAC Meikle, SF James, MD Steiner, C Remus, D AF Sharp, BAC Meikle, SF James, MD Steiner, C Remus, D TI NHQR/NHDR measures for women of reproductive age SO MEDICAL CARE LA English DT Article DE women; quality of care; quality measurement; disparities ID UNITED-STATES; PRENATAL-CARE; SURVEILLANCE AB Background: This article addresses measures of importance to women of reproductive age in the first National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR). Methods: The authors review each of the 4 components of quality of care: effectiveness, safety, timeliness, and patient centeredness. The effectiveness component topics with relevance to women of childbearing age include breast cancer, cervical cancer, HIV, AIDS, mental health, and maternity care. The safety component includes 3 relevant measures of obstetric trauma. The quality aspects of timeliness of care and patient centeredness will be discussed in terms of women, although the NHQR and NHDR did not include them as a separate topic because the data were so limited regarding women. Findings: There is a foundation of knowledge about many aspects of quality health care for women of reproductive age. However, gaps are evident in some measures, usually due to insufficient data. Conclusion: Further development of the measure set would benefit from additional process and outcome variables that can link screening, diagnosis, and treatment with health outcomes. Such linkages will expand our knowledge and capability to improve health outcomes for women of reproductive age. C1 US Dept Hlth & Human Serv, Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. US Dept Hlth & Human Serv, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Sharp, BAC (reprint author), US Dept Hlth & Human Serv, Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM BCSHARP@AHRQ.GOV RI Sandall, Jane/D-4146-2009 OI Sandall, Jane/0000-0003-2000-743X NR 43 TC 3 Z9 3 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 64 EP 71 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300010 ER PT J AU Felix-Aaron, K Moy, E Kang, MS Patel, M Chesley, FD Clancy, C AF Felix-Aaron, K Moy, E Kang, MS Patel, M Chesley, FD Clancy, C TI Variation in quality of men's health care by race/ethnicity and social class SO MEDICAL CARE LA English DT Article DE men's health; disparities; quality of care; racial and ethnic minorities; socioeconomic status ID MEDICARE BENEFICIARIES; RACIAL-DIFFERENCES; UNITED-STATES; MANAGED CARE; DISPARITIES; RACE; ACCESS; IMPACT; SEX AB Background: Until recently, minority and poor men have been characterized as "an invisible population," overlooked by public and private efforts to improve the health status of women, children, and the elderly. Objective: This study compares the health care experiences of racial and ethnic minority men with that of white men, and low socioeconomic status with those of higher status. Measures/Subjects: Quality-of-care measures in multiple clinical domains are evaluated. The authors use data from several databases, including the National Health Inter-view Survey, Medical Expenditure Panel Survey, and Health Care Cost and Utilization Project State Inpatient Database. The relative difference between each racial/ethnic and socioeconomic group and a fixed reference group is used to assess differences in use of services. Statistical significance is assessed using z tests. Results: Hispanic men were much less likely to receive colorectal cancer screening (relative risk [RR] range, 0.61-0.69), cardiovascular risk factor screening and management (RR, 0.84-0.88), and vaccinations (RR, 0.47-0.94). Black and Asian men were significantly less likely to have received selected preventive services (adult immunization and colorectal cancer screening). The differences in end-stage renal disease care that black and white men received were statistically significant (RR, 0.39-0.97), with black men consistently receiving worse care. For some measures of management of end-stage renal disease, Asian men received care that was similar to or better than that received by non-Hispanic whites. Conclusion: Minority men are at a markedly elevated risk for the receipt of poor health care quality. However, generalizations about "minority" men are likely to be misleading and incomplete. There is a considerable variation in the magnitude, direction, and significance of these risks. C1 US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. Univ N Carolina, Sch Publ Hlth, Chapel Hill, NC USA. Univ Michigan, Coll Literature Sci & Arts, Ann Arbor, MI 48109 USA. RP Felix-Aaron, K (reprint author), US Hlth Resources & Serv Adm, Bur Primary Hlth Care, 5600 Fishers Lane,Room 17C-26, Rockville, MD 20587 USA. EM kfelix-aaron@hrsa.gov NR 35 TC 15 Z9 15 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 72 EP 81 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300011 ER PT J AU McNeill, D Kelley, E AF McNeill, D Kelley, E TI How the National Healthcare Quality and Disparities Reports can catalyze quality improvement SO MEDICAL CARE LA English DT Article DE quality; implementation; models AB Background: The purpose of the National Reports on Healthcare Quality and Disparities is to enhance awareness of quality and health care disparities, track progress, understand variations, and catalyze improvements in health care. Objectives: The objective of this paper is to propose a model that will facilitate a user's progression from knowledge to action and to show how the reports, its data warehouse, associated products, and Agency for Healthcare Research and Quality resources are integrated and focused on a comprehensive campaign to improve health care quality. Design: The design of the paper is to present a conceptual model and to show how implementation strategies for the reports fit the model. Findings: The authors propose a quality improvement supply chain model to help elucidate the links of the process, corresponding developmental stages that potential users need to master and progress through, and "just-in-time" supply chain inputs at each of the corresponding stages, and populate the model with examples. Conclusion: The traditional ways of disseminating knowledge derived from science through reports and conferences are inadequate to the humbling need for vast improvements in the US health care system. Our model suggests the need for a wide variety of information, packaged in a diverse ways, and delivered just in time and on demand. It encourages the alignment of decision makers and researchers, along with information intermediaries and innovation brokers, to make the information production cycle more efficient and effective. Future iterations of the reports will improve relevance, meaning, and distribution of information to facilitate its uptake by potential users. C1 US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP McNeill, D (reprint author), US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM dmcneill@ahrq.gov NR 14 TC 2 Z9 2 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2005 VL 43 IS 3 SU S BP 82 EP 88 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902DI UT WOS:000227331300012 ER PT J AU Calonge, N AF Calonge, N CA U S Preventive Services Task Force TI Screening for ovarian cancer: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID ASYMPTOMATIC WOMEN; POSTMENOPAUSAL WOMEN; REPLACEMENT THERAPY; TRIAL; RISK; ULTRASONOGRAPHY; PROSTATE; COLOR; LUNG C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 24 TC 19 Z9 20 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD FEB 15 PY 2005 VL 71 IS 4 BP 759 EP 762 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 899OJ UT WOS:000227153700009 ER PT J AU Hellinger, FJ Young, GJ AF Hellinger, FJ Young, GJ TI Health plan liability and ERISA: The expanding scope of state legislation SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID MANAGED CARE LIABILITY; INCOME SECURITY ACT; MEDICAL MALPRACTICE; INSURANCE; SYSTEM; IMPACT AB The federal Employee Retirement Income Security Act of 1974 (ERISA) supersedes state laws as they relate to employer-based health care plans. Thus, cases brought under ERISA are heard in federal courts. We examined the intent, scope, and impact of recent laws passed in 10 states attempting to expand the legal rights of health plan enrollees to sue their plans. In June 2004, the US Supreme Court ruled that state-law causes of action brought under the Texas Health Care Liability Act involving coverage decisions by Aetna Health Inc and CIGNA Health Care of Texas were preempted by ERISA. The full implications of this decision are not evident at present. C1 Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. Boston Univ, Sch Publ Hlth, Program Hlth Policy & Management, Boston, MA 02215 USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Room 5319,540 Gaither Rd, Rockville, MD 20850 USA. EM fhelling@ahrq.gov NR 39 TC 1 Z9 1 U1 0 U2 0 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD FEB PY 2005 VL 95 IS 2 BP 217 EP 223 DI 10.2105/AJPH.2004.037895 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 895HG UT WOS:000226851000013 PM 15671453 ER PT J AU Correa-de-Araujo, R Moy, E AF Correa-de-Araujo, R Moy, E TI Association of commorbidities with acute myocardial infarction does not result in improved quality of care for women SO CIRCULATION LA English DT Meeting Abstract CT 2nd International Conference on Women Heart Disease and Stroke CY FEB 16-19, 2005 CL Orlando, FL C1 Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD FEB 1 PY 2005 VL 111 IS 4 BP E74 EP E75 PG 2 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 893AW UT WOS:000226692600198 ER PT J AU Duffy, FF Narrow, WE Rae, DS West, JC Zarin, DA Rubio-Stipec, M Pincus, HA Regier, DA AF Duffy, FF Narrow, WE Rae, DS West, JC Zarin, DA Rubio-Stipec, M Pincus, HA Regier, DA TI Concomitant pharmacotherapy among youths treated in routine psychiatric practice SO JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY LA English DT Article ID ATTENTION-DEFICIT DISORDER; PSYCHOTROPIC MEDICATIONS; PEDIATRIC PSYCHOPHARMACOLOGY; NATIONAL TRENDS; CHILDREN; DRUGS; PRESCRIPTION; POLYPHARMACY; ADOLESCENTS; CARE AB Objectives: The aim of this study was to assess rates and correlates of concomitant pharmacotherapy in children and adolescents treated by psychiatrists in a broad range of clinical settings. Methods: Cross-sectional data on 392 child and adolescent patients aged 2-17 years from the 1997 and 1999 American Psychiatric Practice Research Network Study of Psychiatric Patients and Treatments were used, and weighted estimates are provided. Results: Findings indicate that 84% of child and adolescent patients received one or more psychopharmacologic medications; 52% of patients treated with medications received concomitant pharmacotherapy (i.e., two or more medications). Patients who were treated with psychopharmacologic treatments received a median of 2 medications (range, 1-6). Highest rates of concomitant pharmacotherapy were among patients with bipolar disorder (87%). Correlates of concomitant pharmacotherapy included: (1) having a diagnosis of bipolar disorder, (2) having co-occurring Axis I or II disorders or general medical conditions, and (3) currently receiving treatment in an inpatient setting. Conclusions: Over 40% of child and adolescent patients of psychiatrists were prescribed two or more psychopharmacologic medications. Patients with chronic and clinically complex conditions were more likely to receive concomitant pharmacotherapy. Most often, efficacy of U.S. Food and Drug Administration (FDA)-approved medications has been examined as monotherapy, and cautions on drug interactions and off-label use derived from multiple sources accompany each product. With high rates of concomitant pharmacotherapy among children and adolescents in psychiatric care, additional research on efficacy and safety of this treatment strategy is necessary. C1 Amer Psychiat Inst Res & Educ, Arlington, VA 22209 USA. Univ Puerto Rico, Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, San Juan, PR 00936 USA. Univ Puerto Rico, Behav Sci Res Inst, San Juan, PR 00936 USA. Univ Pittsburgh, Sch Med, Western Psychiat Inst & Clin, Dept Psychiat, Pittsburgh, PA 15261 USA. Univ Pittsburgh, Hlth Inst, RAND, Pittsburgh, PA 15260 USA. RP Duffy, FF (reprint author), Amer Psychiat Inst Res & Educ, 1000 Wilson Blvd,Suite 1825, Arlington, VA 22209 USA. EM fduffy@psych.org NR 40 TC 42 Z9 42 U1 1 U2 2 PU MARY ANN LIEBERT INC PI LARCHMONT PA 2 MADISON AVENUE, LARCHMONT, NY 10538 USA SN 1044-5463 J9 J CHILD ADOL PSYCHOP JI J. Child Adolesc. Psychopharmacol. PD FEB PY 2005 VL 15 IS 1 BP 12 EP 25 DI 10.1089/cap.2005.15.12 PG 14 WC Pediatrics; Pharmacology & Pharmacy; Psychiatry SC Pediatrics; Pharmacology & Pharmacy; Psychiatry GA 907RW UT WOS:000227736600004 PM 15741782 ER PT J AU dosReis, S Zito, JM Safer, DJ Gardner, JE Puccia, KB Owens, PL AF dosReis, S Zito, JM Safer, DJ Gardner, JE Puccia, KB Owens, PL TI Multiple psychotropic medication use for youths: A two-state comparison SO JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY LA English DT Article ID ATTENTION-DEFICIT/HYPERACTIVITY DISORDER; COMBINED PHARMACOTHERAPY; CHILDREN; PATTERNS; TRENDS; CARE; ADOLESCENTS AB Objective: The aim of this study was to compare multiple psychotropic use among youths enrolled in two U.S. mid-Atlantic state Medicaid and state Children's Health Insurance Programs (SCHIP). Methods: Administrative data were used to examine multiple psychotropic use among youths less than 20 years of age and who were continuously enrolled in Medicaid or SCHIP programs in two states during 1999. Multiple psychotropic use referred to multiclass combinations and was defined by the number of months of multiple use. Main outcome measures were the prevalence of multiple psychotropic use and months of multiple use. Demographic and clinical characteristics, mental health visits, and common combinations were examined according to months of multiple use. Results: Among continuously enrolled youths, 21%-22% had at least one mental health-related visit, 8%-10% received a psychotropic medication, and 2%-3% received multiple psychotropic medications. Nearly one third (28%-30%) of youths with any psychotropic use received multiple medications, of which almost half was for 5-12 months. Multiclass use was more common in male, white, aged 10-14, disabled, and foster-care youths. Stimulants with antidepressants, antipsychotics, or alpha-agonists were the most common combinations. Conclusions: Multiple use occurred in nearly one third of youths with any psychotropic treatment. Additional research is needed to investigate switching patterns and the effectiveness of combined pharmacotherapy. C1 Johns Hopkins Med, Div Child & Adolescent Psychiat, Baltimore, MD 21287 USA. Johns Hopkins Bloomberg Sch Pub Hlth, Baltimore, MD USA. Univ Maryland, Sch Pharm, Baltimore, MD 21201 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP dosReis, S (reprint author), Johns Hopkins Med, Div Child & Adolescent Psychiat, 600 N Wolfe St,CMSC 346, Baltimore, MD 21287 USA. EM sdosrei1@jhmi.edu NR 20 TC 42 Z9 42 U1 1 U2 4 PU MARY ANN LIEBERT INC PI LARCHMONT PA 2 MADISON AVENUE, LARCHMONT, NY 10538 USA SN 1044-5463 J9 J CHILD ADOL PSYCHOP JI J. Child Adolesc. Psychopharmacol. PD FEB PY 2005 VL 15 IS 1 BP 68 EP 77 DI 10.1089/cap.2005.15.68 PG 10 WC Pediatrics; Pharmacology & Pharmacy; Psychiatry SC Pediatrics; Pharmacology & Pharmacy; Psychiatry GA 907RW UT WOS:000227736600010 PM 15741788 ER PT J AU Baine, WB Kazakova, SV AF Baine, WB Kazakova, SV TI An analysis of administrative data found that proximate clinical event ratios provided a systematic approach to identifying possible iatrogenic risk factors or complications SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Article DE coronary disease; depressive disorder; epidemiologic methods; hip fractures; Medicare Part A; osteoarthritis; pneumonia; aspiration; respiratory insufficiency ID SEROTONIN-REUPTAKE INHIBITORS; NURSING-HOME RESIDENTS; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; ARTERY BYPASS-SURGERY; BETA-BLOCKER THERAPY; LONG-TERM-CARE; SWALLOWING REFLEX; TRICYCLIC ANTIDEPRESSANTS; POSTSTROKE DEPRESSION; ELDERLY-PEOPLE AB Objective: A method to generate hypotheses about iatrogenic risk factors and complications from administrative data was developed and tested using hospitalization of the elderly for depression as a model. Study Design and Setting: Hospital claims were selected for 30,998 elderly inpatients admitted for the first time for depression. Common principal diagnoses and procedures in hospitalizations within 90 days of the index depression admission were tallied. For each of these proximate clinical events, the ratio of how many happened before the index admission to how many occurred afterward was calculated. Ratios diverging markedly from unity were identified to generate hypotheses about possible risk factors associated with depression and complications associated with its management. Results: Hospitalization for degenerative joint disease or back problems; abdominal pain or gastritis and duodenitis; coronary artery disease; or cerebrovascular disease was more common before an index depression admission than after it, as were coronary artery surgery, total knee replacement, and cholecystectomy. Admissions for fracture of the femoral neck-an established iatrogenic complication-were disproportionately likely after the index admission. So were admissions for aspiration pneumonia or acute respiratory failure. Conclusion: Proximate clinical event ratios provide a systematic approach to screening administrative data to identify candidates for further evaluation as possible iatrogenic risk factors or complications. (C) 2005 Elsevier Inc. All rights reserved. C1 Agcy Healthcare Res & Qual, Detp Hlth & Human Serv, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD 21205 USA. RP Baine, WB (reprint author), Agcy Healthcare Res & Qual, Detp Hlth & Human Serv, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM wbaine@ahrq.gov NR 73 TC 2 Z9 2 U1 2 U2 2 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0895-4356 J9 J CLIN EPIDEMIOL JI J. Clin. Epidemiol. PD FEB PY 2005 VL 58 IS 2 BP 162 EP 170 DI 10.1016/j.jclinepi.2004.08.002 PG 9 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 898NN UT WOS:000227083600011 PM 15680750 ER PT J AU Goodman, HS Manski, MC Williams, JN Manski, RJ AF Goodman, HS Manski, MC Williams, JN Manski, RJ TI An analysis of preventive dental visits by provider type, 1996 SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article DE preventive dental care; dental care utilization; dental care providers ID UNITED-STATES; ADOLESCENTS; SERVICES; CARE AB Background. Understanding preventive dental visit utilization patterns facilitates planning of the dental health services delivery system. The authors examine these patterns by analyzing the receipt of preventive dental services in the United States by type of dental provider. Methods. The authors analyzed data from the 1996 Medical Expenditure Panel Survey (MEPS) for the U.S. community-based population. They developed national estimates for the population with preventive dental visits by provider type, including the population with a preventive dental visit and mean number of preventive dental visits per person for socioeconomic and demographic categories. Results. Respondents who are white, are older, are female, have dental insurance, are from higher income and education backgrounds, and reside in small metropolitan areas were more likely (P < .05) to receive preventive care from a dental hygienist than from a dentist. Conclusion. MEPS data showed that people's socioeconomic background and other demographic factors were associated with having a preventive dental visit with a dentist or dental hygienist. These factors also influence the per-person number of preventive visits by type of dental practitioner. These elements must be considered when planning for future dental work force needs. Practice Implications. Estimating future dental work force needs through this analysis assists dentists in meeting patient demand and maximizing the productive output of all services rendered in their practices, including preventive services. C1 Univ Maryland, Sch Dent, Dept Hlth Promot & Policy, Baltimore, MD 21201 USA. Univ Louisville, Sch Dent, Louisville, KY 40292 USA. Agcy Hlth Care Policy & Res, Rockville, MD USA. RP Goodman, HS (reprint author), Univ Maryland, Sch Dent, Dept Hlth Promot & Policy, 666 W Baltimore St, Baltimore, MD 21201 USA. EM hsg001@dental.umaryland.edu NR 19 TC 15 Z9 15 U1 0 U2 0 PU AMER DENTAL ASSN PI CHICAGO PA 211 E CHICAGO AVE, CHICAGO, IL 60611 USA SN 0002-8177 J9 J AM DENT ASSOC JI J. Am. Dent. Assoc. PD FEB PY 2005 VL 136 IS 2 BP 221 EP 228 PG 8 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 898TA UT WOS:000227097900022 PM 15782529 ER PT J AU Zhan, CL Correa-de-Araujo, R Bierman, AS Sangl, J Miller, MR Wickizer, SW Stryer, D AF Zhan, CL Correa-de-Araujo, R Bierman, AS Sangl, J Miller, MR Wickizer, SW Stryer, D TI Suboptimal prescribing in elderly outpatients: Potentially harmful drug-drug and drug-disease combinations SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE prescription drugs; drug interactions; medication errors; aged ID NONSTEROIDAL ANTIINFLAMMATORY DRUGS; INAPPROPRIATE MEDICATION USE; HEART-VALVE REPLACEMENT; EXPLICIT CRITERIA; HIGH-RISK; WARFARIN; ASPIRIN; PREVENTION; THERAPY; PEOPLE AB OBJECTIVES: To assess the prevalence and correlates of potentially harmful drug-drug combinations and drug-disease combinations prescribed for elderly patients at outpatient settings. DESIGN: Retrospective analysis of the 1995-2000 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). SETTING: Physician offices and hospital outpatient departments. PARTICIPANTS: Outpatient visits by patients aged 65 and older in the NAMCS and NHAMCS (n=70,203). MEASUREMENTS: Incidences of six drug-drug combinations and 50 drug-disease combinations that can place elderly patients at risk for adverse events according to expert consensus panels. RESULTS: Overall, 0.74% (95% confidence interval (CI)=0.65-0.83) of visits with two or more prescriptions had at least one inappropriate drug-drug combination, and 2.58% (95% CI=2.44-2.72) of visits with at least one prescription had one or more inappropriate drug-disease combinations. Of visits with a prescription of warfarin, 6.60% (95% CI=5.46-7.74) were prescribed a drug with potentially harmful interaction. Of patients with benign prostatic hypertrophy, 4.06% (95% CI=3.06-5.06) had at least one of six drugs that should be avoided. The number of drugs prescribed is most predictive of inappropriate drug-drug and drug-disease combinations. CONCLUSION: Potentially harmful drug-drug and drug-disease combinations occur in various degrees in outpatient care in the elderly population. Targeting combinations such as those involving warfarin that are high in prevalence and potential harm offers a practical approach to improving prescribing and patient safety. C1 Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. St Michaels Hosp, Toronto, ON M5B 1W8, Canada. NCI, NIH, Frederick, MD 21701 USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. EM czhan@ahrq.gov NR 31 TC 54 Z9 55 U1 3 U2 7 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD FEB PY 2005 VL 53 IS 2 BP 262 EP 267 DI 10.1111/j.1532-5415.2005.53112.x PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 889VW UT WOS:000226471900012 PM 15673350 ER PT J AU Lang, HC AF Lang, HC TI Patients' and caregivers' willingness to pay for a cure for schizophrenia in Taiwan SO PSYCHIATRIC SERVICES LA English DT Editorial Material ID CONTINGENT VALUATION; HEALTH-CARE C1 Univ Calif Berkeley, Agcy Healthcare Res & Qual, Berkeley, CA 94720 USA. Natl Yang Ming Univ, Sch Med, Taipei 112, Taiwan. RP Lang, HC (reprint author), Univ Calif Berkeley, Agcy Healthcare Res & Qual, 140 Warren Hall,MC 7360, Berkeley, CA 94720 USA. EM hclang@berkeley.edu NR 8 TC 4 Z9 6 U1 0 U2 1 PU AMER PSYCHIATRIC PUBLISHING, INC PI ARLINGTON PA 1000 WILSON BOULEVARD, STE 1825, ARLINGTON, VA 22209-3901 USA SN 1075-2730 J9 PSYCHIAT SERV JI Psychiatr. Serv. PD FEB PY 2005 VL 56 IS 2 BP 149 EP 151 DI 10.1176/appi.ps.56.2.149 PG 3 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA 902RL UT WOS:000227374100005 PM 15703341 ER PT J AU Wong, HS Zhan, CL Mutter, R AF Wong, HS Zhan, CL Mutter, R TI Do different measures of hospital competition matter in empirical investigations of hospital behavior SO REVIEW OF INDUSTRIAL ORGANIZATION LA English DT Article DE hospital competition measures; hospital markets ID MARKET-STRUCTURE; COST EFFICIENCY; CARE MARKETS; MANAGED CARE; QUALITY; HETEROSCEDASTICITY; ANTITRUST; MERGERS; IMPACT AB Considerable controversy exists about the appropriate way hospital competition should be measured and whether findings are accurate if certain methods are employed. Data from the Healthcare Cost and Utilization Project (HCUP), the American Hospital Association (AHA), and other supplemental data sources are used to create and evaluate hospital competition measures. Correlation coefficients of these measures are assessed. Moreover, each measure is independently included as an explanatory variable in otherwise identical hospital cost function regressions. Their corresponding parameter estimates are then compared. Most measures are highly correlated. Inferences about the effect of competition on hospital cost remain the same when alternative hospital competition measures are employed. We caution researchers against using this finding to arbitrarily select a competition measure when the magnitude of the estimates is important. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Maryland Baltimore Cty, Baltimore, MD 21228 USA. RP Wong, HS (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM hwong@ahrq.gov NR 53 TC 34 Z9 34 U1 2 U2 11 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0889-938X J9 REV IND ORGAN JI Rev. Ind. Organ. PD FEB PY 2005 VL 26 IS 1 BP 61 EP 87 DI 10.1007/s11151-004-6067-7 PG 27 WC Economics; Management SC Business & Economics GA 898IU UT WOS:000227071300003 ER PT J AU Calonge, N AF Calonge, N CA U S Preventive Services Task For TI Screening for visual impairment in children younger than five years: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID PHOTOSCREENING PHOTOGRAPHS; STRABISMIC AMBLYOPIA; PREVERBAL CHILDREN; RANDOMIZED TRIAL; PENALIZATION; OCCLUSION; EFFICACY; ATROPINE; THERAPY; PROGRAM C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 37 TC 2 Z9 2 U1 1 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JAN 15 PY 2005 VL 71 IS 2 BP 333 EP 336 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 889EA UT WOS:000226425100011 ER PT J AU Lau, DT Kasper, JD Potter, DEB Lyles, A Bennett, RG AF Lau, DT Kasper, JD Potter, DEB Lyles, A Bennett, RG TI Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article; Proceedings Paper CT Annual Meeting of the Academy-of-Health-Services-Research-and-Health-Policy CY JUN 23-25, 2002 CL WASHINGTON, DC SP Acad Hlth Serv Res & Hlth Policy ID ADVERSE DRUG EVENTS; EXPLICIT CRITERIA; OUTCOMES AB Background: This study examines the association of potentially inappropriate medication prescribing (PIRx) with hospitalization and death among elderly long-stay nursing home residents. Methods: We defined PIRx using the combined version of the Beers criteria. Data were from the 1996 Medical Expenditure Panel Survey Nursing Home Component. The study sample included 3372 residents, 65 years and older, who had nursing home stays of 3 consecutive months or longer in 1996. We performed multivariate logistic regression analyses of longitudinal data using generalized estimating equations. Results: Residents who received any PIRx had greater odds (odds ratio [OR], 1.27; P=.002) of being hospitalized in the following month than those receiving no PIRx. Residents with PIRx exposure for 2 consecutive months were at increased risk (OR, 1.27; P=.004) of hospitalization, as were those receiving PlRx in the second month only (OR, 1.80; P=.001), compared with those receiving' no PlRx. Residents who received PIRx were at greater risk of death (OR, 1.28; P=.01) that month or the next. Residents, vith intermittent PlRx exposures were at greater odds of death (OR, 1.89; P<.001), compared with those with no PIRx exposure. Conclusions: The association of PlRx with subsequent adverse outcomes (hospitalization and death) provides new evidence of the importance of improving prescribing practices in the nursing home setting. C1 Northwestern Univ, Buehler Ctr Aging, Feinberg Sch Med, Chicago, IL 60611 USA. Johns Hopkins Univ, Dept Hlth Policy & Management, Bloomberg Sch Publ Hlth, Baltimore, MD 21218 USA. Johns Hopkins Univ, Div Geriatr Med & Gerontol, Sch Med, Baltimore, MD 21218 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. Univ Baltimore, Sch Govt & Publ Adm, Baltimore, MD 21201 USA. RP Lau, DT (reprint author), Northwestern Univ, Buehler Ctr Aging, Feinberg Sch Med, 740 N Lake Shore dr,Suite 601, Chicago, IL 60611 USA. EM d-lau@northwestern.edu NR 25 TC 182 Z9 189 U1 1 U2 14 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD JAN 10 PY 2005 VL 165 IS 1 BP 68 EP 74 DI 10.1001/archinte.165.1.68 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 886IG UT WOS:000226219800009 PM 15642877 ER PT J AU Brazil, K Ozer, E Cloutier, MM Levine, R Stryer, D AF Brazil, K Ozer, E Cloutier, MM Levine, R Stryer, D TI From theory to practice: improving the impact of health services research SO BMC HEALTH SERVICES RESEARCH LA English DT Article ID CLINICAL-PRACTICE; PUBLIC-HEALTH; IMPLEMENTATION; MODEL; CARE AB Background: While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. Discussion: Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. Summary: Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care. C1 McMaster Univ, Fac Hlth Sci, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada. St Josephs Hlth Syst Res Network, Hamilton, ON, Canada. Univ Calif San Francisco, Dept Pediat Adolescent Med, San Francisco, CA 94143 USA. Univ Connecticut, Ctr Hlth, Dept Pediat, Hartford, CT 06112 USA. Connecticut Childrens Med Ctr, Hartford, CT USA. Meharry Med Coll, Nashville, TN 37208 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. RP Brazil, K (reprint author), McMaster Univ, Fac Hlth Sci, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada. EM brazilk@mcmaster.ca; eozer@itsa.ucsf.edu; mclouti@ccmckids.org; rlevine@mmc.edu; dstryer@AHRQ.gov NR 39 TC 19 Z9 20 U1 0 U2 4 PU BIOMED CENTRAL LTD PI LONDON PA MIDDLESEX HOUSE, 34-42 CLEVELAND ST, LONDON W1T 4LB, ENGLAND SN 1472-6963 J9 BMC HEALTH SERV RES JI BMC Health Serv. Res. PD JAN 7 PY 2005 VL 5 AR 1 DI 10.1186/1472-6963-5-1 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 891UR UT WOS:000226607000001 PM 15638931 ER PT J AU Simpson, L Owens, PL Zodet, MW Chevarley, FM Dougherty, D Elixhauser, A McCormick, MC AF Simpson, L Owens, PL Zodet, MW Chevarley, FM Dougherty, D Elixhauser, A McCormick, MC TI Health care for children and youth in the United States: Annual report on patterns of coverage, utilization, quality, and expenditures by income SO AMBULATORY PEDIATRICS LA English DT Review DE health care utilization; hospitalization; income; insurance; poverty; quality; children ID PREVENTABLE HOSPITALIZATIONS; RACIAL/ETHNIC DISPARITIES; SENSITIVE CONDITIONS; MEDICAID EXPANSIONS; INSURANCE-COVERAGE; MANAGED MEDICAID; FAMILY INCOME; ACCESS; PROGRAM; SERVICES AB Objectives.-To examine differences by income in insurance coverage, health care utilization, expenditures, and quality of care for children in the United States. Methods.-Two national health care databases serve as the sources of data for this report: the 2000-2002 Medical Expenditure Panel Survey (MEPS) and the 2001 Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). In the MEPS analyses, low income is defined as less than 200% of the federal poverty level and higher income is defined as 200% of the federal poverty level or more. For the HCUP analyses, median household income for the patient's zip code of residence is used to assign community-level income to individual hospitalizations. Results.-Coverage. Children from low-income families were more likely than children from middle-high-income families to be uninsured (13.0% vs 5.8%) or covered by public insurance (50.8% vs 7.3%), and less likely to be privately insured (36.2% vs 87.0%). Utilization. Children from low-income families were less likely to have had a medical office visit or a dental visit than children from middle-high-income families (63.7% vs 76.5% for office-based visits and 28.8% vs 51.4% for dental visits) and less likely to have medicines prescribed (45.1% vs 56.4%) or have utilized hospital outpatient services (5.2% vs 7.0%), but more likely to have made trips to the emergency department (14.6% vs 11.4%). Although low-income children comprise almost 40% of the child population, one quarter of total medical expenditures were for these children. Hospital Discharges. Significant differences by community-level income occurred in specific characteristics of hospitalizations, including admissions through the emergency department, expected payer, mean total charges per day, and reasons for hospital admission. Leading reasons for admission varied by income within and across age groups. Quality. Low-income children were more likely than middle-high-income children to have their parents report a big problem getting necessary care (2.4% vs 1.0%) and getting a referral to a specialist (11.5% vs 5.3%). Low-income children were at least twice as likely as middle-high-income children to have their parents report that health providers never/sometimes listened carefully to them (10.0% vs 5.1%), explained things clearly to the parents (9.6% vs 3.4%), and showed respect for what the parents had to say (9.2% vs 4.2%). Children from families with lower community-level incomes were more likely to experience ambulatory-sensitive hospitalizations. Racial/Ethnic Differences Between Income Groups. Use and expenditure patterns for most services were not significantly different between low-and middle-high-income black children and were lower than those for white children. Conclusions.-While health insurance coverage is still an important factor in obtaining health care, the data suggest that efforts beyond coverage may be needed to improve access and quality for low-income children overall and for children who are racial and ethnic minorities, regardless of income. C1 Univ S Florida, Chair Child Hlth Policy, Dept Pediat, St Petersburg, FL 33712 USA. Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA. Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD USA. RP Simpson, L (reprint author), Univ S Florida, Chair Child Hlth Policy, Dept Pediat, 601 4th St S,CRI 1008, St Petersburg, FL 33712 USA. EM lsimpso1@hsc.usf.edu RI Dalla Zuanna, Teresa/G-3133-2015; OI McCormmick, Marie/0000-0002-3938-1707 NR 114 TC 73 Z9 75 U1 4 U2 13 PU ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS PI LAWRENCE PA 810 EAST 10TH STREET, LAWRENCE, KS 66044 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD JAN-FEB PY 2005 VL 5 IS 1 BP 6 EP 44 DI 10.1367/A04-119R.1 PG 39 WC Pediatrics SC Pediatrics GA 889RQ UT WOS:000226460500003 PM 15656707 ER PT J AU Norris, SL Zhang, XP Avenell, A Gregg, E Bowman, B Schmid, CH Lau, P AF Norris, SL Zhang, XP Avenell, A Gregg, E Bowman, B Schmid, CH Lau, P TI Long-term effectiveness of weight-loss interventions in adults with pre-diabetes - A review SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Review ID IMPAIRED GLUCOSE-TOLERANCE; TYPE-2 DIABETES-MELLITUS; LIFE-STYLE-INTERVENTION; BODY-FAT DISTRIBUTION; DA QING IGT; PREVENTION PROGRAM; RANDOMIZED-TRIAL; GLYCEMIC CONTROL; BEHAVIORAL TREATMENT; INSULIN-RESISTANCE AB Objective: To assess the effectiveness of weight-loss and weight-control interventions for adults with pre-diabetes (impaired fasting glucose and impaired glucose tolerance), an important risk factor for the development of type 2 diabetes. Methods: Computerized searches were conducted of multiple electronic bibliographic databases tip to August 2003. Randomized controlled trials in any language were selected that examined weight-loss or weight-control strategies rising at least one dietary, physical activity, or behavioral intervention, and with a follow-up interval of aparts per thousandY12 months. Effects were combined using a random effects model. Results: Studies were identified, with a total of 5168 participants. Follow-up ranged front 1 to 10 years. Quantitative synthesis was limited by the heterogeneity of populations, settings, and interventions, and by the small number of studies that examined outcomes other than weight. Overall, compared to usual care, font Studies with a follow-up of 1 year reduced weight by 2.8 kg (95% confidence interval [CI] 1.0-4.7) (3.3% of baseline body weight) and decreased body mass index by 1.4 kg/m(2) (CI=0.5-2.3). Weight loss at 2 bears was 2.7 kg (CI=1.9-3.4) (two studies). Modest improvements were noted in the few studies that examined glycemic control, blood pressure, and lipid concentrations (p>0.05). The incidence of diabetes was significantly lower in the intervention groups versus the controls in three of five studies examining this outcome at 3 to 6 years follow-up. Conclusions: Overall, weight-loss strategies rising dietary, physical activity, or behavioral interventions produced significant improvements in weight among persons with pre-diabetes, and a significant decrease in diabetes incidence. Further work is needed on the long-term effects of these interventions on morbidity and mortality and on how to implement these interventions in the community setting. (C) 2005 American Journal of Preventive Medicine. C1 Ctr Dis Control & Prevent, Div Diabet Translat, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA. Univ Aberdeen, Hlth Serv Res Unit, Aberdeen, Scotland. Tufts New England Med Ctr, Boston, MA USA. RP Norris, SL (reprint author), Ctr Outcomes & Effectiveness, Agcy Hlth Care Res & Qual, 540 Gaither Rd,Room 6325, Rockville, MD 20850 USA. OI Schmid, Christopher/0000-0002-0855-5313 NR 58 TC 79 Z9 82 U1 2 U2 11 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD JAN PY 2005 VL 28 IS 1 BP 126 EP 139 DI 10.1016/j.amepre.2004.08.006 PG 14 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 884ZQ UT WOS:000226125600021 PM 15626569 ER PT J AU Norris, SL Zhang, X Avenell, A Gregg, E Brown, TJ Schmid, CH Lau, J AF Norris, SL Zhang, X Avenell, A Gregg, E Brown, TJ Schmid, CH Lau, J TI Long-term non-pharmacologic weight loss interventions for adults with type 2 diabetes - art. no. CD004095.pub2 SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS LA English DT Review ID LIFE-STYLE INTERVENTION; IMPAIRED GLUCOSE-TOLERANCE; LOW-CALORIE DIET; QUALITY-OF-LIFE; CARDIOVASCULAR RISK-FACTORS; RANDOMIZED CLINICAL-TRIAL; NEWLY-DIAGNOSED NIDDM; 2-YEAR FOLLOW-UP; OBESE-PATIENTS; PHYSICAL-ACTIVITY AB Background Most persons with type 2 diabetes are overweight and obesity worsens the metabolic and physiologic abnormalities associated with diabetes. Objectives The objective of this review is to assess the effectiveness of lifestyle and behavioral weight loss and weight control interventions for adults with type 2 diabetes. Search strategy Studies were obtained from computerized searches of multiple electronic bibliographic dababases, supplemented with hand searches of selected journals and consultation with experts in obesity research. The last search was conducted May, 2004. Selection criteria Studies were included if they were published or unpublished randomized controlled trials in any language, and examined weight loss or weight control strategies using one or more dietary, physical activity, or behavioral interventions, with a follow-up interval of at least 12 months. Data collection and analysis Effects were combined using a random effects model. Main results The 22 studies of weight loss interventions identified had a 4,659 participants and follow-up of 1 to 5 years. The pooled weight loss for any intervention in comparison to usual care among 585 subjects was 1.7 kg (95% confidence interval [CI] 0.3 to 3.2), or 3.1% of baseline body weight among 517 subjects. Other main comparisons demonstrated nonsignificant results: among 126 persons receiving a physical activity and behavioral intervention, those who also received a very low calorie diet lost 3.0 kg ( 95% CI - 0.5 to 6.4), or 1.6% of baseline body weight, more than persons receiving a low-calorie diet. Among 53 persons receiving identical dietary and behavioral interventions, those receiving more intense physical activity interventions lost 3.9 kg ( 95% CI -1.9 to 9.7), or 3.6% of baseline body weight, more than those receiving a less intense or no physical activity intervention. Comparison groups often achieved significant weight loss ( up to 10.0 kg), minimizing between-group differences. Changes in glycated hemoglobin generally corresponded to changes in weight and were not significant when between-group differences were examined. No data were identified on quality of life and mortality. Authors' conclusions Weight loss strategies using dietary, physical activity, or behavioral interventions produced small between-group improvements in weight. These results were minimized by weight loss in the comparison group, however, and examination of individual study armsrevealed that multicomponent interventions including very low calorie diets or low calorie diets may hold promise for achieving weight loss in adults with type 2 diabetes. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaithers Rd, Rockville, MD 20850 USA. EM snorris@ahrq.gov NR 138 TC 73 Z9 73 U1 2 U2 7 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1469-493X EI 1361-6137 J9 COCHRANE DB SYST REV JI Cochrane Database Syst Rev. PY 2005 IS 2 AR CD004095 DI 10.1002/14651858.CD004095.pub2 PG 68 WC Medicine, General & Internal SC General & Internal Medicine GA 968YJ UT WOS:000232199200055 ER PT J AU Norris, SL Zhang, X Avenell, A Gregg, E Schmid, CH Lau, J AF Norris, SL Zhang, X Avenell, A Gregg, E Schmid, CH Lau, J TI Long-term non-pharmacological weight loss interventions for adults with prediabetes SO COCHRANE DATABASE OF SYSTEMATIC REVIEWS LA English DT Review ID IMPAIRED GLUCOSE-TOLERANCE; TYPE-2 DIABETES-MELLITUS; LIFE-STYLE-INTERVENTION; BODY-FAT DISTRIBUTION; LOW-CALORIE DIET; DA QING IGT; BEHAVIORAL TREATMENT; RANDOMIZED-TRIAL; GLYCEMIC CONTROL; PREVENTION PROGRAM AB Background Most persons with prediabetes (impaired glucose tolerance or impaired fasting glucose) are overweight, and obesity worsens the metabolic and physiologic abnormalities associated with this condition. Prediabetes is an important risk factor for the development of type 2 diabetes. Objectives The objective of this review was to assess the effectiveness of dietary, physical activity, and behavioral weight loss, and weight control interventions for adults with prediabetes. Search strategy Studies were obtained from computerized searches of multiple electronic bibliographic dababases, supplemented by hand searches of selected journals, and consultation with experts in obesity research. The last search was conducted May, 2004. Selection criteria Studies were included if they were published or unpublished randomized controlled trials in any language and examined weight loss or weight control strategies using one or more dietary, physical activity, or behavioral interventions, with a follow-up interval of at least 12 months. Data collection and analysis Effects were combined using a random-effects model. Main results Nine studies were identified, with a total of 5,168 participants. Follow-up ranged from 1 to 10 years. Quantitative synthesis was limited by the heterogeneity of populations, settings, and interventions and by the small number of studies that examined outcomes other than weight. Overall, in comparisons with usual care, four studies with a follow-up of one year reduced weight by 2.8 kg (95% confidence interval (CI) 1.0 to 4.7) (3.3% of baseline body weight) and decreased body mass index by 1.3 kg/m(2) (95% CI 0.8 to 1.9). Weight loss at two years was 2.6 kg (95% CI 1.9 to 3.3) ( three studies). Modest improvements were noted in the few studies that examined glycemic control, blood pressure, or lipid concentrations (P > 0.05). No data on quality of life or mortality were found. The incidence of diabetes was significantly lower in the intervention groups versus the controls in three of five studies examining this outcome at 3 to 6 years follow-up. Authors' conclusions Overall, weight loss strategies using dietary, physical activity, or behavioral interventions produced significant improvements in weight among persons with prediabetes and a significant decrease in diabetes incidence. Further work is needed on the long-term effects of these interventions on morbidity and mortality and on how to implement these interventions in diverse community settings. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Norris, SL (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaithers Rd, Rockville, MD 20850 USA. EM snorris@ahrq.gov NR 87 TC 99 Z9 99 U1 2 U2 13 PU WILEY-LISS PI HOBOKEN PA DIV JOHN WILEY & SONS INC, 111 RIVER ST, HOBOKEN, NJ 07030 USA SN 1469-493X J9 COCHRANE DB SYST REV JI Cochrane Database Syst Rev. PY 2005 IS 2 AR CD005270 DI 10.1002/14651858.CD005270 PG 87 WC Medicine, General & Internal SC General & Internal Medicine GA 968YJ UT WOS:000232199200103 ER PT J AU Atkins, D Siegel, J Slutsky, J AF Atkins, D Siegel, J Slutsky, J TI Making policy when the evidence is in dispute SO HEALTH AFFAIRS LA English DT Article ID BREAST SELF-EXAMINATION; SERVICES TASK-FORCE; MARROW-TRANSPLANTATION; PROSTATE-CANCER; UNITED-STATES; HEALTH-CARE; RECOMMENDATIONS; GUIDELINES; MANAGEMENT; RATIONALE AB Policymakers often struggle with medical issues that are the subject of fierce scientific debate. On closer examination, many of these debates are manifestations of conflicting perspectives and values as much as disagreements over the evidence. We summarize common factors underlying recent debates and outline a series of questions that can help disentangle questions of evidence from those of values. These questions focus on identifying the most important outcomes, evaluating the quality of evidence, and assessing the trade-offs involved. We then use four recent policy debates-involving prostate-specific antigen (PSA) screening, high-dose chemotherapy for breast cancer, antibiotic therapy for otitis media, and newborn hearing screening-to illustrate how this approach can help clarify areas of agreement and disagreement of the opposing sides. C1 AHRQ, Rockville, MD USA. RP Atkins, D (reprint author), AHRQ, Rockville, MD USA. EM datkins@ahrq.gov NR 43 TC 42 Z9 42 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2005 VL 24 IS 1 BP 102 EP 113 DI 10.1377/hlthaff.24.1.102 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 909CD UT WOS:000227835600014 PM 15647220 ER PT J AU Clancy, CM Cronin, K AF Clancy, CM Cronin, K TI Evidence-based decision making: Global evidence, local decisions SO HEALTH AFFAIRS LA English DT Article ID HEALTH-CARE; QUALITY; TECHNOLOGY; BENEFITS; DRUGS AB Variations in health care services have been well documented worldwide. The result is that increased health care spending is not uniformly associated with improved health. Interest in increasing the value obtained from health care investments has stimulated efforts to develop the best science and apply it to health care delivery. Advances in communications and information technology have made such developments of the scientific basis for health care a truly global enterprise, but its application must remain local. Consumers' use of evidence-based information to choose providers, make treatment decisions, and play a more active role represents the ultimate local application of scientific information. C1 AHRQ, Rockville, MD USA. Off Natl Coordinator Hlth Informat Technol, Dept Hlth & Human Serv, Washington, DC USA. RP Clancy, CM (reprint author), AHRQ, Rockville, MD USA. EM cclancy@ahrq.gov NR 30 TC 65 Z9 68 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2005 VL 24 IS 1 BP 151 EP 162 DI 10.1377/hlthaff.24.1.151 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 909CD UT WOS:000227835600021 PM 15647226 ER PT J AU Gebo, KA Fleishman, JA Conviser, R Reilly, ED Korthuis, PT Moore, RD Hellinger, J Keiser, P Rubin, HR Crane, L Hellinger, FJ Mathews, WC AF Gebo, KA Fleishman, JA Conviser, R Reilly, ED Korthuis, PT Moore, RD Hellinger, J Keiser, P Rubin, HR Crane, L Hellinger, FJ Mathews, WC TI Racial and gender disparities in receipt of highly active antiretroviral therapy persist in a multistate sample of HIV patients in 2001 SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE highly active antiretroviral therapy; gender; race; disparities; female; injection drug use; African American ID HEALTH-SERVICES USE; SOCIETY-USA PANEL; PROTEASE INHIBITORS; UNITED-STATES; UPDATED RECOMMENDATIONS; INFECTED PATIENTS; AIDS; ACCESS; CARE; COHORT AB Background: National data from the mid-1990s demonstrated that many eligible patients did not receive highly active antiretroviral therapy (HAART) and that racial and gender disparities existed in HAART receipt. We examined whether demographic disparities in the use of HAART persist in 2001 and if outpatient care is associated with HAART utilization. Methods: Demographic, clinical, and pharmacy utilization data were collected from 10 US HIV primary care sites in the HIV Research Network (HIVRN). Using multivariate logistic regression, we examined demographic and clinical differences associated with receipt of HAART and the association of outpatient utilization with HAART. Results: In our cohort in 2001, 84% of patients received HAART and 66% had 4 or more outpatient visits during calendar year (CY) 2001. Of those with 2 or more CD4 counts below 350 cells/mm(3) in 2001, 91% received HAART; 82% of those with I CD4 test result below 350 cells/mm(3) received HAART; and 77% of those with no CD4 counts below 350 cells/mm(3) received HAART. Adjusting for care site in multivariate analyses, age >40 years (adjusted odds ratio [AOR] = 1.13), male gender (AOR = 1.23), Medicaid coverage (AOR = 1. 16), Medicare coverage (AOR = 1. 73), having I or more CD4 counts less than 350 cells/mm(3) (AOR = 1.33), and having 4 or more outpatient visits in a year (OR = 1.34) were significantly associated with an increased likelihood of HAART. African Americans (odds ratio [OR] = 0.84) and those with an injection drug use risk factor (OR = 0.86) were less likely to receive HAART. Conclusions: Although the overall prevalence of HAART has increased since the mid-1990s, demographic disparities in HAART receipt persist. Our results support attempts to increase access to care and frequency of outpatient visits for underutilizing groups as well as increased efforts to reduce persistent disparities in women, African Americans, and injection drug users (IDUs). C1 Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Hlth Resources & Serv Adm, Rockville, MD USA. Oregon Hlth Sci Univ, Dept Med, Portland, OR 97201 USA. Community Med Alliance, Boston, MA USA. Parkland Hlth & Hosp Syst, Dallas, TX USA. Wayne State Univ, Detroit, MI USA. Univ Calif, Dept Med, La Jolla, CA USA. RP Gebo, KA (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, 1830 E Monument St,Room 442, Baltimore, MD 21205 USA. EM kgebo@jhmi.edu RI Gebo, Kelly/B-9223-2009; Mathews, William/E-4451-2010 OI Mathews, William/0000-0002-2352-0725 FU NIAID NIH HHS [1 U01 AI46376-01, 5 P30 AI36214-05]; NIDA NIH HHS [K23-DA00523, K24-DA00432]; PHS HHS [290-01-0012] NR 45 TC 196 Z9 197 U1 0 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1525-4135 J9 JAIDS-J ACQ IMM DEF JI JAIDS PD JAN 1 PY 2005 VL 38 IS 1 BP 96 EP 103 DI 10.1097/00126334-200501010-00017 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 885TI UT WOS:000226179400017 PM 15608532 ER PT J AU Chen, JJ Wiest, SM McDowell, I Kristjansson, B Jones, RN Fleishman, JA Crane, PK AF Chen, JJ Wiest, SM McDowell, I Kristjansson, B Jones, RN Fleishman, JA Crane, PK TI The dimensionality of the modified Mini-Mental State Examination and factorial invariance due to language in the Canadian Study of Health and Aging. SO JOURNAL OF INVESTIGATIVE MEDICINE LA English DT Meeting Abstract C1 Univ Washington, Sch Med, Seattle, WA USA. Univ Ottawa, Ottawa, ON K1N 6N5, Canada. Hebrew Rehabil Ctr Aged Res & Training Inst, Boston, MA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Washington, Div Gen Internal Med, Seattle, WA 98195 USA. RI Crane, Paul/C-8623-2014 NR 0 TC 0 Z9 0 U1 0 U2 1 PU B C DECKER INC PI HAMILTON PA 20 HUGHSON ST SOUTH, PO BOX 620, L C D 1, HAMILTON, ONTARIO L8N 3K7, CANADA SN 1081-5589 J9 J INVEST MED JI J. Invest. Med. PD JAN PY 2005 VL 53 IS 1 SU S MA 287 BP S128 EP S128 PG 1 WC Medicine, General & Internal; Medicine, Research & Experimental SC General & Internal Medicine; Research & Experimental Medicine GA 890VR UT WOS:000226539700300 ER PT J AU Correa-De-Araujo, R AF Correa-De-Araujo, R TI Improving the use and safety of medications in women through sex/gender and race/ethnicity analysis: Introduction SO JOURNAL OF WOMENS HEALTH LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Correa-De-Araujo, R (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Rcorrea@ahrq.gov NR 25 TC 1 Z9 1 U1 0 U2 1 PU MARY ANN LIEBERT INC PI LARCHMONT PA 2 MADISON AVENUE, LARCHMONT, NY 10538 USA SN 1540-9996 J9 J WOMENS HEALTH JI J. Womens Health PD JAN PY 2005 VL 14 IS 1 BP 12 EP 15 DI 10.1089/jwh.2005.14.12 PG 4 WC Public, Environmental & Occupational Health; Medicine, General & Internal; Obstetrics & Gynecology; Women's Studies SC Public, Environmental & Occupational Health; General & Internal Medicine; Obstetrics & Gynecology; Women's Studies GA 898GD UT WOS:000227063700004 PM 15692272 ER PT J AU Correa-De-Araujo, R AF Correa-De-Araujo, R TI It's your health: Use your medications safely SO JOURNAL OF WOMENS HEALTH LA English DT Editorial Material ID DRUG; PREGNANCY; OLDER C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Correa-De-Araujo, R (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Rcorrea@ahrq.gov NR 19 TC 2 Z9 2 U1 0 U2 0 PU MARY ANN LIEBERT INC PI LARCHMONT PA 2 MADISON AVENUE, LARCHMONT, NY 10538 USA SN 1540-9996 J9 J WOMENS HEALTH JI J. Womens Health PD JAN PY 2005 VL 14 IS 1 BP 16 EP 18 DI 10.1089/jwh.2005.14.16 PG 3 WC Public, Environmental & Occupational Health; Medicine, General & Internal; Obstetrics & Gynecology; Women's Studies SC Public, Environmental & Occupational Health; General & Internal Medicine; Obstetrics & Gynecology; Women's Studies GA 898GD UT WOS:000227063700005 PM 15692273 ER PT J AU Correa-De-Araujo, R Miller, E Banthin, JS Trinh, Y AF Correa-De-Araujo, R Miller, E Banthin, JS Trinh, Y TI Gender differences in drug use and expenditures in a privately insured population of older adults SO JOURNAL OF WOMENS HEALTH LA English DT Article ID BENIGN PROSTATIC HYPERPLASIA; THYROID-DYSFUNCTION; WOMENS HEALTH; PREVALENCE; MEDICARE AB We examine gender differences in use and expenditures for prescription drugs among Medicare and privately insured older adults aged 65 and over, using data on a nationally representative sample of prescription drug purchases collected for the Medical Expenditure Panel Survey Household Component. Overall, women spent about $1,178 for drugs, about 17% more than the $1,009 in average expenditures by men. Older women constituted 50.7% of the population and had average annual aggregate expenditures for prescribed medicines of $6.93 billion compared to $5.77 billion for men. Women were more likely than men to use drugs from a number of therapeutic classes-analgesics, hormones and psychotherapeutic agents - and therapeutic subclasses - thyroid drugs, COX-2 inhibitors and anti-depressants. Women also had higher average prescriptions per user for a number of therapeutic classes - hormones, psychotherapeutic agents and analgesics - and therapeutic subclasses - anti-diabetic drugs and beta blockers. Prescribed medications are, arguably, the most important healthcare technology in preventing illness, disability, and death in older adults. It is critical that older women and men have proper access to prescribed medicines. Given the financial vulnerability of this priority population, particularly women, the expanded drug coverage available under the Medicare Modernization Act is of particular relevance in meeting this goal. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Maryland, Sch Pharm, Baltimore, MD 21201 USA. RP Correa-De-Araujo, R (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Rcorrea@ahrq.gov NR 32 TC 26 Z9 27 U1 0 U2 1 PU MARY ANN LIEBERT INC PI LARCHMONT PA 2 MADISON AVENUE, LARCHMONT, NY 10538 USA SN 1540-9996 J9 J WOMENS HEALTH JI J. Womens Health PD JAN PY 2005 VL 14 IS 1 BP 73 EP 81 DI 10.1089/jwh.2005.14.73 PG 9 WC Public, Environmental & Occupational Health; Medicine, General & Internal; Obstetrics & Gynecology; Women's Studies SC Public, Environmental & Occupational Health; General & Internal Medicine; Obstetrics & Gynecology; Women's Studies GA 898GD UT WOS:000227063700013 PM 15692281 ER PT J AU Sedman, A Harris, JM Schulz, K Schwalenstocker, E Remus, D Scanlon, M Bahl, V AF Sedman, A Harris, JM Schulz, K Schwalenstocker, E Remus, D Scanlon, M Bahl, V TI Relevance of the agency for healthcare research and quality patient safety indicators for children's hospitals SO PEDIATRICS LA English DT Article DE patient safety indicators; Agency for Healthcare Research and Quality; medical error; National Association of Children's Hospitals and Related Institutions ID CENTRAL VENOUS CATHETERS; RANDOMIZED TRIAL; PREVENTION; INFECTION; COLONIZATION; EVENTS AB Objectives. Patient safety indicators (PSIs) were developed by the Agency for Healthcare Research and Quality. Our objectives were (1) to apply these algorithms to the National Association of Children's Hospitals and Related Institutions (NACHRI) Aggregate Case Mix Comparative Database for 1999-2002, (2) to establish mean rates for each of the PSI events in children's hospitals, (3) to investigate the inadequacies of PSIs in relation to pediatric diagnoses, and (4) to express the data in such a way that children's hospitals could use the PSIs determined to be appropriate for pediatric use for comparison with their own data. In addition, we wanted to use the data to set priorities for ongoing clinical investigations and to propose interventions if the indicators demonstrated preventable errors Methods. The Agency for Healthcare Research and Quality PSI algorithms (version 2.1, revision 1) were applied to children's hospital administrative data (1.92 million discharges) from the NACHRI Aggregate Case Mix Comparative Database for 1999-2002. Rates were measured for the following events: complications of anesthesia, death in low-mortality diagnosis-related groups (DRGs), decubitus ulcer, failure to rescue (ie, death resulting from a complication, rather than the primary diagnosis), foreign body left in during a procedure, iatrogenic pneumothorax, infection attributable to medical care (ie, infections related to surgery or device placement), postoperative hemorrhage or hematoma, postoperative pulmonary embolism or venous thrombosis, postoperative wound dehiscence, and accidental puncture/laceration. Results. Across the 4 years of data, the mean risk-adjusted rates of PSI events ranged from 0.01% (0.1 event per 1000 discharges) for a foreign body left in during a procedure to 14.0% (140 events per 1000 discharges) for failure to rescue. Review of International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with each PSI category showed that the failure to rescue and death in low-mortality DRG indicators involved very complex cases and did not predict preventable events in the majority of cases. The PSI for infection attributable to medical care appeared to be accurate the majority of the time. Incident risk-adjusted rates of infections attributable to medical care averaged 0.35% (3.5 events per 1000 discharges) and varied up to fivefold from the lowest rate to the highest rate. The highest rates were up to 1.8 times the average. Conclusions. PSIs derived from administrative data are indicators of patient safety concerns and can be relevant as screening tools for children's hospitals; however, cases identified by these indicators do not always represent preventable events. Some, such as a foreign body left in during a procedure, iatrogenic pneumothorax, infection attributable to medical care, decubitus ulcer, and venous thrombosis, seem to be appropriate for pediatric care and may be directly amenable to system changes. Evidence-based practices regarding those particular indicators that have been reported in the adult literature need to be investigated in the pediatric population. In their present form, 2 of the indicators, namely, failure to rescue and death in low-mortality DRGs, are inaccurate for the pediatric population, do not represent preventable errors in the majority of pediatric cases, and should not be used to estimate quality of care or preventable deaths in children's hospitals. The PSIs can assist institutions in prioritizing chart review-based investigations; if clusters of validated events emerge in reviews, then improvement activities can be initiated. Large aggregate databases, such as the NACHRI Case Mix Database, can help establish mean rates of potential pediatric events, giving children's hospitals a context within which to examine their own data. C1 Univ Michigan Hlth Syst, Ann Arbor, MI 48109 USA. Natl Assoc Childrens Hosp & Related Inst, Alexandria, VA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Childrens Hosp Wisconsin, Wauwatosa, WI USA. RP Sedman, A (reprint author), Univ Michigan Hlth Syst, C201 Med Inn Bldg,Box 0825,1500 E Med Ctr Dr, Ann Arbor, MI 48109 USA. EM asedman@umich.edu NR 16 TC 51 Z9 51 U1 0 U2 3 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JAN PY 2005 VL 115 IS 1 BP 135 EP 145 DI 10.1542/peds.2004-1083 PG 11 WC Pediatrics SC Pediatrics GA 884KN UT WOS:000226083700040 PM 15579669 ER PT J AU Zarin, DA Young, JL West, JC AF Zarin, DA Young, JL West, JC TI Challenges to evidence-based medicine: A comparison of patients and treatments in randomized controlled trials with patients and treatments in a practice research network SO SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY LA English DT Article DE evidence-based medicine; randomized controlled trials; generalizability; schizophrenia; bipolar disorder ID CLINICAL-TRIALS; PSYCHIATRIC PRACTICE; BREAST-CANCER; QUALITY; GENERALIZABILITY; SCHIZOPHRENIA; POPULATION; EFFICACY; CARE; INTERVENTIONS AB Background The practice of evidence-based medicine depends on the availability of clinically relevant research, yet questions have been raised about the generalizability of findings from randomized controlled trials (RCTs). Objective The aim of this study was to quantify differences between RCT patients and treatments and those in day-to-day clinical practice. Design Data from published reports of two key RCTs underlying recent treatment advances in psychiatry were compared with data on routine psychiatric practice collected through a Practice Research Network (PRN). Setting Hospital inpatient units (RCT) and the full range of psychiatric practice settings in the United States (PRN). Subjects Adults with bipolar I disorder and adults with schizophrenia. Measures Demographic (age, gender, race), clinical (principal diagnoses, comorbid conditions, psychosocial functioning, and histories of hospitalization), and treatment (medication name and dosage) characteristics. Results PRN patients had more comorbid conditions and were more likely to be white, female, and older than RCT patients. In all, 38% of PRN patients with schizophrenia and 55% of PRN patients with bipolar I disorder would have been ineligible for the corresponding RCT. Most PRN patients receiving an RCT study medication were also receiving other medications not allowed by the RCT protocol. Conclusions Findings support the assertion that RCT patients and treatments are not typical of those in clinical practice, and most patients in clinical practice are receiving treatments that do not have direct empirical support. Research is needed to determine the extent to which RCT findings should be used to guide routine clinical decisions. C1 Amer Psychiat Inst Res & Educ, Practice Res Network, Arlington, VA 22209 USA. AHRQ, Technol Assessment Program, Rockville, MD USA. Math Policy Res Inc, Washington, DC USA. RP West, JC (reprint author), Amer Psychiat Inst Res & Educ, Practice Res Network, 1000 Wilson Blvd,Ste 1825, Arlington, VA 22209 USA. NR 55 TC 44 Z9 43 U1 1 U2 6 PU DR DIETRICH STEINKOPFF VERLAG PI DARMSTADT PA PO BOX 10 04 62, D-64204 DARMSTADT, GERMANY SN 0933-7954 J9 SOC PSYCH PSYCH EPID JI Soc. Psychiatry Psychiatr. Epidemiol. PD JAN PY 2005 VL 40 IS 1 BP 27 EP 35 DI 10.1007/s00127-005-0838-9 PG 9 WC Psychiatry SC Psychiatry GA 882ZV UT WOS:000225979800005 PM 15624072 ER PT J AU Atkins, D Eccles, M Flottorp, S Guyatt, GH Henry, D Hill, S Liberati, A O'Connell, D Oxman, AD Phillips, B Schunemann, H Edejer, TTT Vist, GE Williams, JW AF Atkins, D Eccles, M Flottorp, S Guyatt, GH Henry, D Hill, S Liberati, A O'Connell, D Oxman, AD Phillips, B Schunemann, H Edejer, TTT Vist, GE Williams, JW CA GRADE Working Grp TI Systems for grading the quality of evidence and the strength of recommendations - I: Critical appraisal of existing approaches The GRADE Working Group SO BMC HEALTH SERVICES RESEARCH LA English DT Article ID COMMUNITY-PREVENTIVE-SERVICES; EVIDENCE BASED GUIDELINES; ANTITHROMBOTIC AGENTS; CLINICAL RECOMMENDATIONS; HEALTH-CARE; TASK-FORCE; RULES AB Background: A number of approaches have been used to grade levels of evidence and the strength of recommendations. The use of many different approaches detracts from one of the main reasons for having explicit approaches: to concisely characterise and communicate this information so that it can easily be understood and thereby help people make well-informed decisions. Our objective was to critically appraise six prominent systems for grading levels of evidence and the strength of recommendations as a basis for agreeing on characteristics of a common, sensible approach to grading levels of evidence and the strength of recommendations. Methods: Six prominent systems for grading levels of evidence and strength of recommendations were selected and someone familiar with each system prepared a description of each of these. Twelve assessors independently evaluated each system based on twelve criteria to assess the sensibility of the different approaches. Systems used by 51 organisations were compared with these six approaches. Results: There was poor agreement about the sensibility of the six systems. Only one of the systems was suitable for all four types of questions we considered ( effectiveness, harm, diagnosis and prognosis). None of the systems was considered usable for all of the target groups we considered ( professionals, patients and policy makers). The raters found low reproducibility of judgements made using all six systems. Systems used by 51 organisations that sponsor clinical practice guidelines included a number of minor variations of the six systems that we critically appraised. Conclusions: All of the currently used approaches to grading levels of evidence and the strength of recommendations have important shortcomings. C1 Norwegian Hlth Serv Res Ctr, Informed Choice Res Dept, N-0130 Oslo, Norway. Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. Newcastle Univ, Ctr Hlth Serv Res, Newcastle Upon Tyne NE2 4AA, Tyne & Wear, England. McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada. McMaster Univ, Dept Med, Hamilton, ON L8N 3Z5, Canada. Univ Newcastle, Fac Med & Hlth Sci, Dept Clin Pharmacol, Newcastle Mater Hosp, Waratah, NSW 2298, Australia. Univ Modena & Reggio Emilia, Azienda Osped Policlin, Dept Hematol & Oncol, I-41100 Modena, Italy. CeVEAS, Modena, Italy. NSW Canc Council, Canc Res & Registers Div, Canc Epidemiol Res Unit, Kings Cross, NSW 1340, Australia. Univ Oxford, Warneford Hosp, Dept Psychiat, Ctr Evidence Based Med, Oxford OX3 7JX, England. SUNY Buffalo, Univ Buffalo, Dept Med, Buffalo, NY 14215 USA. SUNY Buffalo, Univ Buffalo, Dept Social & Prevent Med, Buffalo, NY 14215 USA. WHO, Global Programme Evidence Hlth Policy, CH-1211 Geneva 27, Switzerland. Duke Univ, Med Ctr, Durham, NC 27705 USA. Dept Vet Affairs Med Ctr, Ctr Hlth Serv Res Primary Care, HSR&D, Durham, NC 27705 USA. RP Vist, GE (reprint author), Norwegian Hlth Serv Res Ctr, Informed Choice Res Dept, Pb 7004 St Olavs Plass, N-0130 Oslo, Norway. EM DAtkins@AHRQ.GOV; Martin.Eccles@newcastle.ac.uk; signe.flottorp@nhsrc.no; guyatt@mcmaster.ca; mddah@mail.newcastle.edu.au; hillsu@mail.newcastle.edu.au; alesslib@tin.it; dianneo@nswcc.org.au; oxman@online.no; bob.phillips@doctors.org.uk; hjs@buffalo.edu; tantorrest@who.ch; gev@nhsrc.no; jw.williams@duke.edu NR 34 TC 311 Z9 330 U1 4 U2 20 PU BIOMED CENTRAL LTD PI LONDON PA 236 GRAYS INN RD, FLOOR 6, LONDON WC1X 8HL, ENGLAND SN 1472-6963 J9 BMC HEALTH SERV RES JI BMC Health Serv. Res. PD DEC 22 PY 2004 VL 4 AR 38 DI 10.1186/1472-6963-4-38 PG 7 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 890RD UT WOS:000226527600001 PM 15615589 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Serv Task Force TI Screening for suicide risk: Recommendation and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID IDEATION C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 21 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD DEC 1 PY 2004 VL 70 IS 11 BP 2187 EP 2190 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 879GM UT WOS:000225704400015 ER PT J AU Guirguis-Blake, J Hales, CM AF Guirguis-Blake, J Hales, CM TI Screening for suicide risk SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 US Prevent Serv Task Force, Ctr Primary Care Prevent & Clin Partnerships, Agcy Healthcare Res & Qual, Rockville, MD USA. Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. RP Guirguis-Blake, J (reprint author), US Prevent Serv Task Force, Ctr Primary Care Prevent & Clin Partnerships, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 3 TC 0 Z9 0 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD DEC 1 PY 2004 VL 70 IS 11 BP 2193 EP 2194 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 879GM UT WOS:000225704400016 PM 15606067 ER PT J AU Ollenschlager, G Marshall, C Qureshi, S Rosenbrand, K Burgers, J Makela, M Slutsky, J AF Ollenschlager, G Marshall, C Qureshi, S Rosenbrand, K Burgers, J Makela, M Slutsky, J CA Board Trustees 2002 G-I-N TI Improving the quality of health care: using international collaboration to inform guideline programmes by founding the Guidelines International Network (G-I-N) SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID CLINICAL-PRACTICE GUIDELINES; APPRAISAL; INSTRUMENT; COUNTRIES; CANADA; NEED AB Clinical practice guidelines are regarded as powerful tools to achieve effective health care. Although many countries have built up experience in the development, appraisal, and implementation of guidelines, until recently there has been no established forum for collaboration at an international level. As a result, in different countries seeking similar goals and using similar strategies, efforts have been unnecessarily duplicated and opportunities for harmonisation lost because of the lack of a supporting organisational framework. This triggered a proposal in 2001 for an international guidelines network built on existing partnerships. A baseline survey confirmed a strong demand for such an entity. A multinational group of guideline experts initiated the development of a non-profit organisation aimed at promotion of systematic guideline development and implementation. The Guidelines International Network (G-I-N) was founded in November 2002. One year later the Network released the International Guideline Library, a searchable database which now contains more than 2000 guideline resources including published guidelines, guidelines under development, "guidelines for guidelines", training materials, and patient information tools. By June 2004, 52 organisations from 27 countries had joined the network including institutions from Oceania, North America, and Europe, and WHO. This paper describes the process that led to the foundation of the G-I-N, its characteristics, prime activities, and ideas on future projects and collaboration. C1 Agcy Qual Med AQuMed, Cologne, Germany. NZGG, Wellington, New Zealand. SIGN, Edinburgh, Midlothian, Scotland. Dutch Inst Healthcare Improvement, Utrecht, Netherlands. Univ Med Ctr, Ctr Qual Care Res, Nijmegen, Netherlands. Finnish Off Hlth Technol Assessment FinOHTA, Helsinki, Finland. Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Ollenschlager, G (reprint author), Agcy Qual Med, Wegelystr 3, D-10623 Berlin, Germany. EM ollenschlaeger@azq.de NR 32 TC 62 Z9 63 U1 1 U2 10 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD DEC PY 2004 VL 13 IS 6 BP 455 EP 460 DI 10.1136/qshc.2003.009761 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 876FY UT WOS:000225483200015 PM 15576708 ER PT J AU Norris, SL Zhang, XP Avenell, A Gregg, E Bowman, B Serdula, M Brown, TJ Schmid, CH Lau, J AF Norris, SL Zhang, XP Avenell, A Gregg, E Bowman, B Serdula, M Brown, TJ Schmid, CH Lau, J TI Long-term effectiveness of lifestyle and behavioral weight loss interventions in adults with type 2 diabetes: A meta-analysis SO AMERICAN JOURNAL OF MEDICINE LA English DT Review ID LOW-CALORIE DIET; CARDIOVASCULAR-RISK-REDUCTION; IMPAIRED GLUCOSE-TOLERANCE; NEWLY-DIAGNOSED NIDDM; PREPARED MEAL PLAN; OBESE-PATIENTS; METABOLIC CONTROL; FOLLOW-UP; PHYSICAL-ACTIVITY; SOS INTERVENTION AB BACKGROUND: Most persons with type 2 diabetes are overweight, and obesity worsens the metabolic and physiologic abnormalities associated with diabetes. Our objective was to assess the effectiveness of lifestyle and behavioral weight loss and weight control interventions in adults with type 2 diabetes. METHODS: Studies were obtained from searches of multiple electronic bibliographic databases, supplemented with hand searches of selected journals and consultation with experts in obesity research. Studies were included if they were published or unpublished randomized controlled trials in any language that examined weight loss or weight control strategies using one or more dietary, physical activity, or behavioral interventions, with a follow-up interval of at least 12 months. Effects were combined using a random-effects model. RESULTS: The 22 studies of weight loss interventions identified yielded a total of 4659 participants with a follow-up of I to 5 years. The pooled weight loss for any intervention in comparison with usual care among 585 subjects was 1.7 kg (95% confidence interval [CI]: 0.3 to 3.2 kg), or 3.1% of baseline body weight among 511 subjects. Among 126 persons who underwent a physical activity and behavioral intervention, those who also received a very low-caloric diet lost 3.0 kg (95% CI: -0.5 to 6.4 kg), or 1.6% of baseline body weight, more than persons who received a low-caloric diet. Among 53 persons who received identical dietary and behavioral interventions, those who received a more intense physical activity intervention lost 3.9 kg (95% CI: -1.9 to 9.7 kg), or 3.6% of baseline body weight, more than those who received a less intense or no physical activity intervention. Comparison groups often achieved substantial weight loss (up to 10.0 kg), minimizing between-group differences. Changes in glycated hemoglobin level generally corresponded to changes in weight and were not substantial when between-group differences were examined. CONCLUSION: Weight loss strategies involving dietary, physical activity, or behavioral interventions were associated with small between-group improvements in weight. These results were minimized by weight loss in the comparison group, however, and examination of individual study arms revealed that multicomponent interventions, including very low-calorie diets or low-calorie diets, may hold promise for achieving weight loss in adults with type 2 diabetes. (C) 2004 by Elsevier Inc. C1 Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Diabet Translat, Atlanta, GA USA. Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Nutr & Phys Activ, Atlanta, GA USA. Univ Aberdeen, Hlth Serv Res Unit, Aberdeen, Scotland. Univ Manchester, Manchester, Lancs, England. Tufts New England, Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA USA. RP Norris, SL (reprint author), Agcy Hlth Care Res & Qual, Ctr Outcomes & Effectiveness, 540 Gaither Rd, Rockville, MD 20850 USA. EM snorris@ahrq.gov OI Schmid, Christopher/0000-0002-0855-5313 NR 74 TC 121 Z9 122 U1 3 U2 21 PU EXCERPTA MEDICA INC PI NEW YORK PA 650 AVENUE OF THE AMERICAS, NEW YORK, NY 10011 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD NOV 15 PY 2004 VL 117 IS 10 BP 762 EP 774 DI 10.1016/j.amjmed.2004.05.024 PG 13 WC Medicine, General & Internal SC General & Internal Medicine GA 872UA UT WOS:000225232900007 PM 15541326 ER PT J AU Altman, DE Clancy, C Blendon, RJ AF Altman, DE Clancy, C Blendon, RJ TI Improving patient safety - Five years after the IOM report SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID MEDICAL ERRORS C1 Kaiser Family Fdn, Menlo Pk, CA 94025 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA. RP Altman, DE (reprint author), Kaiser Family Fdn, Menlo Pk, CA 94025 USA. NR 5 TC 112 Z9 115 U1 3 U2 6 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD NOV 11 PY 2004 VL 351 IS 20 BP 2041 EP 2043 DI 10.1056/NEJMp048243 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 869TM UT WOS:000225007200003 PM 15537902 ER PT J AU Walsh, KE Miller, MR Vinci, RJ Bauchner, H AF Walsh, KE Miller, MR Vinci, RJ Bauchner, H TI Pediatric resident education about Medicaid errors SO AMBULATORY PEDIATRICS LA English DT Article DE education; medical errors; patient safety; pediatric resident ID EMERGENCY-MEDICINE; EVENTS AB Background.-National organizations have called for patient safety curricula to help reduce the incidence of errors. Little is known about what trainees are taught about medical errors. Objective.-1) To determine the amount and type of training that pediatric residents have about medical errors and 2) to assess pediatric chief resident knowledge about medical errors. Methods.-We surveyed chief residents from a national sample of 51 pediatric training programs by selecting every fourth program from the American Council on Graduate Medical Education list of accredited programs. The 21-item telephone survey was developed with patient safety specialists and piloted on several chief residents. It asked about patient-safety training sessions and awareness and knowledge about medical errors. Results.-The 51 chief residents helped teach 2176 residents, approximately one third of all pediatric residents. One third of programs had no lectures about medical errors and 23% did not have morbidity and mortality rounds. Sixty-one percent of respondents stated that outpatient medical errors were rarely discussed. Informal teaching was most often reported as the primary method for educating residents about medical errors. Although 58% of respondents did not know that a systemic change should be made in response to a medical error, 83% felt that residents are adequately trained to deal with a medical error. Discussion.-Pediatric resident education about medical errors varies widely. Attention by pediatric residency training programs to this important issue seems limited. C1 Boston Univ, Med Ctr, Sch Med, Dept Pediat, Boston, MA 02118 USA. Natl Inst Hlth, Agcy Healthcare Res & Qual, Bethesda, MD USA. Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. RP Walsh, KE (reprint author), Boston Univ, Med Ctr, Sch Med, Dept Pediat, Matern Bldg,Room 4104,91 E Concord St, Boston, MA 02118 USA. EM Kathleen.walsh@bmc.org NR 17 TC 11 Z9 11 U1 0 U2 1 PU ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS PI LAWRENCE PA 810 EAST 10TH STREET, LAWRENCE, KS 66044 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD NOV-DEC PY 2004 VL 4 IS 6 BP 514 EP 517 DI 10.1367/A04-009R1.1 PG 4 WC Pediatrics SC Pediatrics GA 873JI UT WOS:000225275400010 PM 15548104 ER PT J AU Berg, AO Allan, JD Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Services Task Force TI Screening for high blood pressure: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article ID RANDOMIZED CONTROLLED TRIALS; LIPID-LOWERING TREATMENT; ESSENTIAL-HYPERTENSION; SYSTOLIC HYPERTENSION; TASK-FORCE; METAANALYSIS; RISK; CORONARY; COMPLICATIONS; CONSEQUENCES C1 Agcy Healthcare Res & Qual, USPSTF, US Prevent Serv Task Force, Rockville, MD 20850 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, Sch Med, Newark, NJ 07103 USA. Harvard Univ, Sch Med, Boston, MA 02115 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Women & Infants Hosp Rhode Isl, Providence, RI USA. Univ Michigan, Ann Arbor, MI 48109 USA. Mt Sinai Sch Med, Brookdale Dept Geriatr, New York, NY USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, New York, NY USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Community & Prevent Med, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Community & Prevent Med, Fairfax, VA USA. RP Berg, AO (reprint author), Agcy Healthcare Res & Qual, USPSTF, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 46 TC 0 Z9 0 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD NOV PY 2004 VL 104 IS 11 BP 82 EP + PG 5 WC Nursing SC Nursing GA 874BJ UT WOS:000225325600046 ER PT J AU Hughes, RG AF Hughes, RG TI Some tips on getting funding for health services research SO APPLIED NURSING RESEARCH LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, Rockville, MD 20850 USA. RP Hughes, RG (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, 540 Gaither Rd, Rockville, MD 20850 USA. EM rhughes@ahrq.gov NR 0 TC 1 Z9 1 U1 0 U2 0 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0897-1897 J9 APPL NURS RES JI Appl. Nurs. Res. PD NOV PY 2004 VL 17 IS 4 BP 305 EP 307 DI 10.1016/j.apnr.2004.10.001 PG 3 WC Nursing SC Nursing GA 880PI UT WOS:000225801300013 PM 15573341 ER PT J AU Stone, PW Clarke, SP Cimiotti, J Correa-de-Araujo, R AF Stone, PW Clarke, SP Cimiotti, J Correa-de-Araujo, R TI Nurses' working conditions: Implications for infectious disease SO EMERGING INFECTIOUS DISEASES LA English DT Article; Proceedings Paper CT International Conference on Women and Infectious Diseases CY FEB 27-28, 2004 CL Atlanta, GA ID RESISTANT STAPHYLOCOCCUS-AUREUS; INTENSIVE-CARE-UNIT; BLOOD-STREAM INFECTIONS; TO-PATIENT RATIO; NURSING STAFF; HEALTH-CARE; OUTBREAK; TORONTO; SARS; HOSPITALS AB Staffing patterns and nurses' working conditions are risk factors for healthcare-associated infections as well as occupational injuries and infections. Staffing shortages, especially of nurses, have been identified as one of the major factors expected to constrain hospitals' ability to deal with future outbreaks of emerging infections. These problems are compounded by a global nursing shortage. Understanding and improving nurses' working conditions can potentially decrease the incidence of many infectious diseases. Relevant research is reviewed, and policy options are discussed. C1 Columbia Univ, Sch Nursing, New York, NY 10032 USA. Univ Penn, Sch Nursing, Philadelphia, PA 19104 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Stone, PW (reprint author), Columbia Univ, Sch Nursing, 617 W 168th St, New York, NY 10032 USA. EM Ps2024@columbia.edu FU AHRQ HHS [R01 HS13114, R01 HS013114] NR 40 TC 26 Z9 28 U1 0 U2 2 PU CENTER DISEASE CONTROL PI ATLANTA PA ATLANTA, GA 30333 USA SN 1080-6040 J9 EMERG INFECT DIS JI Emerg. Infect. Dis PD NOV PY 2004 VL 10 IS 11 BP 1984 EP 1989 DI 10.3201/eid1011.040253 PG 6 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 869PY UT WOS:000224997700018 PM 15550212 ER PT J AU Hassol, A Walker, JM Kidder, D Rokita, K Young, D Pierdon, S Deitz, D Kuck, S Ortiz, E AF Hassol, A Walker, JM Kidder, D Rokita, K Young, D Pierdon, S Deitz, D Kuck, S Ortiz, E TI Patient experiences and attitudes about access to a patient electronic health care record and linked Web messaging SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article ID E-MAIL COMMUNICATION; PHYSICIAN COMMUNICATION AB Objective: Patient access to their electronic health care record (EHR) and Web-based communication between patients and providers can potentially improve the quality of health care, but little is known about patients' attitudes toward this combined electronic access. The objective of our study was to evaluate patients' values and perceptions regarding Web-based communication with their primary care providers in the context of access to their electronic health care record. Methods: We conducted an online survey of 4,282 members of the Geisinger Health System who are registered users of an application (MyChart) that allows patients to communicate electronically with their providers and view selected portions of their EHR. To supplement the survey, we also conducted focus groups with 25 patients who were using the system and conducted one-on-one interviews with ten primary care clinicians. We collected and analyzed data on user satisfaction, ease of use, communication preferences, and the completeness and accuracy of the patient EHR. Results: A total of 4,282 registered patient EHR users were invited to participate in the survey; 1,421 users (33%) completed the survey, 60% of them female. The age distribution of users was as follows: 18 to 30 (5%),31 to 45 (24%),46 to 64 (54%), 65 and older (16%). Using a continuous scale from 1 to 100, the majority of users indicated that the system was easy to use (mean scores ranged from 78 to 85) and that their medical record information was complete, accurate, and understandable (mean scores ranged from 65 to 85). Only a minority of users was concerned about the confidentiality of their information or about seeing abnormal test results after receiving only an explanatory electronic message from their provider. Patients preferred e-mail communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information), whereas they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer e-mail communication. Conclusion: Patients' attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions. C1 ABT Associates Inc, Cambridge, MA 02138 USA. Geisinger Hlth Syst, Danville, PA USA. Agcy Healthcare Res & Qual, Washington, DC USA. VA Med Ctr, Washington, DC USA. RP Hassol, A (reprint author), ABT Associates Inc, 55 Wheeler St, Cambridge, MA 02138 USA. EM andrea_hassol@abtassoc.com FU PHS HHS [290-00-0003] NR 23 TC 190 Z9 191 U1 3 U2 32 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD NOV-DEC PY 2004 VL 11 IS 6 BP 505 EP 513 DI 10.1197/jamia.M1593 PG 9 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Information Science & Library Science; Medical Informatics SC Computer Science; Information Science & Library Science; Medical Informatics GA 873UB UT WOS:000225305500009 PM 15299001 ER PT J AU Gray, DT AF Gray, DT TI Neonatal circumcision: Cost-effective preventive measure or "the unkindest cut of all"? SO MEDICAL DECISION MAKING LA English DT Editorial Material ID URINARY-TRACT-INFECTIONS; NEWBORN CIRCUMCISION; DECISION C1 Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Gray, DT (reprint author), Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, 540 Gaither Rd,Room 3353, Rockville, MD 20850 USA. EM dgray@ahrq.gov NR 36 TC 2 Z9 2 U1 1 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0272-989X J9 MED DECIS MAKING JI Med. Decis. Mak. PD NOV-DEC PY 2004 VL 24 IS 6 BP 688 EP 692 DI 10.1177/0272989X04271535 PG 5 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA 872KR UT WOS:000225206600013 PM 15534350 ER PT J AU Calonge, N AF Calonge, N TI Prevention of dental caries in preschool children: Recommendations and rationale - U.s. Preventive Services Task Force SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID HEALTH PROMOTION; ENAMEL FLUOROSIS; ORAL HEALTH; EDUCATION C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 18 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD OCT 15 PY 2004 VL 70 IS 8 BP 1529 EP 1532 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 865WY UT WOS:000224736100012 ER PT J AU Clancy, CM AF Clancy, CM TI The new faces of primary care SO AMERICAN JOURNAL OF MEDICINE LA English DT Editorial Material ID EXPERIENCES C1 US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, John M Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20850 USA. NR 6 TC 0 Z9 0 U1 0 U2 1 PU EXCERPTA MEDICA INC PI NEW YORK PA 650 AVENUE OF THE AMERICAS, NEW YORK, NY 10011 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD OCT 15 PY 2004 VL 117 IS 8 BP 613 EP 614 DI 10.1016/j.amjmed.2004.08.005 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 861SQ UT WOS:000224439300012 PM 15465512 ER PT J AU Chen, FM Bauchner, H Burstin, H AF Chen, FM Bauchner, H Burstin, H TI A call for outcomes research in medical education SO ACADEMIC MEDICINE LA English DT Article ID CERTIFICATION; PERSPECTIVE; DOCTORS; QUALITY; LINK; CARE AB The primary goal of medical education is to produce physicians who deliver high-quality health care. Recent calls for greater accountability in medical education and the development of outcomes research methodologies should encourage a new research effort to examine the effects of medical training upon clinical outcomes. The authors offer a research agenda that links medical education and quality of health care and give specific examples of potential research projects that would begin to examine that relationship. A proposed model of patient outcomes research in medical education recognizes the contributory effects of health care system-level factors as well as the continuum of medical education, process measures, and individual training and preparedness to deliver high-quality care. There exists an opportunity to create a research agenda in medical education outcomes research that is multidisciplinary, broad based, and focused on patient-centered outcomes. C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. Boston Univ, Sch Med, Med Ctr, Div Gen Pediat, Boston, MA USA. RP Chen, FM (reprint author), Univ Washington, Dept Family Med, Box 354982, Seattle, WA 98195 USA. EM fchen@u.washington.edu NR 31 TC 92 Z9 95 U1 0 U2 6 PU ASSOC AMER MEDICAL COLLEGES PI WASHINGTON PA 2450 N ST N W, WASHINGTON, DC 20037-1126 USA SN 1040-2446 J9 ACAD MED JI Acad. Med. PD OCT PY 2004 VL 79 IS 10 BP 955 EP 960 DI 10.1097/00001888-200410000-00010 PG 6 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA 857ID UT WOS:000224108800009 PM 15383351 ER PT J AU McInnes, K Landon, BE Malitz, FE Wilson, IB Marsden, PV Fleishman, JA Gustafson, DH Cleary, PD AF McInnes, K Landon, BE Malitz, FE Wilson, IB Marsden, PV Fleishman, JA Gustafson, DH Cleary, PD TI Differences in patient and clinic characteristics at CARE Act funded versus non-CARE Act funded HIV clinics SO AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV LA English DT Article ID SERVICES UTILIZATION; NEEDS; COST AB The Ryan White CARE Act supports comprehensive care to persons with HIV infection. With an annual budget of over $1 billion, it is the largest federally funded programme for HIV care in the USA. We analysed data from the HIV Costs and Services Utilization Study, a nationally representative sample of HIV patients. Patient data were collected in 1996-97 and clinic data were collected in 1998-99. We examined whether CARE Act funded clinics differed from other HIV clinics in (1) the characteristics of their patients, and (2) their organization, staffing, and services. We found that patients at CARE Act clinics were younger, less educated, poorer, and more likely to be female, non-white, unemployed, uninsured, and have heterosexual contact as an HIV risk factor, compared to patients at other HIV clinics. CARE Act clinics tended to specialize in HIV care, had more infectious disease specialists, had fewer total patients, and provided more support services (e.g. mental health, nutrition, case management, child care). These results are consistent with findings of other studies that were limited by non-probability samples or restricted geographical areas. C1 Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. US Hlth Resources & Serv Adm, HIV AIDS Bur, Rockville, MD 20857 USA. Tufts Univ New England Med Ctr, Boston, MA 02111 USA. Harvard Univ, Dept Sociol, Cambridge, MA 02138 USA. Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Wisconsin, Ctr Hlth Syst Res & Anal, Madison, WI USA. RP Cleary, PD (reprint author), Harvard Univ, Sch Med, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA. EM cleary@hcp.med.harvard.edu RI Wilson, Ira/F-9190-2016 OI Wilson, Ira/0000-0002-0246-738X FU AHRQ HHS [R01 HS1040802, R01HS10227, U-01HS08578] NR 10 TC 13 Z9 13 U1 1 U2 2 PU CARFAX PUBLISHING PI BASINGSTOKE PA RANKINE RD, BASINGSTOKE RG24 8PR, HANTS, ENGLAND SN 0954-0121 J9 AIDS CARE JI Aids Care-Psychol. Socio-Med. Asp. Aids/Hiv PD OCT PY 2004 VL 16 IS 7 BP 851 EP 857 DI 10.1080/09540120412331290202 PG 7 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychology, Multidisciplinary; Respiratory System; Social Sciences, Biomedical SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychology; Respiratory System; Biomedical Social Sciences GA 858MF UT WOS:000224195200007 PM 15385240 ER PT J AU London, AS Wilmoth, JM Fleishman, JA AF London, AS Wilmoth, JM Fleishman, JA TI Moving for care: findings from the USHIV cost and services utilization study SO AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV LA English DT Article ID NATIONAL PROBABILITY SAMPLES; LOW-PREVALENCE DISEASES; GEOGRAPHIC-MOBILITY; UNITED-STATES; AIDS EPIDEMIC; SAN-FRANCISCO; RURAL-AREAS; HIV COST; MIGRATION; HEALTH AB This paper examines sociodemographic and HIV-related factors associated with moving post-HIV diagnosis for non-care- and care-related reasons (versus never moving post-HIV diagnosis). Distinctions are made between those who move for informal care only, formal care only, or informal and formal care. Data come from the nationally representative US HIV Cost and Services Utilization Study (N = 2,864). Overall, 31.8% moved at least once post-HIV diagnosis and 16.3% moved most recently for care. Among those who moved for care, 32.6% moved for informal care only, 26.8% for formal care only, and 40.6% moved for both. Post-HIV diagnosis moves for reasons unrelated to care were less likely among African Americans and older persons, and more likely among those with longer durations positive. Moves for care were less likely among African Americans, older persons, and persons with higher educational attainments, while they were more likely among those with an AIDS diagnosis and longer durations HIV-positive. Among those who moved for care, women and persons with higher incomes were less likely to move for formal or mixed care than informal care only. Given that moving for care may reflect disparities in access to care and unmet needs, additional analyses with more detailed data are warranted. C1 Syracuse Univ, Ctr Policy Res, Maxwell Sch Citizenship & Publ Affairs, Syracuse, NY 13244 USA. Syracuse Univ, Dept Sociol, Syracuse, NY 13244 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP London, AS (reprint author), Syracuse Univ, Ctr Policy Res, Maxwell Sch Citizenship & Publ Affairs, 426 Eggers Hall, Syracuse, NY 13244 USA. EM aslondon@maxwell.syr.edu NR 33 TC 11 Z9 11 U1 2 U2 3 PU CARFAX PUBLISHING PI BASINGSTOKE PA RANKINE RD, BASINGSTOKE RG24 8PR, HANTS, ENGLAND SN 0954-0121 J9 AIDS CARE JI Aids Care-Psychol. Socio-Med. Asp. Aids/Hiv PD OCT PY 2004 VL 16 IS 7 BP 858 EP 875 DI 10.1080/09540120412331290149 PG 18 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychology, Multidisciplinary; Respiratory System; Social Sciences, Biomedical SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychology; Respiratory System; Biomedical Social Sciences GA 858MF UT WOS:000224195200008 PM 15385241 ER PT J AU Doty, P Hunt, G Spector, W AF Doty, P Hunt, G Spector, W TI Trends in formal and informal home care: The impact of medicare payment reform SO GERONTOLOGIST LA English DT Meeting Abstract C1 US Dept HHS, Washington, DC 20201 USA. Natl Alliance Caregiving, Bethesda, MD 20814 USA. AHRQ, Rockville, MD 20850 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2004 VL 44 SI 1 BP 153 EP 153 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 875YJ UT WOS:000225458800435 ER PT J AU Hawes, C Holan, S Sherman, M Phillips, C Spector, W AF Hawes, C Holan, S Sherman, M Phillips, C Spector, W TI Effects of assisted living facility characateristics on resident Medicare expenditures SO GERONTOLOGIST LA English DT Meeting Abstract C1 Sch Rural Publ Hlth, Bryan, TX USA. Texas A&M Univ, College Stn, TX USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2004 VL 44 SI 1 BP 247 EP 247 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 875YJ UT WOS:000225458801025 ER PT J AU McAuley, WJ Spector, WD Van Nostrand, J Shaffer, T AF McAuley, WJ Spector, WD Van Nostrand, J Shaffer, T TI The influence of rural location on utilization of formal home care: The role of Medicaid SO GERONTOLOGIST LA English DT Article DE Balanced Budget Act; Medicare home health; Medicaid coverage; metropolitan; nonmetropolitan ID LONG-TERM-CARE; HEALTH-CARE; STATE POLICY; SERVICE USE; AREAS; URBAN AB Purpose: This research examines the impact of rural-urban residence on formal home-care utilization among older people and determines whether and how Medicaid coverage influences the association between rural-urban location and risk of formal home-care use. Design and Methods: We combined data from the 1998 consolidated file of the Medical Expenditure Panel Survey Household Component with data from the Area Resource File to generate the analytical data set. We established two measures of formal home-care utilization: home care reimbursed through any source, and Medicarere-imbursed home health care. Our measures of rural-urban residence included metropolitan counties, nonmetropolitan counties having towns of at least 10,000 people, and nonmetropolitan counties with no towns of 10,000 people. We used logistic regression analyses to examine main effects and interaction effects of Medicaid coverage and residence on the two types of formal home care under controls for person-level characteristics and state fixed effects. Results: The unadjusted logistic analyses demonstrate that older people who reside in the most rural counties (nonmetropolitan counties having no town of 10,000) are significantly more likely than metropolitan residents to use any formal home care and Medicare home health care. The fully adjusted logistic analysis results point to an interplay between residential status and Medicaid coverage with regard to formal home-care use. In comparison with metropolitan residents covered by Medicaid, the adjusted relative risk of any formal home-care use is significantly higher for Medicaid enrollees residing in nonmetropolitan counties having no town of 10,000 people. Use of Medicare home health care is significantly greater for residents of the most rural counties, irrespective of their Medicaid coverage, as well as Medicaid-covered residents of nonmetropolitan counties having a town of at least 10,000 people. Implications: In nonmetropolitan areas, Medicaid may be an important mechanism for linking older individuals with formal home care, especially Medicare home health care, and with the services that generate formal home care. Formal home care, including Medicare home health care, may substitute for less available forms of care in the most rural of nonmetropolitan areas. Therefore, policies that limit access to formal home care could lead to increased service-related vulnerabilities among older rural residents. C1 Univ N Carolina, Dept Hlth Adm & Policy, Charlotte, NC 28223 USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. US Hlth Resources & Serv Adm, Off Rural Hlth Policy, Rockville, MD 20857 USA. RP McAuley, WJ (reprint author), Univ N Carolina, Dept Hlth Adm & Policy, Colvard Bldg,9201 Univ City Blvd, Charlotte, NC 28223 USA. EM wjmcaule@uncc.edu NR 47 TC 6 Z9 6 U1 1 U2 1 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2004 VL 44 IS 5 BP 655 EP 664 PG 10 WC Gerontology SC Geriatrics & Gerontology GA 865DK UT WOS:000224682500008 PM 15498841 ER PT J AU Lau, DT Kasper, JD Potter, DEB Lyles, A AF Lau, DT Kasper, JD Potter, DEB Lyles, A TI Potentially inappropriate medication prescriptions among elderly nursing home residents: Their scope and associated resident and facility characteristics SO HEALTH SERVICES RESEARCH LA English DT Article; Proceedings Paper CT 129th Annual Meeting of the American-Public-Health-Association CY OCT 21-25, 2001 CL ATLANTA, GA SP Amer Public Hlth Assoc DE quality of prescribing; medication errors; patient safety; long-term care residential setting; MEPS NHC ID LONG-TERM-CARE; DRUG-USE; EXPLICIT CRITERIA; QUALITY; OUTCOMES AB Objective. To estimate the scope of potentially inappropriate medication prescriptions (PIRx) among elderly residents in U.S. nursing homes (NHs), and to examine associated resident and facility characteristics. Data Sources. The 1996 Medical Expenditure Panel Survey Nursing Home Component (MEPS NHC), a survey of a nationally representative sample of NHs and residents. Study Design. The PIRx, defined by Beers's consensus criteria (1991, 1997), was identified using up to a year's worth of NH prescribed medicine data for each resident. The study sample represented 1.6 million NH residents (n=3,372). Results. At a minimum, 50 percent of all residents aged 65 or older, with an NH stay of three months or longer received at least one PIRx in 1996. The most common PIRx involved propoxyphene, diphenhydramine, hydroxyzine, oxybutynin, amitriptyline, cyproheptadine, iron supplements, and ranitidine. Resident factors associated with greater odds of PIRx were Medicaid coverage, no high school diploma, and nondementia mental disorders. Facility factors were more beds and lower RN-to-resident ratio. Factors associated with lower odds of PIRx were fewer medications, residents with communication problems, and being in an accredited NH. Onsite availability of pharmacists or mental health providers was not related. Implications. With quality of care and patient safety as major public health concerns, effective policies are needed to avoid PIRx occurrences and improve the quality of prescribing among elderly residents in NHs. Additional studies are needed to determine the impact of PIRx on this NH population. C1 Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD 21205 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. Univ Baltimore, Sch Govt & Publ Adm, Baltimore, MD 21201 USA. RP Kasper, JD (reprint author), Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, 624 N Broadway,Room 641, Baltimore, MD 21205 USA. NR 39 TC 81 Z9 82 U1 2 U2 17 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 2004 VL 39 IS 5 BP 1257 EP U4 DI 10.1111/j.1475-6773.2004.00289.x PG 24 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 893TQ UT WOS:000226742600004 PM 15333108 ER PT J AU Burstin, H Clancy, C AF Burstin, H Clancy, C TI Primary care experience - Crossing the chasm between theory and practice SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Burstin, H (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. NR 2 TC 2 Z9 2 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD OCT PY 2004 VL 19 IS 10 BP 1064 EP 1065 DI 10.1111/j.1525-1497.2004.40702.x PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 860MG UT WOS:000224347100012 PM 15482561 ER PT J AU Poker, A Hubbard, H Sharp, BAC AF Poker, A Hubbard, H Sharp, BAC TI The first national reports on United States Healthcare quality and disparities SO JOURNAL OF NURSING CARE QUALITY LA English DT Article DE healthcare disparities; National Healthcare Disparities Report; National Healthcare Quality Report; quality care AB In the Healthcare Research and Quality Act of 1999 (Public Law 106-129), Congress mandated that the Agency for Healthcare Research and Quality (AHRQ) produce annual reports on healthcare quality and disparities in the United States. The National Healthcare Quality Report and the National Healthcare Disparities Report were first released in 2003 by the AHRQ. These reports include broad sets of performance measures to portray the nation's progress toward improving the quality of care provided to all Americans. This article provides an overview of the framework, development, and future uses of the reports by consumers, practitioners, researchers, and policy makers. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Poker, A (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. EM apoker@abrq.gov NR 5 TC 3 Z9 3 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD OCT-DEC PY 2004 VL 19 IS 4 BP 316 EP 321 PG 6 WC Nursing SC Nursing GA 858AU UT WOS:000224163300005 PM 15535536 ER PT J AU Konetzka, RT Spector, W Shaffer, T AF Konetzka, RT Spector, W Shaffer, T TI Effects of nursing home ownership type and resident payer source on hospitalization for suspected pneumonia SO MEDICAL CARE LA English DT Article DE nursing homes; pneumonia; quality of care; financing; provider behavior incentives ID RESPIRATORY-TRACT INFECTION; DECISION-MAKING PROCESS; CARE; QUALITY; REIMBURSEMENT; MORTALITY; OUTCOMES; RATES AB Background: Whether to hospitalize residents with suspected pneumonia is a complex decision determined both by clinical and financial considerations. The decision to hospitalize may be different in for-profit and not-for-profit facilities and for different payment sources. Objective: The objective of this study was to examine the role of proprietary status in the decision to hospitalize residents with suspected pneumonia, controlling for facility- and resident-level factors. Data and Methods: The analysis uses the 1996 Medical Expenditure Panel Survey Nursing Home Component, a nationally representative sample of 5899 nursing home residents in 815 facilities. During the year, 766 elderly residents in the sample were suspected of having pneumonia infections and 224 were hospitalized for them. Logistic regression is used to assess factors affecting the decision to hospitalize among the 766 with pneumonia infections. Main Outcome Measure: Hospitalization for suspected pneumonia. Results: Residents with suspected pneumonia in not-for-profit facilities are hospitalized at a rate half that of for-profit facilities. The difference is most pronounced for residents who are older and more cognitively impaired and those who are covered by Medicare or private funds. Medicaid residents are most likely overall to be hospitalized, with higher rates in not-for-profit than for-profit facilities. Conclusion: Risk of hospitalization for suspected pneumonia varies widely by ownership type and resident payer source, with lowest overall risk in not-for-profit facilities. Higher Medicaid hospitalization in not-for-profit facilities is consistent with heterogeneity in the not-for-profit sector, where Medicaid residents are sorted into the lower-quality facilities. C1 Univ Chicago, Dept Hlth Studies, Chicago, IL 60637 USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Konetzka, RT (reprint author), Univ Chicago, Dept Hlth Studies, 5841 S Maryland Ave,MC2007, Chicago, IL 60637 USA. EM konetzka@health.bsd.uchicago.edu NR 37 TC 32 Z9 32 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD OCT PY 2004 VL 42 IS 10 BP 1001 EP 1008 DI 10.1097/00005650-200410000-00009 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 858MW UT WOS:000224196900009 PM 15377933 ER PT J AU Benjamins, MR Kirby, JB Huie, SAB AF Benjamins, MR Kirby, JB Huie, SAB TI County characteristics and racial and ethnic disparities in the use of preventive services SO PREVENTIVE MEDICINE LA English DT Article DE preventive health care; utilization; race; ethnicity; contextual effects ID CANCER SCREENING SERVICES; CERVICAL-CANCER; NATIONAL-SURVEY; INCOME INEQUALITY; AFRICAN-AMERICANS; HEALTH-SERVICES; BREAST-CANCER; CARE; WOMEN; MAMMOGRAPHY AB Background. Studies examining predictors of preventive service utilization generally focus on individual characteristics and ignore the role of contextual variables. To help address this gap in the literature, the present study investigates whether county-level characteristics, such as racial and ethnic composition, are associated with the use of preventive services. Methods. Data from the Medical Expenditure Panel Survey and the Area Resource Files (1996-1998) are used to identify the individual- and county-level predictors of five types of preventive services (n = 49,063). Results. County racial or ethnic composition is associated with the utilization of certain preventive services, net of individual-level characteristics. Specifically, individuals in high percent Hispanic counties are more likely to report cholesterol screenings, while those in counties with more blacks are more likely to have regular mammograms. Moreover, county racial or ethnic composition modifies the relationship between individual race or ethnicity and preventive use. In particular, Hispanic individuals who reside in high percent black counties report higher levels of utilization for most preventive services compared to Hispanics living in other counties. Conclusions. Physical and social environments are key determinants of health behaviors and outcomes. Future studies should take into account the racial or ethnic composition of an area and how this interacts with individual race or ethnicity when investigating predictors of preventive care use. (C) 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. C1 Univ Texas, Populat Res Ctr, Austin, TX 78712 USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. SW Educ Dev Lab, Austin, TX USA. RP Benjamins, MR (reprint author), Univ Texas, Populat Res Ctr, 1 Univ Stn G1800, Austin, TX 78712 USA. EM reindl@prc.utexas.edu NR 39 TC 46 Z9 46 U1 0 U2 4 PU ACADEMIC PRESS INC ELSEVIER SCIENCE PI SAN DIEGO PA 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 USA SN 0091-7435 J9 PREV MED JI Prev. Med. PD OCT PY 2004 VL 39 IS 4 BP 704 EP 712 DI 10.1016/j.ypmed.2004.02.039 PG 9 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 856OC UT WOS:000224053500009 PM 15351536 ER PT J AU Henriksen, K Moss, F AF Henriksen, K Moss, F TI From the runway to the airway and beyond SO QUALITY & SAFETY IN HEALTH CARE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. BMJ Grp, QSHC, London, England. RP Henriksen, K (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. EM KHenriks@ahrq.gov NR 7 TC 1 Z9 1 U1 0 U2 0 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD OCT PY 2004 VL 13 SU 1 BP I1 EP I1 DI 10.1136/qhc.13.suppl_1.i1 PG 1 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 866BZ UT WOS:000224749200001 PM 15465948 ER PT J AU Hughes, R Stone, P AF Hughes, R Stone, P TI The perils of shift work SO AMERICAN JOURNAL OF NURSING LA English DT Article ID SLEEP; NIGHT; HEALTH; RISK; PERFORMANCE; NURSES; WOMEN; ADJUSTMENT; ALERTNESS; SCHEDULES C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, New York, NY USA. Columbia Univ, New York, NY USA. RP Hughes, R (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, New York, NY USA. EM rhuges@ahrq.gov NR 38 TC 14 Z9 14 U1 1 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD SEP PY 2004 VL 104 IS 9 BP 60 EP 63 PG 4 WC Nursing SC Nursing GA 853ZM UT WOS:000223869600036 PM 15365343 ER PT J AU Fink, KS Byrns, PJ AF Fink, KS Byrns, PJ TI Changing prescribing patterns and increasing prescription expenditures in medicaid SO ANNALS OF FAMILY MEDICINE LA English DT Article DE medicaid; prescriptions; drug; health expenditures; delivery of health care; health services research; minority groups; costs and cost analysis; physician's practice patterns ID TRENDS AB PURPOSE Prescription drug expenditures are the most rapidly growing component of total health care expenditures and particularly affect state Medicaid programs. We determined the extent to which increasing prescription price and changing prescribing patterns contribute to rising prescription expenditures in Medicaid. METHODS We conducted a claims-based analysis comparing annual prescription drug expenditures and prescribing patterns. Prescription drug and outpatient visit claims for all North Carolina Medicaid enrollees from 1998 through 2000 were included. We analyzed drugs individually by combining all prescriptions and expenditures for the same drug formulation, and we calculated the number of units dispensed per person-year of enrollment. RESULTS Prescription drug coverage for I person-year cost $503 in 1998 and $759 in 2000, for an annual increase of 22.8%. The average number of prescriptions filled per person-year increased from 13.0 in 1998 to 15.5 in 2000. increased prescribing for 6 drugs accounted for more than 25% of the total increase in expenditures. The price for the 15 most expensive drugs increased an average of 4.1% annually. CONCLUSIONS Prices for existing drugs increased slightly during the study period, but the major cause of the increase in drug costs was an increase in the number of prescriptions for new and more expensive medications. Prescribing patterns in Medicaid differ somewhat from those in the private sector and partly reflect the population with low socioeconomic status and high health care needs that it serves. To help control rising prescription drug expenditures, efforts should be undertaken to improve appropriate and cost-effective prescribing. C1 Univ N Carolina, Dept Family Med, Chapel Hill, NC 27514 USA. Univ N Carolina, Off Res & Fac Dev, Chapel Hill, NC USA. RP Fink, KS (reprint author), Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM kfink@ahrq.gov NR 13 TC 13 Z9 13 U1 0 U2 0 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD SEP-OCT PY 2004 VL 2 IS 5 BP 488 EP 493 DI 10.1370/afm.121 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 879JV UT WOS:000225715000020 PM 15506586 ER PT J AU Selden, TM Hudson, JL Banthin, JS AF Selden, TM Hudson, JL Banthin, JS TI Tracking changes in eligibility and coverage among children, 1996-2002 SO HEALTH AFFAIRS LA English DT Article ID HEALTH-INSURANCE COVERAGE; MEDICAID EXPANSIONS; WELFARE-REFORM AB Data from the 1996 Medical Expenditure Panel Survey (MEPS) reveal that 4.7 million children were eligible for Medicaid but were uninsured. Numerous changes have occurred in the landscape for children's health insurance since then, including welfare reform and implementation of the State Children's Health Insurance Program (SCHIP). We use data from the 1996-2002 MEPS to track changes in the eligibility and coverage of children. As of 2002, uninsurance among children remained as much a problem of participation as one of eligibility. Nevertheless, we find evidence of dramatic improvements in program participation, reflecting the success of efforts to improve outreach, simplify enrollment, and increase retention. C1 Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM tselden@ahrq.gov NR 50 TC 39 Z9 40 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2004 VL 23 IS 5 BP 39 EP 50 DI 10.1377/hlthaff.23.5.39 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 856EF UT WOS:000224027800005 PM 15371369 ER PT J AU Dick, AW Brach, C Allison, RA Shenkman, E Shone, LP Szilagyi, PG Klein, JD Lewit, EM AF Dick, AW Brach, C Allison, RA Shenkman, E Shone, LP Szilagyi, PG Klein, JD Lewit, EM TI SCHIP's impact in three states: How do the most vulnerable children fare? SO HEALTH AFFAIRS LA English DT Article ID HEALTH-INSURANCE PROGRAM; NEW-YORK; CARE; ACCESS; ADOLESCENTS; ENROLLMENT; QUALITY; RACE AB This study provides consistent evidence, from three very diverse states with heterogeneous populations and distinct programs (Florida, Kansas, and New York), that the State Children's Health Insurance Program (SCHIP) increased access to and satisfaction with health care among enrolled low-income children and that vulnerable children-minorities, children and adolescents with special health care needs, and children who were uninsured for long periods of time-shared in these improvements. We highlight some areas to target for future improvement, such as reducing the high levels of unmet needs among special-needs children and increasing preventive care, especially for Hispanic children. C1 Univ Rochester, Sch Med & Dent, Dept Community & Prevent Med, Rochester, NY 14627 USA. AHRQ, Ctr Delivery Org & Markets, Rockville, MD USA. Kansas Hlth Inst, Topeka, KS USA. Univ Florida, Inst Child Hlth Policy, Gainesville, FL USA. Univ Rochester, Sch Med & Dent, Dept Pediat, Rochester, NY USA. Univ Rochester, Sch Med & Dent, Strong Childrens Res Ctr, Rochester, NY USA. David & Lucile Packard Fdn, Los Altos, CA USA. RP Dick, AW (reprint author), Univ Rochester, Sch Med & Dent, Dept Community & Prevent Med, Rochester, NY 14627 USA. EM Andrew_Dick@URMC.rochester.edu FU AHRQ HHS [HS10536, HS10450, HS10465] NR 27 TC 52 Z9 52 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2004 VL 23 IS 5 BP 63 EP 75 DI 10.1377/hlthaff.23.5.63 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 856EF UT WOS:000224027800007 PM 15371371 ER PT J AU Zuvekas, SH Hill, SC AF Zuvekas, SH Hill, SC TI Does capitation matter? Impacts on access, use, and quality SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID HEALTH MAINTENANCE ORGANIZATIONS; PRIMARY-CARE PHYSICIANS; FEE-FOR-SERVICE; MANAGED CARE; FINANCIAL INCENTIVES; PERFORMANCE; PAYMENT; PLANS; HMO AB Provider capitation may constrain costs, but it also may reduce access and quality of care. We examine the impacts of capitating the usual source of care of enrollees in health maintenance organizations (HMOs). We account for the endogeneity of capitation and other characteristics using generalized methods of moments (GMM) estimation on a sample from the Medical Expenditure Panel Survey for 1996 and 1997. Being organized as a group/staff HMO generally has stronger impact on access and quality than capitation. Capitation by itself may increase access to consumers' usual sources of care, improve primary preventive care, and reduce coordination, but estimates with GMM were not statistically significant. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Zuvekas, SH (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM szuvekas@ahrq.gov NR 36 TC 7 Z9 7 U1 1 U2 4 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 2004 VL 41 IS 3 BP 316 EP 335 PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 884CA UT WOS:000226061000008 PM 15669749 ER PT J AU Sing, M AF Sing, M TI Using encounter data from Medicaid HMOs for research and monitoring SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID MANAGED-CARE AB Complete encounter data from Medicaid HMOs are necessary to monitor patient access to care, compute risk-adjusted payments, and estimate savings from managed care. Encounter data from TennCare for 1996 and 1997 appear to be incomplete. This is the case despite state review of data quality, financial sanctions for Medicaid HMOs that appeared to be submitting incomplete data, and a preliminary assessment of encounter data for samples of two Medicaid enrollee subgroups suggesting that the encounter data might be reasonably complete. Although all states are required to submit Medicaid encounter data to the government, most states currently produce incomplete encounter data. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Sing, M (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM msing@ahrq.gov NR 30 TC 4 Z9 4 U1 0 U2 0 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 2004 VL 41 IS 3 BP 336 EP 346 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 884CA UT WOS:000226061000009 PM 15669750 ER PT J AU Phillips, S Lavin, R AF Phillips, S Lavin, R TI Readiness and response to public health emergencies: Help needed Now from professional nursing associations SO JOURNAL OF PROFESSIONAL NURSING LA English DT Editorial Material C1 AHRQ, Bioterrorism Preparedness Res Program, Rockville, MD 20850 USA. US PHS, CAPT, Off Assistant Secretary Publ Hlth Emergency Prepa, Washington, DC USA. RP Phillips, S (reprint author), AHRQ, Bioterrorism Preparedness Res Program, 540 Gaither Rd, Rockville, MD 20850 USA. EM sphillip@ahrq.gov RI Lavin, Roberta/H-1892-2016 OI Lavin, Roberta/0000-0001-6106-8066 NR 4 TC 2 Z9 2 U1 0 U2 2 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 8755-7223 J9 J PROF NURS JI J. Prof. Nurs. PD SEP-OCT PY 2004 VL 20 IS 5 BP 279 EP 280 DI 10.1016/j.profnurs.2004.07.003 PG 2 WC Nursing SC Nursing GA 870TQ UT WOS:000225081600004 PM 15494959 ER PT J AU Yabroff, KR Lawrence, WF Clauser, S Davis, WW Brown, ML AF Yabroff, KR Lawrence, WF Clauser, S Davis, WW Brown, ML TI Burden of illness in cancer survivors: Findings from a population-based national sample SO JOURNAL OF THE NATIONAL CANCER INSTITUTE LA English DT Article ID QUALITY-OF-LIFE; STAGE BREAST-CANCER; TIME TRADE-OFF; LONG-TERM; PROSTATE-CANCER; PATIENTS PREFERENCES; PATIENT PREFERENCES; RANDOMIZED-TRIALS; LIMITATION INDEX; HEALTH UTILITIES AB Background: Population trends in aging and improved cancer survival are likely to result in increased cancer prevalence in the United States, but few estimates of the burden of illness among cancer survivors are currently available. The purpose of this study was to estimate the burden of illness in cancer survivors in a national, population-based sample. Methods: A total of 1823 cancer survivors and 5469 age-, sex-, and educational attainment-matched control subjects were identified from the 2000 National Health Interview Survey. Multiple measures of burden, including utility, a summary measure of health, and days lost from work, were compared using two-sided tests of statistical significance for the two groups overall and for subgroups stratified by tumor site and time since diagnosis. Results: Compared with matched control subjects, cancer survivors had poorer outcomes across all burden measures (P<.01). Cancer survivors had lower utility values (0.74 versus 0.80; P<.001) and higher levels of lost productivity and were more likely to report their health as fair or poor (31.0% versus 17.9%; P<.001) than matched control subjects. Cancer survivors reported statistically significantly higher burden than did control subjects across tumor sites and across time since diagnosis (i.e., within the past year, 2-5 years, 6-10 years, and greater than or equal to11 years for the majority of measures. Conclusions: Cancer survivors have poorer health outcomes than do similar individuals without cancer across multiple burden measures. These decrements are consistent across tumor sites and are found in patients many years following reported diagnosis. Improved measurement of long-term burden of illness will be important for future prospective research. C1 NCI, Div Canc Control & Populat Sci, Hlth Serv & Econ Branch, Appl Res Program, Bethesda, MD 20892 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Yabroff, KR (reprint author), NCI, Div Canc Control & Populat Sci, Hlth Serv & Econ Branch, Appl Res Program, Execut Plaza N,Rm 4005,6130 Execut Blvd,MSC 7344, Bethesda, MD 20892 USA. EM yabroffr@mail.nih.gov OI Yabroff, K. Robin/0000-0003-0644-5572 NR 65 TC 290 Z9 293 U1 2 U2 15 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0027-8874 J9 J NATL CANCER I JI J. Natl. Cancer Inst. PD SEP 1 PY 2004 VL 96 IS 17 BP 1322 EP 1330 DI 10.1093/jnci/djh255 PG 9 WC Oncology SC Oncology GA 850JS UT WOS:000223607800012 PM 15339970 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Services Task Force TI Screening for family and intimate partner violence: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID ADVERSE CHILDHOOD EXPERIENCES; PREVENTIVE HEALTH-CARE; HOUSEHOLD DYSFUNCTION; DOMESTIC VIOLENCE; PREGNANT-WOMEN; TASK-FORCE; ABUSE; CHILDREN; RISK; NEGLECT C1 USPSTF, Chair US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Chair US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 47 TC 1 Z9 1 U1 0 U2 2 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD AUG 15 PY 2004 VL 70 IS 4 BP 747 EP 751 PG 5 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 848YX UT WOS:000223505300008 ER PT J AU Atkins, D Clancy, C AF Atkins, D Clancy, C TI Multiple risk factors interventions - Are we up to the challenge? SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Editorial Material ID PREVENTIVE-SERVICES C1 Agcy Hlth Care Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Atkins, D (reprint author), Agcy Hlth Care Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM datkins@ahrq.gov NR 16 TC 19 Z9 20 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD AUG PY 2004 VL 27 IS 2 SU S BP 102 EP 103 DI 10.1016/j.amepre.2004.04.016 PG 2 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 841YD UT WOS:000222967600011 PM 15275678 ER PT J AU Hellinger, FJ Encinosa, WE AF Hellinger, FJ Encinosa, WE TI Antiretroviral therapy and health care utilization: A study of privately insured men and women with HIV disease SO HEALTH SERVICES RESEARCH LA English DT Article DE HIV disease; access to care; gender disparities ID PNEUMOCYSTIS-CARINII-PNEUMONIA; INFECTED ADULTS; ZIDOVUDINE USE; UNITED-STATES; AIDS; SEX; MEDICAID; SERVICES; COST; CITY AB Objective. To compare the use of antiretroviral therapy and other health care resources by women and men with HIV disease who are privately insured. Data Sources. Data were obtained from the MarketScan Commercial Claims and Encounter Database produced by the Medstat Group, Inc., of Ann Arbor, Michigan. This database includes eligibility files as well as claims data for inpatient care, outpatient care, physician services, and prescription drugs for enrollees in employer-sponsored benefit plans for 24 large employers around the nation. Study Design. Examine utilization by 2,026 privately insured persons (1,494 men and 532 women) with HIV disease in calendar year 2000 under the age of 65. Principal Findings. Using a simple comparison, we found that 71 percent of men (68.7 to 73.3 percent is 95 percent confidence interval) and 39 percent of women (35.1 to 43.5 percent is 95 percent confidence interval) with HIV disease received antiretroviral therapy. We also found that the average annual drug cost was $9,037 for a man ($8,372 to $9,702 is 95 percent confidence interval) and $3,893 for a woman ($3,476 to $4,490 is 95 percent confidence interval). Furthermore, we found that the out-of-pocket expenses comprised 10 percent of total expenses for men ($1,617 out of $16,405) and 4 percent for women ($405 out of $10,397). Conclusion. There are major differences in the utilization and cost of health care between privately insured men and women with HIV disease. C1 CDOM, AHRQ, Rockville, MD 20850 USA. RP Hellinger, FJ (reprint author), CDOM, AHRQ, Room 5319,540 Gaither Rd, Rockville, MD 20850 USA. NR 26 TC 17 Z9 19 U1 0 U2 2 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD AUG PY 2004 VL 39 IS 4 BP 949 EP 967 DI 10.1111/j.1475-6773.2004.00266.x PN 1 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 893HT UT WOS:000226710600014 PM 15230936 ER PT J AU Calonge, N AF Calonge, N TI Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID PREGNANT-WOMEN; CONSUMPTION; DEPENDENCE; DRINKING; AUDIT; ABUSE; TESTS; CAGE C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 32 TC 3 Z9 3 U1 4 U2 4 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X EI 1532-0650 J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JUL 15 PY 2004 VL 70 IS 2 BP 353 EP 358 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 841MH UT WOS:000222933900011 ER PT J AU Berg, AO Allan, JD Frame, P Homer, GJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, GJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for syphilis infection: Recommendation statement SO ANNALS OF FAMILY MEDICINE LA English DT Review DE syphilis; mass screening; practice guidelines ID PENICILLIN-G; AZITHROMYCIN; BENZATHINE C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Rochester, NY USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Newark, NJ 07103 USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA 02115 USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Women & Infants Hosp Rhode Isl, Providence, RI USA. Univ Michigan, Ann Arbor, MI 48109 USA. Mt Sinai Med Ctr, Brookdale Dept Geriatr & Adult Dev, New York, NY 10029 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, New York, NY USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Community & Prevent Med, Fairfax, VA USA. RP Berg, AO (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 19 TC 8 Z9 11 U1 0 U2 0 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD JUL-AUG PY 2004 VL 2 IS 4 BP 362 EP 365 DI 10.1370/afm.215 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 879JU UT WOS:000225714900014 ER PT J AU Duggirala, AV Chen, FM Gergen, PJ AF Duggirala, AV Chen, FM Gergen, PJ TI Postoperative adverse events in teaching and nonteaching hospitals SO FAMILY MEDICINE LA English DT Article; Proceedings Paper CT Annual Scientific Assembly of the American-Academy-of-Family-Physicians CY OCT 01-05, 2003 CL New Orleans, LA SP Amer Acad Family Physicians ID QUALITY-OF-CARE; VASCULAR SURGICAL-PROCEDURES; MEDICARE BENEFICIARIES; MORTALITY-RATES; SURGEON VOLUME; OUTCOMES; COSTS AB Background and Objectives: With the recent attention on quality of care and residency training, teaching hospitals are coming under greater scrutiny. Despite several studies, there is still no consensus on whether teaching hospitals deliver higher quality of care than nonteaching hospitals. Methods: This was a retrospective cross-sectional study, using national hospital data. The sample consisted of 3,818 acute care hospitals in the National Inpatient Sample from 1990-1996. The quality indicators were postoperative adverse events, including venous thrombosis/pulmonary embolism (DVT/PE), pulmonary compromise, pneumonia, and urinary tract infection (UTI). Hospitals were classified as major teaching, other teaching, and nonteaching. Quality indicator rates of hospital types were compared and multivariate regression performed to control for specific hospital characteristics. Results: Teaching hospitals had higher rates of postoperative DVT/PE and pulmonary compromise but lower rates of UTI, compared with nonteaching hospitals. In the multivariate analysis, teaching hospitals were more likely to have higher postoperative DVT/PE rates, and other teaching hospitals had higher rates of pulmonary compromise and UTI. Postoperative pneumonia rates were higher in major teaching hospitals than nonteaching hospitals. Conclusions: Rates of postoperative adverse events were higher in teaching hospitals compared to nonteaching hospitals. These findings suggest that quality of care, as measured by postoperative adverse events, may not be higher in teaching hospitals. C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, Rockville, MD USA. Georgetown Univ, Providence Hosp, Family Practice Residency Program, Washington, DC 20057 USA. RP Duggirala, AV (reprint author), Univ Maryland, Sch Med, Dept Family Med, 29 S Paca St LL, Baltimore, MD 21201 USA. EM amar_duggirala@hotmail.com NR 29 TC 17 Z9 17 U1 1 U2 1 PU SOC TEACHERS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, STE 540, LEAWOOD, KS 66207 USA SN 0742-3225 J9 FAM MED JI Fam. Med. PD JUL-AUG PY 2004 VL 36 IS 7 BP 508 EP 513 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 837JP UT WOS:000222625900016 PM 15243833 ER PT J AU Kerker, BD Owens, PL Zigler, E Horwitz, SM AF Kerker, BD Owens, PL Zigler, E Horwitz, SM TI Mental health disorders among individuals with mental retardation: Challenges to accurate prevalence estimates SO PUBLIC HEALTH REPORTS LA English DT Article ID PAST 10 YEARS; INTELLECTUAL DISABILITY; PSYCHIATRIC-DISORDERS; INTERNATIONAL-ASSOCIATION; RETARDED ADULTS; CHILDREN; PEOPLE; PSYCHOPATHOLOGY; CARE; RELIABILITY AB Objectives. The objectives of this literature review were to assess current challenges to estimating the prevalence of mental health disorders among individuals with mental retardation (MR) and to develop recommendations to improve such estimates for this population. Methods. The authors identified 200 peer-reviewed articles, book chapters, government documents, or reports from national and international organizations on the mental health status of people with MR. Based on the study's inclusion criteria, 52 articles were included in the review. Results. Available data reveal inconsistent estimates of the prevalence of mental health disorders among those with MR, but suggest that some mental health conditions are more common among these individuals than in the general population. Two main challenges to identifying accurate prevalence estimates were found: (1) health care providers have difficulty diagnosing mental health conditions among individuals with MR; and (2) methodological limitations of previous research inhibit confidence in study results. Conclusions. Accurate prevalence estimates are necessary to ensure the availability of appropriate treatment services. To this end, health care providers should receive more training regarding the mental health treatment of individuals with MR. Further, government officials should discuss mechanisms of collecting nationally representative data, and the research community should utilize consistent methods with representative samples when studying mental health conditions in this population. C1 Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, New Haven, CT 06510 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Yale Univ, Dept Psychol, New Haven, CT 06520 USA. Yale Univ, Sch Med, Ctr Child Study, New Haven, CT 06510 USA. Case Western Reserve Univ, Dept Psychiat, Cleveland, OH 44106 USA. RP Kerker, BD (reprint author), New York City Dept Hlth & Mental Hyg, 125 Worth St, Rm 315,CN 6, New York, NY 10013 USA. EM bkerker@health.nyc.gov FU NIMH NIH HHS [5T32-MH15783, 5T32-MH19545] NR 56 TC 33 Z9 34 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD JUL-AUG PY 2004 VL 119 IS 4 BP 409 EP 417 DI 10.1016/j.phr.2004.05.005 PG 9 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 860BB UT WOS:000224311100006 PM 15219798 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Serv Task Force TI Screening for coronary heart disease: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID ARTERY-DISEASE; RESTING ELECTROCARDIOGRAM; AMERICAN-COLLEGE; MEN C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 22 TC 0 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JUN 15 PY 2004 VL 69 IS 12 BP 2891 EP 2894 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 831JF UT WOS:000222190000012 ER PT J AU Basu, J Friedman, B Burstin, H AF Basu, J Friedman, B Burstin, H TI Managed care and preventable hospitalization among Medicaid adults SO HEALTH SERVICES RESEARCH LA English DT Article DE preventable hospitalization; ambulatory care sensitive admissions; Medicaid; managed care; HMO enrollment; access ID HEALTH-CARE; RATES; ACCESS; STATE; INSURANCE; CHILDREN; DISEASE; IMPACT AB Objective. The study examines the association between managed care enrollment and preventable hospitalization patterns of adult Medicaid enrollees hospitalized in four states. Data Sources/Study Setting. Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) database of the Agency for Healthcare Research and Quality (AHRQ) for New York (NY), Pennsylvania (PA), Wisconsin (WI), and Tennessee (TN) residents in the age group 20-64 hospitalized in those states, linked to the Area Resource File (ARF) and American Hospital Association (AHA) survey files for 1997. Study Design. The study uses separate logistic models for each state comparing preventable admissions with marker admissions (urgent, insensitive to primary care). The model controls for socioeconomic and demographic variables, and severity of illness. Principal Findings. Consistently in different states, private health maintenance organization (HMO) enrollment was associated with fewer preventable admissions than marker admissions, compared to private fee-for-service (FFS). However, Medicaid managed care enrollment was not associated with a reduction in preventable admissions, compared to Medicaid FFS. Conclusions. Our analysis suggests that the preventable hospitalization pattern for private HMO enrollees differs significantly from that for commercial FFS enrollees. However, little difference is found between Medicaid HMO enrollees and Medicaid FFS patients. The findings did not vary by the level of Medicaid managed care penetration in the study states. C1 AHRQ, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. AHRQ, Ctr Delivery Organizat & Markets, Rockville, MD 20850 USA. RP Basu, J (reprint author), AHRQ, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. NR 32 TC 30 Z9 31 U1 1 U2 4 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 2004 VL 39 IS 3 BP 489 EP 509 DI 10.1111/j.1475-6773.2004.00241.x PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 823TP UT WOS:000221636400005 PM 15149475 ER PT J AU Friedman, B Basu, J AF Friedman, B Basu, J TI The rate and cost of hospital readmissions for preventable conditions SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE cost; preventable readmissions; healthcare cost and utilization project; PQI ID PRIMARY-CARE; AMBULATORY CARE; MEDICAL-CARE; HEALTH-CARE; QUALITY; CHILDREN; INSURANCE; ACCESS AB The study estimates the rate and cost of preventable readmissions within 6 months after a first preventable admission, by age-group, and by payer and race within age-group. The descriptive results are contrasted with several hypotheses. The hospital discharge data are for residents of New York, Pennsylvania, Tennessee, and Wisconsin in 1999,from files of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. About 19 percent of persons with an initial preventable admission had at least one preventable readmission rate within 6 months. Hospital cost for preventable readmissions during 6 months was about $730 million. There were substantial differences in readmission rates by payer group and by race. Some evidence suggests that preventable readmissions may partly reflect complexity of underlying problems. Interventions to reduce cost might focus on identifying high-risk patients before discharge and devising new approaches to follow-up. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Friedman, B (reprint author), Agcy Healthcare Res & Qual, Room 5133,540 Gaither Rd, Rockville, MD 20850 USA. EM bfriedma@ahrq.gov NR 21 TC 100 Z9 100 U1 1 U2 8 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD JUN PY 2004 VL 61 IS 2 BP 225 EP 240 DI 10.1177/1077558704263799 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 821UK UT WOS:000221488200005 PM 15155053 ER PT J AU Miller, MR Zhan, CL AF Miller, MR Zhan, CL TI Pediatric patient safety in hospitals: A national picture in 2000 SO PEDIATRICS LA English DT Article DE safety; quality of health care; medical error; infant; child; adolescent; inpatients; hospitals ID ICD-9-CM ADMINISTRATIVE DATA; CLINICAL COMORBIDITY INDEX; QUALITY-OF-CARE; MORTALITY AB Objective. To describe potential patient safety events for hospitalized children, examine associated factors, and explore impacts of safety events. Methods. The newly released Patient Safety Indicators (PSIs), developed by researchers at the Agency for Healthcare Research and Quality to identify potential in-hospital patient safety problems using administrative data, were applied to hospital discharge data. All 5.7 million discharge records for children younger than 19 years from 27 states in the 2000 Healthcare Cost and Utilization Project were analyzed for PSI events. Prevalence of PSI events and associations with patient-level and hospital-level characteristics were examined. Multivariate regression adjusting for patient severity of illness was used to estimate impacts of safety events in terms of excess length of stay, charges, and in-hospital mortality. Results. The prevalence of pediatric patient safety events is significant. PSI events occurred more frequently in the very young and those on Medicaid insurance, some of the most vulnerable hospitalized children. Regression analysis found that almost all PSIs are associated with significant and substantial increases in length of stay, charges, and in-hospital death. Using the estimates derived here and the actual number of cases identified in the 2000 data, we estimate that patient safety events incurred >$ 1 billion in excess charges for children alone in 2000. Conclusions. Patient safety problems for hospitalized children occur frequently and with substantial impacts to our health care industry. Unmeasurable by this study are the additional "costs" and "burdens" of safety events that our patients are forced to handle. Additional work to describe and quantify better these outcomes in addition to ones measured here can help solidify the "business case" for patient safety efforts. C1 Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Miller, MR (reprint author), Johns Hopkins Childrens Ctr, CMSC 2-125,600 N Wolfe St, Baltimore, MD 21287 USA. EM mmille21@jhmi.edu NR 25 TC 86 Z9 86 U1 0 U2 2 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JUN PY 2004 VL 113 IS 6 BP 1741 EP 1746 DI 10.1542/peds.113.6.1741 PG 6 WC Pediatrics SC Pediatrics GA 825TP UT WOS:000221781500028 PM 15173500 ER PT J AU Calonge, N AF Calonge, N CA US Prevent Serv Task Force TI Screening for thyroid disease: Recommendation statement SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID L-THYROXINE TREATMENT; SUBCLINICAL HYPOTHYROIDISM; DOUBLE-BLIND; BONE MASS; WOMEN; LEVOTHYROXINE; METAANALYSIS; PREVALENCE; HEALTH; TSH C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 25 TC 0 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAY 15 PY 2004 VL 69 IS 10 BP 2415 EP 2418 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 823OT UT WOS:000221623300011 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Klein, JD Lieu, TA Orleans, CT Peipert, JF Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Klein, JD Lieu, TA Orleans, CT Peipert, JF Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Services Task TI Lung cancer screening: Recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer and the supporting scientific evidence and updates the 1996 recommendations on this topic. In 1996, the USPSTF recommended against screening for lung cancer (a grade D recommendation). The Task Force now uses an explicit process in which the balance of benefits and harms is determined exclusively by the quality and magnitude of the evidence. As a result, current letter grades are based on different criteria than those used in 1996. The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the systematic evidence review on this topic, available through the USPSTF Web site ( www.preventiveservices.ahrq.gov) and the National Guideline Clearinghouse (www.guideline.gov). The complete USPSTF recommendation statement (which includes a brief review of the supporting evidence) and the summary of the evidence are also available in print through the Agency for Healthcare Research and Quality Publications Clearinghous (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov). C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 2 TC 58 Z9 58 U1 0 U2 2 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAY 4 PY 2004 VL 140 IS 9 BP 738 EP 739 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 816XR UT WOS:000221143100008 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH TI Prevention of dental caries in preschool children - Recommendations and rationale SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Review ID HEALTH PROMOTION; ENAMEL FLUOROSIS; ORAL HEALTH; EDUCATION C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland Baltimore, Sch Nursing, Baltimore, MD USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Newark, NJ 07103 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Brown Univ, Women & Infants Hosp, Providence, RI USA. Univ Michigan, Ann Arbor, MI 48109 USA. Mt Sinai Sch Med, Div Gen Internal Med, New York, NY USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, New York, NY USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Community & Prevent Med, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. NR 20 TC 7 Z9 7 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD MAY PY 2004 VL 26 IS 4 BP 326 EP 329 DI 10.1016/j.amepre.2004.01.008 PG 4 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 814UV UT WOS:000221000500011 ER PT J AU Manski, RJ Goodman, HS Reid, BC Macek, MD AF Manski, RJ Goodman, HS Reid, BC Macek, MD TI Dental insurance visits and expenditures among older adults SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID UNITED-STATES; CARE; HEALTH; SERVICES AB Objectives. We examined the effect of age, income, and coverage on dental service utilization during 1996. Methods. We used data from the 1996 Medical Expenditure Panel Survey. Results. Edentulous and poorer older adults are less likely to have coverage and less likely to report a dental visit than dentate or wealthier older adults. Conclusions. These analyses help to describe the needs of older adults as they cope with diminishing resources as a consequence of retirement, including persons previously accustomed to accessing oral health services with dental insurance. C1 Univ Maryland, Sch Dent, Dept Hlthk Promot & Policy, Baltimore, MD 21201 USA. Ctr Financing Access & Cost Trends, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Manski, RJ (reprint author), Univ Maryland, Sch Dent, Dept Hlthk Promot & Policy, 666 W Baltimore St, Baltimore, MD 21201 USA. EM manski@dental.umaryland.edu NR 27 TC 30 Z9 31 U1 0 U2 0 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD MAY PY 2004 VL 94 IS 5 BP 759 EP 764 DI 10.2105/AJPH.94.5.759 PG 6 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 816LM UT WOS:000221111400018 PM 15117697 ER PT J AU Calonge, N Allan, JD Berg, AO Frame, PS Garcia, J Gordis, L Gregory, KD Harris, R Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP AF Calonge, N Allan, JD Berg, AO Frame, PS Garcia, J Gordis, L Gregory, KD Harris, R Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Ockene, JK Petitti, DB Siu, AL Teutsch, SM Yawn, BP TI Screening for ovarian cancer: Recommendation statement SO ANNALS OF FAMILY MEDICINE LA English DT Article DE ovarian neoplasms; mass screening; practice guidelines ID ASYMPTOMATIC WOMEN; POSTMENOPAUSAL WOMEN; REPLACEMENT THERAPY; RISK; ULTRASONOGRAPHY; TRIAL; COLOR C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Colorado Dept Publ Hlth & Environm, Denver, CO USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Rochester, NY USA. Pan Amer Hlth Org, Washington, DC USA. Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA. Cedars Sinai Med Ctr, Dept Obstet & Gynecol, Los Angeles, CA 90048 USA. Univ N Carolina, Sch Med, Ctr Hlth Serv Res, Chapel Hill, NC USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Newark, NJ 07103 USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. Univ Texas, Dept Pediat, Houston, TX 77225 USA. Univ Massachusetts, Sch Med, Div Prevent & Behav Med, Worcester, MA 01605 USA. Kaiser Permanente So Calif, Pasadena, CA USA. Mt Sinai Med Ctr, Brookdale Dept Geriatr & Adult Dev, New York, NY 10029 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Olmstead Res Ctr, Rochester, MN USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 23 TC 38 Z9 38 U1 1 U2 2 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD MAY-JUN PY 2004 VL 2 IS 3 BP 260 EP 262 DI 10.1370/afm.200 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 879JT UT WOS:000225714800014 ER PT J AU Berg, AO Allan, JD Calonge, N Frame, P Garcia, J Harris, R Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Orleans, CT Siu, AL Teutsch, SM Westhoff, C Woof, SH AF Berg, AO Allan, JD Calonge, N Frame, P Garcia, J Harris, R Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Orleans, CT Siu, AL Teutsch, SM Westhoff, C Woof, SH CA US Preventative Services Task Forc TI Screening for visual impairment in children younger than age 5 years: Recommendation statement SO ANNALS OF FAMILY MEDICINE LA English DT Article DE amblyopia; mass screening; practice guidelines ID PHOTOSCREENING PHOTOGRAPHS; STRABISMIC AMBLYOPIA; PREVERBAL CHILDREN; RANDOMIZED TRIAL; PENALIZATION; OCCLUSION; EFFICACY; ATROPINE; THERAPY; PROGRAM C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Colorado Dept Publ Hlth & Environm, Denver, CO USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY USA. Pan Amer Hlth Org, Washington, DC USA. Univ N Carolina, Sch Med, Sheps Ctr Hlth Serv Res, Chapel Hill, NC USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Newark, NJ 07103 USA. Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. Univ Texas, Dept Pediat, Houston, TX 77225 USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Mt Sinai Med Ctr, Brookdale Dept Geriatr & Adult Dev, New York, NY 10029 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, New York, NY USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Prevent & Community Med, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 35 TC 19 Z9 19 U1 2 U2 3 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD MAY-JUN PY 2004 VL 2 IS 3 BP 263 EP 266 DI 10.1370/afm.193 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 879JT UT WOS:000225714800015 ER PT J AU Leaf, PJ Owens, PL Leventhal, JM Forsyth, BWC Vaden-Kiernan, M Epstein, LD Riley, AW Horwitz, SM AF Leaf, PJ Owens, PL Leventhal, JM Forsyth, BWC Vaden-Kiernan, M Epstein, LD Riley, AW Horwitz, SM TI Pediatricians' training and identification and management of psychosocial problems SO CLINICAL PEDIATRICS LA English DT Article ID CHILDHOOD PSYCHIATRIC-DISORDERS; SENTINEL PRACTICE NETWORK; HEALTH-SERVICE USE; PRIMARY-CARE; OFFICE SETTINGS; CHILDREN; PREVALENCE; MORBIDITY; RECOGNITION; PSYCHOPATHOLOGY AB This study evaluated the association of pediatrician training on the identification and management of current and ongoing emotional or behavioral problems among children ages 4-8 years in 19 practices in south-central Connecticut. Pediatricians with advanced training in psychosocial Issues were more likely to identify children's psychosocial problems and use multiple management strategies compared with pediatricians with no specialized training. Although pediatricians with moderate training in psychosocial issues were more likely to identify psychosocial problems compared with pediatricians with no training, there was no relationship between moderate training and management of psychosocial problems. These results suggest that identification and management of young children's psychosocial problems demands advanced training and support the American Academy of Pediatrics' call for more extensive training. C1 Johns Hopkins Bloomberg Sch Publ Hlth, Dept Mental Hlth, Baltimore, MD 21205 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Yale Univ, Sch Med, Ctr Child Study, Dept Pediat, New Haven, CT 06510 USA. CDM Grp Inc, Chevy Chase, MD USA. Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA. Catholic Univ Chile, Dept Stat, Santiago, Chile. Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, New Haven, CT 06510 USA. Case Western Reserve Univ, Sch Med, Dept Psychiat, Cleveland, OH 44106 USA. RP Leaf, PJ (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Dept Mental Hlth, 624 N Broadway, Baltimore, MD 21205 USA. FU NIMH NIH HHS [5T32-MH19545, 5T32-MH15783, R01-MH41638] NR 36 TC 37 Z9 37 U1 2 U2 3 PU WESTMINSTER PUBL INC PI GLEN HEAD PA 708 GLEN COVE AVE, GLEN HEAD, NY 11545 USA SN 0009-9228 J9 CLIN PEDIATR JI Clin. Pediatr. PD MAY PY 2004 VL 43 IS 4 BP 355 EP 365 DI 10.1177/000992280404300407 PG 11 WC Pediatrics SC Pediatrics GA 821JX UT WOS:000221457600007 PM 15118779 ER PT J AU Pugh, MJV Fincke, BG Bierman, A Cunningham, F Amuan, M Berlowitz, D AF Pugh, MJV Fincke, BG Bierman, A Cunningham, F Amuan, M Berlowitz, D TI Potentially inappropriate prescribing for older veterans: Who's at risk? SO VALUE IN HEALTH LA English DT Meeting Abstract C1 Bedford VAMC, VA New England, Bedford, MA USA. Boston Univ, Boston, MA 02215 USA. AHRQ, Rockville, MD USA. Ctr Hlth Qual Outomes & Econ Res, Boston, MA USA. VA Bedford, Ctr Hlth Qual Outcomes & Econ Res, Bedford, MA USA. Hines VA Med Ctr, Boston, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2004 VL 7 IS 3 BP 376 EP 376 DI 10.1016/S1098-3015(10)62549-1 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 819ZW UT WOS:000221356600488 ER PT J AU Calonge, N AF Calonge, N CA US Preventive Services Task Force TI Screening for obesity in adults: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 3 TC 3 Z9 3 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD APR 15 PY 2004 VL 69 IS 8 BP 1973 EP 1976 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 815LG UT WOS:000221043200015 ER PT J AU Berg, AO Allan, JD Calonge, N Frame, P Garcia, J Harris, RP Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Orleans, CT Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Calonge, N Frame, P Garcia, J Harris, RP Johnson, MS Klein, JD Loveland-Cherry, C Moyer, VA Orleans, CT Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Services Task Force TI Screening for coronary heart disease: Recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID ARTERY BYPASS-SURGERY; RESTING ELECTROCARDIOGRAM; AMERICAN-COLLEGE; ANGIOPLASTY; TRIAL; MEN AB This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendations on screening for coronary heart disease and the supporting scientific evidence and updates the 1996 recommendations on this topic. The complete information on which this statement is based, including evidence tables and references, is available in the background article and the systematic evidence review, available through the USPSTF Web site (www.preventiveservices.ahrq.gov) and through the National Guideline Clearinghouse (www.guideline.gov). The article and the recommendation statement are also available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov). C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. RP Berg, AO (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. NR 21 TC 85 Z9 87 U1 0 U2 2 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD APR 6 PY 2004 VL 140 IS 7 BP 569 EP 572 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 808OE UT WOS:000220577600010 ER PT J AU Zhan, CL Miller, MR Wong, H Meyer, GS AF Zhan, CL Miller, MR Wong, H Meyer, GS TI The effects of HMO penetration on preventable hospitalizations SO HEALTH SERVICES RESEARCH LA English DT Article DE HMOs; preventable hospitalizations; quality of care ID SMALL-AREA ANALYSIS; MANAGED CARE; HEALTH-CARE; AVOIDABLE HOSPITALIZATION; COST INFLATION; UNITED-STATES; MEDICAL-CARE; RATES; QUALITY; PERFORMANCE AB Objective. To examine the effects of health maintenance organization (HMO) penetration on preventable hospitalizations. Data Source. Hospital inpatient discharge abstracts for 932 urban counties in 22 states from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), hospital data from American Hospital Association (AHA) annual survey, and population characteristics and health care capacity data from Health Resources and Services Administration (HRSA) Area Resource File (ARF) for 1998. Methods. Preventable hospitalizations due to 14 ambulatory care sensitive conditions were identified using the Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators. Multiple regressions were used to determine the association between preventable hospitalizations and HMO penetration while controlling for demographic and socioeconomic characteristics and health care capacity of the counties. Principal Findings. A 10 percent increase in HMO penetration was associated with a 3.8 percent decrease in preventable hospitalizations (95 percent confidence interval, 2.0 percent-5.6 percent). Advanced age, female gender, poor health, poverty, more hospital beds, and fewer primary care physicians per capita were significantly associated with more preventable hospitalizations. Conclusions. Our study suggests that HMO penetration has significant effects in reducing preventable hospitalizations due to some ambulatory care sensitive conditions. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Massachusetts Gen Hosp, Boston, MA 02114 USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD USA. NR 56 TC 39 Z9 39 U1 2 U2 6 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2004 VL 39 IS 2 BP 345 EP 361 DI 10.1111/j.1475-6773.2004.00231.x PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 801MU UT WOS:000220100800008 PM 15032958 ER PT J AU Tierney, WM Hudson, BL Oppenheimer, CC Finn, A Benz, J Zafar, A Lanier, D Gaylin, DS AF Tierney, WM Hudson, BL Oppenheimer, CC Finn, A Benz, J Zafar, A Lanier, D Gaylin, DS TI A national survey of primary care practice-based research networks. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med C1 Indiana Univ, Sch Med, Indianapolis, IN USA. Univ Chicago, Natl Opin Res Ctr, Washington, DC USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2004 VL 19 SU 1 BP 111 EP 111 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 816RA UT WOS:000221125800370 ER PT J AU Johannson, P Moy, E Siegel, S Burstin, H AF Johannson, P Moy, E Siegel, S Burstin, H TI A snapshot of healthcare for American Indians: The National Healthcare Disparities Report SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med C1 Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2004 VL 19 SU 1 BP 112 EP 113 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 816RA UT WOS:000221125800377 ER PT J AU Ortiz, E Surks, M Daniels, G Sawin, C Col, N AF Ortiz, E Surks, M Daniels, G Sawin, C Col, N TI Evidence review: Diagnosis and management of subclinical thyroid disease. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med C1 AHRQ, Rockville, MD USA. Montefiore Med Ctr, Bronx, NY 10467 USA. Albert Einstein Coll Med, Bronx, NY 10467 USA. Massachusetts Gen Hosp, Boston, MA 02114 USA. Brigham & Womens Hosp, Boston, MA 02115 USA. Vet Adm, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2004 VL 19 SU 1 BP 151 EP 151 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 816RA UT WOS:000221125800537 ER PT J AU Ortiz, E Hassol, A Walker, JM Kidder, D Rokita, K Young, D Pierdon, S Deitz, D Kuck, S AF Ortiz, E Hassol, A Walker, JM Kidder, D Rokita, K Young, D Pierdon, S Deitz, D Kuck, S TI Patient experiences and attitudes about electronic communication and online access to medical records. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med C1 Agcy Healthcare Res & Qual, Rockville, MD USA. ABT Associates Inc, Cambridge, MA 02138 USA. Geisinger Hlth Syst, Danville, PA USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2004 VL 19 SU 1 BP 186 EP 186 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 816RA UT WOS:000221125800687 ER PT J AU Thomas, N Fleishman, JA Turner, BJ AF Thomas, N Fleishman, JA Turner, BJ TI The gender gap in access to highly active antiretroviral therapy (HAART): Effect of treatment for mental health disorders and substance abuse. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med C1 Univ Penn, Philadelphia, PA 19104 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2004 VL 19 SU 1 BP 219 EP 219 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 816RA UT WOS:000221125800826 ER PT J AU Hsu, J Huang, J Kinsman, CJ Fagan, J Fireman, BH Ortiz, E Miller, R Selby, JV AF Hsu, J Huang, J Kinsman, CJ Fagan, J Fireman, BH Ortiz, E Miller, R Selby, JV TI Use of e-Health care services between 1999 and 2002: A growing digital divide. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med C1 Kaiser Permanente, Div Res, Oakland, CA USA. Kaiser Permanente, Hlth Plan, Oakland, CA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif San Francisco, San Francisco, CA 94143 USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2004 VL 19 SU 1 BP 232 EP 232 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 816RA UT WOS:000221125800881 ER PT J AU Stryer, DB Siegel, JE Rodgers, AB AF Stryer, DB Siegel, JE Rodgers, AB TI Outcomes research - Priorities for an evolving field SO MEDICAL CARE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Falls Church, VA USA. RP Stryer, DB (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. EM dstryer@ahrq.gov NR 11 TC 5 Z9 5 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 2004 VL 42 IS 4 SU S BP 1 EP 5 DI 10.1097/01.mlr.0000119324.73834.3b PG 5 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 808HH UT WOS:000220559700001 ER PT J AU Weinick, RM Jacobs, EA Stone, LC Ortega, AN Burstin, H AF Weinick, RM Jacobs, EA Stone, LC Ortega, AN Burstin, H TI Hispanic healthcare disparities - Challenging the myth of a monolithic Hispanic population SO MEDICAL CARE LA English DT Article DE Hispanic; disparities; healthcare utilization ID GENERATIONAL-DIFFERENCES; MEXICAN-AMERICANS; LANGUAGE BARRIERS; HHANES 1982-84; UNITED-STATES; SERVICES; WOMEN; IMPACT; ACCESS AB Background: Hispanic Americans are often treated as a monolithic ethnic group with a single pattern of healthcare utilization. However, there could be considerable differences within this population. We examine the association between use of healthcare services and Hispanic Americans' country of ancestry or origin, language of interview, and length of time lived in the United States. Methods: Our data come from the Medical Expenditure Panel Survey, a nationally representative survey of healthcare use and expenditures. Descriptive statistics and logistic regression results are presented. Results: Multivariate models show that Mexicans and Cubans are less likely, and Puerto Ricans more likely, to have any emergency department visits than non-Hispanic whites. Mexicans, Central American/Caribbeans, and South Americans are less likely to have any prescription medications. All Hispanics are less likely to have any ambulatory visits and prescription medications, whereas only those with a Spanish-language interview are less likely to have emergency department visits and inpatient admissions. More recent immigrants are less likely to have any ambulatory care or emergency department visits, whereas all Hispanics born outside the United States are less likely to have any prescription medications. Conclusions: The Hispanic population is composed of many different groups with diverse health needs and different barriers to accessing care. Misconceptions of Hispanics as a monolithic population lacking within-group diversity could function as a barrier to efforts aimed at providing appropriate care to Hispanic persons and could be 1 factor contributing to inequalities in the availability, use, and quality of healthcare services in this population. C1 Agcy Healthcare Res & Qual, Off Performance Accountabil Resources & Technol, Rockville, MD 20850 USA. Ohio State Univ, Sch Publ Hlth, Columbus, OH 43210 USA. Cook Cty Hosp, Collaborat Res Unit, Chicago, IL 60612 USA. Rush Med Coll, Chicago, IL 60612 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. Brandeis Univ, Waltham, MA 02254 USA. Univ New Mexico, Albuquerque, NM 87131 USA. RP Weinick, RM (reprint author), Agcy Healthcare Res & Qual, Off Performance Accountabil Resources & Technol, 540 Gaither Rd, Rockville, MD 20850 USA. EM rweinick@ahrq.gov OI Ortega, Alexander/0000-0001-6861-6993 NR 32 TC 109 Z9 109 U1 2 U2 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 2004 VL 42 IS 4 BP 313 EP 320 DI 10.1097/01.mlr.0000118705.27241.7c PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 807BA UT WOS:000220475800003 PM 15076807 ER PT J AU Simpson, LA Dougherty, D Krause, D Manyan-Ku, C Perrin, J AF Simpson, LA Dougherty, D Krause, D Manyan-Ku, C Perrin, J TI Current priorities, activities, and measures in children's healthcare quality SO PEDIATRIC RESEARCH LA English DT Meeting Abstract CT Annual Meeting of the Pediatric-Academic-Societies CY MAY 03-06, 2003 CL SEATTLE, WA SP Pediat Acad Soc, Amer Pediat Soc, Soc Pediat Res, Ambulatory Pediat Assoc, Tulane Univ Hlth Sci Ctr, Ctr Continuing Educ C1 Univ S Florida, St Petersburg, FL 33701 USA. US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. MGH, Ctr Child & Adolescent Hlth Policy, Boston, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2004 VL 55 IS 4 SU S MA 1296 BP 229A EP 229A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 808TJ UT WOS:000220591101345 ER PT J AU Berg, AO Allan, JD Orleans, CT Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Orleans, CT Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for hepatitis C virus infection in adults: Recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for hepatitis C virus (HCV) infection, which are based on the USPSTF's examination of evidence specific to asymptomatic persons for HCV testing and treatment. The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on this topic. C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Maryland, Baltimore, MD 21201 USA. Colorado Dept Publ Hlth & Environm, Denver, CO USA. Univ Rochester, Rochester, NY USA. Tri Cty Family Med, Cohocton, NY USA. Pan Amer Hlth Org, Washington, DC USA. Univ N Carolina, Sch Med, Chapel Hill, NC USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Newark, NJ 07103 USA. Univ Rochester, Sch Med, Rochester, NY USA. Univ Michigan, Ann Arbor, MI 48109 USA. Univ Texas, Houston, TX USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Mt Sinai Sch Med, New York, NY USA. Merck & Co Inc, W Point, PA USA. Columbia Univ, New York, NY USA. Virginia Commonwealth Univ, Fairfax, VA USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 3 TC 41 Z9 41 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAR 16 PY 2004 VL 140 IS 6 BP 462 EP 464 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 803AU UT WOS:000220204800007 ER PT J AU Simpson, L Zodet, MW Chevarley, FM Owens, PL Dougherty, D McCormick, M AF Simpson, L Zodet, MW Chevarley, FM Owens, PL Dougherty, D McCormick, M TI Health care for children and youth in the United States: 2002 report on trends in access, utilization, quality, and expenditures SO AMBULATORY PEDIATRICS LA English DT Article DE health care utilization; hospitalization; insurance; quality; trends ID PUBLIC INSURANCE EXPANSIONS; MANAGED CARE; MEDICAID EXPANSIONS; PRIVATE COVERAGE; PLAN PERFORMANCE; HOSPITAL USE; NEW-YORK; PROGRAM; IMPACT; EMERGENCY AB Objective.-To examine changes in insurance coverage, health care utilization, perceived quality of care, and expenditures for children and youth in the United States using data from 1987-2001. Methods.-Three national health care databases serve as the sources of data for this report. The Medical Expenditure Panel Survey (1996-2001) provides data on insurance coverage, utilization, expenditures, and perceived quality of care. The National Medical Expenditure Survey (1987) provides additional data on utilization and expenditures. The Nationwide Inpatient Sample (1995-2000) from the Healthcare Cost and Utilization Project provides information on hospitalizations. Results.-The percent of children uninsured for an entire year declined from 10.4% in 1996 to 7.7% in 1999. Most changes in children's health care occurred between 1987 and the late 1990s. Overall utilization of hospital-based services has declined significantly since 1987, especially for inpatient hospitalization. Several of the observed changes from 1987 varied significantly by type of health insurance coverage, poverty status, and geographic region. Quality of care data indicate some improvement between 2000 and 2001, which varies by insurance coverage. Overall, mean length of stay of hospitalizations did not change significantly from 1995 to 2000, but changes in the prevalence of hospitalizations and the length of stay associated with age-specific diagnoses were evident during this time period. Conclusions.-Health care for children and youth has changed significantly since 1987, with most of the changes occurring between 1987 and 1996. Insurance coverage has improved, the site of care has shifted toward ambulatory sites, hospital utilization has declined, and expenditures on children as a proportion of total expenditures have decreased. Variation in these changes is evident by insurance status, poverty, and region. C1 Univ S Florida, ACH Guild Endowed Chair Child Hlth Policy, Dept Pediat, St Petersburg, FL 33701 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Harvard Univ, Sch Publ Hlth, Dept Maternal & Child Hlth, Boston, MA 02115 USA. RP Simpson, L (reprint author), Univ S Florida, ACH Guild Endowed Chair Child Hlth Policy, Dept Pediat, 601 4th St S,CRI 1008, St Petersburg, FL 33701 USA. EM lsimpso1@hsc.usf.edu OI McCormmick, Marie/0000-0002-3938-1707 NR 56 TC 28 Z9 29 U1 1 U2 2 PU ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS PI LAWRENCE PA 810 EAST 10TH STREET, LAWRENCE, KS 66044 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD MAR-APR PY 2004 VL 4 IS 2 BP 131 EP 153 DI 10.1367/1539-4409(2004)4<131:HCFCAY>2.0.CO;2 PG 23 WC Pediatrics SC Pediatrics GA 804TY UT WOS:000220322200002 PM 15018605 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Tracy, C Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Tracy, C Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH TI Screening for type 2 diabetes mellitus in adults: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article ID IMPAIRED GLUCOSE-TOLERANCE; CORONARY-HEART-DISEASE; NUTRITION-EXAMINATION-SURVEY; CONVERTING-ENZYME-INHIBITOR; LOWER-EXTREMITY AMPUTATION; SERVICES-TASK-FORCE; QUALITY-OF-LIFE; CARDIOVASCULAR EVENTS; FOLLOW-UP; CONTROLLED TRIAL C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 68 TC 0 Z9 0 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD MAR PY 2004 VL 104 IS 3 BP 83 EP + PG 7 WC Nursing SC Nursing GA 802MB UT WOS:000220166500043 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH TI Screening for family and intimate partner violence: Recommendation statement SO ANNALS OF FAMILY MEDICINE LA English DT Article DE domestic violence; child abuse; elder abuse; spouse abuse ID ADVERSE CHILDHOOD EXPERIENCES; PREVENTIVE HEALTH-CARE; DOMESTIC VIOLENCE; HOUSEHOLD DYSFUNCTION; HOME VISITATION; PREGNANT-WOMEN; TASK-FORCE; ABUSE; CHILDREN; NEGLECT AB This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for family and intimate partner violence based on the USPSTF's examination of evidence specific to family and intimate partner violence. It updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, second edition. In 1996, the USPSTF found insufficient evidence to recommend for or against the use of specific instruments to detect domestic violence (a "C" recommendation according to 1996 grade definitions). The Task Force now uses an explicit process in which the balance of benefits and harms is determined exclusively by the quality and magnitude of the evidence. As a result, current letter grades are based on different criteria than those in 1996. Current explanations of the ratings and of the strength of overall evidence are given in Appendix A and in Appendix B, respectively. The complete information on which this statement is based, including evidence tables and references, is available in the summary article, and in the Systematic Evidence Review, "Screening for Family and Intimate Partner Violence: Systematic Evidence Review for the U.S. Preventive Services Task Force."' The USPSTF recommendations, the accompanying summary article, and complete Systematic Evidence Review are available through the USPSTF web site (http://www.preventiveservices.ahrq.gov). The summary article and the USPSTF recommendation statement are available in print through the AHRQ Publications Clearinghouse (call 1-800-358-9295 or e-mail ahrqpubs@ahrq.gov). C1 USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD 20850 USA. RP Berg, AO (reprint author), USPSTF, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 48 TC 27 Z9 27 U1 0 U2 0 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD MAR-APR PY 2004 VL 2 IS 2 BP 156 EP 160 DI 10.1370/afm.128 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 879JS UT WOS:000225714700012 ER PT J AU Hellinger, FJ AF Hellinger, FJ TI HIV patients in the HCUP database: A study of hospital utilization and costs SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID ACTIVE ANTIRETROVIRAL THERAPY; ACQUIRED-IMMUNODEFICIENCY-SYNDROME; UNITED-STATES; VIRUS-INFECTION; MEDICAID HOME; CARE; AIDS; IMPACT; EXPENDITURES; COMMUNITY AB This study examines the utilization of hospital care by HIV patients in all hospitals in eight states (California, Colorado, Florida, Kansas, New Jersey, New York, Pennsylvania, and South Carolina), and examines the cost of hospital care for HIV patients in six of these states (California, Colorado, Kansas, New Jersey, New York, and South Carolina). The eight states in the sample account for more than 52% of all persons living with AIDS in the United States; the six states account for 39%. The unit of observation in both studies is a hospital admission by a patient with HIV. Hospital data were obtained from the Healthcare Cost and Utilization Project (HCUP), State Inpatient Database (SID), which is maintained by the Agency for Healthcare Research and Quality (AHRQ). The HCUP contains hospital discharge data and is a federal/state/industry partnership to build a multistate health care data system. Using multivariate analytic techniques and data from 2000, results indicate that cost and length of a hospital stay vary significantly across states after accounting for a patient's gender, insurance type, race, age, and number of diagnoses, as well as the teaching status and ownership category of the hospital. C1 Agcy Healthcare Res & Qual, CDOM, Rockville, MD 20850 USA. RP Hellinger, FJ (reprint author), Agcy Healthcare Res & Qual, CDOM, Suite 5315,540 Gaither Rd, Rockville, MD 20850 USA. EM fhelling@ahrq.gov NR 43 TC 8 Z9 8 U1 0 U2 1 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SPR PY 2004 VL 41 IS 1 BP 95 EP 105 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 829MG UT WOS:000222052000008 PM 15224963 ER PT J AU Clancy, CM AF Clancy, CM TI Carolyn M. Clancy, MD, Director, Agency for Healthcare Research and Quality SO JOURNAL OF INVESTIGATIVE MEDICINE LA English DT Editorial Material C1 Boston Coll, Chestnut Hill, MA 02167 USA. Univ Massachusetts, Sch Med, Amherst, MA 01003 USA. Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU B C DECKER INC PI HAMILTON PA 20 HUGHSON ST SOUTH, PO BOX 620, L C D 1, HAMILTON, ONTARIO L8N 3K7, CANADA SN 1081-5589 J9 J INVEST MED JI J. Invest. Med. PD MAR PY 2004 VL 52 IS 2 BP 77 EP 80 DI 10.2310/6650.2004.17555 PG 4 WC Medicine, General & Internal; Medicine, Research & Experimental SC General & Internal Medicine; Research & Experimental Medicine GA 806EH UT WOS:000220416700001 PM 15068219 ER PT J AU Lawrence, WF Fleishman, JA AF Lawrence, WF Fleishman, JA TI Predicting EuroQoL EQ-5D preference scores from the SF-12 health survey in a nationally representative sample SO MEDICAL DECISION MAKING LA English DT Article; Proceedings Paper CT 24th Annual Meeting of the Society-for-Medical-Decision-Making CY OCT 19-23, 2002 CL BALTIMORE, MARYLAND SP Soc Med Decis Making DE health utilities; health status measures; health-related quality of life; regression models; quality-adjusted life years ID QUALITY-OF-LIFE; GENERAL-POPULATION; UTILITIES INDEX; VALUES; HETEROGENEITY; VALIDITY AB Purpose. To predict the EuroQoL EQ-5D utility index from the SF-12 Health Survey for a US national sample of adults. Methods. The authors used the 2000 Medical Expenditure Panel Survey to examine the relationship between instruments. Linear regression was used to predict EQ-5D scores from Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF-12. A prediction model was derived in one half of the sample and validated in the other half. Results. Complete responses to both measures were available for 14,580 adults; 7313 (50.2%) surveys were used for the derivation set. The 2-variable model predicted 61% of the variance in EQ-5D scores and provided reasonable ability to predict mean EQ-5D scores from mean PCS and MCS scores. Confidence intervals are dependent on sample size and variance of PCS and MCS scores. Conclusions. EQ-5D scores can be reasonably predicted from the SF-12. This model allows researchers to estimate utility data for use in decision and cost-utility analyses. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Lawrence, WF (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Suite 300,540 Gaither Rd, Rockville, MD 20850 USA. EM william.lawrence@ahrq.hhs.gov NR 32 TC 50 Z9 50 U1 2 U2 6 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0272-989X J9 MED DECIS MAKING JI Med. Decis. Mak. PD MAR-APR PY 2004 VL 24 IS 2 BP 160 EP 169 DI 10.1177/0272989X04264015 PG 10 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA 805VA UT WOS:000220392600005 PM 15090102 ER PT J AU Correa-de-Araujo, R AF Correa-de-Araujo, R TI A wake-up call to advance women's health SO WOMENS HEALTH ISSUES LA English DT Editorial Material ID ESTROGEN PLUS PROGESTIN; CARE; DISEASE; RISK C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Correa-de-Araujo, R (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM rcorrea@ahrq.gov NR 28 TC 9 Z9 9 U1 1 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD MAR-APR PY 2004 VL 14 IS 2 BP 31 EP 34 DI 10.1016/j.whi.2004.03.005 PG 4 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 822WM UT WOS:000221571300001 PM 15120412 ER PT J AU Grant, AO Jacobs, AK Clancy, C AF Grant, AO Jacobs, AK Clancy, C TI Cardiovascular disease in women - Are there solutions? SO CIRCULATION LA English DT Editorial Material DE Focused Perspectives; prevention; women; cardiovascular diseases C1 Duke Univ, Med Ctr, Durham, NC 27710 USA. Boston Univ, Med Ctr, Boston, MA USA. Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Grant, AO (reprint author), Duke Univ, Med Ctr, Box 3504, Durham, NC 27710 USA. EM grant007@mc.duke.edu NR 2 TC 3 Z9 3 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD FEB 10 PY 2004 VL 109 IS 5 BP 561 EP 561 DI 10.1161/01.CIR.0000118595.24629.95 PG 1 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 772HM UT WOS:000188836600002 PM 14769674 ER PT J AU Fiore, MC Croyle, RT Curry, SJ Cutler, CM Davis, RM Gordon, C Healton, C Koh, HK Orleans, CT Richling, D Satcher, D Seffrin, J Williams, C Williams, LN Keller, PA Baker, TB AF Fiore, MC Croyle, RT Curry, SJ Cutler, CM Davis, RM Gordon, C Healton, C Koh, HK Orleans, CT Richling, D Satcher, D Seffrin, J Williams, C Williams, LN Keller, PA Baker, TB TI Preventing 3 million premature deaths and helping 5 million smokers quit: A national action plan for tobacco cessation SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID SMOKING-CESSATION; COST-EFFECTIVENESS; CIGARETTE CONSUMPTION; CONTROL-PROGRAM; HEALTH-CARE; INTERVENTIONS; CALIFORNIA; CAMPAIGN; EXPENDITURES; TAXES AB In August 2002, the Subcommittee on Cessation of the Interagency Committee on Smoking and Health (ICSH) was charged with developing recommendations to substantially increase rates of tobacco cessation in the United States. The subcommittee's report, A National Action Plan for Tobacco Cessation, outlines 10 recommendations for reducing premature morbidity and mortality by helping millions of Americans stop using tobacco. The plan includes both evidence-based, population-wide strategies designed to promote cessation (e.g., a national quitline network) and a Smokers' Health Fund to finance the programs (through a $2 per pack excise tax increase). The subcommittee report was presented to the ICSH (February 11, 2003), which unanimously endorsed sending it to Secretary Thompson for his consideration. In this article, we summarize the national action plan. C1 Univ Wisconsin, Sch Med, Ctr Tobacco Res & Intervent, Madison, WI 53711 USA. NCI, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. Univ Illinois, Hlth Res Ctr, Chicago, IL 60680 USA. Univ Illinois, Policy Ctr, Chicago, IL 60680 USA. Amer Assoc Hlth Plans, Washington, DC USA. Henry Ford Hlth Syst, Ctr Hlth Promot & Dis Prevent, Detroit, MI USA. Ctr Med & Medicaid Serv, Baltimore, MD USA. Amer Legacy Fdn, Washington, DC USA. Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Midw Business Grp Hlth, Chicago, IL USA. Morehouse Sch Med, Natl Ctr Primary Care, Atlanta, GA 30310 USA. Amer Canc Soc, Atlanta, GA 30329 USA. Agcy Healthcare Res & Qual, Off Hlth Care Informat, Rockville, MD USA. USN, Dent Corps, Grayslake, IL USA. RP Fiore, MC (reprint author), Univ Wisconsin, Sch Med, Ctr Tobacco Res & Intervent, 1930 Monroe St,Suite 200, Madison, WI 53711 USA. EM mcf@ctri.medicine.wisc.edu FU NIMHD NIH HHS [U54 MD008173] NR 52 TC 162 Z9 163 U1 2 U2 13 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD FEB PY 2004 VL 94 IS 2 BP 205 EP 210 DI 10.2105/AJPH.94.2.205 PG 6 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 770BP UT WOS:000188703600012 PM 14759928 ER PT J AU Spector, WD Cohen, JW Pesis-Katz, I AF Spector, WD Cohen, JW Pesis-Katz, I TI Home care before and after the Balanced Budget Act of 1997: Shifts in financing and services SO GERONTOLOGIST LA English DT Article DE health care expenditures; Medicare; Medicaid; long-term care ID HEALTH AB Purpose: This article describes the pattern of change in home-care use and expenditures, the distribution of payments by source, and the mix of skilled versus nonskilled services before and after 1996. Design and Methods: The analysis is based on tabulations of the 1987 National Medical Expenditure Survey and the 1996, 1998, and 1999 Medical Expenditure Panel Surveys. Estimates are weighted to represent the U.S. civilian noninstitutionalized population. Results: After increasing dramatically between 1987 and 1996, formal home-care use and expenditures fell between 1996 and 1999. The decline was largely due to a decrease in funding under Medicare, which coincided with changes initiated in the Balanced Budget Act of 1997 (BBA). Declines in total spending were attenuated by increases in expenditures under state and local programs. After the BBA, fewer skilled services were provided to the elderly population and more unskilled services were provided to the nonelderly population. Implications: These findings highlight the increasing role of state governments in funding home care after the BBA. However, more recent pressure on state budgets and the institution of prospective payment under Medicare for home care may alter these trends. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Rochester, Dept Community & Prevent Med, Rochester, NY 14627 USA. RP Spector, WD (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM wspector@AHRQ.gov RI Pesis-Katz, Irena/E-2684-2013 NR 29 TC 17 Z9 17 U1 0 U2 3 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD FEB PY 2004 VL 44 IS 1 BP 39 EP 47 PG 9 WC Gerontology SC Geriatrics & Gerontology GA 777EZ UT WOS:000189164000005 PM 14978319 ER PT J AU Siegel, S Moy, E Burstin, H AF Siegel, S Moy, E Burstin, H TI Assessing the nation's progress toward elimination of disparities in health care - The National Healthcare Disparities Report SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE disparities; health care; race; ethnicity; socioeconomic status AB The Agency for Healthcare Research and Quality submitted the first annual National Healthcare Disparities Report to Congress in December, 2003. This first report will provide a snapshot of the state of racial, ethnic, and socioeconomic disparities in access and quality of care in America. It examines disparities in the general population and within the Agency's priority populations. While focused on extant data, the first report will form the foundation for future versions, which examines causes of disparities and shape solutions to the problem. As patient advocates and agents of change, primary care physicians play a critical role in efforts to eliminate disparities in health care. Continuing participation by primary care physicians in the development and refinement of the National Healthcare Disparities Report is essential. C1 US Dept HHS, Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. US Dept HHS, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. RP Siegel, S (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd,6th Floor, Rockville, MD 20850 USA. EM SSIEGEL@ahrq.gov NR 11 TC 16 Z9 16 U1 2 U2 5 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD FEB PY 2004 VL 19 IS 2 BP 195 EP 200 DI 10.1111/j.1525-1497.2004.30221.x PG 6 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 779KD UT WOS:000189293100011 PM 15009799 ER PT J AU Larson, SL Clark, MR Eaton, WW AF Larson, SL Clark, MR Eaton, WW TI Depressive disorder as a long-term antecedent risk factor for incident back pain: A 13-year follow-up study from the Baltimore Epidemiological Catchment Area Sample SO PSYCHOLOGICAL MEDICINE LA English DT Article ID DIAGNOSTIC-INTERVIEW-SCHEDULE; CHRONIC MUSCULOSKELETAL PAIN; PLACEBO-CONTROLLED TRIAL; CORONARY-ARTERY-DISEASE; MYOCARDIAL-INFARCTION; DOUBLE-BLIND; SYMPTOMS; ONSET; SOMATIZATION; METAANALYSIS AB Background. The co-occurrence of affective distress and back pain is well documented but the relationship between them is less certain. This study examines the relationship between lifetime occurrence of depressive disorder and incident back pain reported over a 13-year period. Method. The Baltimore Epidemiologic Catchment Area Study is a prospective Study of a household-residing cohort, selected probabilistically from East Baltimore in 1981. Between 1982-3 (wave 2) and again between 1993-6 (wave 3), a follow-up Study of the original cohort was conducted. Questions on depressive disorder and back pain were drawn from the Diagnostic Interview Schedule. Logistic regression analyses were used to evaluate whether depressive disorder acts as a risk factor for incident back pain. Results. In cross-sectional analyses, lifetime Occurrence of depressive disorder was a significant correlate of lifetime prevalence of back pain Lit wave I (OR = 1.6, P = 0.01), During the 13-year follow-up, across three data collection points, there was an increase in the risk for incident back pain when depressive disorder was present Lit baseline (OR 1.9, 95 % CI 1.03, 3.4). However, during the short-term follow-up period of I year, between baseline and wave 2, depressive disorder at baseline Was unrelated to first-ever reports of back pain. Lifetime depressive disorder in both waves I (baseline) and 2 (1 year later) was associated with a more than three times greater risk for a first-ever report of back pain during the 12 to 13 year follow-up period, in comparison to those who did not have depressive disorder at waves I or 2 (OR = 3.4, 95 % Cl 1.4, 7.8). Back pain Lit wave I was not significantly associated with an increased risk for depression in the longitudinal analysis (OR = 0.8, 95% Cl 0.5, 1.4). Conclusions. Depressive disorder appears to be a risk factor for incident back pain independent of other characteristics often associated with back pain. Back pain is not a short-term consequence of depressive disorder but emerges over periods longer than I year. Moreover, in this study the alternative pathway of back pain as a risk factor for depressive disorder could not be Supported. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. Johns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Baltimore, MD USA. Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Mental Hyg, Baltimore, MD USA. RP Larson, SL (reprint author), AHQR, CFACT, DSER, 540 Gaither Rd,Suite 5000, Rockville, MD 20850 USA. FU NIMH NIH HHS [MH 47447] NR 44 TC 50 Z9 50 U1 1 U2 7 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 40 WEST 20TH ST, NEW YORK, NY 10011-4211 USA SN 0033-2917 J9 PSYCHOL MED JI Psychol. Med. PD FEB PY 2004 VL 34 IS 2 BP 211 EP 219 DI 10.1017/S0033291703001041 PG 9 WC Psychology, Clinical; Psychiatry; Psychology SC Psychology; Psychiatry GA 804HV UT WOS:000220290700003 PM 14982127 ER PT J AU Tunis, SR Stryer, DB AF Tunis, SR Stryer, DB TI Realizing the benefits of practical clinical trials - Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Tunis, SR (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 3 TC 0 Z9 0 U1 0 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 28 PY 2004 VL 291 IS 4 BP 426 EP 426 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 767EF UT WOS:000188426700025 ER PT J AU Zhan, CL Miller, MR AF Zhan, CL Miller, MR TI Definitions of medical injuries - Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20852 USA. Johns Hopkins Childrens Ctr, Qual & Safety Initiat, Baltimore, MD USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20852 USA. NR 4 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 21 PY 2004 VL 291 IS 3 BP 304 EP 305 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 764ZZ UT WOS:000188243100028 ER PT J AU Surks, MI Ortiz, E Daniels, GH Sawin, CT Col, NF Cobin, RH Franklyn, JA Hershman, JM Burman, KD Denke, MA Gorman, C Cooper, RS Weissman, NJ AF Surks, MI Ortiz, E Daniels, GH Sawin, CT Col, NF Cobin, RH Franklyn, JA Hershman, JM Burman, KD Denke, MA Gorman, C Cooper, RS Weissman, NJ TI Subclinical thyroid disease - Scientific review and guidelines for diagnosis and management SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article; Proceedings Paper CT 74th Annual Meeting of the American-Thyroid-Association CY OCT 09-13, 2002 CL LOS ANGELES, CALIFORNIA SP Amer Thyroid Assoc ID PLACEBO-CONTROLLED TRIAL; SICK EUTHYROID SYNDROME; L-THYROXINE TREATMENT; SERUM THYROTROPIN; STIMULATING HORMONE; ATRIAL-FIBRILLATION; DOUBLE-BLIND; RISK-FACTOR; FOLLOW-UP; NONTHYROIDAL ILLNESS AB Context Patients with serum thyroid-stimulating hormone (TSH) levels outside the reference range and levels of free thyroxine (FT4) and triiodothyronine (T-3) within the reference range are common in clinical practice. The necessity for further evaluation, possible treatment, and the urgency of treatment have not been clearly established. Objectives To define subclinical thyroid disease, review its epidemiology, recommend an appropriate evaluation, explore the risks and benefits of treatment and consequences of nontreatment, and determine whether population-based screening is warranted. Data Sources MEDLINE, EMBASE, Biosis, the Agency for Healthcare Research and Quality, National Guideline Clearing House, the Cochrane Database of Systematic Reviews and Controlled Trials Register, and several National Health Services (UK) data bases were searched for articles on subdinical thyroid disease published between 1995 and 2002. Articles published before 1995 were recommended by expert consultants. Study Selection and Data Extraction A total of 195 English-language or translated papers were reviewed. Editorials, individual case studies, studies enrolling fewer than 10 patients, and nonsystematic reviews were excluded. Information related to authorship, year of publication, number of subjects, study design, and results were extracted and formed the basis for an evidence report, consisting of tables and summaries of each subject area. Data Synthesis The strength of the evidence that untreated subdinical thyroid disease is associated with clinical symptoms and adverse clinical outcomes was assessed and recommendations for clinical practice developed. Data relating the progression of subdinical to overt hypothyroidism were rated as good, but data relating treatment to prevention of progression were inadequate to determine a treatment benefit. Data relating a serum TSH level higher than 10 mIU/L to elevations in serum cholesterol were rated as fair but data relating to benefits of treatment were rated as insufficient. All other associations of symptoms and benefit of treatment were rated as insufficient or absent. Data relating a serum TSH concentration lower than 0.1 mIU/L to the presence of atrial fibrillation and progression to overt hyperthyroidism were rated as good, but no data supported treatment to prevent these outcomes. Data relating restoration of the TSH level to within the reference range with improvements in bone mineral density were rated as fair. Data addressing all other associations of subdinical hyperthyroid disease and adverse clinical outcomes or treatment benefits were rated as insufficient or absent. Subclinical hypothyroid disease in pregnancy is a special case and aggressive case finding and treatment in pregnant women can be justified. Conclusions Data supporting associations of subdinical thyroid disease with symptoms or adverse clinical outcomes or benefits of treatment are few. The consequences of subdinical thyroid disease (serum TSH 0.1-0.45 mIU/L or 4.5-10.0 mIU/L) are minimal and we recommend against routine treatment of patients with TSH levels in these ranges. There is insufficient evidence to support population-based screening. Aggressive case finding is appropriate in pregnant women, women older than 60 years, and others at high risk for thyroid dysfunction. C1 Montefiore Med Ctr, Dept Med, Bronx, NY 10467 USA. Montefiore Med Ctr, Dept Pathol, Bronx, NY 10467 USA. Albert Einstein Coll Med, Bronx, NY 10467 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. Harvard Univ, Massachusetts Gen Hosp, Sch Med, Thyroid Unit, Boston, MA USA. Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Med, Boston, MA USA. Vet Adm, Washington, DC USA. Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Womens Hlth, Boston, MA 02115 USA. Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Med, Boston, MA 02115 USA. Mt Sinai Sch Med, Dept Med, New York, NY USA. Univ Birmingham, Div Med Sci, Birmingham, W Midlands, England. Univ Calif Los Angeles, Sch Med, W Los Angeles Vet Affairs Med Ctr, Endocrinol & Diabet Div, Los Angeles, CA 90024 USA. Washington Hosp Ctr, Endocrine Sect, Washington, DC 20010 USA. Univ Texas, SW Med Ctr Dallas, Dept Med, Dallas, TX 75235 USA. Mayo Clin & Mayo Fdn, Res Dev, Rochester, MN 55905 USA. Loyola Univ, Sch Med, Chicago, IL 60611 USA. Georgetown Univ, Coll Med, Dept Med, Washington, DC USA. RP Surks, MI (reprint author), Endocrine Soc, 8401 Connecticut Ave,Suite 900, Chevy Chase, MD 20815 USA. NR 96 TC 885 Z9 984 U1 6 U2 58 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 14 PY 2004 VL 291 IS 2 BP 228 EP 238 DI 10.1001/jama.291.2.228 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 762YZ UT WOS:000188040900032 PM 14722150 ER PT J AU Miller, MR Pronovost, PJ Burstin, HR AF Miller, MR Pronovost, PJ Burstin, HR TI Pediatric patient safety in the ambulatory setting SO AMBULATORY PEDIATRICS LA English DT Article; Proceedings Paper CT Conference on Promoting Safety in Child and Adolescent Health Care CY MAY, 2003 CL BOSTON, MASSACHUSETTS DE adolescent; ambulatory care; child; infant; medical error; primary health care; quality of health care; safety ID ADVERSE DRUG EVENTS; MEDICAL ERRORS; EMERGENCY-MEDICINE; PRIMARY-CARE; INFORMATION TECHNOLOGY; DIAGNOSTIC-ACCURACY; GENERAL-PRACTICE; RISK-MANAGEMENT; INPATIENTS; PHYSICIANS C1 Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. Johns Hopkins Univ, Dept Anesthesia & Crit Care Med, Baltimore, MD 21218 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Res, Rockville, MD USA. RP Miller, MR (reprint author), Johns Hopkins Childrens Ctr, CMSC 2-125,600 N Wolfe St, Baltimore, MD 21287 USA. EM mmille21@jhmi.edu FU AHRQ HHS [1R13HS13883-01] NR 48 TC 9 Z9 9 U1 3 U2 3 PU ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS PI LAWRENCE PA 810 EAST 10TH STREET, LAWRENCE, KS 66044 USA SN 1530-1567 J9 AMBUL PEDIATR JI Ambul. Pediatr. PD JAN-FEB PY 2004 VL 4 IS 1 BP 47 EP 54 DI 10.1367/1539-4409(2004)004<0047:PPSITA>2.0.CO;2 PG 8 WC Pediatrics SC Pediatrics GA 766RR UT WOS:000188389800012 PM 14731091 ER PT J AU Phillips, RL Fryer, GE Chen, FM Morgan, SE Green, LA Valente, E Miyoshi, TJ AF Phillips, RL Fryer, GE Chen, FM Morgan, SE Green, LA Valente, E Miyoshi, TJ TI The Balanced Budget Act of 1997 and the financial health of teaching hospitals SO ANNALS OF FAMILY MEDICINE LA English DT Article; Proceedings Paper CT 29th Annual Meeting of the North-American-Primary-Care-Research-Group CY OCT 13-16, 2001 CL HALIFAX, CANADA SP N Amer Primary Car Res Grp DE education, medical, graduate; Medicare; Medicare Payment Advisory Committee; economics, hospital; economics, medical ID GRADUATE MEDICAL-EDUCATION AB BACKGROUND We wanted to evaluate the most recent, complete data related to the specific effects of the Balanced Budget Act of 1997 relative to the overall financial health of teaching hospitals. We also define cost report variables and calculations necessary for continued impact monitoring. METHODS We undertook a descriptive analysis of hospital cost report variables for 1996, 1998, and 1999, using simple calculations of total, Medicare, prospective payment system, graduate medical education (GME), and bad debt margins, as well as the proportion with negative total operating margins. RESULTS Nearly 35% of teaching hospitals had negative operating margins in 1999. Teaching hospital total margins fell by nearly 50% between 1996 and 1999, while Medicare margins remained relatively stable. GME margins have fallen by nearly 24%, however, even as reported education costs have risen by nearly 12%. Medicare + Choice GME payments were less than 10% of those projected. CONCLUSIONS Teaching hospitals realized deep cuts in profitability between 1996 and 1999; however, these cuts were not entirely attributable to the Balanced Budget Act of 1997. Medicare payments remain an important financial cushion for teaching hospitals, more than one third of which operated in the red. The role of Medicare in supporting GME has been substantially reduced and needs special attention in the overall debate. Medicare+ Choice support of the medical education enterprise is 90% less than baseline projections and should be thoroughly, investigated. The Medicare Payment Advisory Commission, which has a critical role in evaluating the effects of Medicare policy changes, should be more transparent in its methods. C1 Robert Graham Ctr, Policy Studies Family Practice & Primary Care, Washington, DC 20036 USA. Ctr Primary Care Res, Agcy Healthcare Res & Qual, Rockville, MD USA. Maine Med Ctr, Family Practice Residency Program, Portland, ME 04102 USA. Pacific Business Grp Hlth, San Francisco, CA USA. Univ Colorado, Dept Family Med, Denver, CO 80202 USA. RP Phillips, RL (reprint author), Robert Graham Ctr, Policy Studies Family Practice & Primary Care, 1350 Connecticut Ave NW,Suite 950, Washington, DC 20036 USA. EM bphillips@aafp.org NR 31 TC 18 Z9 18 U1 0 U2 1 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672, UNITED STATES SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD JAN-FEB PY 2004 VL 2 IS 1 BP 71 EP 78 DI 10.1370/afm.17 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 879JR UT WOS:000225714600012 PM 15053286 ER PT J AU McNeill, D AF McNeill, D TI Market watch - Do consumer-directed health benefits favor the young and healthy? SO HEALTH AFFAIRS LA English DT Article ID MEDICAL SAVINGS ACCOUNTS; IMPACT; CARE AB This paper demonstrates through a simulation and demographic analysis of consumers' out-of-pocket payments for premiums and medical care that the young and healthy are potential winners with consumer-directed health benefits (CDHBs), and the moderately sick are the losers. However, benefit design constraints and job tenure realities limit the savings opportunities for the young. As employee cost sharing continues unabated, one potential remedy is to cap expenses as a percentage of income, thereby placing a limit on the burden to the sick and ensuring that all Americans share the burden equally according to ability to pay. C1 Brandeis Univ, Heller Sch Social Policy & Management, Waltham, MA 02254 USA. RP McNeill, D (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 32 TC 10 Z9 10 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2004 VL 23 IS 1 BP 186 EP 193 DI 10.1377/hlthaff.23.1.186 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 761KH UT WOS:000187907600023 PM 15002641 ER PT J AU Yawn, BP Fryer, GE Lanier, D AF Yawn, BP Fryer, GE Lanier, D TI Asthma severity: The patient's perspective SO JOURNAL OF ASTHMA LA English DT Article DE asthma; severity; patients ' perspective; population based; control ID PREVALENCE; POPULATION; GUIDELINES; COMMUNITY; CHILDREN; ADULTS; TRENDS; CARE AB Background: Although asthma is a common condition, limited epidemiological data exists on the distribution or course of asthma severity. We know even less about how patients or parents rate the severity of their or their child's asthma or what factors they associate with more severe asthma. A large nationally diverse sample of asthma patients' self-assessment of severity is available but has not been analyzed to look at asthma severity from the patients' perspective. Method: Data from the "household" and "event" files from the 1999 Medical Expenditure Panel Survey were combined to obtain a distribution of patient-reported asthma severity and the health care utilization, medication usage, and personal characteristics associated with different levels of self-reported severity for that subgroup that answered the chronic disease portion of the survey. Results: Almost two thirds of patients (63% of adults) or parents (65% of children) described their or their child's asthma as very or somewhat serious. Among both children and adults, more severe asthma was associated with greater numbers of missed school and workdays, and lower overall health status. The associated differences in health utilization varied by age. Models of severity based on available NAEPP criteria explained less than 10% of the participant's variation in self-reported asthma severity. Conclusion: Parents and patients with asthma appear to use different metrics than physicians and researchers to define the more severe categories of asthma. This disparity suggests the need for an asthma measure that is more widely understood, and accepted by patients and clinicians to serve as a tool to improve asthma-related communications and the achievement of mutually determined therapy goals. C1 Olmsted Med Ctr, Dept Res, Rochester, MN 55904 USA. Robert Graham Policy Ctr, Washington, DC USA. Agcy Healthcare Res & Qual, Washington, DC USA. RP Yawn, BP (reprint author), Olmsted Med Ctr, Dept Res, 210 9th St SE, Rochester, MN 55904 USA. EM yawnX002@umn.edu NR 29 TC 11 Z9 11 U1 0 U2 0 PU MARCEL DEKKER INC PI NEW YORK PA 270 MADISON AVE, NEW YORK, NY 10016 USA SN 0277-0903 J9 J ASTHMA JI J. Asthma PY 2004 VL 41 IS 6 BP 623 EP 630 DI 10.1081/JAS-200026403 PG 8 WC Allergy; Respiratory System SC Allergy; Respiratory System GA 873JT UT WOS:000225276500002 PM 15584311 ER PT J AU Monheit, AC Schone, BS AF Monheit, AC Schone, BS TI How has small group market reform affected employee health insurance coverage? SO JOURNAL OF PUBLIC ECONOMICS LA English DT Article DE health insurance; small group market reform ID MEDICAID EXPANSIONS; PRIVATE INSURANCE; BENEFITS; CHILDREN AB In the early 1990s, over 40 states passed legislation designed to limit a number of exclusionary practices by insurers in the small group market in order to improve the availability and affordability of health insurance to employees in small firms. In this paper, we address the effects of reform on the likelihood that workers are offered insurance, have employment-based coverage, or are policyholders of an employment-based plan. We use differences-in-differences (DD) and differences-indifferences-in-differences (DDD) estimators to evaluate the differential effects of alternative reform measures on high and low risk workers. We generally find little effect of refonn on offer rates and find that, in states with the most stringent reform, employment-based coverage and policyholder rates increased for high risk workers relative to low risk workers. Our results also indicate that the effects of reform varied significantly by the extent to which states adopted guaranteed issue. (C) 2002 Elsevier B.V. All rights reserved. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. Univ Med & Dent New Jersey, Sch Publ Hlth, Div Hlth Syst & Policy, Piscataway, NJ 08854 USA. RP Schone, BS (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 33 TC 15 Z9 15 U1 0 U2 3 PU ELSEVIER SCIENCE SA PI LAUSANNE PA PO BOX 564, 1001 LAUSANNE, SWITZERLAND SN 0047-2727 J9 J PUBLIC ECON JI J. Public Econ. PD JAN PY 2004 VL 88 IS 1-2 BP 237 EP 254 DI 10.1016/S0047-2727(02)00133-0 PG 18 WC Economics SC Business & Economics GA 759AE UT WOS:000187714500011 ER PT J AU Muhuri, PK MacDorman, MF Ezzati-Rice, TM AF Muhuri, PK MacDorman, MF Ezzati-Rice, TM TI Racial differences in leading causes of infant death in the United States SO PAEDIATRIC AND PERINATAL EPIDEMIOLOGY LA English DT Article ID NORTHERN PLAINS INDIANS; LOW-BIRTH-WEIGHT; SLEEP-POSITION; MORTALITY; SURFACTANT; HISPANICS; IMPACT; BLACK AB We used linked birth/infant death records of over 23 million singletons belonging to six birth cohorts (1989-91 and 1995-97) and examined changes in race differentials in the overall and cause-specific infant mortality risks across time in the United States. Results show that infant mortality declined for all races during the time period, with disproportionately greater declines among non-Hispanic American Indians (AIs). Among the leading causes of infant death, declines in mortality from sudden infant death syndrome (SIDS), respiratory distress syndrome (RDS) and congenital anomalies contributed the most to the overall decline in infant mortality in the 1995-97 cohorts, compared with the 1989-91 cohorts. Disproportionately greater reductions in mortality resulting from SIDS and congenital anomalies led to more rapid mortality declines among non-Hispanic AIs than for other races. There are disturbing findings that infants of almost every race experienced increases in mortality from newborn affected by maternal complications of pregnancy (maternal complications) and that none of the race groups experienced a significant decline in mortality from disorders resulting from short gestation/low birthweight. C1 Ctr Dis Control & Prevent, Off Res & Methodol, Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. Ctr Dis Control & Prevent, Div Vital Stat, Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. RP Muhuri, PK (reprint author), Ctr Dis Control & Prevent, Off Res & Methodol, Natl Ctr Hlth Stat, 3311 Toledo Rd,Room 3125, Hyattsville, MD 20782 USA. EM pmuhuri@cdc.gov NR 35 TC 26 Z9 26 U1 1 U2 2 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0269-5022 J9 PAEDIATR PERINAT EP JI Paediatr. Perinat. Epidemiol. PD JAN PY 2004 VL 18 IS 1 BP 51 EP 60 DI 10.1111/j.1365-3016.2004.00535.x PG 10 WC Public, Environmental & Occupational Health; Obstetrics & Gynecology; Pediatrics SC Public, Environmental & Occupational Health; Obstetrics & Gynecology; Pediatrics GA 766ER UT WOS:000188354200008 PM 14738547 ER PT J AU Dougherty, D Simpson, LA AF Dougherty, D Simpson, LA TI Measuring the quality of children's health care: A prerequisite to action SO PEDIATRICS LA English DT Review DE quality of care; public opinion; effectiveness research ID EVIDENCE-BASED MEDICINE; INFORMATION TECHNOLOGY; SPECIALTY REFERRALS; INTENSIVE-CARE; PATIENT SAFETY; YOUNG-CHILDREN; MANAGED CARE; IMPROVEMENT; ADOLESCENTS; SERVICES AB Objective. To assess the availability and use of quality measures for children's health care, highlight promising developments, and develop recommendations for future action steps by the child health quality measurement and improvement fields, pediatrics, and the national quality of care enterprise generally. Study Design. Two-day invitational expert meeting, informed by 3 commissioned articles. Results. Quality of care for children is far less than optimal. A number of measures are available for measuring children's health care quality on a regular basis, although measures are scarce at least in many areas ( eg, pediatric patient safety, end-of-life-care, mental health care, oral health care, neonatal care, care for school-aged children, and coordination of care). Many of the available measures are not being applied regularly to measure the quality of children's health care; barriers to implementation include lack of an information infrastructure that is child- and quality-friendly and lack of public support for improving children's health care quality. To improve the availability and use of quality measures for accountability and improvement, meeting participants recommended that at least 4 activities be national priorities: 1) build public support for quality measurement and improvement in children's health care; 2) create the information technology infrastructure that can facilitate collection and use of data; 3) improve the reliability, validity, and feasibility of existing measures; and 4) create the evidence base for measures development and quality improvement. Conclusions. Although substantial progress has been made in the development of quality measures and the implementation of quality-improvement strategies for children's health care, interest in quality of care for children lags behind that for adult conditions and disorders. Making significant progress will require not only sustained attention by those concerned about improving children's health and health care but also activities to build a broad base of support among the public and key health care decision-makers. C1 Child Hlth Agcy Healthcare Res & Qual, Rockville, MD USA. RP Dougherty, D (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM ddougher@ahrq.gov; las@ichp.edu NR 118 TC 29 Z9 29 U1 1 U2 4 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JAN PY 2004 VL 113 IS 1 SU S BP 185 EP 198 PG 14 WC Pediatrics SC Pediatrics GA 762XY UT WOS:000188010700001 PM 14702501 ER PT J AU Beal, AC Co, JPT Dougherty, D Jorsling, T Kam, J Perrin, J Palmer, RH AF Beal, AC Co, JPT Dougherty, D Jorsling, T Kam, J Perrin, J Palmer, RH TI Quality measures for children's health care SO PEDIATRICS LA English DT Article DE quality of care; child health; health care quality; Institute of Medicine; quality framework ID MEDICAID MANAGED CARE; OF-CARE; CHALLENGES; IMPROVEMENT; SERVICES; CULTURE; IMPACT; STATES; HOME AB Background. The ability to measure and improve the quality of children's health care is of national importance. Despite the existence of numerous health care quality measures, the collective ability of measures to assess children's health care quality is unclear. A review of existing health care quality measures for children is timely for both assessing the current state of quality measures for children and identifying areas requiring additional research and development. Objectives. To identify and collect current health care quality measures for child health and then to systematically categorize and classify measures and identify gaps in child health care quality measures requiring additional development. Design/Methods. We first identified child health care quality instruments with assistance from staff at the Agency for Healthcare Research and Quality, experts in the field, the Computerized Needs-oriented Quality Measurement Evaluation System, the Child and Adolescent Health Measurement Initiative, and a medical literature review. From these instruments, we then selected clinical performance measures applicable to children ( aged 0-18 years). We categorized the individual measures into the Institute of Medicine's framework for the National Health Care Quality Report. The framework includes health care quality domains ( patient safety, effectiveness, patient-centeredness, and timeliness) and patient-perspective domains ( staying healthy, getting better, living with illness, and end-of-life care). We then determined the balance of the measures ( how well they assess care for all children versus children with special health care needs) and their comprehensiveness ( how well the measures apply to the developmental range of children). Finally, we analyzed the ability of the measures to assess equity in care. Results. We identified 19 measure sets, and 396 individual measures were used to assess children's health care quality. The distribution of measures in the health care quality domains was: safety, 14.4%; effectiveness, 59.1%; patient-centeredness, 32.1%; and timeliness, 33.3%. The distribution of measures in the patient-perspective domains was: staying healthy, 24%; getting better, 40.2%; living with illness, 17.4%; end of life, 0%; and multidimensional, 23.5% ( measures were multidimensional if they applied to > 1 domain). Most of the measures were meant for use in the general pediatric population (81.1%), with a significant proportion designed for children with special health care needs (18.9%). The majority (greater than or equal to79%) of the measures could be applied to children across all age groups. However, there were relatively few measures designed specifically for each developmental stage. Regarding the use of measures to study equity in health care, 6 of the measure sets have been used in previous studies of equity. All the survey measure sets contain items that identify patients at risk for poor outcomes, and 4 are available in languages other than English. However, only 1 survey ( Consumer Assessment of Health Plans) has undergone studies of cross-cultural validation. Among the measure sets based on administrative data, 3 included infant mortality, a well-known measure of health disparity. Conclusions. There are several instruments designed to measure health care quality for children. Despite this, we found relatively few measures for assessing patient safety and living with illness and none for end-of-life care. Few measures are designed for specific age categories among children. Although equity is an overarching concern in health care quality, the application of current measures to assess disparities has been limited. These areas need additional research and development for a more complete assessment of health care quality for children. C1 Harvard Univ, Massachusetts Gen Hosp, Sch Med, Ctr Child & Adolescent Hlth Policy, Boston, MA USA. Agcy Healthcare Res & Qual, Off Prior Populat Res, Rockville, MD USA. Harvard Univ, Sch Publ Hlth, Ctr Qual Care Res & Educ, Boston, MA 02115 USA. RP Beal, AC (reprint author), Commonwealth Fund, Qual Care Underdeserved Populat, 1 E 75th St, New York, NY 10021 USA. EM acb@cmwf.org NR 38 TC 69 Z9 69 U1 4 U2 11 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JAN PY 2004 VL 113 IS 1 SU S BP 199 EP 209 PG 11 WC Pediatrics SC Pediatrics GA 762XY UT WOS:000188010700002 PM 14702502 ER PT B AU Battles, JB Kanki, BG AF Battles, JB Kanki, BG BE Spitzer, C Schmocker, U Dang, VN TI The use of socio-technical probabilistic risk assessment at AHRQ and NASA SO PROBABILISTIC SAFETY ASSESSMENT AND MANAGEMENT, VOL 1- 6 LA English DT Proceedings Paper CT Joint Meeting of the 7th International Conference on Probabilistic Safety Assessment and Management/European Safety and Reliability Conference CY JUN 14-18, 2004 CL Berlin, GERMANY SP TUV Suddeutschland, Swiss Fed Nucl Safety Inspectorate, Paul Scherrer Inst, AREVA, Basler & Hofmann, Gottlieb Daimler & Karl Benz Fdn, Swissnucl, VGB PowerTech, ABS Consulting, European Commiss, Joint Res Ctr, European Safety, Reliabil & Data Assoc, US Fed Aviat Adm, Idaho Natl Engn & Environm Lab, Risknowlogy, Scientech Inc, VDI, Assoc Engineers C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Battles, JB (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 10 TC 2 Z9 2 U1 0 U2 1 PU SPRINGER-VERLAG LONDON LTD PI GODALMING PA SWEETAPPLE HOUSE CATTESHALL RD FARNCOMBE, GODALMING GU7 1NH, SURREY, ENGLAND BN 1-85233-827-X PY 2004 BP 2212 EP 2217 PG 6 WC Engineering, Multidisciplinary; Operations Research & Management Science SC Engineering; Operations Research & Management Science GA BAU29 UT WOS:000223579900356 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for obesity in adults: Recommendations and rationale SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID PREVENTION AB This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for obesity in adults based on the USPSTF's examination of evidence specific to obesity and overweight in adults and updates the 1996 recommendations on this topic. The complete USPSTF recommendation and rationale statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (www.preventiveservices.gov), the National Guideline Clearinghouse (www.guideline.gov), and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs@ahrq.gov). The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned. The summary of the evidence is also available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse. C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 5 TC 183 Z9 186 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD DEC 2 PY 2003 VL 139 IS 11 BP 930 EP 932 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 748WW UT WOS:000186884800007 ER PT J AU Solberg, LI Asplin, BR Weinick, RM Magid, DJ AF Solberg, LI Asplin, BR Weinick, RM Magid, DJ TI Emergency department crowding: Consensus development of potential measures SO ANNALS OF EMERGENCY MEDICINE LA English DT Article AB Study objective: We identify measures of emergency department (ED) and hospital workflow that would be of value in understanding, monitoring, and managing crowding. Methods: A national group of 74 experts developed 113 potential measures using a conceptual model of ED crowding that segmented the measures into input, throughput, and output categories. Ten investigators then used group consensus methods to revise and consolidate them into a refined set of 30 measures that were rated by all 74 experts, who used a magnitude estimation technique on a Web site. Each measure was compared with a standard to obtain numeric ratings for feasibility, affordability, early warning potential, long-term planning potential, a summary rating of operational usefulness, and research potential. After review of the comprehensiveness of the resulting measures, 8 additional measures were developed and also rated by all reviewers. Results: The original set of 113 measures (46 input, 35 throughput and 32 output) was, reduced to 38 through the iterative revision and rating process (15 input 9 throughput, and 14 output). Summary scores in each rating category showed significant variation in ratings among the various potential measures. For measures that address similar concepts, the priority ranking depended on the rating category chosen. Conclusion: The final 38 measures of ED and hospital workflow provide a useful pool from which EDs and policymakers can draw to improve their ability to understand and address the issue of ED crowding. These measures require rigorous testing for feasibility, reliability, and value. C1 HealthPartners Res Fdn, Minneapolis, MN 55440 USA. HealthPartners Med Grp & Clin, Minneapolis, MN USA. Reg Hosp, Dept Emergency Med, St Paul, MN USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Colorado Permanente Med Grp, Clin Res Unit, Denver, CO USA. Univ Colorado, Hlth Sci Ctr, Dept Prevent Med, Denver, CO USA. Univ Colorado, Hlth Sci Ctr, Dept Biometr, Denver, CO USA. Univ Colorado, Hlth Sci Ctr, Div Emergency Med, Denver, CO USA. RP Solberg, LI (reprint author), HealthPartners Res Fdn, POB 1524,MS 23302G, Minneapolis, MN 55440 USA. FU PHS HHS [290-00-0015] NR 24 TC 113 Z9 117 U1 0 U2 13 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD DEC PY 2003 VL 42 IS 6 BP 824 EP 834 DI 10.1016/mem.2003.423 PG 11 WC Emergency Medicine SC Emergency Medicine GA 750QW UT WOS:000187009300017 PM 14634610 ER PT J AU Meyer, GS Battles, J Hart, JC Tang, N AF Meyer, GS Battles, J Hart, JC Tang, N TI The US Agency for Healthcare Research and Quality's activities in patient safety research SO INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE LA English DT Article; Proceedings Paper CT 18th International Conference of the International-Society-for-Quality-in-Health-Care CY OCT 04, 2001 CL BUENOS AIRES, ARGENTINA SP Int Soc Quality Hlth Care DE patient safety; quality; research; US Agency for Healthcare Research and Quality AB Purpose. To update the international community on the US Agency for Healthcare Research and Quality's (AHRQ) recent and current activities in improving patient safety. Data sources. Review of the literature concerning the importance of patient safety as a health care quality issue, international perspectives on patient safety, a review of research solicitations, and early results of funded studies. Study selection. A representative sample of patient safety studies from those currently being funded by AHRQ. Results. In response to a growing interest in patient safety in general and a recent US Institute of Medicine report on patient safety in particular, the US Agency for Healthcare Research and Quality has refocused its quality research mission. In the fiscal year 2002, AHRQ spent US$55 million on patient safety research. This investment was spread across six complementary research areas: (1) health systems error reporting, analysis, and safety improvement research demonstrations; (2) Clinical Informatics to Promote Patient Safety (CLIPS); (3) Centers of Excellence for patient safety research and practice (COE); (4) Developmental Centers for Evaluation and Research in Patient Safety (DCERPS); (5) The Effect of Health Care Working Conditions on Quality of Care; and (6) Partnerships for Quality: Patient Safety Research Dissemination and Education. Internal teams of researchers at AHRQ have published studies on patient safety, such as documenting the impact of medication errors. In addition to funding research on patient safety, AHRQ is an integral partner in several national and international collaborations to form strategic synergies that build upon each member organization's strengths, reduce redundant efforts, and benefit from each other's successes. As evidence on patient safety is generated, AHRQ also serves the important mission of disseminating information to the public. Conclusion. The patient safety research field has undergone a period of rapid evolution. It is now incumbent upon the international health care quality improvement community to translate the future results of this research investment into improved safety for patients. C1 Massachusetts Gen Phys Org, Boston, MA USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Harvard Univ, Sch Med, Boston, MA USA. RP Meyer, GS (reprint author), Massachusetts Gen Hosp, Massachusetts Gen Phys Org, Bulfinch 205,55 Fruit St, Boston, MA 02114 USA. NR 15 TC 5 Z9 5 U1 0 U2 2 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 1353-4505 J9 INT J QUAL HEALTH C JI Int. J. Qual. Health Care PD DEC PY 2003 VL 15 SU 1 BP I25 EP I30 DI 10.1093/intqhc/mzg068 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 754AX UT WOS:000187281500005 PM 14660520 ER PT J AU Brach, C Lewit, EM VanLandeghem, K Bronstein, J Dick, AW Kimminau, KS LaClair, B Shenkman, E Shone, LP Swigonski, N Szilagyi, PG AF Brach, C Lewit, EM VanLandeghem, K Bronstein, J Dick, AW Kimminau, KS LaClair, B Shenkman, E Shone, LP Swigonski, N Szilagyi, PG TI Who's enrolled in the State Children's Health Insurance Program (SCHIP)? An overview of findings from the Child Health Insurance Research Initiative (CHIRI) SO PEDIATRICS LA English DT Article DE access; children; children with special health care needs; disparities; enrollment; ethnicity; insurance; Medicaid; minorities; quality; race; State Children's Health Insurance Program ID LOW-INCOME CHILDREN; UNITED-STATES; AMBULATORY CARE; SERVICES; IMPACT; ACCESS; NEEDS AB Background. The State Children's Health Insurance Program ( SCHIP) was enacted in 1997 to provide health insurance coverage to uninsured low-income children from families who earned too much to be eligible for Medicaid. Objectives. To develop a " baseline" portrait of SCHIP enrollees in 5 states ( Alabama, Florida, Kansas, Indiana, and New York) by examining: 1) SCHIP enrollees' demographic characteristics and health care experiences before enrolling in SCHIP, particularly children with special health care needs ( CSHCN), racial and ethnic minority children, and adolescents; 2) the quality of the care adolescents received before enrollment; and 3) the changes in enrollee characteristics as programs evolve and mature. Methods. Each of 5 projects from the Child Health Insurance Research Initiative ( CHIRI) surveyed new SCHIP enrollees as identified by state enrollment data. CHIRI investigators developed the CHIRI common core ( a set of survey items from validated instruments), which were largely incorporated into each survey. Bivariate and multivariate analyses were conducted to ascertain whether there were racial and ethnic disparities in access to health care and differences between CSHCN and those without. Current Population Survey data for New York State were used to identify secular trends in enrollee characteristics. Results. Most SCHIP enrollees ( 65% in Florida to 79% in New York) resided in families with incomes less than or equal to 150% of the federal poverty level. Almost half of SCHIP enrollees lived in single- parent households. A majority of SCHIP parents had not had education beyond high school, and in 2 states ( Alabama and New York) similar to 25% had not completed high school. The vast majority of children lived in households with a working adult, and in a substantial proportion of households both parents worked. Children tended to be either insured for the entire 12 months or uninsured the entire 12 months before enrolling in SCHIP. Private insurance was the predominant form of insurance before enrollment in SCHIP in most states, but 23.3% to 51.2% of insured children had Medicaid as their most recent insurance. Health Care Use and Unmet Needs Before SCHIP. The vast majority of all SCHIP enrollees had a usual source of care ( USC) during the year before SCHIP. The proportion of children who changed their USC after enrolling in SCHIP ranged from 29% to 41.3%. A large proportion of SCHIP enrollees used health services during the year before SCHIP, with some variability across states in the use of health care. Nevertheless, 32% to almost 50% of children reported unmet needs. CSHCN. The prevalence of CSHCN in SCHIP ( between 17% and 25%) in the study states was higher than the prevalence of CSHCN reported in the general population in those states. In many respects, CSHCN were similar to children without special health care needs, but CSHCN had poorer health status, were more likely to have had unmet needs, and were more likely to use the emergency department, mental health care, specialty care, and acute care in the year before enrolling in SCHIP than children without special health care needs. Race and Ethnicity. A substantial proportion of SCHIP enrollees were black non- Hispanic or Hispanic children ( Alabama: 34% and < 1%; Florida: 6% and 26%; Kansas: 12% and 15%; and New York: 31% and 45%, respectively). Minority children were poorer, in poorer health, and less likely to have had a USC or private insurance before enrolling in SCHIP. The prevalence and magnitude of the disparities varied among the states. Quality of Care for Adolescents. Seventy- three percent of adolescent SCHIP enrollees engaged in one or more risk behaviors ( ie, feeling sad or blue; alcohol, tobacco, and drug use; having sexual intercourse; and not wearing seat belts). Although almost 70% of adolescents reported having had a preventive care visit the previous year, a majority of them did not receive counseling in each of 4 counseling areas. Controlling for other factors, having a private, confidential visit with the physician was associated with an increased likelihood ( 2 - 3 times more likely) that the adolescent received counseling for 3 of 4 counseling areas. Trends Over Time. New York SCHIP enrollees in 2001, compared with 1994 enrollees in New York's SCHIP- precursor child health insurance program, were more likely to be black or Hispanic, older, from New York City, and from families with lower education, income, and employment levels. A greater proportion of 2001 enrollees was uninsured for some time in the year before enrollment, was insured by Medicaid, and lacked a USC. Secular trends in the low- income population in the state did not seem to be responsible for these differences. Program modifications during this time period that may be related to the shift in enrollee characteristics include changes to benefits, outreach and marketing efforts, changes in the premium structure, and the advent of a single application form for multiple public programs. Conclusions. SCHIP enrollees are a diverse group, and there was considerable variation among the 5 study states. Overall, SCHIP enrollees had substantial and wide- ranging health care needs despite high levels of prior contact with the health care system. A sizable minority of SCHIP enrollees has special health care needs. There is racial and ethnic diversity in the composition of enrollees as well, with racial and ethnic disparities present. The quality of care adolescents received before enrollment in SCHIP was suboptimal, with many reporting unmet health care needs and not receiving recommended counseling. The characteristics of SCHIP enrollees can be expected to change as SCHIP programs evolve and mature. Policy Implications. 1) Benefits should be structured to meet the needs of SCHIP enrollees, which are comparable to Medicaid enrollees' needs in many respects. 2) Provider networks will have to be broad if continuity of care is to be achieved. 3) Multiple outreach strategies should be used, including using providers to distribute information about SCHIP. 4) The quality of care delivered to vulnerable populations ( eg, minority children, CSHCN, and adolescents) should be monitored. 5) States and health plans should actively promote quality health care with the goal of improving the care received by SCHIP enrollees before enrollment. 6) States will have to craft policies that fit their local context. 7) Collecting baseline information on SCHIP enrollees on a continuous basis is important, because enrollee characteristics and needs can change, and many vulnerable children are enrolling in SCHIP. C1 Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. David & Lucile Packard Fdn, Los Altos, CA USA. Agcy Healthcare Res & Qual, Arlington Hts, IL USA. Univ Alabama, Birmingham, AL USA. Univ Rochester, Sch Med & Dent, Dept Community & Prevent Med, Rochester, NY USA. Kansas Hlth Inst, Topeka, KS USA. Univ Florida, Inst Child Hlth Policy, Gainesville, FL USA. Univ Rochester, Sch Med & Dent, Dept Pediat, Rochester, NY 14642 USA. Indiana Univ, Sch Med, Dept Pediat, Indianapolis, IN 46202 USA. Indiana Univ, Sch Med, Dept Med, Indianapolis, IN 46202 USA. RP Brach, C (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. FU AHRQ HHS [AL HS10435, FL HS10465, IN HS10453, NY HS10450, KS HS10536] NR 45 TC 31 Z9 31 U1 0 U2 2 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD DEC PY 2003 VL 112 IS 6 SU S BP E499 EP E507 PG 9 WC Pediatrics SC Pediatrics GA 749YM UT WOS:000186957700002 PM 14654672 ER PT J AU Shone, LP Dick, AW Brach, C Kimminau, KS LaClair, BJ Shenkman, EA Col, JF Schaffer, VA Mulvihill, F Szilagyi, PG Klein, JD VanLandeghem, K Bronstein, J AF Shone, LP Dick, AW Brach, C Kimminau, KS LaClair, BJ Shenkman, EA Col, JF Schaffer, VA Mulvihill, F Szilagyi, PG Klein, JD VanLandeghem, K Bronstein, J TI The role of race and ethnicity in the State Children's Health Insurance Program (SCHIP) in four states: Are there baseline disparities, and what do they mean for SCHIP? SO PEDIATRICS LA English DT Article DE access to health care; health insurance; children; minorities; racial disparities; race; ethnicity; SCHIP; uninsured; State Children's Health Insurance Program ID BLACK-AND-WHITE; HISPANIC CHILDREN; PRIMARY-CARE; ACCESS; INCOME; MEDICAID; SERVICES; ASSESSMENTS; VARIABLES; DIFFER AB Background. Elimination of racial and ethnic disparities in health has become a major national goal. The State Children's Health Insurance Program ( SCHIP) has the potential to reduce disparities among the children who enroll if they exhibit the same disparities that have been documented in previous studies of low- income children. To determine the potential impact of SCHIP on racial and ethnic disparities, it is critical to assess baseline levels of health disparities among children enrolling in SCHIP. Objective. To use data from the Child Health Insurance Research Initiative ( CHIRI) to 1) describe the sociodemographic profile of new enrollees in SCHIP in Alabama, Florida, Kansas, and New York; 2) determine if there were differences in health insurance and health care experiences among white, black, and Hispanic SCHIP enrollees before enrollment in SCHIP; and 3) explore whether race or ethnicity, controlled for other factors, affected pre- SCHIP access to health coverage and health care. Setting. SCHIP programs in Alabama, Florida, Kansas, and New York, which together include 26% of SCHIP enrollees nationwide. Design. Telephone interview ( mailed survey in Alabama) about the child's health, health insurance, and health care experiences conducted shortly after SCHIP enrollment to assess experience during the time period before SCHIP. Sample. New SCHIP enrollees ( 0 - 17.9 years old in Alabama, Kansas, and New York and 11.5 - 17.9 years old in Florida). Stratified sampling was performed in Kansas and New York, with results weighted to reflect statewide populations of new SCHIP enrollees. Measures. Sociodemographic characteristics including income, education, employment, and other characteristics of the child and the family, race and ethnicity ( white non- Hispanic, black non- Hispanic, and Hispanic [ any race]), prior health insurance, health care access and utilization, and health status. Analyses. Bivariate analyses were used to compare baseline measures upon enrollment for white, black, and Hispanic SCHIP enrollees. Multivariate analyses were performed to assess health status and health care access measures ( prior insurance, presence of a usual source of care ( USC), and use of preventive care), controlling for demographic factors described above. Weighted analyses ( where appropriate) were performed by using SPSS, STATA, or SUDAAN. Results. Racial and ethnic composition varied across the SCHIP cohorts studied, with black and Hispanic children comprising the following proportion of enrollees, respectively: Alabama, 33% and < 1%; Florida, 16% and 26%; Kansas, 12% and 15%; and New York, 24% and 36%. Black and Hispanic children were more likely to reside in single- parent and lower- income families. With some variation by state, children from minority groups were more likely to report poorer health status than were white children. Relative to white children, children from minority groups in Florida and New York were more likely to have been uninsured for the entire year before SCHIP enrollment. In all states, children from minority groups who had prior coverage were more likely to have previously been enrolled in Medicaid than in private health insurance and were less likely to have had employer-sponsored coverage compared with white children. Except in Alabama, there was a difference in having a USC, with children from minority groups less likely to have had a USC before SCHIP enrollment compared with white children. No consistent pattern of health care utilization before SCHIP was noted across states with respect to race or ethnicity. Findings from multivariate analyses, controlling for sociodemographic factors, generally confirmed that black and Hispanic children were more likely to have lacked insurance or a USC before enrollment in SCHIP and to have poorer health status compared with white children. Conclusions. SCHIP is enrolling substantial numbers of racial and ethnic minority children. There are baseline racial and ethnic disparities among new enrollees in SCHIP, with black and Hispanic children faring worse than white children on many sociodemographic and health system measures, and there are differences among states in the prevalence and magnitude of these disparities. After controlling for sociodemographic factors, these disparities persisted. Implications for Monitoring and Improving SCHIP. SCHIP has the potential to play a critical role in efforts to eliminate racial and ethnic disparities in health among the children it serves. However, study findings indicate that programmatic efforts are necessary to ensure that disparities are not perpetuated. Program effectiveness and outcomes should be monitored by race and ethnicity to ensure equity in access, use, and outcomes across all racial and ethnic groups. Assessing the health characteristics and needs of new SCHIP enrollees can provide a benchmark for evaluating the program's impact on eliminating racial and ethnic disparities in health and inform service delivery enhancements. C1 Univ Rochester, Sch Med & Dent, Dept Pediat, Strong Childrens Res Ctr, Rochester, NY 14642 USA. Univ Rochester, Sch Med & Dent, Dept Community & Prevent Med, Rochester, NY USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. Kansas Hlth Inst, Topeka, KS USA. Univ Florida, Inst Child Hlth Policy, Gainesville, FL USA. Univ Alabama, Birmingham, AL USA. RP Shone, LP (reprint author), Univ Rochester, Sch Med & Dent, Dept Pediat, Strong Childrens Res Ctr, Box 777,601 Elmwood Ave, Rochester, NY 14642 USA. FU AHRQ HHS [AL HS 10435, FL HS10465, KS HS10536, NY HS10450] NR 57 TC 43 Z9 43 U1 1 U2 6 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD DEC PY 2003 VL 112 IS 6 SU S BP E521 EP E532 PG 12 WC Pediatrics SC Pediatrics GA 749YM UT WOS:000186957700004 PM 14654674 ER PT J AU Szilagyi, PG Shenkman, E Brach, C LaClair, BJ Swigonski, N Dick, A Shone, LP Schaffer, VA Col, JF Eckert, G Klein, JD Lewit, EM AF Szilagyi, PG Shenkman, E Brach, C LaClair, BJ Swigonski, N Dick, A Shone, LP Schaffer, VA Col, JF Eckert, G Klein, JD Lewit, EM TI Children with special health care needs enrolled in the State Children's Health Insurance Program (SCHIP): Patient characteristics and health care needs SO PEDIATRICS LA English DT Article DE children with special health care needs (CSHCN); State Children's Health Insurance Program (SCHIP) ID MANAGED CARE; IDENTIFYING CHILDREN; DISABILITIES; RISK; ADOLESCENTS; DEFINITION; PHYSICIANS; CHALLENGES; SERVICES; SYSTEM AB Background. Children with special health care needs ( CSHCN) often require more extensive services than children without special needs. The State Children's Health Insurance Program ( SCHIP) in many states typically provides less extensive benefits and services than do state Medicaid programs. To design SCHIP to address the needs of CSHCN adequately, it is important to measure the degree to which children who enroll in SCHIP have special health care needs and to assess their health status and unmet health care needs. Little is known about the characteristics or preenrollment experience of CSHCN who enroll in SCHIP. Objectives. To use data from the Child Health Insurance Research Initiative to measure the prevalence of CSHCN in SCHIP in 4 states, describe their demographic and health care features at enrollment, and compare their sociodemographic characteristics, health status, prior health care experiences, and unmet needs versus children without special health care needs. Methods. Children ( 0 - 18 years old) newly enrolled in SCHIP in 4 states were eligible for the study: New York, Florida ( adolescents only), Kansas, and Indiana ( CSHCN only). Telephone interviews were conducted shortly after enrollment and identified CSHCN by using the Child and Adolescent Health Measurement Initiative CSHCN screener. A common set of core questions assessed demographic characteristics, health status, special health care need status, insurance experience, access, use, quality of health care, and unmet needs during the year before enrollment. Bivariate and multivariate analyses were used to compare characteristics of CSHCN with characteristics of children without special needs. Results. Interviews were completed for parents of 5296 children enrolled in SCHIP in the 4 states. By using the Child and Adolescent Health Measurement Initiative CSHCN screener, the prevalence of CSHCN among SCHIP enrollees was 17% ( New York), 18% ( Florida), and 25% ( Kansas), higher than the prevalence of CSHCN reported in the general population in those states. More than half of CSHCN reported the use of a chronic medication. Demographic characteristics of CSHCN were similar to those of children without special needs, although CSHCN were more likely to reside in single-parent households. Although CSHCN had poorer health status than children without special needs, many CSHCN were reported to be in good health, suggesting a wide spectrum of severity of illnesses within the CSHCN group. Although CSHCN were more likely than children without special needs to have been insured before SCHIP, a large proportion of CSHCN were nevertheless uninsured for at least 12 months before SCHIP ( New York, 56%; Florida, 68%; Kansas, 24%; Indiana, 25%). Although most SCHIP enrollees had a usual source of care ( USC) before SCHIP and there was some variation across states, between 4% and 13% of CSHCN lacked a USC on enrollment, and 23% to 38% of CSHCN changed their USC after enrollment in SCHIP. The majority of all SCHIP enrollees ( including CSHCN) had used some health care during the year before SCHIP including preventive, acute, or specialty care. A high proportion of all SCHIP enrollees, including > 30% to 40% of CSHCN, were reported to have unmet health care needs at enrollment in SCHIP. A variety of unmet needs were reported by CSHCN including specialty care, mental health care, dental care, and prescription medications. Nevertheless, the vast majority of CSHCN as well as children without special needs rated the quality of their medical care before SCHIP highly on several specific quality measures. Findings from multivariate analyses were similar to bivariate results with CSHCN in several states having higher use of care and more unmet health care needs before enrollment. Conclusions. SCHIP is enrolling many CSHCN, with the prevalence of these children occurring at least as high as the prevalence of CSHCN in the general population. CSHCN enrolled in SCHIP represent a heterogeneous population with a wide range of health status and health care needs. Although most CSHCN were already connected to the health care system with a USC and prior health care visits, many had unmet health care needs before enrolling in SCHIP. Implications for Monitoring and Improving SCHIP for CSHCN Enrollees. 1) SCHIP benefit packages need to adequately cover services required by CSHCN such as prescription medications and specialty, mental health, developmental, and home services; 2) because utilization of care will be high among this large group of children, alternative methods of financing and managing care should be considered such as risk adjustment and special programs that involve case management and care coordination; 3) coordination of care across programs ( such as between SCHIP and the state Title V Maternal and Child Health Services program, a component of which serves CSHCN) and ensuring adequate access to primary care and specialty providers might improve access to services for CSHCN; and 4) it is critical to monitor the quality of care for CSHCN enrolled in SCHIP, because these children are among the most vulnerable children covered by public health insurance programs and many of them are enrolling in SCHIP. C1 Univ Rochester, Sch Med & Dent, Dept Pediat, Rochester, NY 14642 USA. Univ Rochester, Sch Med & Dent, Dept Community & Prevent Med, Rochester, NY 14642 USA. Univ Florida, Inst Child Hlth Policy, Gainesville, FL USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. Kansas Hlth Inst, Topeka, KS USA. Indiana Univ, Sch Med, Dept Pediat, Indianapolis, IN 46202 USA. Indiana Univ, Sch Med, Dept Med, Indianapolis, IN 46202 USA. David Lucile Packard Fdn, Los Altos, CA USA. RP Szilagyi, PG (reprint author), Univ Rochester, Sch Med & Dent, Dept Pediat, Rochester, NY 14642 USA. FU AHRQ HHS [FL HS10465, NY HS10450, IN HS10453, KS HS10536] NR 65 TC 31 Z9 31 U1 5 U2 9 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD DEC PY 2003 VL 112 IS 6 SU S BP E508 EP E520 PG 13 WC Pediatrics SC Pediatrics GA 749YM UT WOS:000186957700003 PM 14654673 ER PT J AU Battles, JB Lilford, RJ AF Battles, JB Lilford, RJ TI Organizing patient safety research to identify risks and hazards SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID ADVERSE EVENTS; CARE; QUALITY AB Patient safety has become an international priority with major research programmes being carried out in the USA, UK, and elsewhere. The challenge is how to organize research efforts that will produce the greatest yield in making health care safer for patients. Patient safety research initiatives can be considered in three different stages: (1) identification of the risks and hazards; (2) design, implementation, and evaluation of patient safety practices; and (3) maintaining vigilance to ensure that a safe environment continues and patient safety cultures remain in place. Clearly, different research methods and approaches are needed at each of the different stages of the continuum. A number of research approaches can be used at stage 1 to identify risks and hazards including the use of medical records and administrative record review, event reporting, direct observation, process mapping, focus groups, probabilistic risk assessment, and safety culture assessment. No single method can be universally applied to identify risks and hazards in patient safety. Rather, multiple approaches using combinations of these methods should be used to increase identification of risks and hazards of health care associated injury or harm to patients. C1 US Dept HHS, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Univ Birmingham, UK Natl Hlth Serv, Res & Dev Directorate Methodol Programme, Birmingham B15 2TT, W Midlands, England. RP Battles, JB (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. NR 22 TC 8 Z9 9 U1 0 U2 3 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD DEC PY 2003 VL 12 SU 2 BP II2 EP II7 DI 10.1136/qhc.12.suppl_2.ii2 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 754PA UT WOS:000187324500002 PM 14645888 ER PT J AU Battles, JB AF Battles, JB TI Patient safety: research methods for a new field SO QUALITY & SAFETY IN HEALTH CARE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. RP Battles, JB (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. RI Sandall, Jane/D-4146-2009 OI Sandall, Jane/0000-0003-2000-743X NR 2 TC 1 Z9 1 U1 0 U2 0 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD DEC PY 2003 VL 12 SU 2 BP II1 EP II1 DI 10.1136/qhc.12.suppl_2.ii1 PG 1 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 754PA UT WOS:000187324500001 ER PT J AU Henriksen, K Kaplan, H AF Henriksen, K Kaplan, H TI Hindsight bias, outcome knowledge and adaptive learning SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID JUDGMENTS; MEMORY; EVENTS; CARE AB The ubiquitous nature of hindsight bias is a cause for concern for those engaged in investigations and retrospective analysis of medical error. Hindsight does not equal foresight. Investigations that are anchored to outcome knowledge run the risk of not capturing the complexities and uncertainties facing sharp end personnel and why their actions made sense at the time. Important lessons go unlearned if the exercise is simply to back track someone else's decision landmarks. Outcome knowledge can also bias our thinking on the quality of the processes that led to the outcome. This paper examines the influence of outcome knowledge in relation to reconstructive memory and legal testimony, ways for reducing the impact of outcome knowledge, and an adaptive learning framework that places hindsight bias in a broader context of rapid updating of knowledge. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Columbia Univ Coll Phys & Surg, New York, NY 10032 USA. RP Henriksen, K (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. NR 27 TC 12 Z9 12 U1 0 U2 0 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD DEC PY 2003 VL 12 SU 2 BP II46 EP II50 DI 10.1136/qhc.12.suppl_2.ii46 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 754PA UT WOS:000187324500009 PM 14645895 ER PT J AU Zhan, C Miller, MR AF Zhan, C Miller, MR TI Administrative data based patient safety research: a critical review SO QUALITY & SAFETY IN HEALTH CARE LA English DT Review ID CLINICAL COMORBIDITY INDEX; ADVERSE DRUG EVENTS; HOSPITALIZED-PATIENTS; COMPLICATION RATES; US HOSPITALS; RISK-FACTORS; CARE; MORTALITY; OUTCOMES; VALIDATION AB Administrative data are readily available, inexpensive, computer readable, and cover large populations. Despite coding irregularities and limited clinical details, administrative data supplemented by tools such as the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) could serve as a screen for potential patient safety problems that merit further investigation, offer valuable insights into adverse impacts and risks of medical errors and, to some extent, provide benchmarks for tracking progress in patient safety efforts at local, state, or national levels. C1 US Dept HHS, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20852 USA. Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. RP Zhan, C (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20852 USA. NR 47 TC 23 Z9 23 U1 7 U2 15 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1475-3898 J9 QUAL SAF HEALTH CARE JI Qual. Saf. Health Care PD DEC PY 2003 VL 12 SU 2 BP II58 EP II63 DI 10.1136/qhc.12.suppl_2.ii58 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 754PA UT WOS:000187324500011 PM 14645897 ER PT J AU Mandelblatt, J Saha, S Teutsch, S Hoerger, T Siu, AL Atkins, D Klein, J Helfand, M AF Mandelblatt, J Saha, S Teutsch, S Hoerger, T Siu, AL Atkins, D Klein, J Helfand, M CA Cost Work Grp US Preventive Serv TI The cost-effectiveness of screening mammography beyond age 65 years: A systematic review for the US Preventive Services Task Force SO ANNALS OF INTERNAL MEDICINE LA English DT Review ID BREAST-CANCER PATIENTS; OLDER WOMEN; LIFE-EXPECTANCY; ELDERLY-WOMEN; PATTERNS; SURVIVAL; MODEL; INTERVENTIONS; COMORBIDITY; DIAGNOSIS AB Purpose: There are few data on the effects of disease biology and competing mortality on the effectiveness of screening women for breast cancer after age 65 years. The authors performed a review to determine the costs and benefits of mammography screening after age 65 years. Data Sources: Cost-effectiveness articles published between January 1989 and March 2002. Study Selection: Studies were identified by using MEDLINE and the National Health Service Economic Evaluation Database. The authors included research on screening after age 65 years conducted from a societal or government perspective; reviews and analyses of other technologies were excluded. Data Synthesis: 115 studies were identified and 10 met inclusion criteria. One study modeled age-dependent assumptions of disease biology. No study fully captured the potential harms of screening, including anxiety associated with false-positive results, overdiagnosis, and previous knowledge of cancer or living longer with the consequences of treatment. Studies differed in the specific strategies compared and in analytic approaches. On average, extending biennial screening to age 75 or 80 years was estimated to cost $34 000 to $88 000 (2002 U.S. dollars) per life-year gained, compared with stopping screening at age 65 years. Two studies suggested that it was more cost-effective to target healthy women than those with several competing risks for death. Conclusions: Current estimates suggest that biennial breast cancer screening after age 65 years reduces mortality at reasonable costs for women without clinically significant comorbid conditions. More data are needed on disease biology and preferences for benefits and harms in older women. C1 Georgetown Univ, Med Ctr, Vincent T Lombardi Canc Res Ctr, Washington, DC 20007 USA. Oregon Hlth Sci Univ, Portland Vet Affairs Med Ctr, Portland, OR 97201 USA. Merck & Co Inc, W Point, PA USA. Univ N Carolina, Res Triangle Inst, Res Triangle Pk, NC USA. Mt Sinai Sch Med, New York, NY USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Rochester, Rochester, NY USA. RP Mandelblatt, J (reprint author), Georgetown Univ, Med Ctr, Vincent T Lombardi Canc Res Ctr, 2233 Wisconsin Ave,Suite 317, Washington, DC 20007 USA. FU NCI NIH HHS [KO5 CA96940, U01CA88283]; PHS HHS [290-97-0011, 290-97-0018] NR 44 TC 76 Z9 76 U1 2 U2 5 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD NOV 18 PY 2003 VL 139 IS 10 BP 835 EP 842 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 744ZV UT WOS:000186663500007 PM 14623621 ER PT J AU Weinick, RM AF Weinick, RM TI Researching disparities: Strategies for primary data collection SO ACADEMIC EMERGENCY MEDICINE LA English DT Article; Proceedings Paper CT Conference on Disparaties in Emergency Health Care CY MAY 28, 2003 CL BOSTON, MASSACHUSETTS DE disparities; emergency medicine; race; ethnicity ID HEALTH-CARE; RACE; NEIGHBORHOOD; ETHNICITY; ACCESS; DEATH; MORTALITY; SERVICES; QUALITY; STORES AB Comparatively little disparities research to date has focused on emergency medicine. However, the body of disparities research developed in other areas of health care has identified a number of issues that are directly applicable. To promote research on disparities in emergency medicine, this article addresses several of these issues related to collecting and classifying data on race/ethnicity and socioeconomic status and selected methodologic issues that are particularly important for evaluating disparities. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Weinick, RM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. FU AHRQ HHS [1R13HSO14030-01] NR 33 TC 4 Z9 4 U1 1 U2 1 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD NOV PY 2003 VL 10 IS 11 BP 1161 EP 1168 DI 10.1197/S1069-6563(03)00484-6 PG 8 WC Emergency Medicine SC Emergency Medicine GA 740WY UT WOS:000186426300004 PM 14597490 ER PT J AU Pezzin, LE Fleishman, JA AF Pezzin, LE Fleishman, JA TI Is outpatient care associated with lower use of inpatient and emergency care? An analysis of persons with HIV disease SO ACADEMIC EMERGENCY MEDICINE LA English DT Article DE AIDS; HIV; emergency department; utilization; outpatient care ID HEALTH-SERVICE USE; ANTIRETROVIRAL TREATMENT; COMBINATION THERAPY; AIDS; INFECTION; SELECTION; IMPACT; PEOPLE; ADULTS AB Objectives: The authors use data from the AIDS Costs and Service Utilization Survey (ACSUS) to investigate the extent to which use of ambulatory medical care is associated with inpatient and emergency department use among HIV-infected persons. Methods: Parameter estimates were derived from simultaneous, multiequation models. Results: Higher use of ambulatory medical services is not significantly associated with lower probability of inpatient admissions or emergency department (ED) visits. For the subgroup of patients who received an AIDS diagnosis during the study period, however, the number of ambulatory visits had significant negative effects on hospitalizations and ED use. Conclusions: Outpatient care may offset inpatient and ED services at particular points in the disease course. C1 Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Pezzin, LE (reprint author), Med Coll Wisconsin, Dept Med, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA. NR 19 TC 11 Z9 11 U1 0 U2 0 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD NOV PY 2003 VL 10 IS 11 BP 1228 EP 1238 DI 10.1197/S1069-6563(03)00493-7 PG 11 WC Emergency Medicine SC Emergency Medicine GA 740WY UT WOS:000186426300013 PM 14597499 ER PT J AU Phillips, RL Phillips, KA Chen, FM Melillo, A AF Phillips, RL Phillips, KA Chen, FM Melillo, A TI Exploring residency match violations in family practice SO FAMILY MEDICINE LA English DT Article ID PROGRAM; RECRUITMENT AB Background and Objectives: This study's objective was to learn what student applicants to family practice residency programs in 2002 understood about National Resident Matching Program guideline violations, whether they experienced violations, and how they were affected by perceived violations. Methods: We used qualitative analysis of in-depth interviews with 15 key informant students. Results: Only six of the 15 students believed that they had experienced a violation. Only two students had experienced an actual Match guideline violation, and two more experienced potential violations. There was substantial confusion about what constituted a violation. The sources of confusion involved failure to attend Match orientation, lack of clarity in published information, confusing messages from programs, rumors and word-of-mouth, and students' own personal moral values. Equal Employment Opportunity Commission violations were interpreted by some as Match violations. Some students judged programs based on threats to the integrity of the Match, whether or not they experienced actual violations. Conclusions: Real and potential Match violations did occur, but there is also considerable confusion about what constitutes a violation. There are opportunities to investigate violations, train students to recognize and deal with violations, and clarify actual violation definitions and for programs to avoid the real and perceived violations that affect their recruiting. C1 Robert Graham Ctr Policy Studies Family Practice, Washington, DC 20036 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Res, Washington, DC USA. Univ Calif San Francisco, Dept Family & Community Med, San Francisco, CA 94143 USA. RP Phillips, RL (reprint author), Robert Graham Ctr Policy Studies Family Practice, 1350 Connecticut Ave NW,Suite 950, Washington, DC 20036 USA. NR 11 TC 5 Z9 5 U1 0 U2 0 PU SOC TEACHERS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, STE 540, LEAWOOD, KS 66207 USA SN 0742-3225 J9 FAM MED JI Fam. Med. PD NOV-DEC PY 2003 VL 35 IS 10 BP 717 EP 720 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 744JM UT WOS:000186625500013 PM 14603403 ER PT J AU Weissman, JS Moy, E Campbell, EG Gokhale, M Yucel, R Causino, N Blumenthal, D AF Weissman, JS Moy, E Campbell, EG Gokhale, M Yucel, R Causino, N Blumenthal, D TI Limits to the safety net: Teaching hospital faculty report on their patients' access to care SO HEALTH AFFAIRS LA English DT Article ID HIDDEN CURRICULUM; MEDICAL-EDUCATION; MARKET FORCES; MANAGED CARE; INSURANCE; CENTERS AB Many major teaching hospitals might not be able to offer adequate access to specialty care for uninsured patients. This study found that medical school faculty were more likely to have difficulty obtaining specialty services for uninsured than for privately insured patients. These gaps in access were similar in magnitude for public and private institutions. Initial treatment of uninsured patients at academic health centers (AHCs) does not guarantee access to specialty and other referral services, which suggests that there are limits to relying on a health care safety net for uninsured patients. AHCs and affiliated group practices should examine policies that limit access for uninsured patients. C1 Harvard Univ, Sch Med, Dept Med, Cambridge, MA 02138 USA. Massachusetts Gen Hosp, Inst Hlth Policy, Boston, MA 02114 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Weissman, JS (reprint author), Harvard Univ, Sch Med, Dept Med, Cambridge, MA 02138 USA. NR 31 TC 20 Z9 20 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD NOV-DEC PY 2003 VL 22 IS 6 BP 156 EP 166 DI 10.1377/hlthaff.22.6.156 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 744LN UT WOS:000186632200021 PM 14649442 ER PT J AU Aaron, KF Levine, D Burstin, HR AF Aaron, KF Levine, D Burstin, HR TI African American church participation and health care practices SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article; Proceedings Paper CT Annual Research Meeting of the Academy-of-Health-Services-Research-and-Health-Policy CY JUN, 2001 CL ATLANTA, GEORGIA SP Acad Hlth Serv Res Hlth Policy DE church attendance; health care services; health care practices; preventive services; religiosity ID OLDER-ADULTS; RELIGIOUS INVOLVEMENT; BLACK-AMERICANS; SELF-EFFICACY; MENTAL-HEALTH; PUBLIC-HEALTH; ATTENDANCE; SURVIVAL; CANCER; SPIRITUALITY AB Background: While religious involvement is associated with improvements in health, little is known about the relationship between church participation and health care practices. Objectives: To determine 1) the prevalence of church participation; 2) whether church participation influences positive health care practices; and 3) whether gender, age, insurance status, and levels of comorbidity modified these relationships. Design: A cross-sectional analysis using survey data from 2196 residents of a low-income, African-American neighborhood. Measurements: Our independent variable measured the frequency of church attendance. Dependent variables were: 1) Pap smear; 2) mammogram; and 3) dental visit-all taking place within 2 years; 4) blood pressure measurement within 1 year, 5) having a regular source of care, and 6) no perceived delays in care in the previous year. We controlled for socioeconomic factors and the number of comorbid conditions and also tested for interactions. Results: Thirty-seven percent of community members went to church at least monthly. Church attendance was associated with increased likelihood of positive health care practices by 20% to 80%. In multivariate analyses, church attendance was related to dental visits (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3 to 1.9) and blood pressure measurements (OR, 1.6; 95% CI, 1.2 to 2.1). Insurance status and number of comorbid conditions modified the relationship between church attendance and Pap smear, with increased practices noted for the uninsured (OR, 2.3; 95% CI, 1.2 to 4.1) and for women with 2 or more comorbid conditions (OR, 1.9; 95% CI, 1.1 to 3.5). Conclusion: Church attendance is an important correlate of positive health care practices, especially for the most vulnerable subgroups, the uninsured and chronically ill. Community- and faith-based organizations present additional opportunities to improve the health of low-income and minority populations. C1 Agcy Healthcare Res & Qual, Off Prior Populat Res, Ctr Primary Care Res, Rockville, MD 20850 USA. Johns Hopkins Univ, Sch Hyg & Publ Hlth, Dept Med, Baltimore, MD USA. Johns Hopkins Univ, Sch Hyg & Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. RP Aaron, KF (reprint author), Agcy Healthcare Res & Qual, Off Prior Populat Res, Ctr Primary Care Res, 540 Gaither Rd, Rockville, MD 20850 USA. NR 29 TC 45 Z9 45 U1 1 U2 5 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD NOV PY 2003 VL 18 IS 11 BP 908 EP 913 PG 6 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 743FW UT WOS:000186562600005 ER PT J AU Hostetter, TH Chawla, P Melcher, C Gladstone, E Stryer, D Mcclellan, WM AF Hostetter, TH Chawla, P Melcher, C Gladstone, E Stryer, D Mcclellan, WM TI A comprehensive survey of African Americans on kidney disease SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 NIDDKD, NIH, Bethesda, MD 20892 USA. Univ Minnesota, Minneapolis, MN USA. Equals Three Commun, Bethesda, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Emory Univ, Div Renal, Atlanta, GA 30322 USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 289A EP 289A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219101338 ER PT J AU Mcclellan, WM Chawla, P Melcher, C Gladstone, E Stryer, D Hostetter, TH AF Mcclellan, WM Chawla, P Melcher, C Gladstone, E Stryer, D Hostetter, TH TI Awareness and perceived severity of a family history of chronic kidney disease (FH-CKD) among primary care physicians (PCPs). SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Emory Univ, Div Renal, Atlanta, GA 30322 USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. Univ Minnesota, Minneapolis, MN USA. Equals Three Commun Inc, Bethesda, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NIDDKD, Natl Kidney Dis Educ Program, Bethesda, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 445A EP 445A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219102062 ER PT J AU Lanier, DC Roland, M Burstin, H Knottnerus, JA AF Lanier, DC Roland, M Burstin, H Knottnerus, JA TI Doctor performance and public accountability SO LANCET LA English DT Article ID GENERAL-PRACTICE; QUALITY IMPROVEMENT; HEALTH-CARE; CLINICAL GOVERNANCE; CARDIAC-SURGERY; IMPLEMENTATION; INFORMATION; OUTCOMES; RELEASE AB Public concern about the quality of health care has motivated governments, health-care funders, and clinicians to expand efforts to improve professional performance. In this paper, we illustrate such efforts from the perspective of three countries, the UK, the USA, and the Netherlands. The earliest strategies, which included continuing professional education, clinical audits, and peer review, were aimed at the individual doctor, and produced only modest effects. Other efforts, such as national implementation of practice guidelines, effective use of information technologies, and intensive involvement by doctors in continuous quality-improvement activities, are aimed more broadly at health-care systems. Much is yet unknown about whether these or other strategies-such as centralised supervision or regulation of quality improvement, or use of financial incentives-are effective. As demands for greater public accountability rise, continuing performance improvement efforts of each of our countries offer us opportunities to learn from one another. C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. Natl Primary Care Res & Dev Ctr, Manchester, Lancs, England. Netherlands Sch Primary Care Res, Maastricht, Netherlands. RP Lanier, DC (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. RI Knottnerus, Andre/F-4866-2013; Knottnerus, Johannes/A-3829-2009 NR 29 TC 34 Z9 35 U1 0 U2 7 PU LANCET LTD PI LONDON PA 84 THEOBALDS RD, LONDON WC1X 8RR, ENGLAND SN 0140-6736 J9 LANCET JI Lancet PD OCT 25 PY 2003 VL 362 IS 9393 BP 1404 EP 1408 DI 10.1016/S0140-6736(03)14638-7 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 735YX UT WOS:000186143300024 PM 14585644 ER PT J AU Spector, W Fleishman, J Shaffer, T AF Spector, W Fleishman, J Shaffer, T TI Patterns of functional change and mortality - Impacts of age, gender, race, and education. SO GERONTOLOGIST LA English DT Meeting Abstract C1 Agcy Healthcare Res & Qual, Rockville, MD USA. Agcy Healthcare Policy & Res, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2003 VL 43 SI 1 BP 34 EP 34 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 734VF UT WOS:000186078100090 ER PT J AU Mukamel, D Spector, W Bajorska, A AF Mukamel, D Spector, W Bajorska, A TI Promoting nursing home quality in non competitive markets SO GERONTOLOGIST LA English DT Meeting Abstract C1 Univ Rochester, Med Ctr, Rochester, NY 14642 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2003 VL 43 SI 1 BP 592 EP 592 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 734VF UT WOS:000186078101621 ER PT J AU Tunis, SR Stryer, DB Clancy, CM AF Tunis, SR Stryer, DB Clancy, CM TI Practical clinical trials - Increasing the value of clinical research for decision making in clinical and health policy SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; LIPID-LOWERING TREATMENT; OBSTRUCTIVE PULMONARY-DISEASE; BENIGN PROSTATIC HYPERPLASIA; ACUTE MYOCARDIAL-INFARCTION; ABDOMINAL AORTIC-ANEURYSMS; LOW-BACK-PAIN; MEDICAL LITERATURE; USERS GUIDES; PRIMARY-CARE AB Decision makers in health care are increasingly interested in using high-quality scientific evidence to support clinical and health policy choices; however, the quality of available scientific evidence is often found to be inadequate. Reliable evidence is essential to improve health care quality and to support efficient use of limited resources. The widespread gaps in evidence-based knowledge suggest that systematic flaws exist in the production of scientific evidence, in part because there is no consistent effort to conduct clinical trials designed to meet the needs of decision makers. Clinical trials for which the hypothesis and study design are developed specifically to answer the questions faced by decision makers are called pragmatic or practical clinical trials (PCTs). The characteristic features of PCTs are that they (1) select clinically relevant alternative interventions to compare, (2) include a diverse population of study participants, (3) recruit participants from heterogeneous practice settings, and (4) collect data on a broad range of health outcomes. The supply of PCTs is limited primarily because the major funders of clinical research, the National Institutes of Health and the-medical products industry, do not focus on supporting such trials. Increasing the supply of PCTs will depend on the development of a mechanism to establish priorities for these studies, significant expansion of an infrastructure to conduct clinical research within the health care delivery system, more reliance on high-quality evidence by health care decision makers, and a substantial increase in public and private funding for these studies. For these changes to occur, clinical and health policy decision makers will need to become more involved in all aspects of clinical research, including priority, setting, infrastructure development, and funding. C1 Ctr Medicare Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. Ctr Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Tunis, SR (reprint author), Ctr Medicare Serv, Off Clin Stand & Qual, 7500 Secur Blvd,Mailstop 53-02-01, Baltimore, MD 21244 USA. NR 65 TC 997 Z9 1009 U1 9 U2 60 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD SEP 24 PY 2003 VL 290 IS 12 BP 1624 EP 1632 DI 10.1001/jama.290.12.1624 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 723ZK UT WOS:000185461300028 PM 14506122 ER PT J AU Fleishman, JA Sherbourne, CD Cleary, PD Wu, AW Crystal, S Hays, RD AF Fleishman, JA Sherbourne, CD Cleary, PD Wu, AW Crystal, S Hays, RD TI Patterns of coping among persons with HIV infection: Configurations, correlates, and change SO AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY LA English DT Article DE coping responses; HIV infection; chronic illness ID SOCIAL SUPPORT; DEPRESSIVE SYMPTOMS; PSYCHOLOGICAL ADJUSTMENT; GAY MEN; STRESS; DETERMINANTS; CANCER; HEALTH; MOOD; AIDS AB This study examines coping in response to HIV infection, using longitudinal data from a nationally representative sample (n = 2, 864) of HIV-infected persons. We investigated configurations of coping responses, the correlates of configuration membership, the stability of coping configurations, and the relationship of coping to emotional well-being. Four coping configurations emerged from cluster analyses: relatively frequent use of blame-withdrawal coping, frequent use of distancing, frequent active-approach coping, and infrequent use of all three coping strategies ("passive" copers). Passive copers had few symptoms, high levels of physical functioning, and high emotional well-being; blame-withdrawal copers had the opposite pattern. Of those completing a second interview 1 year after baseline, 46% had the same coping configuration. Increases in the number of HIV-related symptoms raised the probability of blame-withdrawal coping at follow-up, whereas decreases raised the probability of passive coping. Infrequent use of coping responses at baseline was related to greater emotional wellbeing 1 year later. This result, in conjunction with the high levels of emotional well-being in the passive cluster, suggests that high levels of distress can induce blame-withdrawal coping whereas coping efforts are minimal when social support and emotional well-being are high. Results highlight issues in ascertaining the causal direction between coping and psychological outcomes, as well as in specifying the nature of stressful situations with which people are coping. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20852 USA. RAND Corp, Hlth Sci Program, Santa Monica, CA USA. Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. Johns Hopkins Univ, Dept Hlth Policy & Management, Bloomberg Sch Publ Hlth, Baltimore, MD 21218 USA. Rutgers State Univ, Inst Hlth Hlth Policy & Aging Res, New Brunswick, NJ 08903 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 2101 E Jefferson St, Rockville, MD 20852 USA. RI Hays, Ronald/D-5629-2013 FU AHRQ HHS [HS08578] NR 64 TC 13 Z9 13 U1 4 U2 9 PU KLUWER ACADEMIC/PLENUM PUBL PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0091-0562 J9 AM J COMMUN PSYCHOL JI Am. J. Community Psychol. PD SEP PY 2003 VL 32 IS 1-2 BP 187 EP 204 DI 10.1023/A:1025667512009 PG 18 WC Public, Environmental & Occupational Health; Psychology, Multidisciplinary; Social Work SC Public, Environmental & Occupational Health; Psychology; Social Work GA 719PL UT WOS:000185212100017 PM 14570446 ER PT J AU Sommers, AR Wholey, DR AF Sommers, AR Wholey, DR TI The effect of HMO competition on gatekeeping, usual source of care, and evaluations of physician thoroughness SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID MANAGED CARE; HEALTH-CARE; MARKET-STRUCTURE; MEDICAL-CARE; PLAN; EXPENDITURES; QUALITY; ACCESS; TRUST; PERFORMANCE AB Objectives: To examine the effects of HMO enrollment and HMO competition on evaluations of physician thoroughness through their effects on gatekeeping and having a usual source of care and to determine whether the effects of HMO competition spill over to individuals not enrolled in HMOs and whether these effects differ in those enrolled vs not enrolled in HMOs. Study Sample: A nationally representative sample of 27441 adults from the household component of the Community Tracking Study-Round I (July, 1996, through July, 1997). Study Design: A retrospective econometric. analysis of Community Tracking Study data merged with measures of HMO competition. Methods: Gatekeeping was regressed on HMO enrollment, HMO competition, and control variables using ordered logistic regression. Usual source of care was regressed on gatekeeping, HMO enrollment, HMO competition, and control variables using logistic regression. Evaluation of physician thoroughness was regressed on gatekeeping, usual source of care, HMO enrollment, HMO competition, and control variables using multivariate regression. Results: HMO competition increases use of gatekeeping and gatekeeping increases having a usual source of care for all individuals. For HMO enrollees, HMO competition increases having a usual source of care, whereas for those not in HMOs, it decreases having a usual source of care. For all individuals, having a usual source of care increases evaluation of physician thoroughness. For those in HMOs, gatekeeping decreases evaluation of physician thoroughness. Conclusions: For HMO enrollees, the overall effect of HMO competition is to increase evaluations of physician thoroughness. For those not in HMOs, although there are HMO competition spillover effects, they are offsetting, resulting in no overall effect of HMO competition on evaluations of physician thoroughness. C1 Agcy Healthcare Res & Qual, Ctr Outcome & Effectiveness Res, Rockville, MD USA. Univ Minnesota, Sch Publ Hlth, Div Hlth Serv Res & Policy, Minneapolis, MN 55455 USA. RP Sommers, AR (reprint author), RTI Int, 1615 M St NW, Washington, DC 20036 USA. NR 37 TC 5 Z9 5 U1 1 U2 6 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD SEP PY 2003 VL 9 IS 9 BP 618 EP 627 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 724MY UT WOS:000185492400004 PM 14527107 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for dementia: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Editorial Material ID RANDOMIZED CONTROLLED-TRIAL; ALZHEIMERS-DISEASE PATIENTS; MILD COGNITIVE IMPAIRMENT; CLINICAL-TRIAL; PLACEBO; DONEPEZIL; EFFICACY; AD; INTERVENTION; HALOPERIDOL C1 USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Berg, AO (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.gov NR 52 TC 0 Z9 0 U1 2 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD SEP PY 2003 VL 103 IS 9 BP 87 EP + PG 5 WC Nursing SC Nursing GA 733AZ UT WOS:000185978900038 ER PT J AU Rhoades, JA Sommers, JP AF Rhoades, JA Sommers, JP TI Trends in nursing home expenses, 1987 and 1996 SO HEALTH CARE FINANCING REVIEW LA English DT Article ID CATASTROPHIC-COVERAGE-ACT; CARE; ADMISSIONS; RESIDENTS; LENGTH; IMPACT; TERM AB This article presents data about expenses and sources of payment for nursing homes for 1987 and 1996. A central finding is that the role of Medicare in financing nursing home care has greatly expanded. Medicare payments represent 2 and 19 percent of the total for 1987 and 1996, respectively. As Medicare's role increased, there was an accompanying decline in the proportion of expenses paid out of pocket. In 1987, 45 percent was paid out of pocket versus 30 percent in 1996. Those nursing home residents using Medicare most heavily as a source of payment tended to exhibit very short stays (33 days on average), zero limitations in activities of daily living (ADLs), and no mental conditions. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Rhoades, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Room 5212,540 Gather Rd, Rockville, MD 20850 USA. EM jrhoades@ahrq.gov NR 28 TC 3 Z9 3 U1 0 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2003 VL 25 IS 1 BP 99 EP 114 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PF UT WOS:000231089900007 PM 14997696 ER PT J AU Fleishman, JA Hellinger, FH AF Fleishman, JA Hellinger, FH TI Recent trends in HIV-related inpatient admissions 1996-2000 - A 7-state study SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE AIDS; inpatient hospital use; inpatient length of stay; resource use ID ACTIVE ANTIRETROVIRAL THERAPY; INFECTED PATIENTS; CARE AB Background and Objectives: HIV-related inpatient utilization declined immediately after the diffusion of highly active antiretroviral therapy (HAART), but some studies suggest that admission rates may have recently begun to increase. Using comprehensive hospital discharge data from 7 states, this study examines trends in HIV-related inpatient admissions and length of stay (LOS) from 1996 through 2000. Methods: We identified HIV-related admissions by ICD-9-CM diagnosis codes in the range from 042 to 044. Analyses assessed differential patterns of change over time, depending on state, gender, race/ethnicity, and insurance. Results: HIV-related inpatient admissions generally declined each year, but the rate of decline diminished recently. A similar pattern held for trends in inpatient LOS. Admissions for white male patients and for patients with private insurance showed the greatest decreases and the least leveling of the trend. The proportion of HIV admissions to total admissions was highest for black men and lowest for white women. In contrast to the period from 1993 through 1996, the proportion of HIV admissions covered by Medicare was greater than the rate of privately insured admissions. Conclusions: Although there is no substantial evidence for widespread increases in admissions during this period, results suggest that the trend in HIV-related hospital admissions is level in recent years. Racial/ethnic disparities in inpatient utilization persist. Further analysis of the impact of treatment failure or HAART-related complications on HIV admissions is warranted. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20850 USA. Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20850 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 540 Gaither Rd, Rockville, MD 20850 USA. NR 17 TC 38 Z9 38 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1525-4135 J9 JAIDS-J ACQ IMM DEF JI JAIDS PD SEP 1 PY 2003 VL 34 IS 1 BP 102 EP 110 DI 10.1097/00126334-200309010-00015 PG 9 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 719YL UT WOS:000185232600015 PM 14501801 ER PT J AU Holman, RC Curns, AT Belay, ED Steiner, CA Schonberger, LB AF Holman, RC Curns, AT Belay, ED Steiner, CA Schonberger, LB TI Kawasaki syndrome hospitalizations in the United States, 1997 and 2000 SO PEDIATRICS LA English DT Article DE Kawasaki syndrome; Kawasaki disease; hospitalizations; epidemiology; children; infants; United States ID LYMPH-NODE SYNDROME; DISEASE; CHILDREN; COLORADO; HAWAII; RISK AB Objective. To estimate the incidence and describe the epidemiologic characteristics of Kawasaki syndrome (KS) among children in the United States. Methods. Hospital discharge records with a KS diagnosis among patients < 18 years of age were obtained from the 1997 and 2000 Kids' Inpatient Database and weighted to estimate the number and rate of KS-associated hospitalizations for the United States. Results. In 2000, similar to 4248 hospitalizations associated with KS occurred in the United States, and the median age of patients at admission was 2 years. Children < 5 years of age accounted for 3277 of these KS hospitalizations (77%) and had a KS hospitalization rate of 17.1 per 100 000 children. This rate was similar to the 1997 rate of 17.6 per 100 000 children. The KS hospitalization rate was significantly higher for infants < 1 year of age than for children 1 to 4 years of age (19.8 and 16.4 per 100 000 children, respectively). The rate of KS hospitalizations among children aged <5 years was highest among Asian and Pacific Islander children and was followed by the rate for black children (39.0 and 19.7 per 100 000 children, respectively). No deaths associated with KS were reported among hospitalized children. The median charge for a KS hospitalization was $ 7779 ( mean $ 10 725) and the total annual charges for KS hospitalizations in 2000 were approximately $ 35 million among children < 5 years of age. Conclusions. Among children < 5 years of age, the annual KS-associated hospitalization rates were similar for 1997 and 2000. The epidemiologic characteristics and hospitalization rates for KS at a national level were consistent with those reported from earlier studies, suggesting that the incidence for KS has not markedly changed in the United States during the past decade. C1 Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Infect Dis, US Dept HHS, Atlanta, GA 30333 USA. US Dept HHS, Healthcare Cost & Utilizat Project, Ctr Org & Delivery Studies, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Holman, RC (reprint author), Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Infect Dis, US Dept HHS, MS A-39, Atlanta, GA 30333 USA. RI Belay, Ermias/A-8829-2013 NR 39 TC 124 Z9 141 U1 1 U2 4 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD SEP PY 2003 VL 112 IS 3 BP 495 EP 501 DI 10.1542/peds.112.3.495 PG 7 WC Pediatrics SC Pediatrics GA 716NL UT WOS:000185035100016 PM 12949272 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Behavioral counseling in primary care to promote a healthy diet: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article ID CORONARY HEART-DISEASE; WORCESTER-AREA TRIAL; LOW-FAT DIET; RANDOMIZED-TRIAL; GENERAL-PRACTICE; WOMENS HEALTH; HYPERLIPIDEMIA WATCH; NUTRITION EDUCATION; PHYSICIAN ADVICE; EATING PATTERNS C1 US Prevent Serv Task Force, USPSTF, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. NR 54 TC 0 Z9 0 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD AUG PY 2003 VL 103 IS 8 BP 81 EP + PG 7 WC Nursing SC Nursing GA 709HU UT WOS:000184620400034 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for high blood pressure - Recommendations and rationale SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Review ID RANDOMIZED CONTROLLED TRIALS; LIPID-LOWERING TREATMENT; ESSENTIAL-HYPERTENSION; SYSTOLIC HYPERTENSION; METAANALYSIS; RISK; CORONARY; COMPLICATIONS; CONSEQUENCES; ABSENTEEISM C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Natl Initiative Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Newark, NJ 07103 USA. Harvard Univ, Sch Med, Boston, MA USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Women & Infants Hosp Rhode Isl, Providence, RI 02908 USA. Univ Michigan, Ann Arbor, MI 48109 USA. Mt Sinai Sch Med, Dept Geriatr, New York, NY USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, New York, NY USA. Virginia Commonwealth Univ, Dept Community & Prevent Med, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. NR 46 TC 12 Z9 12 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD AUG PY 2003 VL 25 IS 2 BP 159 EP 164 DI 10.1016/S0749-3797(03)00122-3 PG 6 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 703TC UT WOS:000184296200013 ER PT J AU Koken, PJM Piver, WT Ye, F Elixhauser, A Olsen, LM Portier, CJ AF Koken, PJM Piver, WT Ye, F Elixhauser, A Olsen, LM Portier, CJ TI Temperature, air pollution, and hospitalization for cardiovascular diseases among elderly people in Denver SO ENVIRONMENTAL HEALTH PERSPECTIVES LA English DT Article DE acute myocardial infarction; air pollution; cardiac dysrhythmias; cardiovascular diseases; CO; congestive heart failure; coronary atherosclerosis; generalized estimating equations; NO2; O-3; PM10; Poisson regression; pulmonary heart disease; SO2; temperature ID CONGESTIVE-HEART-FAILURE; TIME-SERIES ANALYSIS; CARBON-MONOXIDE; US CITIES; ADMISSIONS; MORTALITY; ASSOCIATION; WEATHER; HEALTH; ARRHYTHMIA AB Daily measures of maximum temperature, particulate matter! 10 Put in aerodynamic diameter (PM10), and gaseous pollution (ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide) were collected in Denver, Colorado, in July and August between 1993 and 1997. We then compared these exposures with concurrent data on the number of daily hospital admissions for cardiovascular diseases in men and women > 65 years of age. Generalized linear models, assuming a Poisson error structure for the selected cardiovascular disease hospital admissions, were constructed to evaluate the associations with air pollution and temperature. After adjusting the admission data for yearly trends, day of-week effects, ambient maximum temperature, and dew point temperature, we studied the associations of the pollutants in single-pollutant models with lag times of 0-4 days. The results suggest that O-3 is associated with an increase in the risk of hospitalization for acute myocardial infarction, coronary atherosclerosis, and pulmonary heart disease. SO2 appears to be related to increased hospital stays for cardiac dysrhythmias, and CO is significantly associated with congestive heart failure. No association was found between particulate matter or NO2 and any of the health outcomes. Males tend to have higher numbers of hospital admissions than do females for all of the selected cardiovascular diseases, except for congestive heart failure. Higher temperatures appear to be an important factor in increasing the frequency of hospitalization for acute myocardial infarction and congestive heart failure, and are associated with a decrease in the frequency of visits for coronary atherosclerosis and pulmonary heart disease. C1 NIEHS, Res Triangle Pk, NC 27709 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NASA, Greenbelt, MD USA. RP Koken, PJM (reprint author), NIEHS, MD A3-06,POB 12233, Res Triangle Pk, NC 27709 USA. RI Portier, Christopher/A-3160-2010 OI Portier, Christopher/0000-0002-0954-0279 NR 46 TC 136 Z9 142 U1 6 U2 22 PU US DEPT HEALTH HUMAN SCIENCES PUBLIC HEALTH SCIENCE PI RES TRIANGLE PK PA NATL INST HEALTH, NATL INST ENVIRONMENTAL HEALTH SCIENCES, PO BOX 12233, RES TRIANGLE PK, NC 27709-2233 USA SN 0091-6765 J9 ENVIRON HEALTH PERSP JI Environ. Health Perspect. PD AUG PY 2003 VL 111 IS 10 BP 1312 EP 1317 DI 10.1289/ehp.5957 PG 6 WC Environmental Sciences; Public, Environmental & Occupational Health; Toxicology SC Environmental Sciences & Ecology; Public, Environmental & Occupational Health; Toxicology GA 711MX UT WOS:000184746600033 PM 12896852 ER PT J AU Bednarek, HL Schone, BS AF Bednarek, HL Schone, BS TI Variation in preventive service use among the insured and uninsured: Does length of time without coverage matter? SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Article DE health insurance; preventive service use ID HEALTH-CARE COVERAGE; UNITED-STATES; INSURANCE; SPELLS; CANCER; DURATIONS; ACCESS AB Lacking health insurance has consequences for the ways in which individuals seek care. In this research, the authors use data from the first panel (1996) of the Medical Expenditure Panel Survey to assess the relationship between preventive services and the length of time with insurance during a 12-month period. Regression analyses show that individuals with continuous coverage during the entire period have dramatically higher rates of preventive service use than individuals who lack coverage for all 12 months. For most services, the authors also find modest differences in preventive service use between the continually insured and those individuals with coverage for 1 to 6 months. Rates of preventive service use for individuals with 7 to 11 months Of coverage are statistically indistinguishable from the continually insured. The authors' findings highlight the importance of considering the length of time without coverage when evaluating preventive service use of the uninsured population. C1 St Louis Univ, St Louis, MO 63103 USA. Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. RP Bednarek, HL (reprint author), St Louis Univ, St Louis, MO 63103 USA. NR 33 TC 19 Z9 19 U1 0 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1049-2089 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PD AUG PY 2003 VL 14 IS 3 BP 403 EP 419 DI 10.1177/1049208903255800 PG 17 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 706XL UT WOS:000184480300009 PM 12955919 ER PT J AU Stryer, D AF Stryer, D TI Steps across the gap: Tools, trials and data SO MEDICAL CARE LA English DT Editorial Material ID IMPLEMENTATION; POLICY; SERVICES C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. RP Stryer, D (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. NR 14 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD AUG PY 2003 VL 41 IS 8 BP 871 EP 873 DI 10.1097/00005650-200308000-00001 PG 3 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 706WH UT WOS:000184477700001 PM 12886167 ER PT J AU Lurie, N Zhan, CL Sangl, J Bierman, AS Sekscenski, ES AF Lurie, N Zhan, CL Sangl, J Bierman, AS Sekscenski, ES TI Variation in racial and ethnic differences in consumer assessments of health care SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID MEDICAL-CARE; SOCIOECONOMIC-STATUS; RATINGS; RACE; SATISFACTION; DISPARITIES; QUALITY; ACCESS; PERFORMANCE; ENROLLEES AB Background: Prior studies have documented significant racial and ethnic disparities in health and healthcare, but data about disparities from consumer assessments of care are inconsistent. Objective: To examine racial/ethnic differences in consumer assessments and explore variation in such differences across health plans. Methods: Data included 160 694 Consumer Assessment of Health Plans Surveys (CAHPS) responses from 307 commercial health plans and 177 489 Medicare beneficiaries in 308 Medicare+Choice managed care plans collected in 1999. We compared adjusted mean CAHPS global rating and composite scores as well as access to and use of care reported by whites, blacks, Hispanics, and Asians. We assessed variation in the differences between plan means for whites and blacks and between whites and Hispanics. Results: Three minority groups rated their health plans higher than whites on at least 1 measure. Blacks rated their care and doctors higher than whites, while Asians rated their care and doctors lower than whites. Blacks reported better experience with care than whites, but Hispanics and Asians reported worse experience than whites. However, all minority groups reported significantly larger problems with access to and less use of healthcare. The differences between blacks and whites, and blacks and Hispanics in CAHPS measures and access/use measures varied greatly from plan to plan. Conclusions: Significant race/ethnic differences in experience with, access to, and use of care exist in health plans. Substantial variation in racial differences suggests compromised quality of healthcare and opportunities for quality improvement. C1 RAND Corp, Arlington, VA 22202 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res & Qual, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Medicare, Rockville, MD USA. Agcy Healthcare Res & Qual, Medicaid Serv, Rockville, MD USA. RP Lurie, N (reprint author), RAND Corp, 1200 S Hayes St, Arlington, VA 22202 USA. NR 28 TC 70 Z9 70 U1 1 U2 8 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD JUL PY 2003 VL 9 IS 7 BP 502 EP 509 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 699VA UT WOS:000184075600003 PM 12866629 ER PT J AU Baine, WB AF Baine, WB TI Systematic screening of secondary diagnoses in medicare administrative data to identify candidate risk factors for the principal diagnosis SO ANNALS OF EPIDEMIOLOGY LA English DT Article DE epidemiologic methods; medicare part A; risk factors ID HOSPITALIZATION; AMERICANS; TRENDS AB PURPOSE: Secondary diagnoses in Medicare hospital discharge claims may include risk factors for the principal diagnosis. However, risk ratios for the principal diagnosis as a function of secondary diagnoses cannot be calculated because no comparable data exist for beneficiaries who are not hospitalized. METHODS: Hospital discharge rates, as proxies for incidence rates, can be calculated by race and sex from Medicare claims and denominator files. If the prevalence of a risk factor is higher in one population group than another, that risk factor will be overrepresented among patients from the group at higher risk. RESULTS: This imbalance is reflected in what is termed the odds difference, OD = [(r + r')/r][f(2)/ (1 - f(2)) - f(1)/(1 - f(1))] in which r is the background incidence rate, and r' is the additional risk conferred by a factor that is present in fractions f(1) and f(2) in the two groups. Unlike the risk ratio, the odds difference can be calculated from claims data. Given f(1) and f(2), the odds difference is directly proportional to the risk ratio, RR = (r + r')/r. CONCLUSIONS: Ranking common secondary diagnoses by the magnitude of their odds difference between groups with disparate discharge rates for a given principal diagnosis may disclose secondary diagnoses that merit evaluation as candidate direct or indirect risk factors. Ann Epidermol 2003;13:443-449. Published by Elsevier Inc. C1 Ctr Outcomes & Effectiveness Res, Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20852 USA. RP Baine, WB (reprint author), Ctr Outcomes & Effectiveness Res, Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Suite 300,6010 Execut Blvd, Rockville, MD 20852 USA. NR 10 TC 0 Z9 0 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1047-2797 J9 ANN EPIDEMIOL JI Ann. Epidemiol. PD JUL PY 2003 VL 13 IS 6 BP 443 EP 449 DI 10.1016/S1047-2797(03)00005-X PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 704YV UT WOS:000184370300008 PM 12875803 ER PT J AU Aaron, KF Stryer, D AF Aaron, KF Stryer, D TI Moving from rhetoric to evidence-based action in health care SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material ID PUBLIC-HEALTH; COMMUNITY C1 Ctr Primary Care Res Agcy, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD USA. RP Aaron, KF (reprint author), Ctr Primary Care Res Agcy, Rockville, MD USA. NR 17 TC 8 Z9 8 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUL PY 2003 VL 18 IS 7 BP 589 EP 591 PG 3 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 699EG UT WOS:000184042500012 PM 12848843 ER PT J AU O'Toole, TP Aaron, KF Chin, MH Horowitz, C Tyson, F AF O'Toole, TP Aaron, KF Chin, MH Horowitz, C Tyson, F TI Community-based participatory research - Opportunities, challenges, and the need for a common language SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material C1 Johns Hopkins Univ, Baltimore, MD 21218 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Chicago, Chicago, IL 60637 USA. Mt Sinai Sch Med, New York, NY USA. Natl Inst Environm Hlth Serv, Res Triangle Pk, NC USA. RP O'Toole, TP (reprint author), Johns Hopkins Univ, Baltimore, MD 21218 USA. NR 13 TC 47 Z9 47 U1 0 U2 2 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUL PY 2003 VL 18 IS 7 BP 592 EP 594 DI 10.1046/j.1525-1497.2003.30416.x PG 3 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 699EG UT WOS:000184042500013 PM 12848844 ER PT J AU Cohen, SB Ayanian, JZ Clancy, CM AF Cohen, SB Ayanian, JZ Clancy, CM TI Health care costs, coverage, and access in the United States: Research findings from the Medical Expenditure Survey Panel - Foreword SO MEDICAL CARE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing, Rockville, MD 20850 USA. Brigham & Womens Hosp, Dept Med, Div Gen Med, Boston, MA 02115 USA. Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. RP Cohen, SB (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing, Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20850 USA. NR 18 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2003 VL 41 IS 7 SU S BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 696QN UT WOS:000183898400001 ER PT J AU Cohen, SB AF Cohen, SB TI Design strategies and innovations in the Medical Expenditure Panel Survey SO MEDICAL CARE LA English DT Article DE health care expenditures; insurance coverage; quality of care; MEPS ID HEALTH-CARE EXPENDITURES; INSURANCE; EUROQOL; STATE AB BACKGROUND. Recent efforts to provide an annual profile of the health care quality of the nation's health care delivery system and to identify health care disparities in the population's access to and use of health care services have served to stimulate design innovations and content enhancements to the Medical Expenditure Panel Survey (MEPS). OBJECTIVES. To present a summary of the analytical objectives, design, and core content of the MEPS, and to provide an overview of the new and innovative design features that add capacity for health status and quality of care measurement and improve data quality. SUMMARY. The MEPS questionnaire has been expanded to include content taken from the Consumer Assessment of Health Plans Study (CAHPS) to facilitate assessments of patient experiences with health care at the national level. The survey now includes the series of questions from the SF-12 and the EuroQol 5D to improve the survey's capacity to measure health status. Additional condition-specific questions for diabetes, asthma, high blood pressure, and heart disease were added to identify the health care services received for treatment and to determine whether the care received was consistent with practice guidelines. Sample design modifications are presented, with particular emphasis given to a summary of the recent sample size increase and resultant improvements in the precision of resultant survey estimates. Attention is also given to changes in survey design, estimation, and data collection strategies that improve data quality. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Execut Off Ctr, Rockville, MD 20852 USA. RP Cohen, SB (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Execut Off Ctr, Suite 500,2101 E Jefferson St, Rockville, MD 20852 USA. NR 29 TC 65 Z9 65 U1 4 U2 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2003 VL 41 IS 7 SU S BP 5 EP 12 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 696QN UT WOS:000183898400002 ER PT J AU Selden, TM Banthin, JS AF Selden, TM Banthin, JS TI Health care expenditure burdens among elderly adults: 1987 and 1996 SO MEDICAL CARE LA English DT Article DE health care costs; Medicaid; Medicare; aging ID OF-POCKET EXPENSES; MEDICARE BENEFICIARIES; METHODOLOGICAL BIASES AB OBJECTIVES. Concerns about the health care expenditure burdens of elderly adults underlie the ongoing debate over expanding Medicare benefits and strengthening Medicare+Choice. We examine burdens for this population using data from the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS). METHODS. We estimate how frequently elderly adults live in families whose health expenditures exceed 20% or 40% of their after-tax disposable incomes. Our methodology reduces bias due to errors in income while providing an intuitive measure of exposure to the risk of high burdens. RESULTS. Despite rapid increases in medical care prices, the percentage of elderly adults facing burdens over 20% of disposable income remained essentially constant at 20.9% in 1987 and 22.9% in 1996. The percentage with burdens exceeding 40% of disposable income was 7.3% in 1987 and 7.9% in 1996. High expenditure burdens were more prevalent among elderly adults who were poorer, older, female, higher risk, and covered only by traditional Medicare. Medicaid coverage helped to reduce burdens among the elderly poor, yet incomplete Medicaid take-up in 1996 left approximately 1.3 million elderly adults eligible for Medicaid but covered only by traditional Medicare. CONCLUSIONS. Our results highlight the widespread prevalence of high health care expenditure burdens among elderly adults and the varying extent to which insurance coverage helped to protect them from rising health care expenditures between 1987 and 1996. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20850 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 540 Gaither Rd, Rockville, MD 20850 USA. NR 33 TC 21 Z9 21 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2003 VL 41 IS 7 SU S BP 13 EP 23 PG 11 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 696QN UT WOS:000183898400003 ER PT J AU Kirby, JB Machlin, SR Cohen, JW AF Kirby, JB Machlin, SR Cohen, JW TI Has the increase in HMO enrollment within the Medicaid population changed the pattern of health service use and expenditures? SO MEDICAL CARE LA English DT Article DE Medicaid; managed care; health services utilization; health care costs ID MANAGED CARE; UNITED-STATES; CHILDREN; ACCESS; COST AB OBJECTIVE. To describe changes in health services use and expenditures within the Medicaid population between 1987 and 1997 and to estimate the extent to which the increase in Health Maintenance Organization (HMO) enrollment has influenced these changes. SUBJECTS. Individuals under the age of 65 years in the 1987 National Medical Expenditure Survey and the 1997 Medical Expenditure Panel Survey enrolled in Medicaid the entire year. RESEARCH DESIGN. Using bivariate and multivariate techniques, we compared several measures of health services use and expenditures across three groups: (1) individuals enrolled in Medicaid for all of 1987; (2) individuals enrolled in Medicaid for all of 1997 but never enrolled in an HMO; and (3) individuals enrolled in Medicaid for all of 1997 and enrolled in an HMO for at least part of the year. RESULTS. Medicaid enrollees in 1997 differ little from Medicaid recipients in 1987 with respect to use and expenditures. Modest but statistically significant differences emerge, however, when a distinction is made between HMO enrollees and non-HMO enrollees in 1997. Specifically, 1997 Medicaid HMO enrollees have significantly fewer hospital visits than 1987 Medicaid enrollees and spend significantly less on health services than 1997 non-HMO enrollees. CONCLUSIONS. Our findings suggest that the increase in HMO enrollment may have held down use and expenditures to rates modestly lower than what would have been expected had HMO enrollment not increased. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Div Socioecon Res, Rockville, MD 20852 USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Div Socioecon Res, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 23 TC 7 Z9 7 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2003 VL 41 IS 7 SU S BP 24 EP 34 PG 11 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 696QN UT WOS:000183898400004 ER PT J AU Cooper, PF Vistnes, J AF Cooper, PF Vistnes, J TI Workers' decisions to take-up offered health insurance coverage: Assessing the importance of out-of-pocket premium costs SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Meeting of the Allied-Social-Science-Association CY JAN 05, 2002 CL ATLANTA, GEORGIA SP Allied Soc Sci Assoc DE health insurance; health care cost ID DEMAND AB BACKGROUND. Many proposed policy initiatives involve subsidies directed toward encouraging employers to offer coverage and toward workers to encourage enrollment in offered plans. Given that insurance coverage reflects employers' decisions to offer coverage, eligibility requirements for such coverage, and employees' take-up decisions, all three elements are important when considering mechanisms to decrease the number of uninsured individuals. RESEARCH DESIGN. In this study, we examine the relationship between workers' decisions to take-up offers of health insurance and annual out-of-pocket contributions, total premiums, and employer and workforce characteristics. We model the take-up decision using cross-sectional data from approximately 18,000 establishments per year from the 1997 to 1999 Medical Expenditure Panel Survey - Insurance Component. RESULTS. We find that workers are less likely to enroll in coverage as single employee contributions increase. Our results for family contributions are much smaller than for single contributions and are not statistically significant in all years. Our simulation results suggest that reducing employee contribution levels for single coverage from existing levels in 1999 to zero would yield an increase in take-up rates of roughly 6% points in establishments that had required a positive level of contributions. Our results also indicate that of the 13.8 million private sector workers who decline coverage from their employers, 2.5 million would potentially enroll in employer-sponsored coverage if the cost of single coverage were to fall to zero. CONCLUSION. Reducing employee contributions will increase take-up rates; however, even when employees pay nothing for their coverage, some employees elect not to enroll. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Cooper, PF (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 2101 E Jefferson St,Suite 500, Rockville, MD 20852 USA. NR 13 TC 9 Z9 9 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2003 VL 41 IS 7 SU S BP 35 EP 43 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 696QN UT WOS:000183898400005 ER PT J AU Moeller, JF Cohen, SB Mathiowetz, NA Wun, LM AF Moeller, JF Cohen, SB Mathiowetz, NA Wun, LM TI Regression-based sampling for persons with high health expenditures: Evaluating accuracy and yield with the 1997 MEPS SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Meeting of the American-Statistical-Association CY AUG 13, 2002 CL NEW YORK, NEW YORK SP Amer Stat Assoc DE logistic regression; predicted probability; high expenditure ID MEDICARE CAPITATION PAYMENTS; HIGH-COST USERS; CARE; INFORMATION AB BACKGROUND. Given the high concentration of health care expenditures among a relatively small percentage of the population, the 1997 Medical Expenditure Panel Survey was designed to learn more about these high expenditure individuals by oversampling them. OBJECTIVE. Oversampling high expenditure individuals enables more precise estimation of what the nation's health care dollar buys and who pays it. It also enhances the ability to discern the causes of high health care expenses and the characteristics of the individuals who incur them. METHOD. Using the 1987 National Medical Expenditure Survey, a probabilistic model was developed to select households from the 1996 National Health Interview Survey likely to contain individuals incurring high levels of medical expenditures in the 1997 MEPS. The accuracy of the selection model, and the degree to which the high expenditure population was oversampled, are assessed with the 1997 MEPS data. RESULTS. Over half of the persons selected by the regression model were expected to have high health expenditures. Of the 456 persons selected by the model for oversampling, 257 individuals or 56.4% did, in fact, have high expenditures. Regression-based sampling increased the proportion of MEPS individuals with high expenditures from 14.3% without oversampling to 17.2% of the total cohort with oversampling (or from 938-1,126 persons). CONCLUSION. This paper demonstrates that a model-based approach to oversampling a high expenditure population, or any population with dynamic characteristics, can be highly successful in terms of sampling yield and accuracy. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Maryland, Joint Program Survey Methodol, College Pk, MD 20742 USA. RP Moeller, JF (reprint author), 2101 E Jefferson St,Suite 500 W, Rockville, MD 20852 USA. NR 19 TC 6 Z9 6 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2003 VL 41 IS 7 SU S BP 44 EP 52 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 696QN UT WOS:000183898400006 ER PT J AU Larson, SL Fleishman, JA AF Larson, SL Fleishman, JA TI Rural-urban differences in usual source of care and ambulatory service use - Analyses of national data using urban influence codes SO MEDICAL CARE LA English DT Article DE access; rural; non-metropolitan; metropolitan; urban; urban influence; utilization; usual source of care ID HEALTH; ACCESS AB BACKGROUND. Rural-urban disparities in access to and utilization of medical care have been a long-standing focus of concern. OBJECTIVE. Using the nine-category Urban Influence Codes, this study examines the relationship between place of residence and having access and utilization of ambulatory health services. RESEARCH DESIGN. Data come from the Medical Expenditure Panel Survey, conducted in 1996. Linear and logistic regression analyses assess the relationship between county type and having a usual source of care and ambulatory visits, controlling for demographic and health status measures. RESULTS. Residents of counties that were totally rural were more likely to report having a usual source of care (adjusted OR: 1.98; CI: 1.01, 3.89) than residents of large metropolitan counties. Residents of places without a city of 10,000 or more, but adjacent to a metropolitan area, were also more likely to report having a usual source of care (adjusted OR: 1.92; CI: 1.16, 3.22). In a regression analysis, residents of the most rural places reported fewer visits during the year (B = -2.42, CI: -3.68, -1.32). CONCLUSIONS. Results suggest that using rural and urban definitions that go beyond the traditional dichotomy of metropolitan and non-metropolitan may assist policymakers and researchers in identifying types of places where there is a disparity in access and subsequent utilization of health care. Rural residents, defined as totally rural in the urban influence coding scheme, may report having a health care provider but report fewer visits to health care providers during a year. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Larson, SL (reprint author), Ctr Cost & Financing Studies, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 30 TC 93 Z9 93 U1 1 U2 7 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2003 VL 41 IS 7 SU S BP 65 EP 74 DI 10.1097/01.MLR.0000076053.28108.F2 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 696QN UT WOS:000183898400008 ER PT J AU Fleishman, JA Lawrence, WF AF Fleishman, JA Lawrence, WF TI Demographic variation in SF-12 scores: True differences or differential item functioning? SO MEDICAL CARE LA English DT Article ID FORM HEALTH SURVEY; CONSTRUCT-VALIDITY; MEDICAL OUTCOMES; SAMPLE; DISABILITY; POPULATION; IMPACT; BIAS AB BACKGROUND. Demographic differences have been reported in summary measures of physical and mental health based on the SF-12 instrument. OBJECTIVES. This study examines the extent to which differential item functioning (DIF) contributes to observed subgroup differences in health status. DIF refers to situations in which the psychometric properties of items are not invariant across different groups. The presence of DIF confounds interpretation of subgroup differences. SUBJECTS. A national sample of 11,626 adult respondents in the 2000 Medical Expenditure Panel Survey who completed a self-administered questionnaire. MEASURES. In addition to the SF-12, we collected data on demographic characteristics (age, gender, education, and race/ethnicity) and whether the person had ever been diagnosed with six chronic medical conditions. RESULTS. Multiple-indicator multiple-cause latent variable models showed significant differences in physical health by gender, age, and education. Adjusting for DIF reduced but did not eliminate age and education differences. However, for mental health, adjusting for DIF resulted in Black-White differences becoming nonsignificant, and the effect for the oldest age group switched from positive to negative. Race/ethnicity was not associated with physical health status. CONCLUSIONS. Age group comparisons of mental health may be particularly affected by DIF. Differences in education, as well as age and gender, need to be controlled when making group comparisons. Additional work is needed to understand factors that give rise to demographic differences in reported health status. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res, Rockville, MD 20852 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 2101 E Jefferson St, Rockville, MD 20852 USA. NR 34 TC 57 Z9 57 U1 2 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2003 VL 41 IS 7 SU S BP 75 EP 86 DI 10.1097/01.MLR.0000076052.42628.CF PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 696QN UT WOS:000183898400009 ER PT J AU Bird, CE Fremont, A Wickstrom, S Bierman, AS McGlynn, E AF Bird, CE Fremont, A Wickstrom, S Bierman, AS McGlynn, E TI Improving women's quality of care for cardiovascular disease and diabetes: The feasibility and desirability of stratified reporting of objective performance measures SO WOMENS HEALTH ISSUES LA English DT Article; Proceedings Paper CT Conference on Women and Heart Disease CY DEC, 2002 CL WASHINGTON, D.C. DE cardiovascular disease; gender; hedis; managed care; quality of care; primary care ID ACUTE MYOCARDIAL-INFARCTION; CORONARY HEART-DISEASE; ESTROGEN/PROGESTIN REPLACEMENT; HEALTH; MEN; POPULATION; MORTALITY; IMPACT; SEX AB Despite growing recognition of significant morbidity and mortality among women from cardiovascular disease, management of primary and secondary cardiac risk factors continues to be suboptimal for many women. Although there is a good deal of room to improve the care for cardiovascular disease and diabetes in men, existing gender differences in performance suggest much can be gained by specifically assessing and monitoring quality of care for these conditions in women. In this paper, we describe recent work showing gender differences in quality of ambulatory care in managed care plans with some plans having substantial gender differences on widely used measures of the quality of primary and secondary prevention of cardiac disease. We then discuss potential benefits of and barriers to routine reporting of objective measures of the quality of care, such as Health Plan Employer Data and Information Set (HEDIS) measures, by health plans. C1 RAND, Santa Monica, CA 90407 USA. UnitedHlth Grp, Ctr Hlth Care Policy & Evaluat, Eden Prairie, MN USA. AHRQ, Rockville, MD USA. RP Bird, CE (reprint author), RAND, 1700 Main St,POB Box 2138, Santa Monica, CA 90407 USA. RI Bird, Chloe/C-7107-2008; Fremont, Allen/A-7752-2009 FU PHS HHS [290-00-0012] NR 28 TC 16 Z9 16 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD JUL-AUG PY 2003 VL 13 IS 4 BP 150 EP 157 DI 10.1016/S1049-3867(03)00035-5 PG 8 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 718VK UT WOS:000185167000006 PM 13678806 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Serv Task Force TI Behavioral counseling in primary care to promote a healthy diet: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID WORCESTER-AREA TRIAL; HYPERLIPIDEMIA WATCH; EATING PATTERNS; CHILDREN DISC; INTERVENTION; FEASIBILITY; ASSOCIATION; CHOLESTEROL; WEIGHT C1 US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. EM uspstf@ahrq.gov NR 29 TC 2 Z9 2 U1 1 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X EI 1532-0650 J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JUN 15 PY 2003 VL 67 IS 12 BP 2573 EP 2576 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 694CU UT WOS:000183756900009 ER PT J AU Stryer, D Clancy, C AF Stryer, D Clancy, C TI Boosting performance measure for measure SO BRITISH MEDICAL JOURNAL LA English DT Editorial Material C1 US Dept HHS, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. RP Stryer, D (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU BRITISH MED JOURNAL PUBL GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0959-535X J9 BRIT MED J JI Br. Med. J. PD JUN 14 PY 2003 VL 326 IS 7402 BP 1278 EP 1278 DI 10.1136/bmj.326.7402.1278 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 691VK UT WOS:000183626500004 PM 12805128 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, CT Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for dementia: Recommendation and rationale SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for dementia and the supporting scientific evidence and updates the 1996 recommendations on this topic. The complete USPSTF recommendation and rationale statement on this topic, which includes a brief review of the supporting evidence, is available through the USPSTF Web site (www.preventiveservices.ahrq.gov) and the National Guideline Clearinghouse (www.guideline.gov) and in print by subscribing to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates. The cost of this subscription is $60, and it can be ordered through the Agency for Healthcare Research and Quality (AHRQ) Publications Clearinghouse (call 1-800-358-9295 or e-mail ahrqpubs@ahrq.gov). The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on the Web sites already mentioned. The summary of the evidence is also available in print through the AHRQ Publications Clearinghouse. C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 4 TC 29 Z9 29 U1 0 U2 1 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD JUN 3 PY 2003 VL 138 IS 11 BP 925 EP 926 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 686AB UT WOS:000183296400008 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Serv Task Force TI Postmenopausal hormone replacement therapy for the primary prevention of chronic conditions: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article ID ESTROGEN-PROGESTIN REPLACEMENT; BREAST-CANCER; ESTROGEN/PROGESTIN REPLACEMENT; OVARIAN-CANCER; FOLLOW-UP; RISK; WOMEN; METAANALYSIS; DISEASE; MORTALITY C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Tricty Family Med, Cohocton, NY USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Newark, NJ 07103 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA USA. Univ Texas, Hlth Sci Ctr, Dept Med, San Antonio, TX 78284 USA. Robert Wood Johnson Generalist Physician Fac Scho, Natl Program Off, San Antonio, TX 78284 USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Brown Univ, Women & Infants Hosp, Providence, RI USA. Univ Michigan, Ann Arbor, MI 48109 USA. CUNY Mt Sinai Sch Med, Div Gen Internal Med, New York, NY 10029 USA. Merck & Co Inc, W Point, PA USA. Columbia Univ, Dept Obstet & Gynecol, New York, NY USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Community & Prevent Med, Fairfax, VA USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 31 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD JUN PY 2003 VL 103 IS 6 BP 83 EP + PG 6 WC Nursing SC Nursing GA 687GD UT WOS:000183367400053 PM 12802162 ER PT J AU London, AS Foote-Ardah, CE Fleishman, JA Shapiro, MF AF London, AS Foote-Ardah, CE Fleishman, JA Shapiro, MF TI Use of alternative therapists among people in care for HIV in the United States SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID NATIONAL PROBABILITY SAMPLES; LOW-PREVALENCE DISEASES; INFECTED PATIENTS; COMPLEMENTARY MEDICINE; SERVICES UTILIZATION; HEALTH-CARE; GAY MEN; AIDS; DETERMINANTS; HIV/AIDS AB Objectives. This study examined the influence of sociodemographic, clinical, and attitudinal variables on the use of alternative therapists by people in care for HIV. Methods. Bivariate and multivariate analyses of baseline data from the nationally representative HIV Cost and Services Utilization Study were conducted. Results. Overall, 15.4% had used an alternative therapist, and among users, 53.9% had fewer than 5 visits in the past 6 months. Use was higher for people who were gay/ lesbian, had incomes above $40000, lived in the Northeast and West, were depressed, and wanted more information about and more decisionmaking involvement in their care. Among users, number of visits was associated with age, education, sexual orientation, insurance status, and CD4 count. Conclusions. Among people receiving medical care for HIV, use of complementary care provided by alternative therapists is associated with several sociodemographic, clinical, and attitudinal variables. Evaluation of the coordination of provider-based alternative and standard medical care is needed. C1 Syracuse Univ, Ctr Policy Res, Syracuse, NY 13244 USA. Syracuse Univ, Dept Sociol, Syracuse, NY 13244 USA. Indiana Univ Purdue Univ, Dept Sociol, Indianapolis, IN 46202 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif Los Angeles, Sch Med, Westwood, CA USA. RAND Corp, Santa Monica, CA USA. RP London, AS (reprint author), Syracuse Univ, Ctr Policy Res, 426 Eggers Hall, Syracuse, NY 13244 USA. FU AHRQ HHS [U01HS08578, U01 HS008578] NR 38 TC 30 Z9 32 U1 5 U2 6 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD JUN PY 2003 VL 93 IS 6 BP 980 EP 987 DI 10.2105/AJPH.93.6.980 PG 8 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 685ZJ UT WOS:000183294800033 PM 12773365 ER PT J AU Banthin, JS Selden, TM AF Banthin, JS Selden, TM TI The ABCs of children's health care: How the Medicaid expansions affected access, burdens, and coverage between 1987 and 1996 SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID INSURANCE-COVERAGE; PRIVATE INSURANCE; ELIGIBILITY AB The Medicaid poverty expansions were among the major health policy initiatives of the late 1980s. This paper examines changes over a nine-year period in access, burdens, and coverage among children eligible for Medicaid through the expansions. Among eligible children, the Medicaid expansions reduced rates of uninsurance, increased access to physicians, and reduced families' risk of bearing a heavy financial burden. Gaps remain, however, and expansion-eligible children are more likely than never-eligible children to have been uninsured, to have gone without a physician office visit, and to have lived in a family that spent at least 20% of family income on medical care. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Banthin, JS (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. NR 21 TC 30 Z9 30 U1 0 U2 2 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SUM PY 2003 VL 40 IS 2 BP 133 EP 145 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 716FR UT WOS:000185018600003 PM 13677561 ER PT J AU Crystal, S Akincigil, A Sambamoorthi, U Wenger, N Fleishman, JA Zingmond, DS Hays, RD Bozzette, SA Shapiro, MF AF Crystal, S Akincigil, A Sambamoorthi, U Wenger, N Fleishman, JA Zingmond, DS Hays, RD Bozzette, SA Shapiro, MF TI The diverse older HIV-positive population: A national profile of economic circumstances, social support, and quality of life SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE HIV/AIDS; aging; quality of life; social support; HIV cost and services utilization study ID IMMUNODEFICIENCY-VIRUS INFECTION; LOW-PREVALENCE DISEASES; SERVICES UTILIZATION; UNITED-STATES; CUMULATIVE DISADVANTAGE; PROBABILITY SAMPLES; ADULTS; AIDS; COST; HIV/AIDS AB The objectives of this study were to provide a national profile of socioeconomic circumstances of the middle-aged and older population living with HIV and to evaluate variations in social support and quality of life (QOL) across age and socioeconomic subgroups, controlling for indicators of disease progression. The design used was a cross-sectional analysis of nationally representative interview data on HIV-infected individuals collected in the HIV Cost and Services Utilization Study. Multiple measures of social support and QOL were used. Bivariate comparisons of outcomes across categories of age and exposure category were performed; multivariate analyses to isolate the effect of older age on outcomes within exposure categories were performed, controlling for socioeconomic and clinical co-variates. Study results indicate that older gay men with HIV/AIDS are a predominantly white population and more likely to have health insurance than their younger counterparts; 38% were employed and 48% reported incomes of more than $25,000. Older injection drug users (IDUs) with HIV/AIDS are a predominantly black population with a particularly high concentration of disadvantages; only 11% were employed and 74% reported incomes of less than $10,000. Older IDUs reported especially low levels of physical functioning and emotional support in comparison with their younger counterparts, whereas older gay men did not significantly differ from younger gay men in these respects. The authors conclude that characteristics and care needs of the older HIV-positive population are very diverse and vary sharply by exposure route. Interventions need to be tailored to the needs of these distinct subpopulations, with an emphasis on development of supportive care interventions for older IDUs. C1 Rutgers State Univ, Inst Hlth Hlth Care Policy & Aging Res, New Brunswick, NJ 08901 USA. Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res, Los Angeles, CA 90024 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Calif San Diego, Dept Med, San Diego, CA 92103 USA. San Diego Healthcare Syst, Dept Vet Admin, San Diego, CA USA. RAND Corp, Hlth Sci Program, Santa Monica, CA USA. RP Crystal, S (reprint author), Rutgers State Univ, Inst Hlth Hlth Care Policy & Aging Res, 30 Coll Ave, New Brunswick, NJ 08901 USA. RI Hays, Ronald/D-5629-2013 FU AHRQ HHS [R01 HS010227, U01HS08578]; NIA NIH HHS [AG-02-004]; NIDA NIH HHS [R01 DA 11855]; NIMH NIH HHS [P01-MH 43450, R01 MH 58984-01]; NIMHD NIH HHS [P20-MD00148-01] NR 32 TC 41 Z9 42 U1 2 U2 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1525-4135 J9 JAIDS-J ACQ IMM DEF JI JAIDS PD JUN 1 PY 2003 VL 33 SU 2 BP S76 EP S83 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 696QT UT WOS:000183898800004 PM 12853856 ER PT J AU Miller, MR Elixhauser, A Zhan, CL AF Miller, MR Elixhauser, A Zhan, CL TI Patient safety events during pediatric hospitalizations SO PEDIATRICS LA English DT Article DE safety; medical error; in-patients; hospitals; child ID INTENSIVE-CARE UNIT; BRACHIAL-PLEXUS INJURY; FETAL MACROSOMIA; QUALITY; ERRORS; MORTALITY; DELIVERY; TRAUMA; COMPLICATIONS; SURGERY AB Objective. Our objective was to describe potential patient safety events for hospitalized children, using the patient safety indicators (PSIs), and examine associations with these events. Methods. PSI algorithms, developed by researchers at the Agency for Healthcare Research and Quality to identify potential in-hospital patient safety problems using administrative data, were applied to 3.8 million discharge records for children under 19 years from 22 states in the 1997 Healthcare Cost and Utilization Project. Prevalence of PSI events and associations with patient-level and hospital-level characteristics, length of stay, in-hospital mortality, and total charges were examined. Results. The prevalence of pediatric patient safety events is significant with the highest rate found for birth trauma at 1.5 cases per every 100 births. The majority of these events for birth trauma consist of long bone and skull fractures, excluding the clavicle. Compared with records without PSI events, discharges with PSI events had 2- to 6-fold longer lengths of stay, 2- to 18-fold higher rates of in-hospital mortality, and 2- to 20-fold higher total charges. Bivariate and multivariate analyses found that all PSI events except birth trauma were directly associated with factors related to greater severity of illness and large urban teaching institutions. Birth trauma, however, was directly associated with black and Hispanic ethnicity but was not consistently associated with technologically sophisticated teaching institutions. Conclusions. The prevalence of birth trauma and other potential patient safety events for hospitalized children is high and comparable to hospitalized adults. These events are associated with increased length of stay, in-hospital mortality, and total charges. Associated factors differ significantly for birth trauma compared with other PSI events. Institutional application of the PSIs may be useful to identify processes of care that warrant further evaluation as the health care industry tackles the problem of patient safety, particularly for children. C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD USA. Johns Hopkins Univ, Dept Pediat, Baltimore, MD 21218 USA. RP Miller, MR (reprint author), Johns Hopkins Childrens Ctr, CMSC 2-125,600 N Wolfe St, Baltimore, MD 21287 USA. NR 45 TC 72 Z9 73 U1 0 U2 2 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JUN PY 2003 VL 111 IS 6 BP 1358 EP 1366 DI 10.1542/peds.111.6.1358 PG 9 WC Pediatrics SC Pediatrics GA 693CA UT WOS:000183696000032 PM 12777553 ER PT J AU Hsia, D AF Hsia, D TI Can administrative data assess physicians' quality of care? Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Hsia, D (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 6 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 28 PY 2003 VL 289 IS 20 BP 2648 EP 2648 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 682DG UT WOS:000183075600022 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Services Task Forc TI Screening for type 2 diabetes in adults: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Article C1 US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 6 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAY 15 PY 2003 VL 67 IS 10 BP 2177 EP 2180 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 681QD UT WOS:000183046100010 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JE Render, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JE Render, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Chemoprevention of breast cancer: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Editorial Material ID RANDOMIZED TRIAL; TAMOXIFEN; RALOXIFENE; PREVENTION; WOMEN; RISK C1 Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Texas, Hlth Sci Ctr, Sch Nursing, San Antonio, TX USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Dept Pediat, Rochester, NY USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Family Med, Newark, NJ 07103 USA. Harvard Univ, Sch Med, Boston, MA 02115 USA. Harvard Univ, Pilgrim Hlth Care, Dept Ambulatory Care, Boston, MA 02115 USA. Univ Texas, Hlth Sci Ctr, Dept Med, San Antonio, TX 78284 USA. Robert Wood Johnson Generalist Phys Fac Scholars, Natl Program Off, San Antonio, TX USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Women & Infants Hosp Rhode Isl, Providence, RI USA. Univ Michigan, Ann Arbor, MI 48109 USA. Mt Sinai Sch Med, Div Gen Internal Med, New York, NY USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, Dept Obstet & Gynecol, New York, NY USA. Virginia Commonwealth Univ, Dept Prevent & Community Med, Fairfax, VA USA. RP Berg, AO (reprint author), Ctr Practice & Technol Assessement, Agcy Healthcare Res & Qual, US Prevent Serv Task Force, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 13 TC 5 Z9 5 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD MAY PY 2003 VL 103 IS 5 BP 107 EP + PG 4 WC Nursing SC Nursing GA 676YU UT WOS:000182780800043 PM 12759615 ER PT J AU Jiang, HJ Stryer, D Friedman, B Andrews, R AF Jiang, HJ Stryer, D Friedman, B Andrews, R TI Multiple hospitalizations for patients with diabetes SO DIABETES CARE LA English DT Article ID GLYCEMIC CONTROL; MANAGED CARE; MELLITUS; IMPACT; ADULTS; US AB OBJECTIVE - To describe the extent to which hospitalizations for patients with diabetes reflect multiple stays by the same individuals and to examine how multiple hospitalizations vary by patient demographic and socioeconomic characteristics. RESEARCH DESIGN AND METHODS - Using the Healthcare Cost and Utilization Project complete discharge data For five states (California, Missouri, New York, Tennessee, and Virginia) in 1999, we identified 648,748 nonneonatal, nonmaternal patients who had one or more hospitalizations listing diabetes. Multiple hospitalizations were measured as percent of patients with multiple stays, percent of total stays represented by multiple stays, and average number Of Stays Per patient. Total hospital costs were also examined. Stratified analysis and regression were performed to assess differences by age, sex, race/ethnicity, payer, location, and income. RESULTS - Among patients with diabetes who had been hospitalized, 30% had two or more stays accounting for >50% of total hospitalizations and hospital costs. Controlled for patient age, sex, and clinical characteristics, the likelihood of having multiple hospitalizations was higher for Hispanics and non-Hispanic blacks compared with non-Hispanic whites, as well as for patients covered by Medicare or Medicaid and those living in low-income areas. The prevalence of diabetes complications and multiple conditions differed by age, race/ethnicity, and payer among patients with multiple stays. CONCLUSIONS - Multiple hospitalizations are common among patients With diabetes but vary by age, race/ethnicity, payer, and income, with those populations traditionally considered to be more vulnerable experiencing higher likelihoods of multiple stays. Significant opportunities exist to reduce the proportion of multiple hospitalizations for patients with diabetes. Clinical and policy interventions to improve the quality of care and Outcomes for these patients shou be designed accordingly and have the potential to pay major dividends. C1 Agcy Hlth Care Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. Agcy Hlth Care Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20852 USA. RP Jiang, HJ (reprint author), Agcy Hlth Care Res & Qual, Ctr Org & Delivery Studies, 2101 E Jefferson St,Suite 605, Rockville, MD 20852 USA. NR 18 TC 88 Z9 90 U1 1 U2 1 PU AMER DIABETES ASSOC PI ALEXANDRIA PA 1701 N BEAUREGARD ST, ALEXANDRIA, VA 22311-1717 USA SN 0149-5992 J9 DIABETES CARE JI Diabetes Care PD MAY PY 2003 VL 26 IS 5 BP 1421 EP 1426 DI 10.2337/diacare.26.5.1421 PG 6 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA 724UQ UT WOS:000185505400016 PM 12716799 ER PT J AU Hunkeler, EM Spector, WD Fireman, B Rice, DP Weisner, C AF Hunkeler, EM Spector, WD Fireman, B Rice, DP Weisner, C TI Psychiatric symptoms, impaired function, and medical care costs in an HMO setting SO GENERAL HOSPITAL PSYCHIATRY LA English DT Article DE symptoms; function; medical care costs; depression; anxiety ID ADDICTION SEVERITY INDEX; DRINKING PATTERNS; HEALTH-SERVICES; MANAGED CARE; DEPRESSION; ALCOHOL; PSYCHOTHERAPY; DISABILITY; MEMBERSHIP; ANXIETY AB More information is needed regarding the medical care utilization and costs of individuals who report depressed mood, persistent anxiety, brief anxiety, panic, and trouble controlling violent behavior. We present findings from a 1-year prospective follow-up study of a stratified random sample of adult HMO enrollees (N = 10,377) originally interviewed by telephone. A strong association was observed between these psychiatric symptoms, associated impaired function, and general medical care costs during the year following the interview. After controlling for age, gender, race, medical conditions, and smoking, the mean costs of general medical care were $1,948 for respondents who reported none of the psychiatric symptoms or impaired function: $3,006 for respondents with all 5 symptoms but no impaired function; and $3.906 for those with all 5 symptoms and pervasive functional impairment. Persistent anxiety and depressed mood had the greatest impact on total general medical costs, while impaired function was associated with increased likelihood of hospital admission and emergency room use. We conclude that depressed mood, persistent anxiety, and related impaired function are associated with substantial increases in the use and cost of general medical care. (C) 2003 Elsevier Inc. All rights reserved. C1 Kaiser Permanente, No Calif Div Res, Oakland, CA USA. Agcy Healthcare Res & Qual, Bethesda, MD USA. Univ Calif San Francisco, San Francisco, CA 94143 USA. RP Hunkeler, EM (reprint author), Kaiser Permanente, No Calif Div Res, Oakland, CA USA. NR 34 TC 22 Z9 22 U1 3 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0163-8343 J9 GEN HOSP PSYCHIAT JI Gen. Hosp. Psych. PD MAY-JUN PY 2003 VL 25 IS 3 BP 178 EP 184 DI 10.1016/S0163-8343(03)00018-5 PG 7 WC Psychiatry SC Psychiatry GA 679YT UT WOS:000182950100005 PM 12748030 ER PT J AU Dovey, S Weitzman, M Fryer, G Green, L Yawn, B Lanier, D Phillips, R AF Dovey, S Weitzman, M Fryer, G Green, L Yawn, B Lanier, D Phillips, R TI The ecology of medical care for children in the United States SO PEDIATRICS LA English DT Article DE ecology; medical care; health systems; Medical Expenditure Panel Survey; primary care ID ORAL HEALTH AB Background. Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children. Objective. To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings. Methods. Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors ( age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care). Results. Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age (< 2 years and 13-17 years) and poverty status were associated with hospitalization ( P <.05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals. Conclusions. The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care. C1 Amer Acad Family Physicians, Robert Graham Ctr, Washington, DC 20036 USA. Univ Rochester, Sch Med & Dent, Amer Acad Pediat, Ctr Child Hlth Res, Rochester, NY USA. Univ Rochester, Sch Med & Dent, Dept Pediat, Rochester, NY 14642 USA. Olmsted Med Ctr, Dept Res, Rochester, MN USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Dovey, S (reprint author), Amer Acad Family Physicians, Robert Graham Ctr, 2023 Massachusetts Ave NW, Washington, DC 20036 USA. NR 24 TC 43 Z9 43 U1 1 U2 3 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD MAY 1 PY 2003 VL 111 IS 5 BP 1024 EP 1029 DI 10.1542/peds.111.5.1024 PG 6 WC Pediatrics SC Pediatrics GA 673KC UT WOS:000182579300032 PM 12728083 ER PT J AU Zhan, C Correa-de-Araujo, R Wickizer, S Miller, MR Bierman, A AF Zhan, C Correa-de-Araujo, R Wickizer, S Miller, MR Bierman, A TI Inappropriate drug prescribing in outpatient care for the elderly: The case of potentially harmful drug-drug and drug-disease combinations SO VALUE IN HEALTH LA English DT Meeting Abstract C1 AHRQ, Rockville, MD USA. NCI, Frederick, MD 21701 USA. Johns Hopkins Childrens Ctr, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 3 U2 4 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2003 VL 6 IS 3 BP 196 EP 197 DI 10.1016/S1098-3015(10)63847-8 PG 2 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 688DX UT WOS:000183419000049 ER PT J AU Ware, JE Bierman, AS Gandek, B Sinclair, SJ Lawrence, WF AF Ware, JE Bierman, AS Gandek, B Sinclair, SJ Lawrence, WF TI Comparison of SF-36 summary and preference-based utility scores across groups differing in disease severity: Results from the medicare health outcomes survey SO VALUE IN HEALTH LA English DT Meeting Abstract C1 Qual Metr Inc, Lincoln, RI USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Hlth Assessment Lab, Boston, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 3 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2003 VL 6 IS 3 BP 304 EP 304 DI 10.1016/S1098-3015(10)64112-5 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 688DX UT WOS:000183419000314 ER PT J AU Berg, AO AF Berg, AO CA USPSTF TI Screening for cervical cancer: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID HUMAN-PAPILLOMAVIRUS; WOMEN; SMOKING; RISK; ABNORMALITIES; HYSTERECTOMY; HISTORIES; FREQUENCY; EFFICACY; CYTOLOGY C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 32 TC 29 Z9 29 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD APR 15 PY 2003 VL 67 IS 8 BP 1759 EP 1766 PG 8 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 671QU UT WOS:000182476200011 ER PT J AU Sun, BC Burstin, HR Brennan, TA AF Sun, BC Burstin, HR Brennan, TA TI Predictors and outcomes of frequent emergency department users SO ACADEMIC EMERGENCY MEDICINE LA English DT Article; Proceedings Paper CT New England Regional SAEM Meeting CY APR, 2002 CL WORCESTER, MASSACHUSETTS SP SAEM DE emergency department; frequent users; heavy users ID PUBLIC HOSPITAL EMERGENCY; HEALTH-CARE; HEAVY USERS; PATIENT SATISFACTION; FOLLOW-UP; VISITS; POPULATION; INSURANCE; URBAN; DEPARTMENTS AB Objective: To identify predictors and outcomes associated with frequent emergency department (ED) users. Methods: Cross-sectional intake surveys, medical chart reviews, and telephone follow-up interviews of patients presenting with selected chief complaints were performed at five urban EDs during a one-month study period in 1995. Frequent use was defined by four or more self-reported, prior ED visits. Multivariate logistic regression identified predictors of frequent ED visitors from five domains (demographics, health status, health access, health care preference, and severity of acute illness). Associations between high use and selected outcomes were assessed with logistic regression models. Results: All study components were completed by 2,333 of 3,455 eligible patients (67.5%). Demographics predicting frequent use included being a single parent, single or divorced marital status, high school education or less, and income of less than $10,000 (1995). Health status predictors included hospitalization in the preceding three months, high ratings of psychological distress, and asthma. Health access predictors included identifying an ED or a hospital clinic as the primary care site, having a primary care physician (PCP), and visiting a PCP in the past month. Choosing the ED for free care was the only health preference predictive of heavy use. Illness severity measures were higher in frequent visitors, although these were not independently predictive in the multivariate model. Outcomes correlated with heavy use include increased hospital admissions, higher. rates of ED return visits, and lower patient satisfaction, but not willingness to return to the ED or follow-up with a doctor. Conclusions: Frequent ED visits are associated with socioeconomic distress, chronic illness, and high use of other health resources. Efforts to reduce ED visits require addressing the unique needs of these patients in the emergency and primary care settings. C1 Brigham & Womens Hosp, Dept Emergency Med, Boston, MA 02115 USA. Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Sun, BC (reprint author), Brigham & Womens Hosp, Dept Emergency Med, 75 Francis St, Boston, MA 02115 USA. NR 41 TC 124 Z9 124 U1 3 U2 12 PU HANLEY & BELFUS INC PI PHILADELPHIA PA 210 S 13TH ST, PHILADELPHIA, PA 19107 USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD APR PY 2003 VL 10 IS 4 BP 320 EP 328 DI 10.1111/j.1553-2712.2003.tb01344.x PG 9 WC Emergency Medicine SC Emergency Medicine GA 663FL UT WOS:000181995500006 PM 12670845 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Services Task Force TI Behavioral counseling, in primary care to promote physical activity: Recommendation and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Editorial Material ID RANDOMIZED CONTROLLED TRIAL; GENERAL-PRACTICE; HEALTH BEHAVIORS; ADVICE; EXERCISE; ADULTS C1 US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Berg, AO (reprint author), US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 20 TC 8 Z9 9 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD APR PY 2003 VL 103 IS 4 BP 101 EP + PG 4 WC Nursing SC Nursing GA 665AU UT WOS:000182098100037 PM 12677132 ER PT J AU Mukamel, DB Spector, WD AF Mukamel, DB Spector, WD TI Quality report cards and nursing home quality SO GERONTOLOGIST LA English DT Article DE quality of care; competition; quality indicators; quality report cards; risk-adjusted outcomes ID RISK-ADJUSTMENT METHODS; PLAN REPORT CARDS; NEW-YORK-STATE; HEALTH-CARE; MEDICAID REIMBURSEMENT; OUTCOME MEASURES; BYPASS-SURGERY; MORTALITY DATA; INFORMATION; DEMAND AB Purpose: This study examined the potential role that publicly disseminated quality report cards can play in improving quality of care in nursing homes. Design and Methods: We review the literature and the experience gained over the last two decades with report cards for hospitals, physicians, and health plans, and consider the issues that are of particular importance in the context of nursing home care. Results: Experience with report cards in other areas of the health care system suggests that nursing home quality reports may have a role to play in informing consumers' choices and providing incentives for quality improvement. Their impact may, however, not be large. Methodological issues that may limit the accuracy of quality indicators and issues related to the design and comprehension of the information by consumers are discussed. Implications: Quality report cards should be viewed as one of several options to ensure higher quality nursing home care. C1 Univ Rochester, Med Ctr, Dept Community & Prevent Med, Rochester, NY 14642 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Mukamel, DB (reprint author), Univ Rochester, Med Ctr, Dept Community & Prevent Med, 601 Elmwood Ave,POB 644, Rochester, NY 14642 USA. FU NIA NIH HHS [AG 15965] NR 63 TC 59 Z9 59 U1 1 U2 2 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD APR PY 2003 VL 43 SI 2 BP 58 EP 66 PG 9 WC Gerontology SC Geriatrics & Gerontology GA 670XJ UT WOS:000182435100007 PM 12711725 ER PT J AU Lawrence, WF Yabroff, KR Fleishman, JA AF Lawrence, WF Yabroff, KR Fleishman, JA TI Measuring health utilities in national data sets: A new approach to valuing the HALex. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 26th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 30-MAY 03, 2003 CL VANCOUVER, CANADA SP Soc Gen Internal Med C1 Agcy Healthcare Res & Qual, Rockville, MD USA. NCI, Rockville, MD USA. NR 0 TC 3 Z9 3 U1 1 U2 4 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2003 VL 18 SU 1 BP 164 EP 164 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 673DF UT WOS:000182564300614 ER PT J AU Straus, S Ortiz, E AF Straus, S Ortiz, E TI SGIM EBM website: The needs of the SGIM members. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 26th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 30-MAY 03, 2003 CL VANCOUVER, CANADA SP Soc Gen Internal Med C1 Univ Toronto, Toronto, ON, Canada. Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2003 VL 18 SU 1 BP 255 EP 256 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 673DF UT WOS:000182564301043 ER PT J AU Romano, PS Geppert, J Davies, S McDonald, K Miller, M Elixhauser, A AF Romano, PS Geppert, J Davies, S McDonald, K Miller, M Elixhauser, A TI Refinement and validation of the AHRQ patient safety indicators (PSI). SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 26th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 30-MAY 03, 2003 CL VANCOUVER, CANADA SP Soc Gen Internal Med C1 Univ Calif Davis, Sacramento, CA 95817 USA. Natl Bur Econ Res, Stanford, CA USA. Stanford Univ, Stanford, CA 94305 USA. Johns Hopkins Childrens Ctr, Baltimore, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RI Romano, Patrick/N-4225-2014 OI Romano, Patrick/0000-0001-6749-3979 NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2003 VL 18 SU 1 BP 294 EP 295 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 673DF UT WOS:000182564301227 ER PT J AU Mukamel, DB Watson, NM Meng, HD Spector, WD AF Mukamel, DB Watson, NM Meng, HD Spector, WD TI Development of a risk-adjusted urinary incontinence outcome measure of quality for nursing homes SO MEDICAL CARE LA English DT Article ID MINIMUM DATA SET; LONG-TERM-CARE; NEW-YORK-STATE; RESIDENT ASSESSMENT; OLDER ADULTS; HEALTH-CARE; RELIABILITY; PREDICTORS; MDS AB BACKGROUND. Quality of nursing home care is of ongoing concern. The availability of uniform, patient-level information-the Minimum Data Set (MDS)-offers the opportunity to assess quality based on risk-adjusted health outcomes. OBJECTIVE. To develop a risk-adjusted measure of quality based on urinary incontinence (UI) outcomes for nursing homes, derived from the MDS. RESEARCH DESIGN. A retrospective statistical analysis of individual resident level data. SUBJECTS. MDS+ data for 46,453 residents of 671 nursing homes in New York State during the 1995 to 1997 period. MEASURES. Improvement in UI status was defined based on the resident's UI status at 3 months post admission relative to status at admission. Individual risk factors were also defined at admission. Facility level quality indicators were developed. RESULTS. Facility level indicators show substantial variation. An average facility, providing average quality care to a population of average risk, would experience improvement in UI outcomes for 11 of its 25 admissions in a year. The difference between the best and the worst facilities (two standard deviations above and below the average) is eight new residents with improvement in UI outcomes out of 25 annual admissions. CONCLUSIONS. This study demonstrates the feasibility of measuring quality of UI care based on nationally available MDS data. The measures presented can be used to support internal quality improvement efforts. Before such measures can be used externally, either in the survey process or in quality report cards, they should be further validated. C1 Univ Rochester, Med Ctr, Dept Community & Prevent Med, Rochester, NY 14642 USA. Univ Rochester, Sch Nursing, Rochester, NY 14642 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Mukamel, DB (reprint author), Univ Rochester, Med Ctr, Dept Community & Prevent Med, Box 644,601 Elmwood Ave, Rochester, NY 14642 USA. FU AHRQ HHS [R01HS08491]; NIA NIH HHS [R01 AG15965] NR 52 TC 16 Z9 16 U1 2 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 2003 VL 41 IS 4 BP 467 EP 478 DI 10.1097/00005650-200304000-00003 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 663LE UT WOS:000182006400003 PM 12665711 ER PT J AU Dougherty, D Chevarley, FM Bethell, C AF Dougherty, D Chevarley, FM Bethell, C TI Quality of care for children with special health care needs: New data from a nationally representative survey SO PEDIATRIC RESEARCH LA English DT Meeting Abstract CT Annual Meeting of the Pediatric-Academic-Society CY MAY 03-06, 2003 CL SEATTLE, WASHINGTON SP Pediat Acad Soc, Amer Pediat Soc, Soc Pediat Res, Ambulatory Pediat Assoc, Tulane Univ Hlth Sci Ctr, Ctr Continuing Educ C1 US Dept HHS, Agcy Hlth Care Res & Qual, Rockville, MD USA. FACCT, Portland, OR USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2003 VL 53 IS 4 SU S MA 20 BP 4A EP 4A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 661PA UT WOS:000181897900021 ER PT J AU Berg, AO AF Berg, AO CA US PREVENTIVE SERV TASK FORC TI Chemoprevention of breast cancer: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID RANDOMIZED-TRIAL; TAMOXIFEN; PREVENTION; RALOXIFENE; WOMEN; RISK RP Berg, AO (reprint author), Care of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. EM uspstf@ahrq.gov NR 13 TC 0 Z9 0 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X EI 1532-0650 J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD MAR 15 PY 2003 VL 67 IS 6 BP 1309 EP 1314 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 658BH UT WOS:000181701400019 ER PT J AU Swan, JS Sainfort, F Lawrence, WF Kuruchittham, V Kongnakorn, T Heisey, DM AF Swan, JS Sainfort, F Lawrence, WF Kuruchittham, V Kongnakorn, T Heisey, DM TI Process utility for imaging in cerebrovascular disease SO ACADEMIC RADIOLOGY LA English DT Article DE magnetic resonance (MR), vascular studies; radiology and radiologists, outcomes studies ID COST-EFFECTIVENESS; HEALTH-STATE; MR-ANGIOGRAPHY; STROKE; PREFERENCES; RADIOLOGY AB Rationale and Objectives. The morbidity associated with a diagnostic test can influence its cost-effectiveness, but the quantification of that morbidity is controversial. Accounting for pain and invasiveness requires the measurement of "process utility" in addition to the expected value of testing. An original time trade-off variant was applied to the imaging evaluation of cerebrovascular disease, for which differences in morbidity are important to patients. Materials and Methods. A "waiting trade-off' (WTO) was used to evaluate the preferences of 89 patients for magnetic resonance (MR) angiography and conventional x-ray angiography. Patients were experienced with both tests. A weighted difference was calculated between the period a patient was willing to wait for a test result and treatment after a hypothetical "ideal" test and the choice to undergo conventional angiography or MR angiography with immediate treatment. A rating scale was used to check the convergent validity of the WTO. Results. Paired data showed a highly significant difference (P =.0001) between the mean preference for conventional and MR angiography, favoring the latter and translating into a difference of 5 quality-adjusted life days. The more negatively patients judged their conventional angiographic experience, the longer they were willing to wait for the ideal test result. Conclusion. The WTO provides a reasonable estimate of the relative morbidity of more invasive conventional angiographic procedures and provides a quality-adjustment term for economic analysis. Such an approach may enable more complete evaluation of the effects of other processes on medical care. C1 Indiana Univ, Dept Radiol, Educ & Res Inst, Sect Hlth Serv Res, Indianapolis, IN 46202 USA. Georgetown Univ, Lombardi Canc Ctr Hlth Econ Core, Washington, DC USA. Georgia Inst Technol, Sch Ind & Syst Engn, Atlanta, GA 30332 USA. Univ Wisconsin, Dept Surg, Madison, WI USA. Univ Wisconsin, Coll Engn, Agcy Hlth Care Policy & Res, Madison, WI USA. RP Swan, JS (reprint author), Indiana Univ, Dept Radiol, Educ & Res Inst, Sect Hlth Serv Res, 714 N Senate Ave,Suite 100, Indianapolis, IN 46202 USA. FU AHRQ HHS [1R01HS10277] NR 25 TC 24 Z9 24 U1 1 U2 1 PU ASSOC UNIV RADIOLOGISTS PI OAK BROOK PA 820 JORIE BLVD, OAK BROOK, IL 60523-2251 USA SN 1076-6332 J9 ACAD RADIOL JI Acad. Radiol. PD MAR PY 2003 VL 10 IS 3 BP 266 EP 274 DI 10.1016/S1076-6332(03)80100-9 PG 9 WC Radiology, Nuclear Medicine & Medical Imaging SC Radiology, Nuclear Medicine & Medical Imaging GA 650DX UT WOS:000181248300005 PM 12643553 ER PT J AU Wang, CC Schwaitzberg, S Berliner, E Zarin, DA Lau, J AF Wang, CC Schwaitzberg, S Berliner, E Zarin, DA Lau, J TI Hyperbaric oxygen for treating wounds - A systematic review of the literature SO ARCHIVES OF SURGERY LA English DT Article ID INDUCED HEMORRHAGIC CYSTITIS; GAS-GANGRENE; NECROTIZING FASCIITIS; RADIATION CYSTITIS; FOURNIERS-GANGRENE; ADJUNCTIVE TREATMENT; SURGICAL PATIENTS; CLINICAL-TRIAL; FOOT ULCER; THERAPY AB Objective: To determine whether hyperbaric oxygen (HBO) therapy is an effective adjunct treatment for hypoxic wounds. Methods: We identified studies from technology assessment reports on HBO and a MEDLINE search from mid-1998 to August 2001. We accepted randomized controlled trials (RCTs), cohorts, and case series that reported original data, included at least 5 patients, evaluated the use of HBO for wound care, and reported clinical outcomes: Demographics, wound conditions, HBO regimen; adverse events, and major clinical outcomes were extracted from each study. Results: Fifty-seven studies, 7 RCTs, 16 nonrandomized studies, and 34 case series involving more than 2000 patients are included in this review. None of the studies used wound tissue hypoxia as a patient inclusion criterion. The study results suggest that HBO may be beneficial as An adjunctive therapy for chronic nonhealing diabetic wounds, compromised skin grafts, osteoradionecrosis, soft tissue radionecrosis, and gas gangrene compared with standard wound care, alone. Serious adverse events associated with HBO include seizures and pressure-related traumas, such as pneumothorax. A few deaths in the studies were associated with these adverse events. Conclusions: The overall study quality is poor, with inadequate or no controls in most studies. The studies suggest that HBO may be helpful for some wounds, but there is insufficient evidence to ascertain the appropriate time to initiate therapy and to establish criteria that determine whether patients Will benefit. Serious adverse events may occur. High-quality RCTs that evaluate the short- and long-term risks and benefits of HBO are necessary to better inform clinical decisions. C1 Tufts New England Med Ctr, Evidence Based Practice Ctr, Div Clin Care Res, Boston, MA USA. Tufts New England Med Ctr, Dept Surg, Boston, MA USA. Agcy Healthcare Res & Qual, Technol Assessment Program, Ctr Practice & Technol Assessment, Rockville, MD USA. RP Wang, CC (reprint author), Tufts Univ New England Med Ctr, Div Clin Care Res, Box 63, Boston, MA 02111 USA. NR 74 TC 91 Z9 96 U1 1 U2 14 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0004-0010 J9 ARCH SURG-CHICAGO JI Arch. Surg. PD MAR PY 2003 VL 138 IS 3 BP 272 EP 279 DI 10.1001/archsurg.138.3.272 PG 8 WC Surgery SC Surgery GA 653KW UT WOS:000181435200009 PM 12611573 ER PT J AU Clancy, CM Scully, T AF Clancy, CM Scully, T TI Perspective - A call to excellence SO HEALTH AFFAIRS LA English DT Article AB Health care improvement affects us all and is not optional. For change to occur, consumers must demand excellence from their providers and clinicians. Patient safety is part of a broader set of health care quality issues.. Championing this view will not be easy, for it means fundamental change to the myriad interrelated systems that make up U.S. health care. HHS is taking the lead on patient safety through a number of initiatives and activities. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 6 TC 6 Z9 6 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP 113 EP 115 DI 10.1377/hlthaff.22.2.113 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400019 PM 12674413 ER PT J AU Cohen, JW Krauss, NA AF Cohen, JW Krauss, NA TI Spending and service use among people with the fifteen most costly medical conditions, 1997 SO HEALTH AFFAIRS LA English DT Article AB This study addresses the Institute of Medicine's recommendation that AHRQ use MEPS data to identify a set of priority conditions to inform efforts at improving quality of care. Using MEPS data we identify the fifteen most expensive conditions in the U.S. in 1997: chronic diseases such as heart disease, cancer, and diabetes, and acute conditions such as trauma, pneumonia, and infectious disease. Comorbidities were also associated with increased expenses. Type-of-service and source-of-payment distributions varied considerably across this set of conditions. Our findings highlight some of the challenges likely to be encountered in efforts to reform the current system. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Div Social & Econ Res, Rockville, MD 20852 USA. RP Cohen, JW (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Div Social & Econ Res, Rockville, MD 20852 USA. NR 17 TC 80 Z9 80 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP 129 EP 138 DI 10.1377/hlthaff.22.2.129 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400023 PM 12674416 ER PT J AU Zuvekas, SH Tallaferro, GS AF Zuvekas, SH Tallaferro, GS TI Pathways to access: Health insurance, the health care delivery system, and racial/ethnic disparities, 1996-1999 SO HEALTH AFFAIRS LA English DT Article AB We examine the roles that insurance coverage, the delivery system, and external factors play in explaining persistent disparities in access among racial and ethnic groups of all ages. Using data from the 1996-1999 Medical Expenditure Panel Surveys and regression-based decomposition methods, we find that our measures of health care system capacity explain little and that while insurance clearly matters, external factors are equally important. Employment, job characteristics, and marital status are key determinants of disparities in access to insurance but are difficult for health policy to affect directly. Much of existing disparities remains unexplained, presenting a challenge to developing policies to eliminate them. C1 Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. RP Zuvekas, SH (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. NR 15 TC 153 Z9 155 U1 1 U2 7 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP 139 EP 153 DI 10.1377/hlthaff.22.2.139 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400024 PM 12674417 ER PT J AU Romano, PS Geppert, JJ Davies, S Miller, MR Elixhauser, A McDonald, KM AF Romano, PS Geppert, JJ Davies, S Miller, MR Elixhauser, A McDonald, KM TI A national profile of patient safety in US hospitals SO HEALTH AFFAIRS LA English DT Article ID COMPLICATIONS SCREENING-PROGRAM; ADVERSE EVENTS; ADMINISTRATIVE DATA; MYOCARDIAL-INFARCTION; MEDICARE PATIENTS; REPORTING SYSTEM; SUBSTANDARD CARE; QUALITY; SURGERY; DATABASES AB Measures based on routinely collected data would be useful to examine the epidemiology of patient safety. Extending previous work, we established the face and consensual validity of twenty Patient Safety Indicators (PSIs). We generated a national profile of patient safety by applying these PSIs to the HCUP Nationwide Inpatient Sample. The incidence of most nonobstetric PSIs increased. with age and was higher among African Americans than among whites. The adjusted incidence of most PSIs was highest at urban teaching hospitals. The PSIs may be used in AHRQ's National Quality Report, while providers may use them to screen for preventable complications, target opportunities for improvement, and benchmark performance. C1 Univ Calif Davis, Div Gen Med, Davis, CA 95616 USA. NBER, Stanford, CA USA. Ctr Primary Care & Outcomes Res, Stanford, CA USA. Johns Hopkins Childrens Ctr, Baltimore, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Romano, PS (reprint author), Univ Calif Davis, Div Gen Med, Davis, CA 95616 USA. RI Romano, Patrick/N-4225-2014 OI Romano, Patrick/0000-0001-6749-3979 NR 46 TC 163 Z9 163 U1 3 U2 5 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP 154 EP 166 DI 10.1377/hlthaff.22.2.154 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400025 PM 12674418 ER PT J AU Elixhauser, A Steiner, C Fraser, I AF Elixhauser, A Steiner, C Fraser, I TI Volume thresholds and hospital characteristics in the United States SO HEALTH AFFAIRS LA English DT Article ID NONTEACHING HOSPITALS; HEALTH-CARE; MORTALITY; QUALITY; OUTCOMES; LENGTH; STAY AB Procedure volume has been used as a proxy for quality and recommended as a basis for hospital referrals. We studied the volume, mortality, and associated hospital and staffing characteristics of ten complex procedures in U.S. hospitals using the 2000 HCUP Nationwide Inpatient Sample. Although the majority of patients had their procedures performed in high-volume hospitals, for seven procedures, more than three-fourths of hospitals would be considered low-volume. Unadjusted mortality rates were significantly higher at low-volume hospitals for five procedures. Low-volume hospitals also tended to have lower mean numbers of residents and RNs. However, for two procedures, low-volume hospitals had RN and resident staffing equal to or higher than those of high-volume hospitals, and the unadjusted mortality rates were no different. C1 Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Elixhauser, A (reprint author), Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. NR 22 TC 67 Z9 67 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP 167 EP 177 DI 10.1377/hlthaff.22.2.167 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400026 PM 12674419 ER PT J AU Fink, KS Phillips, RL Fryer, GE Koehn, N AF Fink, KS Phillips, RL Fryer, GE Koehn, N TI International medical graduates and the primary care workforce for rural underserved areas SO HEALTH AFFAIRS LA English DT Article AB The proportion of international medical graduates (IMGs) serving as primary care physicians in rural underserved areas (RUAs) has important policy implications. We analyzed the 2000 American Medical Association Masterfile and Area Resource File to calculate the percentage of primary care IMGs, relative to U.S. medical graduates (USMGs), working in RUAs. We found that 2.1 percent of both primary care USMGs and IMGs were in RUAs, where USMGs were more likely to be family physicians but less likely to be internists or pediatricians. IMGs appear to have been no more likely than USMGs were to practice primary care in RUAs, but the distribution by specialty differs. C1 Univ N Carolina, Dept Family Med, Chapel Hill, NC 27514 USA. Amer Acad Family Phys, Robert Graham Ctr, Washington, DC USA. Tacoma Family Med, Tacoma, WA USA. RP Fink, KS (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 27 TC 23 Z9 23 U1 1 U2 5 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP 255 EP 262 DI 10.1377/hlthaff.22.2.255 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400036 PM 12674429 ER PT J AU Berliner, E Ozbilgin, B Zarin, DA AF Berliner, E Ozbilgin, B Zarin, DA TI A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers SO JOURNAL OF VASCULAR SURGERY LA English DT Review ID INTERMITTENT COMPRESSION; LEG ULCERS; POSTPHLEBITIC-SYNDROME; MANAGEMENT; THERAPY; EDEMA; UNITS; VEINS; PUMP AB Introduction: As part of a reconsideration of coverage policy, the Centers for Medicare and Medicaid Services requested a systematic review of the evidence on the use of pneumatic compression devices in the home environment for treatment of chronic venous insufficiency (CVI) and venous ulcers. Methods: Articles were found with a systematic literature search of MEDLINE, EMBASE, and AMED (Allied and Complementary Medicine) databases, hand searches of reference lists, and suggestions of experts. Results. Eight trials that met the inclusion criteria, including several randomized control trials, were found. Most studies were small and may have been underpowered. However, several were well-designed randomized controlled trials. Three studies showed that the devices could alleviate symptoms of CVI No studies directly measured whether the devices could prevent the occurrence of venous ulcers. Some studies on the treatment of venous ulcers did not show a benefit for pneumatic compression, but other studies showed a benefit for the devices in healing long-standing chronic ulcers that had not healed with other methods. No studies directly compared single-chamber and multiple-chamber devices or studied whether the effectiveness of the pump was dependent on types of treatment used concurrently with the pump. Few adverse events were reported in the trials. Patients generally expressed satisfaction with the pneumatic compression devices, and several studies reported higher compliance than with other compression methods. Conclusion: The available data cannot be relied on to inform the optimal choice of compression therapy or optimal protocol for patients with CVI or venous ulcers. Methodologically rigorous research designed to answer these questions would be useful for treatment decisions. The Centers for Medicare and Medicaid Services considered the results of this study and issued a decision that pneumatic compression will only be covered for patients with refractory edema with significant ulceration of the lower extremities after a 6-month trial of standard therapies, such as compression stockings, has failed. C1 Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Berliner, E (reprint author), Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, 6010 Execut Blvd,Ste 300, Rockville, MD 20852 USA. NR 36 TC 24 Z9 26 U1 0 U2 4 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD MAR PY 2003 VL 37 IS 3 BP 539 EP 544 DI 10.1067/mva.2003.103 PG 6 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA 652DJ UT WOS:000181364400010 PM 12618689 ER PT J AU Bauchner, H Besser, RE AF Bauchner, H Besser, RE TI Promoting the appropriate use of oral antibiotics: There is some very good news SO PEDIATRICS LA English DT Editorial Material ID ACUTE OTITIS-MEDIA; RESISTANT STREPTOCOCCUS-PNEUMONIAE; PNEUMOCOCCAL CONJUGATE VACCINE; RESPIRATORY-TRACT INFECTIONS; GRAM-NEGATIVE BACILLI; INTENSIVE-CARE-UNIT; CLINICAL CHARACTERISTICS; ANTIMICROBIAL AGENTS; INTERVENTION TRIAL; RISK-FACTORS C1 Boston Univ, Sch Med, Boston Med Ctr, Agcy Healthcare Res & Qual, Boston, MA 02118 USA. Ctr Dis Control & Prevent, Epidemiol Sect, Resp Dis Branch, Natl Ctr Infect Dis, Atlanta, GA 30333 USA. RP Bauchner, H (reprint author), Boston Univ, Sch Med, Boston Med Ctr, Agcy Healthcare Res & Qual, Matern Bldg,91 E Concord St, Boston, MA 02118 USA. EM howard.bauchner@bmc.org NR 47 TC 6 Z9 6 U1 0 U2 0 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD MAR PY 2003 VL 111 IS 3 BP 668 EP 670 DI 10.1542/peds.111.3.668 PG 3 WC Pediatrics SC Pediatrics GA 650ZD UT WOS:000181294000049 PM 12612251 ER PT J AU Aaron, KF Clancy, CM AF Aaron, KF Clancy, CM TI Improving quality and reducing disparities - Toward a common pathway SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID CARE; RACE; SEX C1 Agcy Healthcare Res & Qual, Off Prior Populat Res, Rockville, MD 20852 USA. RP Aaron, KF (reprint author), Agcy Healthcare Res & Qual, Off Prior Populat Res, 2101 E Jefferson St,Suite 600, Rockville, MD 20852 USA. NR 19 TC 22 Z9 22 U1 2 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD FEB 26 PY 2003 VL 289 IS 8 BP 1033 EP 1034 DI 10.1001/jama.289.8.1033 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 648BK UT WOS:000181129800033 PM 12597759 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Services Task Force TI Screening for prostate cancer: Recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Article ID DIGITAL RECTAL EXAMINATION; ANTIGEN; MORTALITY; TRIAL; MEN C1 Care of Atkins D, US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Berg, AO (reprint author), Care of Atkins D, US Prevent Serv Task Force, Ctr Practice & Technol Assessment, Agcy Healthcare Res & Qual, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 23 TC 10 Z9 10 U1 0 U2 1 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD FEB 15 PY 2003 VL 67 IS 4 BP 787 EP 792 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 648EG UT WOS:000181136400012 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teulsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Orleans, CT Peipert, JF Pender, NJ Siu, AL Teulsch, SM Westhoff, C Woolf, SH CA US Preventive Services Task Force TI Screening for gestational diabetes mellitus: Recommendations and rationale SO OBSTETRICS AND GYNECOLOGY LA English DT Editorial Material C1 Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Rochester, NY USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Family Med, Newark, NJ 07103 USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA 02115 USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Women & Infants Hosp Rhode Isl, Providence, RI USA. Univ Michigan, Ann Arbor, MI 48109 USA. Mt Sinai Sch Med, New York, NY USA. Merck & Co Inc, W Point, PA USA. Columbia Univ, Dept Obstet & Gynecol, New York, NY USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Prevent & Community Med, Fairfax, VA USA. RP Berg, AO (reprint author), Care of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 7 TC 12 Z9 12 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0029-7844 J9 OBSTET GYNECOL JI Obstet. Gynecol. PD FEB PY 2003 VL 101 IS 2 BP 393 EP 395 DI 10.1016/S0029-7844(02)03056-9 PG 3 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 641GP UT WOS:000180737200027 ER PT J AU Holman, RC Belay, ED Curns, A Schonberger, LB Steiner, C AF Holman, RC Belay, ED Curns, A Schonberger, LB Steiner, C TI Kawasaki syndrome hospitalizations among children in the United States, 1988-1997 SO PEDIATRICS LA English DT Letter C1 US Dept Hlth & Human Serv, Div Viral & Rickettsial Dis, Natl Ctr Infect Dis, Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. US Dept Hlth & Human Serv, Healthcare & Cost Utilizat Project, Ctr Organizat & Delivery Studies, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Holman, RC (reprint author), US Dept Hlth & Human Serv, Div Viral & Rickettsial Dis, Natl Ctr Infect Dis, Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. RI Belay, Ermias/A-8829-2013 NR 5 TC 15 Z9 16 U1 0 U2 2 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD FEB PY 2003 VL 111 IS 2 BP 448 EP 448 DI 10.1542/peds.111.2.448 PG 1 WC Pediatrics SC Pediatrics GA 640VR UT WOS:000180709100061 PM 12563081 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Serv Task Force TI Postmenopausal hormone replacement therapy for the primary prevention of chronic conditions recommendations and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID ESTROGEN-PROGESTIN REPLACEMENT; BREAST-CANCER; RISK; WOMEN; METAANALYSIS; MORTALITY; DISEASE; STROKE; HEART C1 US Prevent Serv Task Force, Rockville, MD USA. RP Berg, AO (reprint author), Care Of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 32 TC 6 Z9 6 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD JAN 15 PY 2003 VL 67 IS 2 BP 358 EP 364 PG 7 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 638MW UT WOS:000180575700012 ER PT J AU Graham, R Roberts, RG Ostergaard, DJ Kahn, NB Pugno, PA Green, LA AF Graham, R Roberts, RG Ostergaard, DJ Kahn, NB Pugno, PA Green, LA TI Challenges facing family practice and primary care - Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Univ Wisconsin, Sch Med, Dept Family Med, Madison, WI USA. Amer Acad Family Phys, Leawood, KS USA. Robert Graham Ctr Policy Studies Family Practice, Washington, DC USA. RP Graham, R (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 15 PY 2003 VL 289 IS 3 BP 299 EP 299 DI 10.1001/jama.289.3.299-a PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 634MV UT WOS:000180345100018 ER PT J AU Hsia, DC AF Hsia, DC TI Medicare quality improvement - Bad apples or bad systems? SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID CARE; PERFORMANCE; OUTCOMES C1 Agcy Healthcare Res & Qual, US Dept HHS, Rockville, MD 20852 USA. RP Hsia, DC (reprint author), Agcy Healthcare Res & Qual, US Dept HHS, 6010 Execut Blvd, Rockville, MD 20852 USA. NR 33 TC 9 Z9 9 U1 4 U2 4 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 15 PY 2003 VL 289 IS 3 BP 354 EP 356 DI 10.1001/jama.289.3.354 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 634MV UT WOS:000180345100031 PM 12525237 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Serv Task Force TI Screening for osteoporosis in postmenopausal women: Recommendations and rationale SO AMERICAN JOURNAL OF NURSING LA English DT Article ID BONE-MINERAL DENSITY; FRACTURE RISK; VERTEBRAL FRACTURES; ELDERLY WOMEN; HIP FRACTURE; IDENTIFICATION; DENSITOMETRY; ALENDRONATE; VALIDATION; TRIAL C1 Care Of Atkins David, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, US Prevent Serv Task Force, Rockville, MD 20852 USA. Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Family Med, Newark, NJ 07103 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA 02115 USA. Univ Texas, Hlth Sci Ctr, Dept Med, San Antonio, TX 78284 USA. Natl ProgramOff, Robert Wood Johnson Generalist Phys Fac Scholars, San Antonio, TX USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Brown Univ, Women & Infants Hosp, Providence, RI 02908 USA. Univ Michigan, Ann Arbor, MI 48109 USA. CUNY Mt Sinai Sch Med, Div Gen Internal Med, New York, NY 10029 USA. Merck & Co Inc, Outcomes Res & Management, W Point, PA USA. Columbia Univ, New York, NY 10032 USA. Virginia Commonwealth Univ, Dept Family Practice, Fairfax, VA USA. Virginia Commonwealth Univ, Dept Community & Prevent Med, Fairfax, VA USA. RP Berg, AO (reprint author), Care Of Atkins David, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, US Prevent Serv Task Force, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 32 TC 8 Z9 9 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0002-936X J9 AM J NURS JI Am. J. Nurs. PD JAN PY 2003 VL 103 IS 1 BP 73 EP + PG 5 WC Nursing SC Nursing GA 636EZ UT WOS:000180442800029 PM 12544063 ER PT J AU Coben, JH Steiner, CA AF Coben, JH Steiner, CA TI Hospitalization for firearm-related injuries in the United States, 1997 SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID SURVEILLANCE; GUNSHOT; COSTS; POPULATION; WOUNDS AB Background: Firearm-related injuries are a serious public health problem in the United States. Despite the magnitude of this problem, prior national estimates of nonfatal, firearm-related morbidity have been limited to an emergency department-based surveillance system. The objective of this study was to assess and report the information available on firearm-related injuries in an existing national database, derived from hospital discharge data. Methods: Cross-sectional analysis of the 1997 Nationwide Inpatient Sample (NIS), a stratified probability sample of 1012 nonfederal community hospitals from 22 states. The database was queried using E codes to identify firearm-related injuries. The SUDAAN software program was used to convert raw counts into weighted counts that represent national estimates and 95% confidence intervals (CIs). Results: An estimated 35,810 (95% CI 32,615-38,947) cases nationwide were identified, of which 86% were male. Assault was the leading cause of firearm-related hospitalization, followed by unintentional injury. The mean length of stay (LOS) for patients with a firearm-related assault was 6 days. Seven percent of all firearm cases died during the hospitalization. The total estimated hospital charges for firearm-related injuries in the United States in 1997 was over $802 million, and 29% of the patients admitted for this condition were uninsured. Conclusions: Firearm-related injuries rank highest among all conditions in the number of uninsured hospital stays, and the average LOS is much longer compared to other medical conditions. National estimates derived from the NIS are consistent with previous estimates, and NIS provides additional information not available from other data sources. C1 US Dept HHS, Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness, Rockville, MD USA. US Dept HHS, Agcy Healthcare Res & Qual, Ctr Org & Delivery Studies, Rockville, MD USA. RP Coben, JH (reprint author), Ctr Violence & Injury Control, 320 E North Ave,Snyder Pavil,Suite 214, Pittsburgh, PA 15212 USA. NR 26 TC 18 Z9 18 U1 1 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD JAN PY 2003 VL 24 IS 1 BP 1 EP 8 AR PII S0749-3797(02)00578-0 DI 10.1016/S0749-3797(02)00578-0 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 634EA UT WOS:000180326000001 PM 12554017 ER PT J AU Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH AF Berg, AO Allan, JD Frame, P Homer, CJ Johnson, MS Klein, JD Lieu, TA Mulrow, CD Orleans, TC Peipert, JF Pender, NJ Siu, AL Teutsch, SM Westhoff, C Woolf, SH CA US Preventive Service Task Force TI Behavioral counseling in primary care to promote a healthy diet - Recommendations and rationale SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID CORONARY-HEART-DISEASE; WORCESTER-AREA TRIAL; LOW-FAT DIET; RANDOMIZED-TRIAL; GENERAL-PRACTICE; WOMENS HEALTH; HYPERLIPIDEMIA WATCH; NUTRITION EDUCATION; PHYSICIAN ADVICE; EATING PATTERNS C1 Univ Washington, Dept Family Med, Seattle, WA 98195 USA. Univ Maryland, Sch Nursing, Baltimore, MD 21201 USA. Tri Cty Family Med, Cohocton, NY USA. Univ Rochester, Rochester, NY USA. Natl Initiat Childrens Healthcare Qual, Boston, MA USA. Univ Med & Dent New Jersey, New Jersey Med Sch, Dept Family Med, Newark, NJ 07103 USA. Univ Rochester, Sch Med, Dept Pediat, Rochester, NY 14642 USA. Harvard Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA USA. Harvard Univ, Sch Med, Boston, MA USA. Univ Texas, Hlth Sci Ctr, Dept Med, San Antonio, TX 78284 USA. Robert Wood Johnson Fdn, Princeton, NJ 08540 USA. Brown Univ, Women & Infants Hosp, Providence, RI USA. Univ Michigan, Ann Arbor, MI 48109 USA. Mt Sinai Sch Med, Div Gen Internal Med, New York, NY USA. Merck & Co Inc, Outcomes Res & Management, West Point, PA USA. Columbia Univ, New York, NY USA. Dept Family Practice, Fairfax, VA USA. Dept Community & Prevent Med, Fairfax, VA USA. RP Berg, AO (reprint author), Care of Atkins D, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. EM uspstf@arhq.gov NR 54 TC 47 Z9 50 U1 1 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 EI 1873-2607 J9 AM J PREV MED JI Am. J. Prev. Med. PD JAN PY 2003 VL 24 IS 1 BP 93 EP 100 AR PII S0749-3797(02)00581-0 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 634EA UT WOS:000180326000012 ER PT J AU Lawrencc, WF Clancy, CM AF Lawrencc, WF Clancy, CM TI Health outcomes assessment in cancer - Current measurement strategies and recommendations for improvement SO DISEASE MANAGEMENT & HEALTH OUTCOMES LA English DT Review ID QUALITY-OF-LIFE; LOCALIZED PROSTATE-CANCER; CENTRAL-NERVOUS-SYSTEM; ITEM RESPONSE THEORY; SICKNESS IMPACT PROFILE; SURGICAL-ADJUVANT-BREAST; 20-YEAR FOLLOW-UP; BOWEL-PROJECT P-1; CLINICAL-TRIALS; LUNG-CANCER AB Measuring the outcomes of cancer care has become increasingly important both in clinical practice and in health policy. Responsiveness to patient-centered needs, preferences, and outcomes is one of the hallmarks of quality healthcare. Health-related quality of life (HR-QOL) measures can be considered within a framework based upon: (i) whether the measure is a generic instrument applicable across a wide range of health conditions, or whether it is specific to cancer or a specific cancer site; (ii) whether it measures a single domain of health or multiple domains; and (iii) whether or not the measure is preference based. Judicious selection of a set of instruments from within different areas of this framework can provide a detailed description of relevant aspects of a patient's health for a wide variety of research and clinical needs. Current health outcomes research is focused not only on the development of improved measures of health, but also on how to expand the use of these measures from research settings into clinical practice and health policy in ways to improve the process and outcomes of cancer care. Shared decision-making tools incorporating HR-QOL data can assist patients in clarifying decision alternatives for difficult cancer treatment decisions. Observational studies of HR-QOL of cancer patients can help patients better understand potential outcomes of their choices. HR-QOL measures are being used in quality of care initiatives. Cancer care is composed of a spectrum of services, ranging from prevention and early detection, through to diagnosis and treatment, as well as end-of-life care. As the importance of the patient's perspective has become more clearly recognized, health outcomes measures have become more widely used and can contribute to improved care across the spectrum of cancer services. While further research needs to focus on developing better measures of health, it is equally imperative that future research focus on methods to incorporate health outcomes measurement into practice in ways to improve clinical practice, health policy, and ultimately to improve the outcomes of care of patients with cancer. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Effect Res, Rockville, MD 20852 USA. RP Lawrencc, WF (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Effect Res, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 133 TC 2 Z9 2 U1 4 U2 6 PU ADIS INTERNATIONAL LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 10, NEW ZEALAND SN 1173-8790 J9 DIS MANAG HEALTH OUT JI Dis. Manag. Health Outcomes PY 2003 VL 11 IS 11 BP 709 EP 721 DI 10.2165/00115677-200311110-00003 PG 13 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 741XB UT WOS:000186484700003 ER PT J AU Zhang, J Meikle, S Trumble, A AF Zhang, J Meikle, S Trumble, A TI Severe maternal morbidity associated with hypertensive disorders in pregnancy in the United States SO HYPERTENSION IN PREGNANCY LA English DT Article DE eclampsia; maternal morbidity; preeclampsia ID RISK-FACTORS; PREECLAMPSIA; ECLAMPSIA; HEALTHY; EPIDEMIOLOGY; WOMEN AB Objectives: This study was to report the incidence of severe maternal morbidity associated with hypertensive disorders of pregnancy in the United States. Study Design: We used data from the National Hospital Discharge Survey, a nationally representative sample of discharge records, from 1988 to 1997. The database consisted of approximately 300,000 deliveries, which represented 39 million births during the 10-year period. Results: The overall incidence of hypertensive disorders in pregnancy was 5.9% [95% confidence interval (CI): 5.2 to 6.5%]. Eclampsia was reported at 1.0 per 1000 deliveries (95% CI: 0.8 to 1.2). The incidence of eclampsia, severe preeclampsia, and superimposed preeclampsia remained unchanged during the 10-year period. Women with preeclampsia and eclampsia had a 3- to 25-fold increased risk of severe complications, such as abruptio placentae, thrombocytopenia, disseminated intravascular coagulation, pulmonary edema, and aspiration pneumonia. More than half of women with preeclampsia and eclampsia had cesarean delivery. African American women not only had higher incidence of hypertensive disorders in pregnancy but also tended to have a greater risk for most severe complications. Preeclamptic and eclamptic women younger than 20 years or older than 35 years had substantially higher morbidity. Conclusion: Preeclampsia and eclampsia carry a high risk for severe maternal morbidity. Compared to Caucasians, African Americans have higher incidence of hypertensive disorders in pregnancy and suffer from more severe complications. C1 NICHHD, Epidemiol Branch, Div Epidemiol Stat & Prevent Res, NIH,Dept Hlth & Human Serv, Bethesda, MD 20892 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP NICHHD, Epidemiol Branch, Div Epidemiol Stat & Prevent Res, NIH,Dept Hlth & Human Serv, NIH Bldg 6100,Room 7B03, Bethesda, MD 20892 USA. EM jim_zhang@nih.gov NR 21 TC 121 Z9 131 U1 0 U2 2 PU TAYLOR & FRANCIS INC PI PHILADELPHIA PA 530 WALNUT STREET, STE 850, PHILADELPHIA, PA 19106 USA SN 1064-1955 EI 1525-6065 J9 HYPERTENS PREGNANCY JI Hypertens. Pregnancy PY 2003 VL 22 IS 2 BP 203 EP 212 DI 10.1081/PRG-120021066 PG 10 WC Obstetrics & Gynecology; Physiology; Peripheral Vascular Disease SC Obstetrics & Gynecology; Physiology; Cardiovascular System & Cardiology GA 699FC UT WOS:000184045200010 PM 12909005 ER PT J AU Forrest, CB Shipman, SA Dougherty, D Miller, MR AF Forrest, CB Shipman, SA Dougherty, D Miller, MR TI Outcomes research in pediatric settings: Recent trends and future directions SO PEDIATRICS LA English DT Review DE outcomes research effectiveness; child; healthcare financing; organization of health care ID QUALITY-OF-LIFE; WEIGHT PREMATURE-INFANTS; HEALTH PROFILE-TYPES; CHILD HEALTH; METHODOLOGIC ISSUES; DEVELOPMENT PROGRAM; EARLY INTERVENTION; ADOLESCENT HEALTH; FUNCTIONAL STATUS; HOME VISITATION AB Objective. Pediatric outcomes research examines the effects of health care delivered in everyday medical settings on the health of children and adolescents. It is an area of inquiry in its nascent stages of development. Methods. We conducted a systematic literature review that covered articles published during the 6-year interval 1994-1999 and in 39 peer-reviewed journals chosen for their likelihood of containing child health services research. This article summarizes the article abstraction, reviews the literature, describes recent trends, and makes recommendations for future work. Results. In the sample of journals that we examined, the number of pediatric outcomes research articles doubled between 1994 and 1999. Hospitals and primary care practices were the most common service sectors, accounting for more than half of the articles. Common clinical categories included neonatal conditions, asthma, psychosocial problems, and injuries. Approximately 1 in 5 studies included multistate or national samples; 1 in 10 used a randomized controlled trial study design. Remarkably few studies examined the health effects of preventive, diagnostic, long-term management, or curative services delivered to children and adolescents. Conclusions. Outcomes research in pediatric settings is a rapidly growing area of inquiry that is acquiring breadth but has achieved little depth in any single content area. Much work needs to be done to inform decision making regarding the optimal ways to finance, organize, and deliver child health care services. To improve the evidence base of pediatric health care, more effectiveness research is needed to evaluate the overall and relative effects of services delivered to children and adolescents in everyday settings. C1 Johns Hopkins Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. Johns Hopkins Med Inst, Dept Pediat, Baltimore, MD 21205 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Forrest, CB (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, 624 N Broadway,Rm 689, Baltimore, MD 21205 USA. NR 58 TC 42 Z9 42 U1 2 U2 5 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JAN PY 2003 VL 111 IS 1 BP 171 EP 178 DI 10.1542/peds.111.1.171 PG 8 WC Pediatrics SC Pediatrics GA 630XC UT WOS:000180135200044 PM 12509573 ER PT J AU Swan, JS Sainfort, F Lawrence, W Kongakorn, T Heisey, D AF Swan, JS Sainfort, F Lawrence, W Kongakorn, T Heisey, D TI Process utility for imaging in cerebrovascular disease SO STROKE LA English DT Meeting Abstract CT 28th International Stroke Conference CY FEB 13-15, 2003 CL PHOENIX, ARIZONA C1 Univ Wisconsin, Madison, WI USA. Georgia Inst Technol, Atlanta, GA 30332 USA. Georgetown Univ, AHRQ, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD JAN PY 2003 VL 34 IS 1 BP 317 EP 317 PG 1 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 632XX UT WOS:000180251100485 ER PT J AU Lee, SJ Wilkinson, SL Battles, JB Hynan, LS AF Lee, SJ Wilkinson, SL Battles, JB Hynan, LS TI An objective structured clinical examination to evaluate health historian competencies SO TRANSFUSION LA English DT Article ID BLOOD-TRANSFUSION; TECHNICAL ISSUES; QUALITY AB BACKGROUND: Post-donation information events in the blood-collection process account for the majority of errors reported to the FDA. An eight-station objective structured clinical examination (OSCE) based on information reported after donation was developed as a competency examination for health historians. STUDY DESIGN AND METHODS: The OSCE measured two individual skill components: history-taking technique (HXE) and ability to record and interpret a medical history (HXI). Donor historians at the Hoxworth Blood Center, University of Cincinnati Medical Center, were examined (n = 56). RESULTS: In general, staff performance was acceptable, but several areas for improvement were identified. Of particular concern were the deferrals associated with the malaria scenarios. The overall reliability score was greater than 0.8 for the total OSCE and HXI. Using the cut score of 0.9, or 90 percent, 10 subjects would not have passed the exam based on the HXE score and one person would not have demonstrated competency based on the HXI score. CONCLUSION: An OSCE is a reliable, valid, and practical method for assessing continued competency in health historians. This form of competency assessment and subsequent retraining may reduce the incidence of errors in information reported after donation and should be further studied as a suitable national standard for assessing competency. C1 Blood Ctr SE Wisconsin Inc, Milwaukee, WI 53233 USA. Univ Cincinnati, Med Ctr, Hoxworth Blood Ctr, Cincinnati, OH 45267 USA. Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, Rockville, MD USA. Univ Texas, SW Med Ctr Dallas, Acad Comp Serv, Dallas, TX 75235 USA. RP Lee, SJ (reprint author), Blood Ctr SE Wisconsin Inc, 638 N 18th St, Milwaukee, WI 53233 USA. OI Hynan, Linda/0000-0002-4642-7769 FU NHLBI NIH HHS [R01HL53772] NR 32 TC 7 Z9 7 U1 0 U2 0 PU AMER ASSOC BLOOD BANKS PI BETHESDA PA 8101 GLENBROOK RD, BETHESDA, MD 20814-2749 USA SN 0041-1132 J9 TRANSFUSION JI Transfusion PD JAN PY 2003 VL 43 IS 1 BP 34 EP 41 DI 10.1046/j.1537-2995.2003.00275.x PG 8 WC Hematology SC Hematology GA 634BY UT WOS:000180321200006 PM 12519428 ER PT J AU Randhawa, G Fink, K AF Randhawa, G Fink, K TI Screening for breast cancer SO AMERICAN FAMILY PHYSICIAN LA English DT Article C1 Johns Hopkins Sch Publ Hlth, Prevent Med Program, Baltimore, MD 21218 USA. Univ N Carolina, Dept Family Med, Chapel Hill, NC 27514 USA. Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, Rockville, MD 20852 USA. RP Randhawa, G (reprint author), Johns Hopkins Sch Publ Hlth, Prevent Med Program, Baltimore, MD 21218 USA. NR 4 TC 1 Z9 1 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD DEC 15 PY 2002 VL 66 IS 12 BP 2283 EP 2284 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 628QP UT WOS:000180008000012 PM 12507167 ER PT J AU Berg, AO AF Berg, AO CA US Preventive Services Task Force TI Screenig for colorectal cancer: Recommendation and rationale SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material RP Berg, AO (reprint author), Care of Atkins D, US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Ctr Practice & Technol Assessment, 6010 Execut Blvd,Suite 300, Rockville, MD 20852 USA. NR 10 TC 9 Z9 9 U1 0 U2 0 PU AMER ACAD FAMILY PHYSICIANS PI KANSAS CITY PA 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA SN 0002-838X J9 AM FAM PHYSICIAN JI Am. Fam. Physician PD DEC 15 PY 2002 VL 66 IS 12 BP 2287 EP 2290 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 628QP UT WOS:000180008000013 ER PT J AU Basu, J Friedman, B Burstin, H AF Basu, J Friedman, B Burstin, H TI Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions - A new approach SO MEDICAL CARE LA English DT Article DE preventable hospitalization; ambulatory care sensitive admissions; primary care; managed care ID PREVENTABLE HOSPITALIZATIONS; HEALTH-INSURANCE; RATES; CHILDREN; QUALITY; ADMISSION; DISEASE; SERVICE; IMPACT; ACCESS AB OBJECTIVE. To examine the association of primary care availability, HMO enrollment, and other person and location variables with potentially preventable hospitalization for adults in New York State, compared with other types of hospitalization. DATA SOURCES/STUDY SETTING. Hospital discharges of New York residents in the age group 20-64 hospitalized either in New York or in three contiguous states: New Jersey, Pennsylvania, or Connecticut using 1995 state-wide discharge files from the Health care Cost and Utilization Project (HCUP) maintained by the Agency for Health care Research and Quality. STUDY DESIGN. A multinomial logit model uses the individual discharge as the unit of analysis. ACS admissions are compared with marker admissions (urgent but non-ACS) and referral sensitive surgeries (more discretionary), controlling for severity of illness. PRINCIPAL FINDINGS. Higher primary care density was associated with a lower likelihood of ACS admission, compared with marker admissions, without increasing referral-sensitive admissions. The study also supports the hypothesis of ACS admissions being less likely for private HMO enrollees than for other insured adults. This result was not found for Medicaid HMO enrollees, even by comparison to other Medicaid enrollees. CONCLUSIONS. A key policy-relevant result is the negative association of primary care physicians per capita with the likelihood of ACS admissions, without an offsetting association with resource costs via referral-sensitive admissions. The method allowed for examining the possible effects of personal and area variables on one type of hospital admission (ACS) by contrast with other specific types of admissions. This type of analysis could be strengthened in several ways for a defined population when better data on individual patients and several time periods are used. C1 AHRQ, Ctr Primary Care Res, Rockville, MD 20852 USA. AHRQ, Ctr Org & Delivery Studies, Rockville, MD 20852 USA. RP Basu, J (reprint author), AHRQ, Ctr Primary Care Res, Suite 201,6010 Execut Blvd, Rockville, MD 20852 USA. NR 30 TC 73 Z9 73 U1 2 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD DEC PY 2002 VL 40 IS 12 BP 1260 EP 1269 DI 10.1097/01.MLR.0000036409.56436.ED PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 621ZM UT WOS:000179621500012 PM 12458307 ER EF