FN Thomson Reuters Web of Science™ VR 1.0 PT J AU Touchette, DR Masica, AL Dolor, RJ Schumock, GT Choi, YK Kim, Y Smith, SR AF Touchette, Daniel R. Masica, Andrew L. Dolor, Rowena J. Schumock, Glen T. Choi, Young Ku Kim, Yoonsang Smith, Scott R. TI Safety-focused medication therapy management: A randomized controlled trial SO JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION LA English DT Article DE Medication therapy management; Medicare; pharmacists; medication errors; medication-related problems; medication adherence ID ADVERSE DRUG EVENTS; PHARMACIST INTERVENTIONS; PATIENT OUTCOMES; OLDER-ADULTS; PART-D; ECONOMIC OUTCOMES; UNITED-STATES; CARE; RECOMMENDATIONS; PRESCRIPTION AB Objective: To evaluate the effect of a medication therapy management (MTM) intervention on adverse drug events (ADEs), health care visits, and drug-related problems (DRPs). Design: Randomized, controlled, clinical trial. Setting: Academic medical center community pharmacies and family medicine clinics at three U.S. sites between December 2007 and January 2010 Patients: Individuals aged 65 years or older with three or more chronic illnesses, six or more prescription medications, and at risk for a DRP. Intervention: At 0 and 3 months, pharmacists conducted comprehensive medication reviews and screened for and resolved DRPs through patient education and recommendations to physicians. Main outcome measures: Frequency of ADEs reported by patients and confirmed by clinical algorithm, health care visits at 3 and 6 months, and number of DRPs, pharmacist recommendations, and medication discrepancies. Results: 637 participants enrolled. No differences were observed in potential ADEs or health care visits among the usual care and MTM groups. DRPs declined in both MTM intervention groups over time. Physicians responded to 54.6% of pharmacist recommendations. Enhanced MTM patients had fewer medication list discrepancies than basic MTM patients (33.8% vs. 47.1%, P < 0.001). Conclusion: This specific design of MTM was associated with reduced DRPs but did not reduce potential ADEs or health care visits. C1 [Touchette, Daniel R.; Schumock, Glen T.] Univ Illinois, Coll Pharm, Chicago, IL 60612 USA. [Masica, Andrew L.] Baylor Hlth Care Syst, Clin Innovat, Inst Hlth Care Res & Improvement, Dallas, TX USA. [Dolor, Rowena J.] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA. [Choi, Young Ku] Univ Illinois, Sch Publ Hlth, Inst Hlth Res & Policy, Chicago, IL 60612 USA. [Kim, Yoonsang] Univ Oklahoma, Hlth Sci Ctr, Dept Biostat & Epidemiol, Oklahoma City, OK USA. [Smith, Scott R.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Touchette, DR (reprint author), Univ Illinois, Coll Pharm, 833 S Wood St,M-C 886, Chicago, IL 60612 USA. EM drtouche@uic.edu OI Touchette, Daniel/0000-0003-1972-8934 FU University of Illinois at Chicago, Chicago-Area DEcIDE Center from the Agency for Healthcare Research and Quality [HHSA290-05-0038]; U.S. Department of Health Human Services FX Contract no. HHSA290-05-0038 (University of Illinois at Chicago, Chicago-Area DEcIDE Center) from the Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services, as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. NR 33 TC 11 Z9 11 U1 3 U2 17 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 2012 VL 52 IS 5 BP 603 EP + DI 10.1331/JAPhA.2012.12036 PG 12 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 014AD UT WOS:000309346500017 PM 23023840 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Reducing Hospital Readmissions: Aligning Financial and Quality Incentives SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material ID PROGRAM C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Carolyn.Clancy@ahrq.hhs.gov NR 10 TC 3 Z9 3 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 SEP-OCT PY 2012 VL 27 IS 5 BP 441 EP 443 DI 10.1177/1062860612452371 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 003ZV UT WOS:000308650800012 PM 22822170 ER PT J AU McHugh, M Van Dyke, KJ Yonek, J Moss, D AF McHugh, Megan Van Dyke, Kevin J. Yonek, Julie Moss, Dina TI TIME AND EXPENSES ASSOCIATED WITH THE IMPLEMENTATION OF STRATEGIES TO REDUCE EMERGENCY DEPARTMENT CROWDING SO JOURNAL OF EMERGENCY NURSING LA English DT Article DE Improvement; Cost; Crowding AB Introduction: The Emergency Nurses Association and other groups have encouraged the adoption of patient flow improvement strategies to reduce ED crowding, but little is known about time and expenses associated with implementation. The purpose of this study was to estimate the time spent and expenses incurred as 6 Urgent Matters hospitals planned and implemented strategies to improve patient flow and reduce crowding. Methods: We conducted key informant interviews with members of the hospitals' patient flow improvement teams at 2 points in time: immediately after strategy implementation and approximately 6 months later. A total of 129 interviews were conducted using a semistructured interview protocol. Interviews were recorded, transcribed, and coded for analysis. Results: Eight strategies were implemented. The time spent planning and implementing the strategies ranged from 40 to 1,017 hours per strategy. The strategies were largely led by nurses, and collectively, nurses spent more time planning and implementing strategies than others. The most time-consuming strategies were those that involved extensive staff training, large implementation teams, or complex process changes. Only 3 strategies involved sizable expenditures, ranging from $32,850 to $490,000. Construction and the addition of new personnel represented the most costly expenditures. Discussion: The time and expenses involved in the adoption of patient flow improvement strategies are highly variable. Nurses play an important role in leading and implementing these efforts. Hospital, ED, and nurse leaders should set realistic expectations for the time and expenses needed to support patient flow improvement. C1 [McHugh, Megan] Northwestern Univ, Inst Healthcare Studies, Feinberg Sch Med, Chicago, IL 60611 USA. [McHugh, Megan] Northwestern Univ, Dept Emergency Med, Feinberg Sch Med, Chicago, IL 60611 USA. [Van Dyke, Kevin J.] Natl Assoc Publ Hosp & Hlth Syst, Washington, DC USA. [Moss, Dina] Agcy Healthcare Res & Qual, Rockville, MD USA. RP McHugh, M (reprint author), Northwestern Univ, Inst Healthcare Studies, Feinberg Sch Med, 750 N Lake Shore Dr,10th Floor, Chicago, IL 60611 USA. EM megan-mchugh@northwestern.edu FU Agency for Healthcare Research and Quality FX This study was funded by the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. NR 16 TC 3 Z9 3 U1 0 U2 9 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0099-1767 J9 J EMERG NURS JI J. Emerg. Nurs. PD SEP PY 2012 VL 38 IS 5 BP 420 EP 428 DI 10.1016/j.jen.2011.07.001 PG 9 WC Emergency Medicine; Nursing SC Emergency Medicine; Nursing GA 007SG UT WOS:000308907800012 PM 21907399 ER PT J AU Cooper, PF Manski, RJ Pepper, JV AF Cooper, Philip F. Manski, Richard J. Pepper, John V. TI The Effect of Dental Insurance on Dental Care Use and Selection Bias SO MEDICAL CARE LA English DT Article DE dental; insurance; selection; instrument; bounds ID NONPARAMETRIC BOUNDS; UNITED-STATES; SERVICES; COVERAGE AB Objectives: We examine the effect of dental insurance coverage on the probability of having a dental care visit in light of selection bias. Methods: We use data from the 2003 Medical Expenditure Panel Survey and use 3 different approaches to control for selection bias. First, we use a probit specification and include a rich set of independent variables that we posit control for unobserved attitudes toward risk and health care. Second, we use an instrumental variable model with family employment status as our instrument. Finally, we use a nonparametric approach to identify the upper and lower bounds of a dental insurance effect. We also ran a base probit model that did not include controls for attitudes toward risk and health care. Results: The base probit, the probit including measure of attitudes, and the instrumental variable models provided similar estimates of the effect of dental insurance on the probability to seek dental care. This may indicate that selection bias may not be a concern. All estimates were within the bounds obtained through the nonparametric approach. Conclusions: Despite concerns of the potential endogeneity of dental insurance in models that estimate dental care use, we find evidence that these concerns may be unfounded. C1 [Cooper, Philip F.; Manski, Richard J.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [Manski, Richard J.] Univ Maryland, Sch Dent, College Pk, MD 20742 USA. [Pepper, John V.] Univ Virginia, Dept Dent, Charlottesville, VA USA. RP Cooper, PF (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM philip.cooper@ahrq.hhs.gov FU Agency for Healthcare Research and Quality, Rockville, MD FX Supported by the Agency for Healthcare Research and Quality, Rockville, MD. NR 21 TC 10 Z9 10 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 SEP PY 2012 VL 50 IS 9 BP 757 EP 763 DI 10.1097/MLR.0b013e318255172d PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 993OU UT WOS:000307869900002 PM 22525615 ER PT J AU Bolton, LL Baine, WB AF Bolton, Laura L. Baine, William B. TI Using Science to Advance Wound Care Practice: Lessons from the Literature SO OSTOMY WOUND MANAGEMENT LA English DT Article DE evidence-based practice; wounds; review literature; treatment outcome AB Wound care professionals can improve clinical, patient-oriented wound outcomes and do so cost-effectively by using scientific evidence to meet patient and wound care goals and needs. A review of the literature was conducted to define evidence-based wound management, describe the potential of science to improve outcomes in wound care, and summarize strategies, tactics, and tools for wound care providers and recipients to utilize science to their mutual benefit. In addition, changes in the availability of randomized and nonrandomized and clinical and preclinical evidence during the past 50 years were examined using MEDLINE database searches of English-language publications, combining the search terms wound, ulcer, or burn limited by the terms randomized or clinical for each decade since 1960. The number of published, nonrandomized wound studies has increased exponentially during the last five decades but, more recently, evidence from randomized controlled trials also has become available. Moreover, while many questions remain unanswered, a substantial number of publications have shown the use of available evidence-based guidelines and wound care strategies improves outcomes of care while saving time and money. The application of science-based wound care in clinical practice is increasing slowly; expensive techniques supported by limited or inconsistent evidence are still in use and add to wound care costs without certainty they improve outcomes. The literature provides compelling evidence that patients with a wide variety of diagnoses benefit when opinion-based care is replaced by clinical wisdom applied on a substrate of best available evidence. Patients with wounds deserve no less. C1 [Bolton, Laura L.] Robert Wood Johnson Univ, Sch Med, Dept Surg Bioengn, Piscataway, NJ USA. [Bolton, Laura L.] Bolton SCI LLC, Metuchen, NJ USA. [Baine, William B.] US Dept HHS, Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Bolton, LL (reprint author), 15 Franklyn Pl, Metuchen, NJ 08840 USA. EM llbolton@gmail.com NR 52 TC 1 Z9 1 U1 1 U2 2 PU H M P COMMUNICATIONS PI MALVERN PA 83 GENERAL WARREN BLVD, STE 100, MALVERN, PA 19355 USA SN 0889-5899 J9 OSTOMY WOUND MANAG JI Ostomy Wound Manag. PD SEP PY 2012 VL 58 IS 9 BP 16 EP 31 PG 16 WC Surgery SC Surgery GA V30TQ UT WOS:000208838700005 PM 22933698 ER PT J AU Desai, R Curns, AT Steiner, CA Tate, JE Patel, MM Parashar, UD AF Desai, Rishi Curns, Aaron T. Steiner, Claudia A. Tate, Jacqueline E. Patel, Manish M. Parashar, Umesh D. TI All-Cause Gastroenteritis and Rotavirus-Coded Hospitalizations Among US Children, 2000-2009 SO CLINICAL INFECTIOUS DISEASES LA English DT Article ID UNITED-STATES; VACCINATION; SURVEILLANCE; DIARRHEA; DECLINE; IMPACT AB Background. Rotavirus vaccine was recommended for US infants in 2006. We estimated baseline prevaccine burden and monitored postvaccine trends in gastroenteritis-coded and rotavirus-coded hospitalizations among US children. Methods. We analyzed data from the State Inpatient Databases (SID) for 29-44 US states over a 10-year period (2000-2009) to calculate gastroenteritis and rotavirus-coded hospitalization rates by age group, sex, and region, among children <5 years of age. By extrapolating observed pre- and postvaccine gastroenteritis hospitalization rates to the US population <5 years and based on the 2009 cost of a diarrhea hospitalization, we estimated national reductions in diarrhea hospitalizations and associated treatment costs. Results. The prevaccine (2000-2006) annual average gastroenteritis-coded hospitalization rate among children <5 years of age was 74 per 10 000 (annual range, 71-82 per 10 000), and declined to 51 and 50 per 10 000 in 2008 and 2009, respectively (P < .001). The prevaccine (2000-2006) annual average rotavirus-coded hospitalization rate among children < 5 years of age was 15 per 10 000 (annual range, 13-18 per 10 000), and declined to 5 and 6 per 10 000 in 2008 and 2009, respectively (P < .001). The decreases in rotavirus-coded hospitalization rates in 2008 and 2009 compared with rates in prevaccine years were observed among all age groups and US regions. Nationally, during 2008 and 2009 combined, we estimated a reduction of approximately 77 000 diarrhea hospitalizations and approximately $242 million in hospital costs. Conclusions. Since implementation of the US rotavirus vaccination program, a marked reduction in diarrhea hospitalizations and related hospital charges has occurred among US children. C1 [Desai, Rishi; Curns, Aaron T.; Tate, Jacqueline E.; Patel, Manish M.; Parashar, Umesh D.] Ctr Dis Control & Prevent, Div Viral Dis, Atlanta, GA 30333 USA. [Steiner, Claudia A.] US Dept HHS, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Desai, R (reprint author), Ctr Dis Control & Prevent, Div Viral Dis, 1600 Clifton Rd NE,MS-34, Atlanta, GA 30333 USA. EM rdesai1@cdc.gov NR 17 TC 33 Z9 33 U1 0 U2 4 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1058-4838 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD AUG 15 PY 2012 VL 55 IS 4 BP E28 EP E34 DI 10.1093/cid/cis443 PG 7 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 977RQ UT WOS:000306682500002 PM 22543022 ER PT J AU Gliklich, R Levy, D Leavy, M Campion, DM Karl, J Berliner, E AF Gliklich, Richard Levy, Dan Leavy, Michelle Campion, Daniel M. Karl, Jannette Berliner, Elise TI Development of a New System for Registration of Patient Registries SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Gliklich, Richard; Levy, Dan; Leavy, Michelle; Campion, Daniel M.; Karl, Jannette] Outcome, Cambridge, MA USA. [Berliner, Elise] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU WILEY PERIODICALS, INC PI SAN FRANCISCO PA ONE MONTGOMERY ST, SUITE 1200, SAN FRANCISCO, CA 94104 USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2012 VL 21 SU 3 SI SI MA 724 BP 337 EP 337 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 996YU UT WOS:000308131701696 ER PT J AU Basu, J AF Basu, Jayasree TI Preventable Hospitalizations and Medicare Managed Care: A Small Area Analysis SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID AVOIDABLE HOSPITALIZATIONS; SOCIOECONOMIC-STATUS; SENSITIVE CONDITIONS; HEALTH-CARE; RATES; HMOS; INSURANCE; ACCESS; IMPACT; BENEFICIARIES AB Objective: To examine the association between preventable hospitalization rates and proportions of managed care enrollment at the primary care service area level. Study Design: Multivariate design. Methods: The study used the Healthcare Cost and Utilization Project State Inpatient Data from the Agency for Healthcare Research and Quality for Arizona, Massachusetts, and New York for the years 1995 and 2005 to examine the association between preventable hospitalization rates and proportions of managed care enrollment in 1995 and 2005. The period 1995-2005 was marked by the beginning and end of several legislative and policy initiatives causing changes in elderly hospitalization patterns as well as Medicare managed care enrollment patterns. The study used ordinary least squares regressions, adjusting for heteroscedasticity. A cross-sectional analysis was used to examine the association each year. A pooled sample analysis over years tested the changes in relative contributions of managed care over time. Results: Preventable hospitalization rates were inversely associated with Medicare managed enrollment in both years. This association was, however, found to be weaker in 2005 than in 1995. The decline in contributions of managed care was also statistically significant. Conclusions: Despite increased managed care enrollment, the role of Medicare managed care in explaining declines in preventable hospitalization rates diminished over time. The results could be explained by the growth of private fee-for-service types of managed care plans and the resultant decline in emphasis on care coordination relative to health maintenance organization plans. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Basu, J (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jayasree.basu@ahrq.hhs.gov FU Agency for Healthcare Research and Quality FX This research was funded wholly by the author's employer, the Agency for Healthcare Research and Quality. NR 34 TC 3 Z9 3 U1 1 U2 6 PU MANAGED CARE & HEALTHCARE COMMUNICATIONS LLC PI PLAINSBORO PA 666 PLAINSBORO RD, STE 300, PLAINSBORO, NJ 08536 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD AUG PY 2012 VL 18 IS 8 BP E280 EP E288 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 009OY UT WOS:000309036300011 PM 22928797 ER PT J AU Melnyk, BM Grossman, DC Chou, R Mabry-Hernandez, I Nicholson, W DeWitt, TG Cantu, AG Flores, G AF Melnyk, Bernadette Mazurek Grossman, David C. Chou, Roger Mabry-Hernandez, Iris Nicholson, Wanda DeWitt, Thomas G. Cantu, Adelita G. Flores, Glenn CA US Preventive Serv Task Force TI USPSTF Perspective on Evidence-Based Preventive Recommendations for Children SO PEDIATRICS LA English DT Article DE clinical preventive services; children; adolescents; evidence-based practice; primary care; guidelines; research ID SERVICES-TASK-FORCE; PRIMARY-CARE; HEALTH; GUIDELINES; IMPLEMENTATION; EDUCATION; OBESITY; MANAGEMENT; CHILDHOOD; ATTITUDES AB The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge. This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted. Pediatrics 2012;130:e399-e407 C1 [Melnyk, Bernadette Mazurek] Ohio State Univ, Coll Nursing, Columbus, OH 43210 USA. [Melnyk, Bernadette Mazurek] Ohio State Univ, Coll Med, Columbus, OH 43210 USA. [Grossman, David C.] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. [Grossman, David C.] Univ Washington, Grp Hlth Res Inst, Grp Hlth Cooperat, Seattle, WA 98195 USA. [Chou, Roger] Oregon Hlth & Sci Univ, Oregon Evidence Based Practice Ctr, Portland, OR 97201 USA. [Mabry-Hernandez, Iris] Ctr Primary Care Prevent & Clin Partnerships, Agcy Healthcare Res & Qual, Rockville, MD USA. [Nicholson, Wanda] Univ N Carolina, Dept Obstet & Gynecol, Div Womens Primary Healthcare, Chapel Hill, NC USA. [DeWitt, Thomas G.] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Gen & Community Pediat, Cincinnati, OH USA. [Cantu, Adelita G.] Univ Texas Hlth Sci Ctr San Antonio, Sch Nursing, San Antonio, TX 78229 USA. [Flores, Glenn] Childrens Med Ctr, SW Med Sch, Div Gen Pediat, Dallas, TX 75235 USA. RP Melnyk, BM (reprint author), Ohio State Univ, Coll Nursing, Newton Hall,1585 Neil Ave, Columbus, OH 43210 USA. EM melnyk.15@osu.edu NR 41 TC 23 Z9 23 U1 1 U2 7 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 AUG PY 2012 VL 130 IS 2 BP E399 EP E407 DI 10.1542/peds.2011-2087 PG 9 WC Pediatrics SC Pediatrics GA 983MI UT WOS:000307123000020 PM 22753558 ER PT J AU Kirby, JB Liang, L Chen, HJ Wang, YF AF Kirby, James B. Liang, Lan Chen, Hsin-Jen Wang, Youfa TI Race, Place, and Obesity: The Complex Relationships Among Community Racial/Ethnic Composition, Individual Race/Ethnicity, and Obesity in the United States SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID BODY-MASS INDEX; LIFE EXPECTANCY; US ADULTS; ATHEROSCLEROSIS RISK; PHYSICAL-ACTIVITY; OVERWEIGHT; ENVIRONMENT; HEALTH; AGE; SMOKING AB Objectives. We explored the association between community racial/ethnic composition and obesity risk. Methods. In this cross-sectional study, we used nationally representative data from the Medical Expenditure Panel Survey linked to geographic data from the US Decennial Census and Census Business Pattern data. Results. Living in communities with a high Hispanic concentration (>= 25%) was associated with a 0.55 and 0.42 increase in body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) and 21% and 23% higher odds for obesity for Hispanics and non-Hispanic Whites, respectively. Living in a community with a high non-Hispanic Asian concentration (>= 25%) was associated with a 0.68 decrease in BMI and 28% lower odds for obesity for non-Hispanic Whites. We controlled for individual- and community-level social, economic, and demographic variables. Conclusions. Community racial/ethnic composition is an important correlate of obesity risk, but the relationship differs greatly by individual race/ethnicity. To better understand the obesity epidemic and related racial/ethnic disparities, more must be learned about community-level risk factors, especially how built environment and social norms operate within communities and across racial/ethnic groups. (Am J Public Health. 2012;102:1572-1578. doi:10.2105/AJPH.2011.300452) C1 [Kirby, James B.; Liang, Lan] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Chen, Hsin-Jen] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA. [Wang, Youfa] Johns Hopkins Bloomberg Sch Publ Hlth, Johns Hopkins Global Ctr Childhood Obes, Baltimore, MD USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM jkirby@ahrq.gov FU National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases [R01DK81335-01A1] FX The study was supported in part by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (grant R01DK81335-01A1). NR 45 TC 31 Z9 31 U1 1 U2 22 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 2012 VL 102 IS 8 BP 1572 EP 1578 DI 10.2105/AJPH.2011.300452 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 981AO UT WOS:000306937900020 PM 22698012 ER PT J AU Singleton, RJ Holman, RC Folkema, AM Wenger, JD Steiner, CA Redd, JT AF Singleton, Rosalyn J. Holman, Robert C. Folkema, Arianne M. Wenger, Jay D. Steiner, Claudia A. Redd, John T. TI Trends in Lower Respiratory Tract Infection Hospitalizations among American Indian/Alaska Native Children and the General US Child Population SO JOURNAL OF PEDIATRICS LA English DT Article ID PNEUMOCOCCAL CONJUGATE VACCINE; RISK-FACTORS; DISEASE; COVERAGE AB Objective To describe trends in the rate of hospitalization for lower respiratory tract infection (LRTI) among American Indian/Alaska Native (AI/AN) children and the general US population of children aged < 5 years. Study design This was a retrospective analysis of trends and hospitalization rates for LRTI-associated hospitalizations in 1998-2008 among AI/AN children aged < 5 years using the Indian Health Service direct/contract inpatient data, and also among the general population of US children aged < 5 years using the Nationwide Inpatient Sample. Results The 2006-2008 LRTI-associated hospitalization rate for AI/AN children aged < 5 years (21.8 per 1000/year) was 32% lower than the 1998-1999 rate, and 1.6-fold higher than the general US children rate (13.8 per 1000/year; 95% CI, 12.8-14.8). Higher rates were seen in AI/AN children aged < 5 years in the Alaska and the Southwest regions of the United States (41.2 and 28.0 per 1000/year, respectively). In infants, these rates were 136.4 and 82.4 per 1000/year, respectively, exceeding the rate in the general US infant population (37.1 per 1000/year; 95% CI, 34.3-40.0). The greatest disparity in the LRTI-associated hospitalization rate between AI/AN infants and the general US infant population was seen for pneumonia, with a 3-fold higher rate in AI/AN infants (36.2 per 1000/year vs 12.7 per 1000/year; 95% CI, 11.8-13.6). Conclusion The LRTI-associated hospitalization rate is higher in AI/AN children, particularly infants from Alaska and the American Southwest, compared with the general US child population. Closing this gap will require addressing housing and sanitation inequities and ensuring high immunization rates and access to care. (J Pediatr 2012;161:296-302). C1 [Singleton, Rosalyn J.; Wenger, Jay D.] Ctr Dis Control & Prevent, Arctic Invest Program, Natl Ctr Emerging & Zoonot Infect Dis, US Dept HHS, Anchorage, AK USA. [Holman, Robert C.; Folkema, Arianne M.] Ctr Dis Control & Prevent, Div High Consequence Pathogens & Pathol, Natl Ctr Emerging & Zoonot Infect Dis, US Dept HHS, Atlanta, GA USA. [Steiner, Claudia A.] US Dept HHS, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. [Redd, John T.] US Dept HHS, Div Epidemiol & Dis Prevent, Off Publ Hlth Support, Indian Hlth Serv, Albuquerque, NM USA. RP Singleton, RJ (reprint author), AIP CDC, 4055 Tudor Ctr Dr, Anchorage, AK 99508 USA. EM ris2@cdc.gov FU Pfizer Inc FX R.S. and J.W. have conducted research sponsored by Pfizer Inc. The authors declare no conflicts of interest. NR 32 TC 21 Z9 21 U1 1 U2 3 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0022-3476 J9 J PEDIATR-US JI J. Pediatr. PD AUG PY 2012 VL 161 IS 2 BP 296 EP + DI 10.1016/j.jpeds.2012.02.004 PG 9 WC Pediatrics SC Pediatrics GA 977VV UT WOS:000306693800026 PM 22437150 ER PT J AU Sarpong, EM Bernard, DM Miller, GE AF Sarpong, Eric M. Bernard, Didem M. Miller, G. Edward TI Changes in Pharmaceutical Treatment of Diabetes and Family Financial Burdens SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE diabetes; comorbidities; out-of-pocket drug expenditures; financial burden; nonelderly adults ID BLOOD-GLUCOSE CONTROL; HEALTH-CARE; MEDICATION USE; ADULTS; MELLITUS; COMPLICATIONS; TRENDS; COSTS; DRUGS; RISK AB Recent changes in diabetes treatment guidelines and the introduction of new, more expensive pharmaceuticals appear to increase the financial challenges for nonelderly adults with diabetes. The authors used Medical Expenditure Panel Survey data to examine changes in the prevalence of diabetes and comorbidities, diabetes treatment, financial burdens, and the relationship between high financial burdens and patient characteristics. From 1997-1998 to 2006-2007, the total number of nonelderly adults treated for diabetes nearly doubled, from 5.4 to 10.7 million, and the proportion of diabetes patients using multiple drugs to treat their condition increased significantly. About a fifth of diabetes patients spent 10% or more of their family income on health care, and about one in nine spent 20% or more of their family income on health care. In 2006-2007, diabetes patients who were older, female, in poor health, or lacked insurance were more likely than others to have high burdens. C1 [Sarpong, Eric M.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Sarpong, EM (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM eric.sarpong@ahrq.hhs.gov NR 29 TC 5 Z9 5 U1 1 U2 6 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 AUG PY 2012 VL 69 IS 4 BP 474 EP 491 DI 10.1177/1077558712442570 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 976TW UT WOS:000306609400006 PM 22513449 ER PT J AU Yehia, BR Fleishman, JA Metlay, JP Moore, RD Gebo, KA AF Yehia, Baligh R. Fleishman, John A. Metlay, Joshua P. Moore, Richard D. Gebo, Kelly A. TI Sustained Viral Suppression in HIV-Infected Patients Receiving Antiretroviral Therapy SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter ID PREVENTION; CARE C1 [Yehia, Baligh R.; Metlay, Joshua P.] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. [Fleishman, John A.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Moore, Richard D.; Gebo, Kelly A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. RP Yehia, BR (reprint author), Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. EM byehia@upenn.edu FU NIAAA NIH HHS [R01 AA 16893, R01 AA016893]; NIAID NIH HHS [K24 AI073957, U01 AI069918]; NIDA NIH HHS [K24 DA 00432, K24 DA000432, R01 DA011602, R01DA11602]; PHS HHS [290-01-0012] NR 6 TC 33 Z9 33 U1 1 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 25 PY 2012 VL 308 IS 4 BP 339 EP 342 DI 10.1001/jama.2012.5927 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 977SR UT WOS:000306685500016 PM 22820781 ER PT J AU Pitzer, VE Burgner, D Viboud, C Simonsen, L Andreasen, V Steiner, CA Lipsitch, M AF Pitzer, Virginia E. Burgner, David Viboud, Cecile Simonsen, Lone Andreasen, Viggo Steiner, Claudia A. Lipsitch, Marc TI Modelling seasonal variations in the age and incidence of Kawasaki disease to explore possible infectious aetiologies SO PROCEEDINGS OF THE ROYAL SOCIETY B-BIOLOGICAL SCIENCES LA English DT Article DE infectious disease dynamics; mathematical modelling; seasonality ID SYNDROME HOSPITALIZATIONS; SOCIAL CONTACTS; UNITED-STATES; DYNAMICS; VACCINATION; PREVALENCE; CHILDHOOD; EPIDEMICS; PATTERNS; CHILDREN AB The average age of infection is expected to vary during seasonal epidemics in a way that is predictable from the epidemiological features, such as the duration of infectiousness and the nature of population mixing. However, it is not known whether such changes can be detected and verified using routinely collected data. We examined the correlation between the weekly number and average age of cases using data on pre-vaccination measles and rotavirus. We show that age-incidence patterns can be observed and predicted for these childhood infections. Incorporating additional information about important features of the transmission dynamics improves the correspondence between model predictions and empirical data. We then explored whether knowledge of the age-incidence pattern can shed light on the epidemiological features of diseases of unknown aetiology, such as Kawasaki disease (KD). Our results indicate KD is unlikely to be triggered by a single acute immunizing infection, but is consistent with an infection of longer duration, a non-immunizing infection or co-infection with an acute agent and one with longer duration. Age-incidence patterns can lend insight into important epidemiological features of infections, providing information on transmission-relevant population mixing for known infections and clues about the aetiology of complex paediatric diseases. C1 [Pitzer, Virginia E.; Lipsitch, Marc] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. [Pitzer, Virginia E.; Lipsitch, Marc] Harvard Univ, Sch Publ Hlth, Ctr Communicable Dis Dynam, Boston, MA 02115 USA. [Pitzer, Virginia E.; Viboud, Cecile; Simonsen, Lone; Andreasen, Viggo] Fogarty Int Ctr, Natl Inst Hlth, Bethesda, MD 20892 USA. [Burgner, David] Royal Childrens Hosp, Murdoch Childrens Res Inst, Parkville, Vic 3052, Australia. [Simonsen, Lone] George Washington Univ, Sch Publ Hlth, Dept Global Hlth, Washington, DC 20037 USA. [Simonsen, Lone] George Washington Univ, Hlth Serv, Washington, DC 20037 USA. [Andreasen, Viggo] Roskilde Univ, Dept Sci, DK-4000 Roskilde, Denmark. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Healthcare Cost & Utilizat Project, US Dept Hlth, Rockville, MD 20850 USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Healthcare Cost & Utilizat Project, Human Serv, Rockville, MD 20850 USA. [Lipsitch, Marc] Harvard Univ, Sch Publ Hlth, Dept Immunol & Infect Dis, Boston, MA 02115 USA. RP Pitzer, VE (reprint author), Princeton Univ, Dept Ecol & Evolutionary Biol, 212 Eno Hall, Princeton, NJ 08544 USA. EM vepitzer@princeton.edu OI Pitzer, Virginia/0000-0003-1015-2289; Simonsen, Lone/0000-0003-1535-8526; Lipsitch, Marc/0000-0003-1504-9213 FU Science & Technology Directorate, Department of Homeland Security; Fogarty International Center, National Institutes of Health; (Models of Infectious Disease Agent Study) from the National Institutes of Health [5U01GM076497, 5U54GM088558-02]; National Health and Medical Research Council; Victorian Government; Danish Medical Research Council [271-07-0555]; [T32 AI07535] FX V.E.P. was supported by training grant T32 AI07535 and the RAPIDD programme of the Science & Technology Directorate, Department of Homeland Security, and the Fogarty International Center, National Institutes of Health. V.E.P. and M.L. were supported by cooperative agreement 5U01GM076497 and 5U54GM088558-02 (Models of Infectious Disease Agent Study) from the National Institutes of Health. D.B. was supported by a National Health and Medical Research Council Career Development Award and by the Victorian Government's Operational Infrastructure Support Programme. V.A. was supported by grant 271-07-0555 from the Danish Medical Research Council. We thank Christina Mills Astley for helpful comments, Jessica Jacobs for assistance with data retrieval, and all the states that provided hospitalization-discharge data to support the Healthcare Cost and Utilization Project. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of General Medical Sciences or the National Institutes of Health. NR 35 TC 9 Z9 9 U1 0 U2 6 PU ROYAL SOC PI LONDON PA 6-9 CARLTON HOUSE TERRACE, LONDON SW1Y 5AG, ENGLAND SN 0962-8452 J9 P ROY SOC B-BIOL SCI JI Proc. R. Soc. B-Biol. Sci. PD JUL 22 PY 2012 VL 279 IS 1739 BP 2736 EP 2743 DI 10.1098/rspb.2011.2464 PG 8 WC Biology; Ecology; Evolutionary Biology SC Life Sciences & Biomedicine - Other Topics; Environmental Sciences & Ecology; Evolutionary Biology GA 959ED UT WOS:000305294500005 PM 22398170 ER PT J AU Wilt, TJ Brawer, MK Jones, KM Barry, MJ Aronson, WJ Fox, S Gingrich, JR Wei, JT Gilhooly, P Grob, DM Nsouli, I Iyer, P Cartagena, R Snider, G Roehrborn, C Sharifi, R Blank, W Pandya, P Andriole, GL Culkin, D Wheeler, T AF Wilt, Timothy J. Brawer, Michael K. Jones, Karen M. Barry, Michael J. Aronson, William J. Fox, Steven Gingrich, Jeffrey R. Wei, John T. Gilhooly, Patricia Grob, B. Mayer Nsouli, Imad Iyer, Padmini Cartagena, Ruben Snider, Glenn Roehrborn, Claus Sharifi, Roohollah Blank, William Pandya, Parikshit Andriole, Gerald L. Culkin, Daniel Wheeler, Thomas CA Prostate Cancer Intervention Versu TI Radical Prostatectomy versus Observation for Localized Prostate Cancer SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID POSITIVE SURGICAL MARGINS; QUALITY-OF-LIFE; RANDOMIZED-TRIAL; PROGNOSTIC-SIGNIFICANCE; ACTIVE SURVEILLANCE; MEN; SPECIMENS; OUTCOMES; TRENDS; MANAGEMENT AB BACKGROUND The effectiveness of surgery versus observation for men with localized prostate cancer detected by means of prostate-specific antigen (PSA) testing is not known. METHODS From November 1994 through January 2002, we randomly assigned 731 men with localized prostate cancer (mean age, 67 years; median PSA value, 7.8 ng per milliliter) to radical prostatectomy or observation and followed them through January 2010. The primary outcome was all-cause mortality; the secondary outcome was prostate-cancer mortality. RESULTS During the median follow-up of 10.0 years, 171 of 364 men (47.0%) assigned to radical prostatectomy died, as compared with 183 of 367 (49.9%) assigned to observation (hazard ratio, 0.88; 95% confidence interval [CI], 0.71 to 1.08; P = 0.22; absolute risk reduction, 2.9 percentage points). Among men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment, as compared with 31 men (8.4%) assigned to observation (hazard ratio, 0.63; 95% CI, 0.36 to 1.09; P = 0.09; absolute risk reduction, 2.6 percentage points). The effect of treatment on all-cause and prostate-cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor. Radical prostatectomy was associated with reduced all-cause mortality among men with a PSA value greater than 10 ng per milliliter (P = 0.04 for interaction) and possibly among those with intermediate-risk or high-risk tumors (P = 0.07 for interaction). Adverse events within 30 days after surgery occurred in 21.4% of men, including one death. CONCLUSIONS Among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up. Absolute differences were less than 3 percentage points. (Funded by the Department of Veterans Affairs Cooperative Studies Program and others; PIVOT ClinicalTrials.gov number, NCT00007644.) C1 [Wilt, Timothy J.] Univ Minnesota, Ctr Chron Dis Out comes Res, Minneapolis Vet Affairs VA, Hlth Care Syst, Minneapolis, MN 55455 USA. [Wilt, Timothy J.] Univ Minnesota, Sch Med, Sect Gen Med, Minneapolis, MN 55455 USA. [Brawer, Michael K.] Urol IDEA, Seattle, WA USA. [Jones, Karen M.] Coordinating Ctr, VA Cooperat Studies Program, Perry Point, MD USA. [Fox, Steven] Agcy Healthcare Res & Qual, Rockville, MD USA. [Barry, Michael J.] Massachusetts Gen Hosp, Div Gen Med, Boston, MA 02114 USA. [Aronson, William J.] Greater Angeles Healthcare Syst, VA Med Ctr, Los Angeles, CA USA. [Iyer, Padmini] VA Med Ctr, Long Beach, CA USA. [Grob, B. Mayer] Richmond VA Med Ctr, Richmond, VA USA. [Gingrich, Jeffrey R.] Univ Pittsburgh, Dept Urol, Pittsburgh, PA USA. [Gingrich, Jeffrey R.] VA Pittsburgh Hlth Care Syst, Pittsburgh, PA USA. [Wei, John T.] Univ Michigan, Ann Arbor, MI 48109 USA. [Gilhooly, Patricia] VA New Jer sey Hlth Care Syst, E Orange, NJ USA. [Nsouli, Imad] VA Med Ctr Syracuse, Syracuse, NY USA. [Blank, William] Brooklyn VA Med Ctr, Brooklyn, NY USA. [Cartagena, Ruben] VA Western New York Hlth Syst, Buffalo, NY USA. [Snider, Glenn] Louis Johnson VA Med Ctr, Clarksburg, WV USA. [Roehrborn, Claus] Univ Texas Dallas, SW Med Ctr, Dept Urol, Dallas, TX USA. [Pandya, Parikshit] Temple VA Med Ctr, Temple, TX USA. [Wheeler, Thomas] Baylor Coll Med, Houston, TX 77030 USA. [Sharifi, Roohollah] Jesse Brown VA Med Ctr, Chicago, IL USA. [Andriole, Gerald L.] Washington Univ, St Louis, MO USA. [Culkin, Daniel] Univ Oklahoma, Norman, OK 73019 USA. RP Wilt, TJ (reprint author), Univ Minnesota, Ctr Chron Dis Out comes Res, Minneapolis Vet Affairs VA, Hlth Care Syst, Minneapolis, MN 55455 USA. EM tim.wilt@va.gov RI Wei, John/E-8967-2012 FU Department of Veterans Affairs; National Cancer Institute; Agency for Healthcare Research and Quality; Sanofi-Aventis; Amgen; Augmenix; Bayer; Bristol-Myers Squibb; Cambridge Endo; Caris; GlaxoSmithKline; Janssen Biotech; Myriad Genetics; Steba Biotech; Ortho Clinical Diagnostics; Viking Medical; Envisioneering Medical; Johnson Johnson; Medivation; Wilex FX Supported by grants from the Department of Veterans Affairs Cooperative Studies Program, the National Cancer Institute, and the Agency for Healthcare Research and Quality.; Dr. Barry reports being employed by and serving as a board member of the Foundation for Informed Medical Decision Making, which receives royalties from Health Dialog. Dr. Wei reports serving on the board for Envisioneering, receiving consulting fees and grant support from Sanofi-Aventis, providing expert testimony for Genprobe concerning prostate-cancer detection, and serving as proctor for benign prostatic hyperplasia laser surgery for American Medical Systems. Dr. Andriole reports receiving consulting fees, payment for the development of presentations, and payment for travel, accommodation, and meeting expenses from Amgen; consulting fees, stock options, and payment for travel, accommodation, and meeting expenses from Augmenix; consulting fees and payment for travel, accommodation, and meeting expenses from Bayer; consulting fees and payment for travel, accommodation, and meeting expenses from Bristol-Myers Squibb; consulting fees, stock options, and payment for travel, accommodation, and meeting expenses from Cambridge Endo; consulting fees and payment for travel, accommodation, and meeting expenses from Caris; consulting fees and payment for travel, accommodation, and meeting expenses from GlaxoSmithKline; consulting fees and payment for travel, accommodation, and meeting expenses from Janssen Biotech; consulting fees and payment for travel, accommodation, and meeting expenses from Myriad Genetics; consulting fees and payment for travel, accommodation, and meeting expenses from Steba Biotech; consulting fees and payment for travel, accommodation, and meeting expenses from Ortho Clinical Diagnostics; consulting fees and stock options from Viking Medical; stock options from Envisioneering Medical; and grant support to his institution from Johnson & Johnson, Medivation, and Wilex; and being a member of an independent data monitoring committee for Amarex. Dr. Wheeler reports serving as a board member of Medscape; receiving consulting fees from GlaxoSmithKline; providing expert testimony for various law firms regarding medical malpractice, product liability, and toxic tort; receiving royalties from Metabolon; and receiving stock options from Digipath. No other potential conflict of interest relevant to this article was reported. NR 43 TC 788 Z9 801 U1 0 U2 59 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JUL 19 PY 2012 VL 367 IS 3 BP 203 EP 213 DI 10.1056/NEJMoa1113162 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 975PI UT WOS:000306522900004 PM 22808955 ER PT J AU Randhawa, GS Slutsky, JR AF Randhawa, Gurvaneet S. Slutsky, Jean R. TI Building Sustainable Multi-functional Prospective Electronic Clinical Data Systems SO MEDICAL CARE LA English DT Article DE prospective data; comparative effectiveness research; electronic health records; distributed research; governance; patient outcomes; quality improvement; clinical decision support AB A better alignment in the goals of the biomedical research enterprise and the health care delivery system can help fill the large gaps in our knowledge of the impact of clinical interventions on patient outcomes in the real world. There are several initiatives underway to align the research priorities of patients, providers, researchers, and policy makers. These include Agency for Healthcare Research and Quality (AHRQ)-supported projects to build flexible prospective clinical electronic data infrastructure that meet the needs of these diverse users. AHRQ has previously supported the creation of 2 distributed research networks as a new approach to conduct comparative effectiveness research (CER) while protecting a patient's confidential information and the proprietary needs of a clinical organization. It has applied its experience in building these networks in directing the American Recovery and Reinvestment Act funds for CER to support new clinical electronic infrastructure projects that can be used for several purposes including CER, quality improvement, clinical decision support, and disease surveillance. In addition, AHRQ has funded a new Electronic Data Methods forum to advance the methods in clinical informatics, research analytics, and governance by actively engaging investigators from the American Recovery and Reinvestment Act-funded projects and external stakeholders. C1 [Randhawa, Gurvaneet S.; Slutsky, Jean R.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Randhawa, GS (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM gurvaneet.randhawa@ahrq.hhs.gov NR 17 TC 8 Z9 8 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 2012 VL 50 IS 7 SU 1 BP S3 EP S6 DI 10.1097/MLR.0b013e3182588ed1 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 080IM UT WOS:000314235100003 PM 22692255 ER PT J AU Dolor, RJ Masica, AL Touchette, DR Smith, SR Schumock, GT AF Dolor, Rowena J. Masica, Andrew L. Touchette, Daniel R. Smith, Scott R. Schumock, Glen T. TI Patient Safety-Focused Medication Therapy Management: Challenges Affecting Future Implementation SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article AB Objectives/Background: Lessons learned from the implementation of a pharmacist-delivered medication therapy management (MTM) intervention in primary care (PC) can inform future MTM studies and be adopted into real-world clinical settings. We sought to describe the variations and challenges of patient recruitment, enrollment, MTM pharmacist visits, and telephone follow-up in a 3-arm randomized trial of MTM interventions conducted at 3 health centers. Study Design/Methods: Using a post-study structured interview, we interviewed study personnel, clinical pharmacists, and investigators about 5 study domains: recruitment, enrollment visits, MTM pharmacist visits, telephone follow-up, and data collection. Results: All centers screened clinic schedules and conducted queries of administrative databases to identify eligible participants. Patients were recruited either during existing primary care visits or by mailing letters with telephone follow-up. Patients with many medical problems, with transportation difficulties, or who were unaccompanied by a family member were less likely to enroll. MTM visits scheduled separately from other clinic appointments had higher cancellation or no-show rates. Provider response to pharmacist recommendations was low overall but better when the provider was acquainted with the pharmacist who was making contact Conclusions: Off-site implementation of MTM services results in lower participation by patients and providers. Future MTM studies should consider integrating MTM services within the clinic during existing appointments by a pharmacist familiar to the primary care provider. (Am J Manag Care. 2012;18(7):e238-e244) C1 [Dolor, Rowena J.] Duke Univ, Med Ctr, Duke Primary Care Res Consortium, Dept Med, Durham, NC 27710 USA. [Masica, Andrew L.] Baylor Hlth Care Syst, Inst Hlth Care Res & Improvement, Dallas, TX USA. [Touchette, Daniel R.; Schumock, Glen T.] Univ Illinois, Coll Pharm, Ctr Pharmacoecon Res, Chicago, IL USA. [Smith, Scott R.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Dolor, RJ (reprint author), Duke Univ, Med Ctr, Duke Primary Care Res Consortium, Dept Med, Box 3850, Durham, NC 27710 USA. EM rowena.dolor@duke.edu FU Agency for Healthcare Research and Quality, US Department of Health and Human Services [HHSA290-05-0032, HHSA290-05-0036, HHSA290-05-0038] FX This study is funded under Contract Numbers: HHSA290-05-0032 (Duke University DEcIDE Center), HHSA290-05-0036 (RTI International DEcIDE Center), and HHSA290-05-0038 (University of Illinois at Chicago, Chicago-area DEcIDE Center) from the Agency for Healthcare Research and Quality, US Department of Health and Human Services, as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. Clinicaltrials.gov registration number: NCT00773942. NR 7 TC 1 Z9 1 U1 0 U2 2 PU MANAGED CARE & HEALTHCARE COMMUNICATIONS LLC PI PLAINSBORO PA 666 PLAINSBORO RD, STE 300, PLAINSBORO, NJ 08536 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD JUL PY 2012 VL 18 IS 7 BP E238 EP E242 PG 5 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 001EQ UT WOS:000308443600006 PM 22823552 ER PT J AU Mukamel, DB Weimer, DL Li, Y Bailey, L Spector, WD Harrington, C AF Mukamel, Dana B. Weimer, David L. Li, Yue Bailey, Lauren Spector, William D. Harrington, Charlene TI Nursing Homes Appeals of Deficiencies: The Informal Dispute Resolution Process SO JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION LA English DT Article DE Nursing homes; quality; deficiencies; regulation; appeal ID ENFORCEMENT; QUALITY AB Objective: Nursing homes that are not meeting quality standards are cited for deficiencies. Before 1995, the only recourse for a nursing home was a formal appeal process, which is lengthy and costly. In 1995, the Centers for Medicare & Medicaid Services instituted the Informal Dispute Resolution (IDR) process. This study presents for the first time national statistics about the IDR process and an analysis of the factors that influence nursing homes' decisions to request an IDR. Design: Retrospective study including descriptive statistics and multivariate logistic hierarchical models. Setting: US nursing homes from 2005 to 2008. Participants: Participants were 15,916 Medicaid- and Medicare-certified nursing homes nationally, with 94,188 surveys and 9388 IDRs. Measures: The unit of observation was an annual survey or a complaint survey that generated at least one deficiency. The dependent variable was dichotomous and indicated whether the annual or a complaint survey triggered an IDR request. Independent variables included characteristics of the nursing home, the deficiency, the market, and the state regulatory environment. Results: Ten percent of all annual surveys and complaint surveys resulted in IDRs. There was substantial variation across states, which persisted over time. Multivariate results suggest that nursing homes' decisions to request an IDR depend on their assessment of the probability of success and assessment of the benefits of the submission. Conclusions: Nursing homes avail themselves of the IDR process. Their propensity to do so depends on a number of factors, including the state regulatory system and the market environment in which they operate. Copyright (C) 2012 - American Medical Directors Association, Inc. C1 [Mukamel, Dana B.; Bailey, Lauren] Univ Calif Irvine, Hlth Policy Res Inst, Dept Med, Irvine, CA 92697 USA. [Weimer, David L.] Univ Wisconsin, LaFollette Sch Publ Affairs, Madison, WI 53706 USA. [Li, Yue] Univ Rochester, Med Ctr, Rochester, NY 14642 USA. [Spector, William D.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Harrington, Charlene] Univ Calif San Francisco, Dept Social & Behav Sci, San Francisco, CA USA. RP Mukamel, DB (reprint author), Univ Calif Irvine, Hlth Policy Res Inst, Dept Med, 100 Theory,Suite 110, Irvine, CA 92697 USA. EM dmukamel@uci.edu FU National Institutes of Aging [AG027420] FX The authors gratefully acknowledge funding from the National Institutes of Aging, Grant AG027420. NR 12 TC 3 Z9 3 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1525-8610 J9 J AM MED DIR ASSOC JI J. Am. Med. Dir. Assoc. PD JUL PY 2012 VL 13 IS 6 BP 512 EP 516 DI 10.1016/j.jamda.2012.01.005 PG 5 WC Geriatrics & Gerontology SC Geriatrics & Gerontology GA 968AF UT WOS:000305948700008 PM 22402171 ER PT J AU Liang, L Meyerhoefer, C Wang, J AF Liang, Lan Meyerhoefer, Chad Wang, Justin TI Obesity Counseling by Pediatric Health Professionals: An Assessment Using Nationally Representative Data SO PEDIATRICS LA English DT Article DE obesity; counseling by health professionals; healthy eating; physical activity ID BODY-MASS INDEX; UNITED-STATES; PRIMARY-CARE; WEIGHT-LOSS; ADOLESCENT OBESITY; CHILDHOOD OBESITY; PHYSICAL-ACTIVITY; OVERWEIGHT; CHILDREN; MANAGEMENT AB OBJECTIVE: Examine the rate of screening for adolescent overweight and obesity by pediatric health care professionals and the provision of advice on healthy eating and physical activity. METHODS: Our sample contains adolescents 11 to 17 years old (6911 girls and 6970 boys) from the 2001-2007 Medical Expenditure Panel Survey who reported having at least 1 health provider visit in the previous 12 months. Using logistic regression, we investigated factors associated with whether parents reported that their children were weighed and measured and whether they or their children received counseling on their eating habits and physical activity. All models were estimated separately by gender. RESULTS: Forty-seven percent of girls and 44% of boys who visited a health provider were advised to eat healthy, and 36% of boys and girls were advised to exercise more. Obese boys and girls were both more likely to be advised to eat healthy (odds ratio [OR] = 2.10, P < .001 and OR = 1.70, P < .001) and exercise more (OR = 2.37, P < .001 and OR = 1.90, P < .001) than adolescents who have normal weight. However, overweight boys and girls were counseled at a much lower rate than those who were obese. Adolescents who were more likely to receive such advice lived in the northeast, were from higher-income households, had parents with at least some college education, and had a usual source of medical care. CONCLUSIONS: Greater efforts should be made to incorporate guidelines on childhood obesity screening and counseling into clinical practice. Pediatrics 2012; 130: 67-77 C1 [Liang, Lan] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [Meyerhoefer, Chad] Lehigh Univ, Dept Econ, Bethlehem, PA 18015 USA. [Wang, Justin] Worcester Polytech Inst, Sch Business, Worcester, MA 01609 USA. RP Liang, L (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd,Suite 5000, Rockville, MD 20850 USA. EM lliang@ahrq.gov NR 46 TC 11 Z9 11 U1 1 U2 10 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 2012 VL 130 IS 1 BP 67 EP 77 DI 10.1542/peds.2011-0596 PG 11 WC Pediatrics SC Pediatrics GA 967KH UT WOS:000305905900045 PM 22665411 ER PT J AU Fleishman, JA Yehia, BR Moore, RD Korthuis, PT Gebo, KA AF Fleishman, John A. Yehia, Baligh R. Moore, Richard D. Korthuis, P. Todd Gebo, Kelly A. CA HIV Res Network TI Establishment, Retention, and Loss to Follow-Up in Outpatient HIV Care SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE HIV; loss to follow-up; retention in care; outpatient use ID ACTIVE ANTIRETROVIRAL THERAPY; MEDICAL-CARE; VIROLOGICAL FAILURE; INFECTED PERSONS; MISSED VISITS; ENGAGEMENT; ACCESS; INTERVENTION; PREDICTORS; ATTENDANCE AB Background: For optimal clinical benefit, HIV-infected patients should receive periodic outpatient care indefinitely. However, initially establishing HIV care and subsequent retention in care are problematic. This study examines establishment, retention, and loss to follow-up (LTFU) in a large multi-site cohort over a 2-8 year period. Methods: Medical record data were reviewed for 22,984 adult HIV patients receiving care at 12 clinics in the HIV Research Network between 2001 and 2009. Three dichotomous outcome measures were based on each patient's history of outpatient visits. Establishment reflects whether the patient made outpatient visits for longer than 6 months after initial enrollment. The retention measure reflects whether the patient had at least 2 outpatient visits separated by 90 days in each year in care. LTFU reflects whether the patient had no outpatient visits for more than 12 months without returning. Multiple logistic regression examined demographic and clinical correlates of each outcome and the combined outcome of meeting all 3 measures. Results: Overall, 21.7% of patients never established HIV care after an initial visit. Among established patients, 57.4% did not meet the retention criterion in all years, and 34.9% were LTFU. Only 20.4% of all patients met all 3 criteria. The odds of successfully meeting all 3 criteria were higher for women, for older patients, for Hispanics compared with whites, and for those with CD4 levels <= 50 cells per cubic millimeter. Conclusions: These data highlight the need to improve establishment and retention in HIV care. C1 [Fleishman, John A.] Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20850 USA. [Yehia, Baligh R.] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. [Moore, Richard D.; Gebo, Kelly A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Korthuis, P. Todd] Oregon Hlth & Sci Univ, Dept Med, Portland, OR 97201 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. EM john.fleishman@ahrq.hhs.gov FU Agency for Healthcare Research and Quality [AHRQ-06-0025]; NIH [R01-DA11602, R01-AA16893, K24-DA00432]; National Institutes of Health, National Institute on Drug Abuse [K23DA019809] FX Supported by Agency for Healthcare Research and Quality (AHRQ-06-0025); R. D. M. is supported by NIH grants R01-DA11602, R01-AA16893, and K24-DA00432; P. T. K. was supported by the National Institutes of Health, National Institute on Drug Abuse (K23DA019809). NR 34 TC 66 Z9 66 U1 2 U2 16 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 JUL 1 PY 2012 VL 60 IS 3 BP 249 EP 259 DI 10.1097/QAI.0b013e318258c696 PG 11 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 965YT UT WOS:000305804400015 PM 22531758 ER PT J AU Graber, ML Kissam, S Payne, VL Meyer, AND Sorensen, A Lenfestey, N Tant, E Henriksen, K LaBresh, K Singh, H AF Graber, Mark L. Kissam, Stephanie Payne, Velma L. Meyer, Ashley N. D. Sorensen, Asta Lenfestey, Nancy Tant, Elizabeth Henriksen, Kerm LaBresh, Kenneth Singh, Hardeep TI Cognitive interventions to reduce diagnostic error: a narrative review SO BMJ QUALITY & SAFETY LA English DT Review ID COMPUTER-AIDED DIAGNOSIS; CLINICAL DECISION-MAKING; CHANGE PHYSICIAN BEHAVIOR; EMERGENCY-MEDICINE; FORCING STRATEGIES; SUPPORT-SYSTEMS; EDUCATIONAL-STRATEGIES; PREDICTIVE INSTRUMENT; SCREENING MAMMOGRAPHY; REASONING STRATEGIES AB Background: Errors in clinical reasoning occur in most cases in which the diagnosis is missed, delayed or wrong. The goal of this review was to identify interventions that might reduce the likelihood of these cognitive errors. Design: We searched PubMed and other medical and non-medical databases and identified additional literature through references from the initial data set and suggestions from subject matter experts. Articles were included if they either suggested a possible intervention or formally evaluated an intervention and excluded if they focused solely on improving diagnostic tests or provider satisfaction. Results: We identified 141 articles for full review, 42 reporting tested interventions to reduce the likelihood of cognitive errors, 100 containing suggestions, and one article with both suggested and tested interventions. Articles were classified into three categories: (1) Interventions to improve knowledge and experience, such as simulation-based training, improved feedback and education focused on a single disease; (2) Interventions to improve clinical reasoning and decision-making skills, such as reflective practice and active metacognitive review; and (3) Interventions that provide cognitive 'help' that included use of electronic records and integrated decision support, informaticians and facilitating access to information, second opinions and specialists. Conclusions: We identified a wide range of possible approaches to reduce cognitive errors in diagnosis. Not all the suggestions have been tested, and of those that have, the evaluations typically involved trainees in artificial settings, making it difficult to extrapolate the results to actual practice. Future progress in this area will require methodological refinements in outcome evaluation and rigorously evaluating interventions already suggested, many of which are well conceptualised and widely endorsed. C1 [Graber, Mark L.] VA Med Ctr, Northport, NY USA. [Graber, Mark L.] SUNY Stony Brook, Dept Med, New York, NY USA. [Graber, Mark L.; Kissam, Stephanie; Sorensen, Asta; Lenfestey, Nancy; Tant, Elizabeth; LaBresh, Kenneth] RTI Int, Res Triangle Pk, NC USA. [Payne, Velma L.] Univ Texas Hlth Sci Ctr Houston, Sch Biomed Informat, Houston, TX USA. [Payne, Velma L.] Univ Texas Hlth Sci Ctr Houston, Natl Ctr Cognit Informat & Decis Making Healthcar, Houston, TX USA. [Meyer, Ashley N. D.; Singh, Hardeep] Michael E DeBakey VA Med Ctr, Houston VA HSR&D Ctr Excellence, Houston, TX USA. [Meyer, Ashley N. D.; Singh, Hardeep] Michael E DeBakey VA Med Ctr, Ctr Inquiry Improve Outpatient Safety Effect Elec, Houston, TX USA. [Meyer, Ashley N. D.; Singh, Hardeep] Baylor Coll Med, Dept Med, Sect Hlth Serv Res, Houston, TX 77030 USA. [Henriksen, Kerm] Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Graber, ML (reprint author), RTI Int, 1 Breezy Hollow, St James, NY 11780 USA. EM mgraber@rti.org RI LaBresh, Kenneth/A-6995-2017; OI LaBresh, Kenneth/0000-0001-9040-1956; Graber, Mark/0000-0002-3600-0446; Meyer, Ashley/0000-0001-7993-8584 FU Agency for Healthcare Research and Quality (AHRQ) ACTION II Task Order #8 [HHSA290200600001]; Houston VA HSR&D Center of Excellence [HFP90-020] FX This study was funded by the Agency for Healthcare Research and Quality (AHRQ) ACTION II Task Order #8, Contract No. HHSA290200600001 and in part by the Houston VA HSR&D Center of Excellence (HFP90-020). NR 173 TC 71 Z9 71 U1 7 U2 45 PU BMJ PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 2044-5415 J9 BMJ QUAL SAF JI BMJ Qual. Saf. PD JUL PY 2012 VL 21 IS 7 BP 535 EP 557 DI 10.1136/bmjqs-2011-000149 PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 961PG UT WOS:000305477700002 PM 22543420 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Eliminating Central Line-Associated Blood Stream Infections Progress Continues on a National Patient Safety Imperative SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 5 TC 3 Z9 3 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 JUL-SEP PY 2012 VL 27 IS 3 BP 191 EP 193 DI 10.1097/NCQ.0b013e31825733d1 PG 3 WC Nursing SC Nursing GA 956EA UT WOS:000305071500001 PM 22647980 ER PT J AU Steiner, C Owens, PL Barrett, ML AF Steiner, Claudia Owens, Pamela L. Barrett, Marguerite L. TI INCIDENCE OF POST-SURGICAL INFECTIONS AFTER LOW-RISK, SHORT-STAY SURGERIES PERFORMED IN AMBULATORY AND INPATIENT SETTINGS SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 [Steiner, Claudia] Agcy Healthcare Res & Qual, Rockville, MD USA. [Barrett, Marguerite L.] ML Barrett Inc, Del Mar, CA USA. [Owens, Pamela L.] AHRQ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUL PY 2012 VL 27 SU 2 BP S228 EP S228 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA V35IG UT WOS:000209142900300 ER PT J AU Yen, C Tate, JE Steiner, CA Cortese, MM Patel, MM Parashar, UD AF Yen, Catherine Tate, Jacqueline E. Steiner, Claudia A. Cortese, Margaret M. Patel, Manish M. Parashar, Umesh D. TI Trends in Intussusception Hospitalizations Among US Infants Before and After Implementation of the Rotavirus Vaccination Program, 2000-2009 SO JOURNAL OF INFECTIOUS DISEASES LA English DT Article ID UNITED-STATES; DISCHARGE DATA; RISK-FACTORS; CHILDREN; GASTROENTERITIS; REDUCTION; DIARRHEA; SAFETY; ASSOCIATION; AUSTRALIA AB Background. Although US data have not documented an intussusception risk with current rotavirus vaccines, international data indicate a possible low risk, primarily after the first dose. Methods. Among infants in 26 US states comprising 75% of the birth cohort, we examined age-specific trends in population-level intussusception hospitalization rates before (2000-2005) and after (2007-2009) rotavirus vaccine introduction. Results. Compared with 2000-2005 (35.3 per 100 000), the rate was greater in 2007 (39.0 per 100 000; rate ratio [RR], 1.10; 95% confidence interval [CI], 1.04-1.18), similar in 2008 (33.4 per 100 000; RR, 0.95; 95% CI,.89-1.01), and lower in 2009 (32.9 per 100 000; RR, 0.93; 95% CI,.87-.99). Among infants aged 8-11 weeks, compared with 2000-2005 (6.9 per 100 000), a small, significant increase was observed in each of 2007 (11.4 per 100 000; RR, 1.64; 95% CI, 1.08-2.50), 2008 (12.2 per 100 000; RR, 1.76; 95% CI, 1.17-2.65), and 2009 (11.0 per 100 000; RR, 1.59; 95% CI, 1.04-2.44). Conclusions. Following rotavirus vaccine introduction, a small increase in intussusception rates was seen among US infants aged 8-11 weeks, to whom most first doses of vaccine are given; no sustained population-level change in overall rates was observed. C1 [Yen, Catherine; Tate, Jacqueline E.; Cortese, Margaret M.; Patel, Manish M.; Parashar, Umesh D.] Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, Atlanta, GA 30333 USA. [Yen, Catherine] Ctr Dis Control & Prevent, Epidem Intelligence Serv, Sci Educ & Profess Dev Program Off, Atlanta, GA 30333 USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Yen, C (reprint author), Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, 1600 Clifton Rd NE,MS A-04, Atlanta, GA 30333 USA. EM cyen@cdc.gov NR 39 TC 29 Z9 29 U1 0 U2 1 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0022-1899 J9 J INFECT DIS JI J. Infect. Dis. PD JUL 1 PY 2012 VL 206 IS 1 BP 41 EP 48 DI 10.1093/infdis/jis314 PG 8 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 948YN UT WOS:000304540200007 PM 22539812 ER PT J AU Konetzka, RT Karon, SL Potter, DEB AF Konetzka, R. Tamara Karon, Sarita L. Potter, D. E. B. TI Users Of Medicaid Home And Community-Based Services Are Especially Vulnerable To Costly Avoidable Hospital Admissions SO HEALTH AFFAIRS LA English DT Article ID LONG-TERM-CARE; PROGRAM AB Although Medicaid's coverage of home and community-based services and the program's capacity to provide such services have increased markedly in recent years, relatively little is known about the population that uses these services. We combined Medicaid and Medicare data to characterize the national Medicaid population of service users by key demographic and health-related attributes. We also assessed one important dimension of their health outcomes: potentially avoidable hospital admissions. We found that in 2005 there were 2.2 million users of Medicaid home and community-based services-almost 4 percent of the total Medicaid population-and that two-thirds of these users were dually eligible for Medicare and Medicaid. Users of home and community-based services were particularly vulnerable to avoidable hospital admissions, compared to the full Medicaid and US populations, and these hospitalizations occur at substantial cost to public payers. For the dual eligibles using home and community-based services, Medicare pays most of the costs of these avoidable hospital stays. Our findings emphasize the need for further research to establish policies and practices that can best meet the needs of users of Medicaid home and community-based services. C1 [Konetzka, R. Tamara] Univ Chicago, Dept Hlth Studies, Chicago, IL 60637 USA. [Karon, Sarita L.] Univ Wisconsin Madison, Ctr Hlth Syst Res & Anal, Madison, WI 53715 USA. [Potter, D. E. B.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Konetzka, RT (reprint author), Univ Chicago, Dept Hlth Studies, Chicago, IL 60637 USA. EM konetzka@uchicago.edu FU Agency for Healthcare Research and Quality [290-04-0020, 290-2009-00010C] FX Part of this work was funded by contracts from the Agency for Healthcare Research and Quality (Contract Nos. 290-04-0020 and 290-2009-00010C). The views expressed in this article are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the Department of Health and Human Services is intended or should be inferred. NR 25 TC 14 Z9 14 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 JUN PY 2012 VL 31 IS 6 BP 1167 EP 1175 DI 10.1377/hlthaff.2011.0902 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 957AM UT WOS:000305130900004 PM 22665828 ER PT J AU Hill, SC AF Hill, Steven C. TI Individual Insurance Benefits To Be Available Under Health Reform Would Have Cut Out-Of-Pocket Spending In 2001-08 SO HEALTH AFFAIRS LA English DT Article ID MARKET; CARE; MODELS; POLICY AB Under the Affordable Care Act, individual health insurance will probably become more generous and more like employment-related insurance. Currently, individual insurance typically has less generous benefits than employment-related insurance. This study compared out-of-pocket spending on health care between individual and employment-related insurance, controlling for numerous characteristics such as health status. Then it simulated the impact of full implementation of provisions of the Affordable Care Act on adults who currently have individual insurance, including important subgroups-adults with chronic conditions, the near-elderly (ages 55-64), and low-income populations. If adults who had individual insurance during 2001-08 had instead had benefits similar to those under the Affordable Care Act, their average annual out-of-pocket spending on medical care and drugs might have been $280 less. The near-elderly and people with low incomes might have saved $589 and $535, respectively. An important improvement would have been the reduced probability of incurring very high out-of-pocket spending. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Hill, SC (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM steven.hill@ahrq.hhs.gov NR 23 TC 2 Z9 2 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 JUN PY 2012 VL 31 IS 6 BP 1349 EP 1356 DI 10.1377/hlthaff.2011.1206 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 957AM UT WOS:000305130900027 PM 22591659 ER PT J AU Hartmann, KE Matchar, DB Chang, S AF Hartmann, K. E. Matchar, D. B. Chang, S. TI Chapter 6: Assessing Applicability of Medical Test Studies in Systematic Reviews SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Review DE systematic evidence review; diagnostic test; screening test; prognostic test; applicability ID CYTOLOGY AB Use of medical tests should be guided by research evidence about the accuracy and utility of those tests in clinical care settings. Systematic reviews of the literature about medical tests must address applicability to real-world decision-making. Challenges for reviews include: (1) lack of clarity in key questions about the intended applicability of the review, (2) numerous studies in many populations and settings, (3) publications that provide too little information to assess applicability, (4) secular trends in prevalence and the spectrum of the condition for which the test is done, and (5) changes in the technology of the test itself. We describe principles for crafting reviews that meet these challenges and capture the key elements from the literature necessary to understand applicability. C1 [Hartmann, K. E.] Vanderbilt Univ, Sch Med, Nashville, TN 37203 USA. [Hartmann, K. E.] Vanderbilt Univ, Vanderbilt AHRQ Evidence Based Practice Ctr, Nashville, TN USA. [Hartmann, K. E.] Vanderbilt Univ, Inst Med & Publ Hlth, Nashville, TN USA. [Matchar, D. B.] Duke Univ, Ctr Clin Hlth Policy Res, Durham, NC USA. [Matchar, D. B.] Duke Univ, Med Ctr, Durham, NC USA. [Chang, S.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Hartmann, KE (reprint author), Vanderbilt Univ, Sch Med, 2525 W End Ave,Suite 600, Nashville, TN 37203 USA. EM katherine.hartmann@vanderbilt.edu OI Matchar, David/0000-0003-3020-2108 FU Agency for Healthcare Research and Quality, US Department of Health and Human Services [290-2007-10065-I, 290-2007-10066-I] FX This project was funded under contract no. 290-2007-10065-I and 290-2007-10066-I from the Agency for Healthcare Research and Quality, US Department of Health and Human Services. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. NR 9 TC 2 Z9 2 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2012 VL 27 SU 1 BP S39 EP S46 DI 10.1007/s11606-011-1961-9 PG 8 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 950PN UT WOS:000304661300007 PM 22648674 ER PT J AU Singh, S Chang, SM Matchar, DB Bass, EB AF Singh, Sonal Chang, Stephanie M. Matchar, David B. Bass, Eric B. TI Chapter 7: Grading a Body of Evidence on Diagnostic Tests SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE grades; diagnostic tests; publication bias; health care intervention ID HEALTH-CARE RESEARCH; QUALITY; GASTROENTERITIS; OUTBREAKS; NOROVIRUS; STRENGTH; PROGRAM; AGENCY AB Grading the strength of a body of diagnostic test evidence involves challenges over and above those related to grading the evidence from health care intervention studies. This chapter identifies challenges and outlines principles for grading the body of evidence related to diagnostic test performance. Diagnostic test evidence is challenging to grade because standard tools for grading evidence were designed for questions about treatment rather than diagnostic testing; and the clinical usefulness of a diagnostic test depends on multiple links in a chain of evidence connecting the performance of a test to changes in clinical outcomes. Reviewers grading the strength of a body of evidence on diagnostic tests should consider the principle domains of risk of bias, directness, consistency, and precision, as well as publication bias, dose response association, plausible unmeasured confounders that would decrease an effect, and strength of association, similar to what is done to grade evidence on treatment interventions. Given that most evidence regarding the clinical value of diagnostic tests is indirect, an analytic framework must be developed to clarify the key questions, and strength of evidence for each link in that framework should be graded separately. However if reviewers choose to combine domains into a single grade of evidence, they should explain their rationale for a particular summary grade and the relevant domains that were weighed in assigning the summary grade. C1 [Singh, Sonal; Bass, Eric B.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Singh, Sonal; Bass, Eric B.] Johns Hopkins Univ, Dept Epidemiol, Bloomberg Sch Publ Hlth, Baltimore, MD 21205 USA. [Chang, Stephanie M.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Matchar, David B.] Duke NUS Med Sch, Singapore, Singapore. [Matchar, David B.] Duke Ctr Clin Hlth Policy Res, Durham, NC USA. RP Singh, S (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, 624 N Broadway,Rm 680 B, Baltimore, MD 21205 USA. EM Ssingh31@jhu.edu RI Singh, Sonal/A-4614-2008; OI Singh, Sonal/0000-0003-0912-941X; Matchar, David/0000-0003-3020-2108 NR 21 TC 4 Z9 4 U1 0 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2012 VL 27 SU 1 BP S47 EP S55 DI 10.1007/s11606-012-2021-9 PG 9 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 950PN UT WOS:000304661300008 PM 22648675 ER PT J AU Smetana, GW Umscheid, CA Chang, S Matchar, DB AF Smetana, Gerald W. Umscheid, Craig A. Chang, Stephanie Matchar, David B. TI Methods Guide for Authors of Systematic Reviews of Medical Tests: A Collaboration Between the Agency for Healthcare Research and Quality (AHRQ) and the Journal of General Internal Medicine SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material ID METAANALYSES; STATEMENT C1 [Smetana, Gerald W.] Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Boston, MA 02215 USA. [Smetana, Gerald W.] Harvard Univ, Sch Med, Boston, MA USA. [Umscheid, Craig A.] Univ Penn Hlth Syst, Ctr Evidence Based Practice, Philadelphia, PA USA. [Umscheid, Craig A.] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. [Chang, Stephanie] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Matchar, David B.] Duke Natl Univ Singapore, Grad Sch Med, Hlth Serv & Syst Res Program, Singapore, Singapore. [Matchar, David B.] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA. RP Smetana, GW (reprint author), Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Shapiro 621D,330 Brookline Ave, Boston, MA 02215 USA. EM gsmetana@bidmc.harvard.edu OI Matchar, David/0000-0003-3020-2108 NR 11 TC 3 Z9 3 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2012 VL 27 SU 1 BP S1 EP S3 DI 10.1007/s11606-012-2053-1 PG 3 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 950PN UT WOS:000304661300001 PM 22648668 ER PT J AU Trikalinos, TA Kulasingam, S Lawrence, WF AF Trikalinos, Thomas A. Kulasingam, Shalini Lawrence, William F. TI Chapter 10: Deciding Whether to Complement a Systematic Review of Medical Tests with Decision Modeling SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE decision modeling; test accuracy; test performance; systematic review; medical tests ID HEALTH TECHNOLOGY-ASSESSMENT; SERVICES TASK-FORCE; USERS GUIDES; CANCER; QUALITY; INFORMATION; GUIDELINES; STATEMENT; PROGRAM; EXAMPLE AB Limited by what is reported in the literature, most systematic reviews of medical tests focus on "test accuracy" (or better, test performance), rather than on the impact of testing on patient outcomes. The link between testing, test results and patient outcomes is typically complex: even when testing has high accuracy, there is no guarantee that physicians will act according to test results, that patients will follow their orders, or that the intervention will yield a beneficial endpoint. Therefore, test performance is typically not sufficient for assessing the usefulness of medical tests. Modeling (in the form of decision or economic analysis) is a natural framework for linking test performance data to clinical outcomes. We propose that (some) modeling should be considered to facilitate the interpretation of summary test performance measures by connecting testing and patient outcomes. We discuss a simple algorithm for helping systematic reviewers think through this possibility, and illustrate it by means of an example. C1 [Trikalinos, Thomas A.] Brown Univ, Ctr Evidence Based Med, Providence, RI 02912 USA. [Trikalinos, Thomas A.] Brown Univ, Dept Hlth Serv Policy & Practice, Providence, RI 02912 USA. [Trikalinos, Thomas A.] Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Tufts Evidence Based Practice Ctr, Boston, MA USA. [Kulasingam, Shalini] Univ Minnesota, Sch Publ Hlth, Div Epidemiol, Minneapolis, MN 55455 USA. [Lawrence, William F.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Trikalinos, TA (reprint author), Brown Univ, Ctr Evidence Based Med, G-S121-7, Providence, RI 02912 USA. EM thomas_trikalinos@brown.edu FU Agency for Healthcare Research and Quality (AHRQ) FX This manuscript is based on work funded by the Agency for Healthcare Research and Quality (AHRQ). Authors TT and SK are members of AHRQ-funded Evidence-based Practice Centers, and author WL is an AHRQ employee. The opinions expressed are those of the authors and do not reflect the official position of AHRQ or the U. S. Department of Health and Human Services. NR 33 TC 4 Z9 4 U1 0 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2012 VL 27 SU 1 BP S76 EP S82 DI 10.1007/s11606-012-2019-3 PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 950PN UT WOS:000304661300011 PM 22648678 ER PT J AU Yehia, BR Fleishman, JA Metlay, JP Korthuis, PT Agwu, AL Berry, SA Moore, RD Gebo, KA AF Yehia, Baligh R. Fleishman, John A. Metlay, Joshua P. Korthuis, P. Todd Agwu, Allison L. Berry, Stephen A. Moore, Richard D. Gebo, Kelly A. CA HIV Res Network TI Comparing different measures of retention in outpatient HIV care SO AIDS LA English DT Article DE engagement in care; HIV outpatient care; HIV quality improvement; performance measures; retention in care; retention measures ID ACTIVE ANTIRETROVIRAL THERAPY; MEDICAL-CARE; INFECTED ADULTS; UNITED-STATES; RISK-FACTORS; FOLLOW-UP; ENGAGEMENT; PREVENTION; OUTREACH; PREDICTORS AB Objectives: The US National HIV/AIDS Strategy identifies retention in care as an important quality performance measure. There is no gold standard to measure retention in care. This study is the first to compare different measures of retention, using a large geographically diverse sample. Design: A prospective cohort of 17 425 HIV-infected adults enrolled in care at 12 US HIV clinics between 2001 and 2008. Methods: We compared three measures of retention for each patient: proportion of time not spent in a gap of more than 6 months between successive outpatient visits; proportion of 91-day quarters in which at least one visit occurred; proportion of years in which two or more visits separated by at least 90 days occurred. Associations among measures and effects of sociodemographic and clinical characteristics were examined. Results: The three measures of retention were moderately to strongly correlated. Averaging across patients, 71% of time in care was not spent in a gap more than 6 months; 73% of all quarters had at least one visit; and 75% of all years had at least two visits separated by at least 90 days. For all measures, retention was significantly higher for women, whites, older individuals, men who had sex with men (MSM)-related HIV transmission, and initial CD4 cell counts 50 cell/ml or less. Conclusions: This is one of the first studies to provide a national estimate of retention in HIV care in the US, which ranged from 71 to 75% using any of the accepted retention measures. Future studies should assess how well different measures predict clinical outcomes and establish acceptable target levels for retention. (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins C1 [Yehia, Baligh R.; Metlay, Joshua P.] Univ Penn, Perelman Sch Med, Dept Med, Philadelphia, PA 19104 USA. [Fleishman, John A.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Korthuis, P. Todd] Oregon Hlth & Sci Univ, Dept Med, Portland, OR 97201 USA. [Agwu, Allison L.; Berry, Stephen A.; Moore, Richard D.; Gebo, Kelly A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. RP Yehia, BR (reprint author), Univ Penn, Perelman Sch Med, Dept Med, 1309 Blockley Hall,423 Guardian Dr, Philadelphia, PA 19104 USA. EM byehia@upenn.edu FU Agency for Healthcare Research and Quality [290-01-0012]; National Institutes of Health [K24 AI073957, K24 DA 00432, R01DA11602, R01 AA 16893, K23AI084854]; National Institutes of Health, National Institute on Drug Abuse [K23DA019809] FX The work was supported by the Agency for Healthcare Research and Quality (290-01-0012). J.P.M. is supported by a Mid-Career Award from the National Institutes of Health (K24 AI073957). P.T.K.'s time was supported by the National Institutes of Health, National Institute on Drug Abuse (K23DA019809). R. D. M is supported by NIH (K24 DA 00432, R01DA11602, R01 AA 16893). S. A. B. is supported by NIH (K23AI084854). NR 34 TC 52 Z9 52 U1 2 U2 13 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0269-9370 J9 AIDS JI Aids PD JUN 1 PY 2012 VL 26 IS 9 BP 1131 EP 1139 DI 10.1097/QAD.0b013e3283528afa PG 9 WC Immunology; Infectious Diseases; Virology SC Immunology; Infectious Diseases; Virology GA 946PK UT WOS:000304364900009 PM 22382143 ER PT J AU Mallery, C Ganachari, D Smeeding, L Fernandez, J Lavallee, D Siegel, J Robinson, S Moon, M AF Mallery, C. Ganachari, D. Smeeding, L. Fernandez, J. Lavallee, D. Siegel, J. Robinson, S. Moon, M. TI INNOVATIVE METHODS FOR STAKEHOLDER ENGAGEMENT: AN ENVIRONMENTAL SCAN SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Mallery, C.; Moon, M.] Amer Inst Res, Silver Spring, MD USA. [Ganachari, D.; Smeeding, L.; Fernandez, J.; Robinson, S.] Amer Inst Res, Washington, DC USA. [Lavallee, D.] Ctr Med Technol Policy, Baltimore, MD USA. [Siegel, J.] AHRQ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD JUN PY 2012 VL 15 IS 4 BP A14 EP A14 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 947XP UT WOS:000304468200066 ER PT J AU Moy, E Newman-Toker, DE Valente, E Coffey, R Hines, AL AF Moy, E. Newman-Toker, D. E. Valente, E. Coffey, R. Hines, A. L. TI MISSED AND DELAYED DIAGNOSIS OF STROKE IN EMERGENCY DEPARTMENT PATIENTS WITH HEADACHE OR DIZZINESS SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Moy, E.] AHRQ, Rockville, MD USA. [Newman-Toker, D. E.] Johns Hopkins Univ Hosp, Baltimore, MD 21287 USA. [Valente, E.] Blue Cross Blue Shield Minnesota, Eagan, MN USA. [Coffey, R.; Hines, A. L.] Thomson Reuters, Washington, DC USA. 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 1098-3015 J9 VALUE HEALTH JI Value Health PD JUN PY 2012 VL 15 IS 4 BP A116 EP A117 PG 2 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 947XP UT WOS:000304468200603 ER PT J AU Wong, H Karaca, Z AF Wong, H. Karaca, Z. TI DID MASSACHUSETTS HEALTH REFORM LOWER HOSPITAL INPATIENT COST? SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Wong, H.; Karaca, Z.] AHRQ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD JUN PY 2012 VL 15 IS 4 BP A9 EP A9 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 947XP UT WOS:000304468200042 ER PT J AU Vistnes, J Zawacki, A Simon, K Taylor, A AF Vistnes, Jessica Zawacki, Alice Simon, Kosali Taylor, Amy TI Declines in Employer-Sponsored Insurance between 2000 and 2008: Examining the Components of Coverage by Firm Size SO HEALTH SERVICES RESEARCH LA English DT Article DE Employer-sponsored health insurance; offer rates; take-up rates; dependent coverage ID HEALTH-INSURANCE; DEMAND; WORKERS; OFFER; DECISIONS; BENEFITS; COSTS; RISE AB Objective To examine trends in employer-sponsored health insurance coverage rates and its associated components between 2000 and 2008, to provide a baseline for later evaluations of the Affordable Care Act, and to provide information to policy makers as they design the implementation details of the law. Data Sources Private sector employer data from the 2000, 2001, and 2008 Medical Expenditure Panel Survey-Insurance Component (MEPS-IC). Study Design We examine time trends in employer offer, eligibility, and take-up rates. We add a new dimension to the literature by examining dependent coverage and decomposing its trends. We investigate heterogeneity in trends by firm size. Data Collection The MEPS-IC is an annual survey, sponsored by the Agency for Healthcare Research and Quality and conducted by the U.S. Census Bureau. The MEPS-IC obtains information on establishment characteristics, whether an establishment offers health insurance, and details on up to four plans. Principal Findings We find that coverage rates for workers declined in both small and large firms. In small firms, coverage declined due to a drop in both offer and take-up rates. In the largest firms, offer rates were stable and the decline was due to falling take-up rates. In addition, enrollment shifted toward single coverage and away from dependent coverage in both small and large firms. For small firms, this shift was due to declining offer and take-up rates for dependent coverage. In large firms, offers of dependent coverage were stable but take-up rates dropped. Within the category of dependent coverage, the availability of employee-plus-one plans increased in all firm size categories, but take-up rates for these plans declined in small firms. C1 [Vistnes, Jessica; Taylor, Amy] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [Zawacki, Alice] US Bur Census, Ctr Econ Studies, Washington, DC 20233 USA. [Simon, Kosali] Indiana Univ, Sch Publ & Environm Affairs, Bloomington, IN USA. RP Vistnes, J (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jessica.Vistnes@ahrq.hhs.gov NR 25 TC 11 Z9 11 U1 3 U2 8 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 2012 VL 47 IS 3 BP 919 EP 938 DI 10.1111/j.1475-6773.2011.01368.x PN 1 PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 939HN UT WOS:000303800200004 PM 22250730 ER PT J AU Zhou, H Thompson, WW Viboud, CG Ringholz, CM Cheng, PY Steiner, C Abedi, GR Anderson, LJ Brammer, L Shay, DK AF Zhou, Hong Thompson, William W. Viboud, Cecile G. Ringholz, Corinne M. Cheng, Po-Yung Steiner, Claudia Abedi, Glen R. Anderson, Larry J. Brammer, Lynnette Shay, David K. TI Hospitalizations Associated With Influenza and Respiratory Syncytial Virus in the United States, 1993-2008 SO CLINICAL INFECTIOUS DISEASES LA English DT Article ID YOUNG-CHILDREN; POPULATION; EPIDEMICS; MORTALITY; BURDEN; IMPACT; SURVEILLANCE; INFECTION; INFANTS; DISEASE AB Background. Age-specific comparisons of influenza and respiratory syncytial virus (RSV) hospitalization rates can inform prevention efforts, including vaccine development plans. Previous US studies have not estimated jointly the burden of these viruses using similar data sources and over many seasons. Methods. We estimated influenza and RSV hospitalizations in 5 age categories (<1, 1-4, 5-49, 50-64, and >= 65 years) with data for 13 states from 1993-1994 through 2007-2008. For each state and age group, we estimated the contribution of influenza and RSV to hospitalizations for respiratory and circulatory disease by using negative binomial regression models that incorporated weekly influenza and RSV surveillance data as covariates. Results. Mean rates of influenza and RSV hospitalizations were 63.5 (95% confidence interval [CI], 37.5-237) and 55.3 (95% CI, 44.4-107) per 100 000 person-years, respectively. The highest hospitalization rates for influenza were among persons aged >= 65 years (309/100 000; 95% CI, 186-1100) and those aged,1 year (151/100 000; 95% CI, 151-660). For RSV, children aged,1 year had the highest hospitalization rate (2350/100 000; 95% CI, 2220-2520) followed by those aged 1-4 years (178/100 000; 95% CI, 155-230). Age-standardized annual rates per 100 000 person-years varied substantially for influenza (33-100) but less for RSV (42-77). Conclusions. Overall US hospitalization rates for influenza and RSV are similar; however, their age-specific burdens differ dramatically. Our estimates are consistent with those from previous studies focusing either on influenza or RSV. Our approach provides robust national comparisons of hospitalizations associated with these 2 viral respiratory pathogens by age group and over time. C1 [Zhou, Hong; Cheng, Po-Yung; Brammer, Lynnette; Shay, David K.] Ctr Dis Control & Prevent, Influenza Div, Atlanta, GA 30333 USA. [Abedi, Glen R.; Anderson, Larry J.] Ctr Dis Control & Prevent, Div Viral Dis, Atlanta, GA 30333 USA. [Thompson, William W.] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA 30333 USA. [Anderson, Larry J.] Emory Univ, Div Pediat Infect Dis, Atlanta, GA 30322 USA. [Viboud, Cecile G.; Ringholz, Corinne M.] Natl Inst Hlth, Fogarty Int Ctr, Bethesda, MD USA. [Steiner, Claudia] Agcy Healthcare Res & Qual, Rockville, MD USA. [Ringholz, Corinne M.] Analyt Serv Inc, Arlington, VA USA. RP Shay, DK (reprint author), Ctr Dis Control & Prevent, Influenza Div, 1600 Clifton Rd NE,MS A-20, Atlanta, GA 30333 USA. EM dshay@cdc.gov OI Shay, David/0000-0001-9619-4820 FU Centers for Disease Control and Prevention; National Institutes of Health; Agency for Healthcare Research and Quality; Medimmune; Novartis Vaccines; Trellis Bioscience FX This work was supported by internal funds from the Centers for Disease Control and Prevention, the National Institutes of Health, and the Agency for Healthcare Research and Quality.; Dr. Anderson has received consulting fees from Medimmune and Novartis Vaccines, grants from Trellis Bioscience, and travel expenses from Medimmune. All other authors have no conflicts to report. NR 31 TC 167 Z9 169 U1 2 U2 20 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1058-4838 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD MAY 15 PY 2012 VL 54 IS 10 BP 1427 EP 1436 DI 10.1093/cid/cis211 PG 10 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 942MW UT WOS:000304049300013 PM 22495079 ER PT J AU Fleishman, JA Yehia, BR Moore, RD Gebo, KA Agwu, AL AF Fleishman, John A. Yehia, Baligh R. Moore, Richard D. Gebo, Kelly A. Agwu, Allison L. CA HIV Res Network TI Disparities in Receipt of Antiretroviral Therapy Among HIV-infected Adults (2002-2008) SO MEDICAL CARE LA English DT Article DE ART; disparities; time trends; utilization; sociodemographic differences ID UNITED-STATES; HEALTH-CARE; COHORT; ADHERENCE; RACE; DISCONTINUATION; INTERRUPTION; ASSOCIATION; PREVALENCE; MORTALITY AB Objective: Prior research has documented sociodemographic disparities in the use of antiretroviral therapy (ART). Recent therapeutic developments and changing epidemiological profiles may have altered such disparities. We examine the extent to which sociodemographic differences in prescribed ART have changed between 2002 and 2008. Methods: We analyzed data abstracted from medical records at 13 US sites participating in the Human Immunodeficiency Virus Research Network. Prescription of ART was assessed for each year in care for each patient. A total of 14,092 patients were followed up for 39,251 person-years. We examined ART use as a function of sex, race/ethnicity, human immunodeficiency virus risk group, age, and CD4 history (no test <500 cells/mm(3), one or more tests between 500 and 350 cells/mm(3), 1 test <= 350 cells/mm(3), and 2 or more tests <= 350 cells/mm(3)). Using multiple logistic regression, we ascertained interactions between each of these variables and calendar year. Results: The overall percentage prescribed ART increased from 60% to 80% between 2002 and 2008. Among those with 2 or more CD4 tests <= 350 cells/mm(3), the percentage increased from 82% to 92%. ART rates were higher for those with lower CD4 counts but increased over time for all CD4 groups and for all demographic groups. Nevertheless, sex and racial/ethnic disparities persisted. Significant interactions were obtained for CD4 history by year, age by year, and age by CD4 history. Conclusions: Although prescription of ART became more widespread from 2002 to 2008, patients who were female, black, or younger still had lower ART rates than male, white, or older patients. C1 [Fleishman, John A.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [Yehia, Baligh R.] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. [Moore, Richard D.; Gebo, Kelly A.; Agwu, Allison L.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Agwu, Allison L.] Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21205 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. EM john.fleishman@ahrq.hhs.gov FU Agency for Healthcare Research and Quality [AHRQ-06-0025]; National Institutes of Allergy and Infectious Diseases [K23 AI084549]; Johns Hopkins University Richard S. Ross Clinician Scientist Award; NIH [K24 DA 00432, R01DA11602, R01 AA 16893]; Agency for Healthcare Research and Quality, Rockville, MD; Health Resources and Services Administration, Rockville, MD FX Supported by the Agency for Healthcare Research and Quality (AHRQ-06-0025). A. L. A. is supported by the National Institutes of Allergy and Infectious Diseases (K23 AI084549) and the Johns Hopkins University Richard S. Ross Clinician Scientist Award. R. D. M. is supported by NIH (K24 DA 00432, R01DA11602, R01 AA 16893).; Sponsoring Agencies: Agency for Healthcare Research and Quality, Rockville, MD (Fred Hellinger, PhD, John A. Fleishman, PhD); Health Resources and Services Administration, Rockville, MD (Robert Mills, PhD). NR 36 TC 22 Z9 22 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 2012 VL 50 IS 5 BP 419 EP 427 DI 10.1097/MLR.0b013e31824e3356 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 083IH UT WOS:000314456400010 PM 22410406 ER PT J AU Du, DY Goldsmith, J Aikin, KJ Encinosa, WE Nardinelli, C AF Du, Dongyi 'Tony' Goldsmith, John Aikin, Kathryn J. Encinosa, William E. Nardinelli, Clark TI Despite 2007 Law Requiring FDA Hotline To Be Included In Print Drug Ads, Reporting Of Adverse Events By Consumers Still Low SO HEALTH AFFAIRS LA English DT Article ID PRESCRIPTION AB In 2007 the federal government began requiring drug makers to include in their print direct-to-consumer advertisements information for consumers on how to contact the Food and Drug Administration directly, either by phone or through the agency's website, to report any adverse events that they experienced after taking a prescription drug. Adverse events can range from minor skin problems like itching to serious injuries or illness that result in hospitalization, permanent disability, or even death. Even so, current rates of adverse event reporting are low. We studied adverse event reports about 123 drugs that came from patients before and after the enactment of the print advertising requirement and estimated that requirement's impact with model simulations. We found that if monthly spending on print direct-to-consumer advertising increased from zero to $7.7 million per drug, the presence of the Food and Drug Administration contact information tripled the increase in patient-reported adverse events, compared to what would have happened in the absence of the law. However, the absolute monthly increase was fewer than 0.24 reports per drug, suggesting that the public health impact of the increase was small and that the adverse event reporting rate would still be low. The study results suggest that additional measures, such as more publicity about the Adverse Event Reporting System or more consumer education, should be considered to promote patient reporting of adverse events. C1 [Du, Dongyi 'Tony'] Food & Drug Adm, Ctr Biol Evaluat & Res, Rockville, MD USA. [Goldsmith, John] Food & Drug Adm, Off Planning, Rockville, MD USA. [Aikin, Kathryn J.] Food & Drug Adm, Off Prescript Drug Promot, Rockville, MD USA. [Encinosa, William E.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Nardinelli, Clark] Food & Drug Adm, Off Policy Planning & Budget, Rockville, MD USA. RP Du, DY (reprint author), Food & Drug Adm, Ctr Biol Evaluat & Res, Rockville, MD USA. EM dongyi.du@fda.hhs.gov FU Food and Drug Administration's Center for Drug Evaluation and Research FX The authors thank John Quinn, Lynette Swartz, and Elaine Hu Cunningham of the Food and Drug Administration's Center for Drug Evaluation and Research for their support. The authors have no financial interests in this article and received no funding to conduct this study. The opinions expressed in the article are those of the authors and are not intended to represent the opinions of the Food and Drug Administration. NR 26 TC 4 Z9 4 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 MAY PY 2012 VL 31 IS 5 BP 1022 EP 1029 DI 10.1377/hlthaff.2010.1004 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 940EP UT WOS:000303873100017 PM 22566442 ER PT J AU Schneeweiss, S Seeger, JD Smith, SR AF Schneeweiss, Sebastian Seeger, John D. Smith, Scott R. TI Methods for developing and analyzing clinically rich data for patient-centered outcomes research: an overview SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Editorial Material C1 [Schneeweiss, Sebastian; Seeger, John D.] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02115 USA. [Smith, Scott R.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Schneeweiss, S (reprint author), Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02115 USA. RI Schneeweiss, Sebastian/C-2125-2013 NR 18 TC 3 Z9 3 U1 1 U2 11 PU WILEY PERIODICALS, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN STREET, MALDEN, MA 02148-529 USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD MAY PY 2012 VL 21 SU 2 BP 1 EP 5 DI 10.1002/pds.3270 PG 5 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 935ET UT WOS:000303502500001 PM 22552973 ER PT J AU Marie, C AF Marie, Celeste TI The Role of the Geographic Information Systems Infrastructure in Childhood Obesity Prevention Perspective from the Robert Wood Johnson Foundation SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Editorial Material ID PHYSICAL-ACTIVITY; NEIGHBORHOOD; OVERWEIGHT C1 [Marie, Celeste] Robert Wood Johnson Fdn, Princeton, NJ USA. RP Marie, C (reprint author), Agcy Healthcare Res & Qual, Sci Publ Reporting Initiat, Ctr Delivery Org & Markets, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM celeste.torio@gmail.com NR 11 TC 0 Z9 0 U1 1 U2 4 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 2012 VL 42 IS 5 BP 513 EP 515 DI 10.1016/j.amepre.2012.02.003 PG 3 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 928ED UT WOS:000302963300017 ER PT J AU Agwu, AL Siberry, GK Ellen, J Fleishman, JA Rutstein, R Gaur, AH Korthuis, PT Warford, R Spector, SA Gebo, KA AF Agwu, Allison L. Siberry, George K. Ellen, Jonathan Fleishman, John A. Rutstein, Richard Gaur, Aditya H. Korthuis, P. Todd Warford, Robert Spector, Stephen A. Gebo, Kelly A. TI Predictors of Highly Active Antiretroviral Therapy Utilization for Behaviorally HIV-1-Infected Youth: Impact of Adult Versus Pediatric Clinical Care Site SO JOURNAL OF ADOLESCENT HEALTH LA English DT Article DE Adolescents; Youth; Highly active antiretroviral therapy (HAART); Disparities; Utilization; HIV Research Network; Clinical site ID HUMAN-IMMUNODEFICIENCY-VIRUS; HIV-INFECTED PATIENTS; NAIVE PATIENTS; UNITED-STATES; SPECIAL NEEDS; ADOLESCENTS; SERVICES; ADHERENCE; COHORT; EXPERIENCE AB Objectives: We evaluated highly active antiretroviral therapy (HAART) utilization in youth infected with HIV through risk behaviors who met treatment criteria for HAART. We assessed the impact of receiving care at an adult or pediatric HIV clinical site on initiation and discontinuation of the first HAART regimen in behaviorally infected youth (BIY). Methods: This was a retrospective analysis of treatment-naive BIY, aged 12-24 years, who enrolled in the HIV Research Network between 2002 and 2008 and who met criteria for HAART. The outcomes were time from meeting criteria to initiation of HAART and time to discontinuation of the first HAART regimen. Analyses were conducted using Cox proportional hazards regression. Results: Of 287 treatment-eligible youth, 198 (69%) received HAART; of these 198 youth, 58 (29.3%) subsequently discontinued HAART. In multivariable analyses, there was no significant difference in the time between meeting treatment criteria and initiating HAART for BIY followed at adult or pediatric HIV clinical sites. However, BIY followed at adult sites discontinued HAART sooner than BIY followed at pediatric HIV clinical sites (adjusted hazard ratio [AHR]: 3.19 [1.26-8.06]). Conclusions: Two-thirds of treatment-eligible BIY in the HIV Research Network cohort initiated HAART; however, one-third who initiated HAART discontinued it during the study period. Identifying factors associated with earlier HAART initiation and sustainability can inform interventions to enhance HAART utilization among treatment-eligible youth. The finding of earlier HAART discontinuation for youth at adult care sites deserves further study. (C) 2012 Society for Adolescent Health and Medicine. All rights reserved. C1 [Agwu, Allison L.] Johns Hopkins Sch Med, Div Pediat Infect Dis, Dept Pediat, Johns Hopkins Med Inst, Baltimore, MD 21287 USA. [Agwu, Allison L.; Gebo, Kelly A.] Johns Hopkins Sch Med, Dept Med, Div Infect Dis, Baltimore, MD 21287 USA. [Siberry, George K.] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Pediat Adolescent & Maternal AIDS Branch, Ctr Res Mothers & Children, NIH, Baltimore, MD 21287 USA. [Ellen, Jonathan] Johns Hopkins Sch Med, Div Adolescent Med, Baltimore, MD 21287 USA. [Fleishman, John A.] Agcy Hlth Care Res & Qual, Ctr Financing, Rockville, MD USA. [Rutstein, Richard] Childrens Hosp Philadelphia, Div Gen Pediat, Philadelphia, PA 19104 USA. [Gaur, Aditya H.] St Jude Childrens Hosp, Dept Infect Dis, Memphis, TN USA. [Korthuis, P. Todd] Oregon Hlth & Sci Univ, Dept Internal Med, Portland, OR 97201 USA. [Korthuis, P. Todd] Oregon Hlth & Sci Univ, Dept Publ Hlth & Prevent Med, Portland, OR 97201 USA. [Warford, Robert] St Lukes Roosevelt Hosp, New York, NY 10032 USA. [Spector, Stephen A.] Univ Calif San Diego, Div Pediat Infect Dis, La Jolla, CA 92093 USA. [Spector, Stephen A.] Rady Childrens Hosp, Div Pediat Infect Dis, San Diego, CA USA. RP Agwu, AL (reprint author), Johns Hopkins Sch Med, Div Pediat Infect Dis, Dept Pediat, Johns Hopkins Med Inst, 200 N Wolfe St,Room 3145, Baltimore, MD 21287 USA. EM ageorg10@jhmi.edu FU Agency for Healthcare Research and Quality [290-01-0012]; National Institute on Aging, NIH [RO1 AG026250]; Johns Hopkins University; National Institutes of Allergy and Infectious Diseases [1K23AI084549-01A1]; Johns Hopkins Ross Clinician scientist Award; National Institute on Drug Abuse [K23DA019809]; Health Resources and Services Administration, Rockville, MD; Data Coordinating Center Johns Hopkins University; Tibotec FX The study was supported by the Agency for Healthcare Research and Quality (290-01-0012) and the National Institute on Aging, NIH (RO1 AG026250). K.A.G. also received support from the Johns Hopkins University Richard Ross Clinician Scientist Award.; A.L.A. is supported by the National Institutes of Allergy and Infectious Diseases (1K23AI084549-01A1) and the Johns Hopkins Ross Clinician scientist Award. P.T.K. is supported by the National Institute on Drug Abuse (K23DA019809).; Sponsoring Agencies: Agency for Healthcare Research and Quality, Rockville, MD (Fred Hellinger, Ph.D.; John Fleishman, Ph.D., Irene Fraser, Ph.D.); Health Resources and Services Administration, Rockville, MD (Robert Mills, Ph.D.); and Data Coordinating Center Johns Hopkins University (Richard Moore, M.D., Jeanne Keruly, C.R.N.P., Kelly Gebo, M.D., Cindy Voss, M.A., Bonnie Cameron, M.S.).; K.A.G. has received research funding from Tibotec. NR 36 TC 7 Z9 8 U1 2 U2 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1054-139X J9 J ADOLESCENT HEALTH JI J. Adolesc. Health PD MAY PY 2012 VL 50 IS 5 BP 471 EP 477 DI 10.1016/j.jadohealth.2011.09.001 PG 7 WC Psychology, Developmental; Public, Environmental & Occupational Health; Pediatrics SC Psychology; Public, Environmental & Occupational Health; Pediatrics GA 930HP UT WOS:000303128600009 PM 22525110 ER PT J AU Basch, E Aronson, N Berg, A Flum, D Gabriel, S Goodman, SN Helfand, M Ioannidis, JPA Lauer, M Meltzer, D Mittman, B Newhouse, R Normand, SL Schneeweiss, S Slutsky, J Tinetti, M Yancy, C AF Basch, Ethan Aronson, Naomi Berg, Alfred Flum, David Gabriel, Sherine Goodman, Steven N. Helfand, Mark Ioannidis, John P. A. Lauer, Michael Meltzer, David Mittman, Brian Newhouse, Robin Normand, Sharon-Lise Schneeweiss, Sebastian Slutsky, Jean Tinetti, Mary Yancy, Clyde CA Methodology Comm Patient-Centered TI Methodological Standards and Patient-Centeredness in Comparative Effectiveness Research The PCORI Perspective SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID IMPLEMENTATION-RESEARCH; RANDOMIZED-TRIALS; PROPENSITY SCORE; CLINICAL-TRIALS; QUALITY IMPROVEMENT; PUBLICATION BIAS; MEDICATIONS; EXPERIENCE; BENEFITS; LESSONS AB Rigorous methodological standards help to ensure that medical research produces information that is valid and generalizable, and are essential in patient-centered outcomes research (PCOR). Patient-centeredness refers to the extent to which the preferences, decision-making needs, and characteristics of patients are addressed, and is the key characteristic differentiating PCOR from comparative effectiveness research. The Patient Protection and Affordable Care Act signed into law in 2010 created the Patient-Centered Outcomes Research Institute (PCORI), which includes an independent, federally appointed Methodology Committee. The Methodology Committee is charged to develop methodological standards for PCOR. The 4 general areas identified by the committee in which standards will be developed are (1) prioritizing research questions, (2) using appropriate study designs and analyses, (3) incorporating patient perspectives throughout the research continuum, and (4) fostering efficient dissemination and implementation of results. A Congressionally mandated PCORI methodology report (to be issued in its first iteration in May 2012) will begin to provide standards in each of these areas, and will inform future PCORI funding announcements and review criteria. The work of the Methodology Committee is intended to enable generation of information that is relevant and trustworthy for patients, and to enable decisions that improve patient-centered outcomes. JAMA. 2012;307(15):1636-1640 www.jama.com C1 [Basch, Ethan] Mem Sloan Kettering Canc Ctr, Hlth Outcomes Res Grp, New York, NY 10463 USA. [Aronson, Naomi] Blue Cross Blue Shield Assoc, Chicago, IL USA. [Berg, Alfred; Flum, David] Univ Washington, Seattle, WA 98195 USA. [Gabriel, Sherine] Mayo Clin, Rochester, MN USA. [Goodman, Steven N.; Ioannidis, John P. A.] Stanford Univ, Stanford, CA 94305 USA. [Helfand, Mark] Portland VA Med Ctr, Portland, OR USA. [Lauer, Michael] NHLBI, Bethesda, MD 20892 USA. [Meltzer, David] Univ Chicago, Chicago, IL 60637 USA. [Mittman, Brian] Dept Vet Affairs, Sepulveda, CA USA. [Newhouse, Robin] Univ Maryland, Baltimore, MD 21201 USA. [Normand, Sharon-Lise; Schneeweiss, Sebastian] Harvard Univ, Sch Med, Boston, MA USA. [Normand, Sharon-Lise] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Slutsky, Jean] Agcy Healthcare Res & Qual, Rockville, MD USA. [Tinetti, Mary] Yale Univ, New Haven, CT USA. [Yancy, Clyde] Northwestern Univ, Chicago, IL 60611 USA. RP Basch, E (reprint author), Mem Sloan Kettering Canc Ctr, Hlth Outcomes Res Grp, 307 63rd St, New York, NY 10463 USA. EM ebasch@mskcc.org RI Schneeweiss, Sebastian/C-2125-2013; Meltzer, David/C-2926-2009 OI Meltzer, David/0000-0003-2790-7393 FU PCORI of the Methodology Committee FX The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. All of the authors reported receiving funding from PCORI as members of the Methodology Committee, including compensation for travel and lodging for PCORI-related meetings as well as time spent providing service to the PCORI. NR 45 TC 96 Z9 96 U1 3 U2 26 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD APR 18 PY 2012 VL 307 IS 15 BP 1636 EP 1640 DI 10.1001/jama.2012.466 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 927GU UT WOS:000302896100026 ER PT J AU Chou, R Croswell, JM AF Chou, Roger Croswell, Jennifer M. TI Screening for Prostate Cancer RESPONSE SO ANNALS OF INTERNAL MEDICINE LA English DT Letter ID MORTALITY C1 [Chou, Roger] Oregon Hlth & Sci Univ, Portland, OR 97239 USA. [Croswell, Jennifer M.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Chou, R (reprint author), Oregon Hlth & Sci Univ, Portland, OR 97239 USA. NR 2 TC 1 Z9 1 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 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD APR 3 PY 2012 VL 156 IS 7 BP 540 EP 540 DI 10.7326/0003-4819-156-7-201204030-00017 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 921GP UT WOS:000302466400014 ER PT J AU Desai, R Haberling, D Holman, RC Singleton, RJ Cheek, JE Groom, AV Steiner, CA Parashar, UD Esposito, DH AF Desai, Rishi Haberling, Dana Holman, Robert C. Singleton, Rosalyn J. Cheek, James E. Groom, Amy V. Steiner, Claudia A. Parashar, Umesh D. Esposito, Douglas H. TI Impact of Rotavirus Vaccine on Diarrhea-Associated Disease Burden Among American Indian and Alaska Native Children SO PEDIATRICS LA English DT Article DE rotavirus; American Indian; Alaska Native; children; infants ID IMMUNIZATION PRACTICES ACIP; UNITED-STATES; ADVISORY-COMMITTEE; HOSPITALIZATIONS; GASTROENTERITIS; DISPARITIES; INFANTS; RECOMMENDATIONS; PREVENTION; DECLINE AB OBJECTIVE: Beginning in 2006, the Indian Health Service (IHS) began rotavirus vaccination of American Indian and Alaska Native (Al/AN) infants. To assess vaccine impact, we examined trends in IHS diarrhea-associated hospitalization and outpatient visits among Al/AN children in the pre- and postrotavirus vaccine era. METHODS: Diarrhea-associated hospitalizations and outpatient visits among Al/AN children <5 years of age during 2001 through 2010 were examined by gender, age group, and region for prevaccine years 2001-2006 and postvaccine years 2008, 2009, and 2010. To account for secular declining trends observed in prevaccine years, expected diarrhea-associated hospitalization and outpatient rates for postvaccine years were generated by using Poisson regression analysis of the 2001-2006 annual rates. RESULTS: Coverage with at least 1 dose of rotavirus vaccine among Al/AN infants aged 3 to 5 months in the first half of 2008, 2009, and 2010 ranged from 48% to 80% in various IHS regions. The prevaccine average annual diarrhea-associated hospitalization rates among Al/AN children <5 years of age was 63 per 10 000 persons (range: 57-75 per 10 000), and declined to 39, 31, and 27 per 10 000 in 2008, 2009, and 2010, respectively. Observed 2008, 2009, and 2010 rates were 24%, 37%, and 44% lower than expected rates, respectively. Decreases in diarrhea-associated hospitalizations and outpatient visits were observed in all IHS regions. CONCLUSIONS: Diarrhea-associated hospitalization and outpatient visit rates among Al/AN children have declined after implementation of rotavirus vaccination in Al/AN populations. Pediatrics 2012;129:e907-e913 C1 [Desai, Rishi; Parashar, Umesh D.] Ctr Dis Control & Prevent, Div Viral Dis, Atlanta, GA 30333 USA. [Desai, Rishi; Esposito, Douglas H.] Ctr Dis Control & Prevent, Epidem Intelligence Serv, Off Workforce & Career Dev, Atlanta, GA 30333 USA. [Haberling, Dana; Holman, Robert C.] Ctr Dis Control & Prevent, Div High Consequence Pathogens & Pathol, Atlanta, GA 30333 USA. [Groom, Amy V.] Ctr Dis Control & Prevent, Immunizat Serv Div, Atlanta, GA 30333 USA. Ctr Dis Control & Prevent, Div Global Migrat & Quarantine, Natl Ctr Emerging Zoonot & Infect Dis, Atlanta, GA 30333 USA. [Singleton, Rosalyn J.] Alaska Native Tribal Hlth Consortium, Anchorage, AK USA. [Singleton, Rosalyn J.] US Dept HHS, Arctic Invest Program, Natl Ctr Emerging & Zoonot Infect Dis, Ctr Dis Control & Prevent, Anchorage, AK USA. [Cheek, James E.; Groom, Amy V.] US Dept HHS, Div Epidemiol & Dis Prevent, Off Publ Hlth Support, Indian Hlth Serv, Albuquerque, NM USA. [Steiner, Claudia A.; Esposito, Douglas H.] US Dept HHS, Hlth Care Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Hlth Care Res & Qual, Rockville, MD USA. RP Desai, R (reprint author), Ctr Dis Control & Prevent, Div Viral Dis, 1600 Clifton Rd NE,MS-A34, Atlanta, GA 30333 USA. EM rdesai1@cdc.gov NR 22 TC 5 Z9 5 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 EI 1098-4275 J9 PEDIATRICS JI Pediatrics PD APR PY 2012 VL 129 IS 4 BP E907 EP E913 DI 10.1542/peds.2011-2537 PG 7 WC Pediatrics SC Pediatrics GA 922IX UT WOS:000302541700007 PM 22430454 ER PT J AU Berry, SA Fleishman, JA Moore, RD Gebo, KA AF Berry, Stephen A. Fleishman, John A. Moore, Richard D. Gebo, Kelly A. CA HIV Res Network TI Trends in Reasons for Hospitalization in a Multisite United States Cohort of Persons Living With HIV, 2001-2008 SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE AIDS-defining illnesses; hospitalizations; health care utilization; organ-system comorbidities ID HEALTH-SERVICES UTILIZATION; INFECTED PATIENTS; MYOCARDIAL-INFARCTION; HAART ERA; ANTIRETROVIRAL THERAPY; KIDNEY-DISEASE; URBAN COHORT; DRUG-USE; RATES; RISK AB Introduction: Hospitalization rates for comorbid conditions among persons living with HIV in the current highly active antiretroviral therapy era are unknown. Methods: Hospitalization data from 2001 to 2008 were obtained on 11,645 adults receiving longitudinal HIV care at 4 geographically diverse US HIV clinics within the HIV Research Network. Modified clinical classification software from the Agency for Healthcare Research and Quality assigned primary ICD-9 codes into diagnostic categories. Analysis was performed with repeated measures negative binomial regression. Results: During 2001 to 2008, the rate of AIDS-defining illness (ADI) hospitalizations declined from 6.7 to 2.7 per 100 person-years, incidence rate ratio per year, 0.89 (0.87, 0.91). Among the other diagnostic categories with average rates >2 per 100 person-years, cardiovascular hospitalizations increased over time [1.07 (1.03, 1.11)], whereas non-AIDS-defining infection [0.98 (0.96, 1.00)], psychiatric [0.96 (0.93, 1.00)], and gastrointestinal/liver [0.96 (0.92, 1.00)] were slightly decreasing or stable. Although less frequent overall, renal and pulmonary admissions also increased over time in univariate and multivariate analyses. Of all diagnostic categories, ADI admissions had the longest mean length of stay, 10.5 days. Discussion: ADI hospitalizations have continued to decline in recent years but are still relatively frequent and potentially costly given long lengths of stay. Increases or stability in the rates of chronic end-organ disease admissions imply a need for broader medical knowledge among individual clinicians and/or teams who care for persons living with HIV and a need for long-term access to medications for these conditions. C1 [Berry, Stephen A.] Johns Hopkins Univ, Sch Med, Dept Med, Div Infect Dis, Baltimore, MD 21287 USA. [Fleishman, John A.] Agcy Hlth Care Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Berry, SA (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, Div Infect Dis, 1830 E Monument St,Suite 452, Baltimore, MD 21287 USA. EM sberry8@jhmi.edu FU Merck; Pfizer; Gilead; Tibotec; Agency for Healthcare Research and Quality [290-01-0012]; National Institutes of Health [K23AI084854, R01 AG026250, R01 DA011602, R01 AA16893, K24 DA00432] FX The author R. D. M has been a consultant for Bristol-Myers Squibb and has received research funding from Merck, Pfizer, and Gilead. The author K. A. G. has been a consultant and received research funding from Tibotec.; Sponsorship: Agency for Healthcare Research and Quality (290-01-0012) and the National Institutes of Health K23AI084854, R01 AG026250, R01 DA011602, R01 AA16893, K24 DA00432. NR 37 TC 42 Z9 42 U1 0 U2 3 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 APR 1 PY 2012 VL 59 IS 4 BP 368 EP 375 DI 10.1097/QAI.0b013e318246b862 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 907KL UT WOS:000301416100014 PM 22240460 ER PT J AU Jiang, HJ Lockee, C Fraser, I AF Jiang, H. Joanna Lockee, Carlin Fraser, Irene TI Enhancing board oversight on quality of hospital care: An agency theory perspective SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article DE agency theory; hospital governance; quality of care ID HEALTH-CARE; PHYSICIAN; IMPROVEMENT; LEADERSHIP; PATIENT AB Background: Community hospitals in the United States are almost all governed by a governing board that is legally accountable for the quality of care provided. Increasing pressures for better quality and safety are prompting boards to strengthen their oversight function on quality. Purpose: In this study, we aimed to provide an update to prior research by exploring the role and practices of governing boards in quality oversight through the lens of agency theory and comparing hospital quality performance in relation to the adoption of those practices. Methodology: Data on board practices from a survey conducted by The Governance Institute in 2007 were merged with data on hospital quality drawn from two federal sources that measured processes of care and mortality. The study sample includes 445 public and private not-for-profit hospitals. We used factor analysis to explore the underlying dimensions of board practices. We further compared hospital quality performance by the adoption of each individual board practice. Findings: Consistent with the agency theory, the 13 board practices included in the survey appear to center around enhancing accountability of the board, management, and the medical staff. Reviewing the hospital's quality performance on a regular basis was the most common practice. A number of board practices, not examined in prior research, showed significant association with better performance on process of care and/or risk-adjusted mortality: requiring major new clinical programs to meet quality-related criteria, setting some quality goals at the "theoretical ideal" level, requiring both the board and the medical staff to be as involved as management in setting the agenda for discussion on quality, and requiring the hospital to report its quality/safety performance to the general public. Practice Implications: Hospital governing boards should examine their current practices and consider adopting those that would enhance the accountability of the board itself, management, and the medical staff. C1 [Jiang, H. Joanna; Fraser, Irene] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Lockee, Carlin] Governance Inst, San Diego, CA USA. RP Jiang, HJ (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. EM joanna.jiang@ahrq.hhs.gov NR 23 TC 7 Z9 7 U1 6 U2 28 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 APR-JUN PY 2012 VL 37 IS 2 BP 144 EP 153 DI 10.1097/HMR.0b013e3182224237 PG 10 WC Health Policy & Services SC Health Care Sciences & Services GA 906HD UT WOS:000301334600005 PM 21712722 ER PT J AU Santaguida, P Oremus, M Walker, K Wishart, LR Siegel, KL Raina, P AF Santaguida, Pasqualina Oremus, Mark Walker, Kathryn Wishart, Laurie R. Siegel, Karen Lohmann Raina, Parminder TI Systematic reviews identify important methodological flaws in stroke rehabilitation therapy primary studies: review of reviews SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Review DE Methods; Systematic review; Clinical trials; Stroke; Rehabilitation; Reporting ID RANDOMIZED CONTROLLED-TRIALS; COMPLEX INTERVENTIONS; POSTURAL CONTROL; UPPER EXTREMITY; MOTOR RECOVERY; METAANALYSIS; STIMULATION; ELABORATION; EXPLANATION; STATEMENT AB Objective: A "review of reviews" was undertaken to assess methodological issues in studies evaluating nondrug rehabilitation interventions in stroke patients. Study Design and Setting: MEDLINE, CINAHL, PsycINFO, and the Cochrane Database of Systematic Reviews were searched from January 2000 to January 2008 within the stroke rehabilitation setting. Electronic searches were supplemented by reviews of reference lists and citations identified by experts. Eligible studies were systematic reviews; excluded citations were narrative reviews or reviews of reviews. Review characteristics and criteria for assessing methodological quality of primary studies within them were extracted. Results: The search yielded 949 English-language citations. We included a final set of 38 systematic reviews. Cochrane reviews, which have a standardized methodology, were generally of higher methodological quality than non-Cochrane reviews. Most systematic reviews used standardized quality assessment criteria for primary studies, but not all were comprehensive. Reviews showed that primary studies had problems with randomization, allocation concealment, and blinding. Baseline comparability, adverse events, and cointervention or contamination were not consistently assessed. Blinding of patients and providers was often not feasible and was not evaluated as a source of bias. Conclusions: The eligible systematic reviews identified important methodological flaws in the evaluated primary studies, suggesting the need for improvement of research methods and reporting. (C) 2012 Elsevier Inc. All rights reserved. C1 [Raina, Parminder] McMaster Univ, Dept Clin Epidemiol & Biostat, Fac Hlth Sci, Evidence Based Practice Ctr, Hamilton, ON L8S 4K1, Canada. [Wishart, Laurie R.] McMaster Univ, Sch Rehabil Sci, Fac Hlth Sci, Hamilton, ON L8S 1C7, Canada. [Siegel, Karen Lohmann] US PHS, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Raina, P (reprint author), McMaster Univ, Dept Clin Epidemiol & Biostat, Fac Hlth Sci, Evidence Based Practice Ctr, 1280 Main St W,DTC Room 310, Hamilton, ON L8S 4K1, Canada. EM praina@mcmaster.ca OI Siegel, Karen Lohmann/0000-0002-0788-6612 NR 67 TC 4 Z9 6 U1 0 U2 13 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 APR PY 2012 VL 65 IS 4 BP 358 EP 367 DI 10.1016/j.jclinepi.2011.10.012 PG 10 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902JF UT WOS:000301033700003 PM 22360987 ER PT J AU Oremus, M Santaguida, P Walker, K Wishart, LR Siegel, KL Raina, P AF Oremus, Mark Santaguida, Pasqualina Walker, Kathryn Wishart, Laurie R. Siegel, Karen Lohmann Raina, Parminder TI Studies of stroke rehabilitation therapies should report blinding and rationalize use of outcome measurement instruments SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Review DE Literature review; Purposive sample; Rehabilitation therapy; Stroke; Study design; Research methods ID BURDEN AB Objective: To review the reporting of key design features in studies of stroke rehabilitation therapies. Study Design and Setting: We used purposive sampling to examine English-language, human-subject, comparative studies focusing on stroke rehabilitation therapy provided the effect of therapy was evaluated in at least one of the following six outcome domains: ambulation, cognition, quality of life, daily activities, dysphagia, or communication. We searched MEDLINE (R), CINAHL (R), PsycINFO (R), and the Cochrane Database of Systematic Reviews (date range: January 2000 through late-January 2008) and extracted data from included studies using standardized forms. We depicted the extracted data in tables and summarized the findings qualitatively in the text. Results: We retrieved 1,674 citations in the literature search and extracted data from 99 studies. Authors' reporting of key design features in stroke rehabilitation studies was lacking in four areas, that is, the background of persons delivering therapy, timing of therapy, subjects' receipt of prior or concomitant treatment, and psychometric properties of outcome measurement instruments. Conclusions: Except for four areas, reporting of key design features in studies of stroke rehabilitation therapies was quite comprehensive. Researchers should pay particular attention to reporting blinding, and they should rationalize the number of outcome measurement instruments used in their studies. (C) 2012 Elsevier Inc. All rights reserved. C1 [Oremus, Mark; Santaguida, Pasqualina; Walker, Kathryn; Raina, Parminder] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8S 4K1, Canada. [Wishart, Laurie R.] McMaster Univ, Sch Rehabil Sci, Hamilton, ON L8S 4K1, Canada. [Siegel, Karen Lohmann] US PHS, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Raina, P (reprint author), McMaster Univ, Dept Clin Epidemiol & Biostat, 1280 Main St W,DTC Room 310, Hamilton, ON L8S 4K1, Canada. EM praina@mcmaster.ca OI Siegel, Karen Lohmann/0000-0002-0788-6612 NR 9 TC 1 Z9 1 U1 1 U2 5 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 APR PY 2012 VL 65 IS 4 BP 368 EP 374 DI 10.1016/j.jclinepi.2011.10.013 PG 7 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 902JF UT WOS:000301033700004 PM 22360988 ER PT J AU Gray, D Pourmoghadam, K Hsu, A Dicks, V Jacobs, J Steiner, C Jacobs, M AF Gray, Darryl Pourmoghadam, Kamal Hsu, Alan Dicks, Vivian Jacobs, Jeffrey Steiner, Claudia Jacobs, Marshall TI POPULATION-BASED TRENDS IN PEDIATRIC CARDIAC SURGERY AND INTERVENTIONAL CARDIOLOGY PROCEDURES FROM 1997 THROUGH 2009 IN THE UNITED STATES SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Meeting Abstract CT 61st Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC) CY MAR 24-27, 2012 CL Chicago, IL SP Amer Coll Cardiol (ACC) C1 [Gray, Darryl; Pourmoghadam, Kamal; Hsu, Alan; Dicks, Vivian; Jacobs, Jeffrey; Steiner, Claudia; Jacobs, Marshall] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 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 MAR 27 PY 2012 VL 59 IS 13 SU S BP E818 EP E818 PG 1 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 919LB UT WOS:000302326700819 ER PT J AU Bukowski, R Davis, KE Wilson, PWF AF Bukowski, Radek Davis, Karen E. Wilson, Peter W. F. TI Delivery of a Small for Gestational Age Infant and Greater Maternal Risk of Ischemic Heart Disease SO PLOS ONE LA English DT Article ID PARENTAL CARDIOVASCULAR-DISEASE; BIRTH-WEIGHT; PRETERM BIRTH; FOLLOW-UP; PREECLAMPSIA; MORTALITY; WOMEN; PREGNANCY; HISTORY; ATHEROSCLEROSIS AB Background: Delivery of a small for gestational age (SGA) infant has been associated with increased maternal risk of ischemic heart disease (IHD). It is uncertain whether giving birth to SGA infant is a specific determinant of later IHD, independent of other risk factors, or a marker of general poor health. The purpose of this study was to investigate the association between delivery of a SGA infant and maternal risk for IHD in relation to traditional IHD risk factors. Methods and Findings: Risk of maternal IHD was evaluated in a population based cross-sectional study of 6,608 women with a prior live term birth who participated in the National Health and Nutrition Examination Survey (1999-2006), a probability sample of the U.S. population. Sequence of events was determined from age at last live birth and at diagnosis of IHD. Delivery of a SGA infant is strongly associated with greater maternal risk for IHD (age adjusted OR; 95% CI: 1.8; 1.2, 2.9; p = 0.012). The association was independent of the family history of IHD, stroke, hypertension and diabetes (family history-adjusted OR; 95% CI: 1.9; 1.2, 3.0; p = 0.011) as well as other risk factors for IHD (risk factor-adjusted OR; 95% CI: 1.7; 1.1, 2.7; p = 0.025). Delivery of a SGA infant was associated with earlier onset of IHD and preceded it by a median of 30 (interquartile range: 20, 36) years. Conclusions: Giving birth to a SGA infant is strongly and independently associated with IHD and a potential risk factor that precedes IHD by decades. A pregnancy that produces a SGA infant may induce long-term cardiovascular changes that increase risk for IHD. C1 [Bukowski, Radek] Univ Texas Galveston, Med Branch, Dept Obstet & Gynecol, Galveston, TX 77550 USA. [Davis, Karen E.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Wilson, Peter W. F.] Emory Univ, Sch Med, Dept Med,Cardiol Div, Atlanta VA Med Ctr,Emory Clin Cardiovasc Res Inst, Atlanta, GA USA. RP Bukowski, R (reprint author), Univ Texas Galveston, Med Branch, Dept Obstet & Gynecol, Galveston, TX 77550 USA. EM rkbukows@utmb.edu NR 49 TC 13 Z9 13 U1 0 U2 3 PU PUBLIC LIBRARY SCIENCE PI SAN FRANCISCO PA 1160 BATTERY STREET, STE 100, SAN FRANCISCO, CA 94111 USA SN 1932-6203 J9 PLOS ONE JI PLoS One PD MAR 14 PY 2012 VL 7 IS 3 AR e33047 DI 10.1371/journal.pone.0033047 PG 7 WC Multidisciplinary Sciences SC Science & Technology - Other Topics GA 931EO UT WOS:000303198600038 PM 22431995 ER PT J AU Sulku, SN Bernard, DM AF Sulku, S. Nur Bernard, D. Minbay TI Financial Burden of Health Care Expenditures: Turkey SO IRANIAN JOURNAL OF PUBLIC HEALTH LA English DT Article DE Out of Pocket expenditures; Financial burden; Health care reform; Turkey AB In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to "The Health Transformation Programme". Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to health care and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of health care expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on health care. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the health care reform in terms of providing financial protection. C1 [Sulku, S. Nur] Gazi Univ, Econ & Management Sci Fac, Dept Econometr, Ankara, Turkey. [Bernard, D. Minbay] US Dept HHS, Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Sulku, SN (reprint author), Gazi Univ, Econ & Management Sci Fac, Dept Econometr, Ankara, Turkey. EM nursulku@gazi.edu.tr FU AHRQ [IM07266] FX We are grateful to the Strategy Development Headship of the Turkish Ministry of Health (MoH) for sponsoring Seher Nur Sulku's visit to US Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ). This study has been completed as a project of AHRQ titled as 'Project of Financial Burden of HealthCare', Project No: IM07266, 2008-2009. We thank the MoH Turkey Turkish Institute of Health (TUSAK) for providing access to the 2002- 2003 National Household Health Expenditure Survey data and TUSAK specialists for technical assistance. We are grateful to Steve Cohen, Director of the Center for Financing, Access and Cost Trends (CFACT), AHRQ, Jessica Banthin, Director of the Division of Modeling and Simulation, CFACT, AHRQ, and Joel Cohen, Director of the Division for Economic and Social Studies, CFACT, AHRQ, for helpful comments. Any remaining errors are our own. All the views expressed in this paper belong to the authors and do not necessarily represent those of the MoH, TUSAK or AHRQ. NR 17 TC 1 Z9 1 U1 1 U2 5 PU IRANIAN SCIENTIFIC SOCIETY MEDICAL ENTOMOLOGY PI TEHRAN PA SCHOOL PUBLIC HEALTH & INST HEALTH RESEARCH, TEHRAN UNIV MEDICAL SCIENCES, P O BOX 6446-14155, TEHRAN, 00000, IRAN SN 2251-6085 J9 IRAN J PUBLIC HEALTH JI Iran J. Public Health PD MAR PY 2012 VL 41 IS 3 BP 48 EP 64 PG 17 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 915CM UT WOS:000302000900006 PM 23113149 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Progress on a National Patient Safety Imperative to Eliminate CLABSI SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material ID BLOOD-STREAM INFECTIONS C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 6 TC 6 Z9 6 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 2012 VL 27 IS 2 BP 170 EP 171 DI 10.1177/1062860611433382 PG 2 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 907ZY UT WOS:000301461000011 PM 22416280 ER PT J AU Meyers, D AF Meyers, David TI Introduction from the Agency for Healthcare Research and Quality SO JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE LA English DT Editorial Material C1 [Meyers, David] US Dept HHS, Ctr Agcy Healthcare Res & Qual, Rockville, MD USA. RP Meyers, D (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, 540 Gaither Rd, Rockville, MD 20850 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER BOARD FAMILY MEDICINE PI LEXINGTON PA 2228 YOUNG DR, LEXINGTON, KY 40505 USA SN 1557-2625 J9 J AM BOARD FAM MED JI J. Am. Board Fam. Med. PD MAR-APR PY 2012 VL 25 SU S BP S1 EP S1 DI 10.3122/jabfm.2012.02.120023 PG 1 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 905VR UT WOS:000301304800001 PM 22403244 ER PT J AU Lomotan, EA Hoeksema, LJ Edmonds, DE Ramirez-Garnica, G Shiffman, RN Horwitz, LI AF Lomotan, Edwin A. Hoeksema, Laura J. Edmonds, Diana E. Ramirez-Garnica, Gabriela Shiffman, Richard N. Horwitz, Leora I. TI Evaluating the use of a computerized clinical decision support system for asthma by pediatric pulmonologists SO INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS LA English DT Article DE Decision support systems; Clinical; Qualitative evaluation; Asthma ID EVIDENCE BASED GUIDELINES; SPECIALTY CARE; MANAGEMENT; TRIAL AB Purpose: To investigate use of a new guideline-based, computerized clinical decision support (CCDS) system for asthma in a pediatric pulmonology clinic of a large academic medical center. Methods: We conducted a qualitative evaluation including review of electronic data, direct observation, and interviews with all nine pediatric pulmonologists in the clinic. Outcome measures included patterns of computer use in relation to patient care, and themes surrounding the relationship between asthma care and computer use. Results: The pediatric pulmonologists entered enough data to trigger the decision support system in 397/445 (89.2%) of all asthma visits from January 2009 to May 2009. However, interviews and direct observations revealed use of the decision support system was limited to documentation activities after clinic sessions ended. Reasons for delayed use reflected barriers common to general medical care and barriers specific to subspecialty care. Subspecialist-specific barriers included the perceived high complexity of patients, the impact of subject matter expertise on the types of decision support needed, and unique workflow concerns such as the need to create letters to referring physicians. Conclusions: Pediatric pulmonologists demonstrated low use of a computerized decision support system for asthma care because of a combination of general and subspecialist-specific factors. Subspecialist-specific factors should not be underestimated when designing guideline-based, computerized decision support systems for the subspecialty setting. (C) 2011 Elsevier Ireland Ltd. All rights reserved. C1 [Horwitz, Leora I.] Yale Univ, Sch Med, Gen Internal Med Sect, Dept Med, New Haven, CT 06520 USA. [Lomotan, Edwin A.] Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, Rockville, MD USA. [Hoeksema, Laura J.] Dept Vet Affairs, Natl Ctr Patient Safety, Ann Arbor, MI USA. [Edmonds, Diana E.; Shiffman, Richard N.] Yale Univ, Sch Med, Yale Ctr Med Informat, New Haven, CT 06520 USA. [Ramirez-Garnica, Gabriela] Nemours Clin Management Program, Orlando, FL USA. [Horwitz, Leora I.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. RP Horwitz, LI (reprint author), Yale Univ, Sch Med, Gen Internal Med Sect, Dept Med, POB 208093, New Haven, CT 06520 USA. EM Leora.horwitz@yale.edu RI Horwitz, Leora/A-6959-2009 OI Horwitz, Leora/0000-0003-1800-6040 FU Agency for Healthcare Research and Quality [HHSA 290200810011]; National Library of Medicine [T15-LM07065]; National Center for Research Resources (NCRR) [UL1 RR024139, KL2 RR024138]; National Institutes of Health (NIH); NIH Roadmap for Medical Research FX This work was supported by contract HHSA 290200810011 from the Agency for Healthcare Research and Quality and grant T15-LM07065 from the National Library of Medicine. Dr. Horwitz is supported by the CTSA Grant UL1 RR024139 and KL2 RR024138 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Article contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR, NIH, or AHRQ. Drs. Lomotan, Shiffman, and Horwitz had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. NR 35 TC 8 Z9 8 U1 3 U2 9 PU ELSEVIER IRELAND LTD PI CLARE PA ELSEVIER HOUSE, BROOKVALE PLAZA, EAST PARK SHANNON, CO, CLARE, 00000, IRELAND SN 1386-5056 J9 INT J MED INFORM JI Int. J. Med. Inform. PD MAR PY 2012 VL 81 IS 3 BP 157 EP 165 DI 10.1016/j.ijmedinf.2011.11.004 PG 9 WC Computer Science, Information Systems; Health Care Sciences & Services; Medical Informatics SC Computer Science; Health Care Sciences & Services; Medical Informatics GA 897AS UT WOS:000300613600002 PM 22204897 ER PT J AU Basu, J AF Basu, Jayasree TI Medicare managed care and primary care quality: examining racial/ethnic effects across states SO HEALTH CARE MANAGEMENT SCIENCE LA English DT Article DE Managed care; Medicare; Racial and ethnic disparities; Preventable hospitalizations; Ambulatory care senstive conditions; Primary care ID PREVENTABLE HOSPITALIZATIONS; RACIAL DISPARITIES; SOCIOECONOMIC-STATUS; SENSITIVE CONDITIONS; HEALTH-CARE; OF-CARE; ACCESS; HMOS; BENEFICIARIES; ENROLLMENT AB The study assesses the role of Medicare Advantage (MA) plans in providing quality primary care in comparison to FFS Medicare in three states, New York, California, Florida, across three racial ethnic groups. The performance is measured in terms of providing better quality primary care, as defined by lowering the risks of preventable hospital admissions. Using 2004 hospital discharge data (HCUP-SID) of Agency for Healthcare Research and Quality for three states, a multivariate cross sectional design is used with individual admission as the unit of analysis. The study found that MA plans were associated with lower preventable hospitalizations relative to marker admissions. The benefit also spilled over to different racial and ethnic subgroups and in some states, e.g. CA and FL, MA enrollment was associated with significantly lower odds of minority admissions than of white admissions. These results may indicate a potentially favorable role of MA plans in attenuating racial/ethnic inequalities in primary care in some states. C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Basu, J (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jayasree.basu@ahrq.hhs.gov RI Dalla Zuanna, Teresa/G-3133-2015 NR 28 TC 4 Z9 4 U1 1 U2 4 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1386-9620 J9 HEALTH CARE MANAG SC JI Health Care Manag. Sci. PD MAR PY 2012 VL 15 IS 1 BP 15 EP 28 DI 10.1007/s10729-011-9176-5 PG 14 WC Health Policy & Services SC Health Care Sciences & Services GA 881XJ UT WOS:000299525000002 PM 21892596 ER PT J AU Koh, HK Berwick, DM Clancy, CM Baur, C Brach, C Harris, LM Zerhusen, EG AF Koh, Howard K. Berwick, Donald M. Clancy, Carolyn M. Baur, Cynthia Brach, Cindy Harris, Linda M. Zerhusen, Eileen G. TI New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly 'Crisis Care' SO HEALTH AFFAIRS LA English DT Article ID PHYSICIAN-PATIENT COMMUNICATION; RANDOMIZED CONTROLLED-TRIAL; EDUCATION MATERIALS; MANAGEMENT PROGRAM; HOSPITAL DISCHARGE; INTERVENTION; QUALITY; INFORMATION; CONSUMERS AB Health literacy is the capacity to understand basic health information and make appropriate health decisions. Tens of millions of Americans have limited health literacy-a fact that poses major challenges for the delivery of high-quality care. Despite its importance, health literacy has until recently been relegated to the sidelines of health care improvement efforts aimed at increasing access, improving quality, and better managing costs. Recent federal policy initiatives, including the Affordable Care Act of 2010, the Department of Health and Human Services' National Action Plan to Improve Health Literacy, and the Plain Writing Act of 2010, have brought health literacy to a tipping point-that is, poised to make the transition from the margins to the mainstream. If public and private organizations make it a priority to become health literate, the nation's health literacy can be advanced to the point at which it will play a major role in improving health care and health for all Americans. C1 [Koh, Howard K.] Dept Hlth & Human Serv HHS, Washington, DC 20201 USA. [Clancy, Carolyn M.; Brach, Cindy] AHRQ, Rockville, MD USA. [Baur, Cynthia] Ctr Dis Control & Prevent, Off Associate Director Commun, Atlanta, GA USA. [Harris, Linda M.] HHS, Rockville, MD USA. [Zerhusen, Eileen G.] CMS, Off Commun, Baltimore, MD USA. [Berwick, Donald M.] CMS, Washington, DC USA. [Berwick, Donald M.] CMS, Washington, DC USA. RP Koh, HK (reprint author), Dept Hlth & Human Serv HHS, Washington, DC 20201 USA. EM Howard.Koh@HHS.gov FU Intramural AHRQ HHS [HS999999] NR 54 TC 59 Z9 60 U1 2 U2 24 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 FEB PY 2012 VL 31 IS 2 BP 434 EP 443 DI 10.1377/hlthaff.2011.1169 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 894GE UT WOS:000300414300024 PM 22262723 ER PT J AU Peikes, D Zutshi, A Genevro, JL Parchman, ML Meyers, DS AF Peikes, Deborah Zutshi, Aparajita Genevro, Janice L. Parchman, Michael L. Meyers, David S. TI Early Evaluations of the Medical Home: Building on a Promising Start SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Review ID RANDOMIZED-CONTROLLED-TRIAL; LATE-LIFE DEPRESSION; LOW-INCOME SENIORS; PRIMARY-CARE; GUIDED CARE; HEALTH-CARE; GERIATRIC RESOURCES; COLLABORATIVE CARE; TOO IMPORTANT; COST SAVINGS AB Objectives: To systematically review the current evidence on the patient-centered medical home (PCMH, or medical home), which aims to reinvigorate primary care and achieve the triple aim of better quality, improved experience, and lower costs. Study Design: Systematic review of quantitative evidence on the PCMH. Methods: Out of 498 studies published or disseminated from January 2000 to September 2010 on US-based interventions, 14 evaluations of 12 interventions met our inclusion criteria: (1) tested a practice-level intervention with 3 or more of 5 key PCMH components and (2) conducted a quantitative study of one of the triple aim outcomes or of healthcare professional experience. We synthesized findings on interventions that were evaluated using rigorous methods, We also provide guidance to structure future evaluations to maximize learning. Results:The interventions most often cited to support the medical home can be viewed as precursors to the medical home. Evaluations of 6 of these interventions provided rigorous evidence on 1 or more outcomes. This evidence indicates some favorable effects on all 3 triple aim outcomes, a few unfavorable effects on costs, and many inconclusive results. Conclusions: Although the PCMH is a promising innovation, rigorous quantitative evaluations and comprehensive implementation analyses are needed to assess effectiveness and refine the model to meet stakeholders' needs. Findings from future evaluations will help guide the substantial. efforts practices and payers invest to adopt the PCMH with the goal of achieving the triple aim outcomes. (Am J Manag Care. 2012;18(2):105-116) C1 [Peikes, Deborah; Zutshi, Aparajita] Math Policy Res, Princeton, NJ 08543 USA. [Genevro, Janice L.; Parchman, Michael L.; Meyers, David S.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Peikes, D (reprint author), Math Policy Res, POB 2393, Princeton, NJ 08543 USA. EM dpeikes@mathematica-mpr.com FU Agency for Healthcare Research and Quality, US Department of Health and Human Services [HHSA 290200900019I/HHSA29032002T, HHSA290200900019I/HHSA 29032005T] FX This project was funded under contracts HHSA 290200900019I/HHSA29032002T and HHSA290200900019I/HHSA 29032005T from the Agency for Healthcare Research and Quality, US Department of Health and Human Services. NR 80 TC 99 Z9 99 U1 5 U2 29 PU MANAGED CARE & HEALTHCARE COMMUNICATIONS LLC PI PLAINSBORO PA 666 PLAINSBORO RD, STE 300, PLAINSBORO, NJ 08536 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD FEB PY 2012 VL 18 IS 2 BP 105 EP 116 PG 12 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 903BE UT WOS:000301089200004 PM 22435838 ER PT J AU Zuvekas, SH Vitiello, B AF Zuvekas, Samuel H. Vitiello, Benedetto TI Stimulant Medication Use in Children: A 12-Year Perspective SO AMERICAN JOURNAL OF PSYCHIATRY LA English DT Article ID ATTENTION-DEFICIT/HYPERACTIVITY DISORDER; DEFICIT HYPERACTIVITY DISORDER; NATIONAL TRENDS; ADHD; ADOLESCENTS; PREVALENCE; PRESCHOOLERS; PATTERNS AB Objective: The authors examined the utilization of stimulant medications for the treatment of ADHD in U.S. children during the period 1996-2008 to determine trends by age, sex, race/ethnicity, family income, and geographic region. Method: The 1996-2008 database of the Medical Expenditure Panel Survey, a nationally representative annual survey of U.S. households, was analyzed for therapeutic stimulant use in children age 18 and younger. The data for 1987 were also recalculated for reference. Results: An estimated 3.5% (95% confidence interval=3.0-4.1) of U.S. children received stimulant medication in 2008, up from 2.4% in 1996. Over the period 1996-2008, stimulant use increased consistently at an overall annual growth rate of 3.4%. Use increased in adolescents (annual growth, 6.5%), but it did not significantly change in 6- to 12-year-olds, and it decreased in preschoolers. Use remained higher in boys than in girls, and it remained consistently lower in the West than in other U.S. regions. While differences by family income have disappeared over time, use of stimulants in ADHD treatment is significantly lower in racial/ethnic minorities. Conclusions: Overall, pediatric stimulant use has been slowly but steadily increasing since 1996, primarily as a result of greater use in adolescents. Use in preschoolers remains low and has declined over time. Important variations related to racial/ethnic background and geographic region persist, thus indicating a substantial heterogeneity in the approach to the treatment of ADHD in U.S. communities. C1 [Vitiello, Benedetto] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. Div Serv & Intervent Res, Bethesda, MD USA. RP Vitiello, B (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM bvitiell@mail.nih.gov FU Intramural NIH HHS [Z99 MH999999] NR 24 TC 92 Z9 92 U1 2 U2 12 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 FEB PY 2012 VL 169 IS 2 BP 160 EP 166 DI 10.1176/appi.ajp.2011.11030387 PG 7 WC Psychiatry SC Psychiatry GA 890BW UT WOS:000300121100011 PM 22420039 ER PT J AU Singh, H Graber, ML Kissam, SM Sorensen, AV Lenfestey, NF Tant, EM Henriksen, K LaBresh, KA AF Singh, Hardeep Graber, Mark L. Kissam, Stephanie M. Sorensen, Asta V. Lenfestey, Nancy F. Tant, Elizabeth M. Henriksen, Kerm LaBresh, Kenneth A. TI System-related interventions to reduce diagnostic errors: a narrative review SO BMJ QUALITY & SAFETY LA English DT Review ID TEST RESULT COMMUNICATION; PATIENT SAFETY; EMERGENCY-DEPARTMENT; FOLLOW-UP; INFORMATION-TECHNOLOGY; COGNITIVE-PSYCHOLOGY; MALPRACTICE CLAIMS; CLINICAL JUDGMENT; MEDICAL-RECORDS; PRIMARY-CARE AB Background: Diagnostic errors (missed, delayed or wrong diagnosis) have recently gained attention and are associated with significant preventable morbidity and mortality. The authors reviewed the recent literature and identified interventions that address system-related factors that contribute directly to diagnostic errors. Methods: The authors conducted a comprehensive search using multiple search strategies. First, they performed a PubMed search to identify articles exclusively related to diagnostic error or delay published in English between 2000 and 2009. They then sought papers from references in the initial dataset, searches of additional databases, and subject matter experts. Articles were included if they formally evaluated an intervention to prevent or reduce diagnostic error; however, papers were also included if interventions were suggested and not tested to inform the state of the science on the subject. Interventions were characterised according to the step in the diagnostic process they targeted: patient-provider encounter; performance and interpretation of diagnostic tests; follow-up and tracking of diagnostic information; subspecialty and referral-related issues; and patient-specific care-seeking and adherence processes. Results: 43 articles were identified for full review, of which six reported tested interventions and 37 contained suggestions for possible interventions. Empirical studies, although somewhat positive, were non-experimental or quasi-experimental and included a small number of clinicians or healthcare sites. Outcome measures in general were underdeveloped and varied markedly among studies, depending on the setting or step in the diagnostic process. Conclusions: Despite a number of suggested interventions in the literature, few empirical studies in the past decade have tested interventions to reduce diagnostic errors. Advancing the science of diagnostic error prevention will require more robust study designs and rigorous definitions of diagnostic processes and outcomes to measure intervention effects. C1 [Singh, Hardeep] Baylor Coll Med, Sect Hlth Serv Res, Dept Med, Houston, TX 77030 USA. [Singh, Hardeep] Houston VA Hlth Serv R&D Ctr Excellence, Houston, TX USA. [Singh, Hardeep] Michael E DeBakey VA Med Ctr, Ctr Inquiry Improve Outpatient Safety Effect Elec, Houston, TX USA. [Graber, Mark L.; Kissam, Stephanie M.; Sorensen, Asta V.; Lenfestey, Nancy F.; Tant, Elizabeth M.; LaBresh, Kenneth A.] RTI Int, Res Triangle Pk, NC USA. [Henriksen, Kerm] Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Singh, H (reprint author), Baylor Coll Med, Sect Hlth Serv Res, Dept Med, 2002 Holcombe Blvd,VAMC 152, Houston, TX 77030 USA. EM hardeeps@bcm.edu RI LaBresh, Kenneth/A-6995-2017; OI LaBresh, Kenneth/0000-0001-9040-1956; Graber, Mark/0000-0002-3600-0446 FU Agency for Healthcare Research and Quality (AHRQ) [HHSA290200600001]; NIH [K23CA125585]; VA National Center of Patient Safety; Agency for Health Care Research and Quality; Houston VA HSR&D Center of Excellence [HFP90-020] FX This study was funded by the Agency for Healthcare Research and Quality (AHRQ) Task Order Contract No. HHSA290200600001, Task 8. Dr Singh is additionally supported by an NIH K23 career development award (K23CA125585), the VA National Center of Patient Safety, Agency for Health Care Research and Quality, and in part by the Houston VA HSR&D Center of Excellence (HFP90-020). NR 68 TC 36 Z9 36 U1 4 U2 15 PU BMJ PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 2044-5415 J9 BMJ QUAL SAF JI BMJ Qual. Saf. PD FEB PY 2012 VL 21 IS 2 BP 160 EP 170 DI 10.1136/bmjqs-2011-000150 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 879JF UT WOS:000299324800010 PM 22129930 ER PT J AU Weinberger, DM Simonsen, L Jordan, R Steiner, C Miller, M Viboud, C AF Weinberger, Daniel M. Simonsen, Lone Jordan, Richard Steiner, Claudia Miller, Mark Viboud, Cecile TI Impact of the 2009 Influenza Pandemic on Pneumococcal Pneumonia Hospitalizations in the United States SO JOURNAL OF INFECTIOUS DISEASES LA English DT Article ID A H1N1 INFECTION; STREPTOCOCCUS-PNEUMONIAE; BACTERIAL PNEUMONIA; DISEASE; VIRUS; ASSOCIATION; CHILDREN; COINFECTIONS; PATHOGENS; EFFICACY AB Background. Infection with influenza virus increases the risk for developing pneumococcal disease. The A/H1N1 influenza pandemic in autumn 2009 provided a unique opportunity to evaluate this relationship. Background. Infection with influenza virus increases the risk for developing pneumococcal disease. The A/H1N1 influenza pandemic in autumn 2009 provided a unique opportunity to evaluate this relationship. Methods. Using weekly age-, state-, and cause-specific hospitalizations from the US State Inpatient Databases of the Healthcare Cost and Utilization Project 2003-2009, we quantified the increase in pneumococcal pneumonia hospitalization rates above a seasonal baseline during the pandemic period. Results. We found a significant increase in pneumococcal hospitalizations from late August to mid-December 2009, which corresponded to the timing of highest pandemic influenza activity. Individuals aged 5-19 years, who have a low baseline level of pneumococcal disease, experienced the largest relative increase in pneumococcal hospitalizations (ratio, 1.6 [95% confidence interval {CI}, 1.4-1.7]), whereas the largest absolute increase was observed among individuals aged 40-64 years. In contrast, there was no excess disease in the elderly. Geographical variation in the timing of excess pneumococcal hospitalizations matched geographical patterns for the fall pandemic influenza wave. Conclusions. The 2009 influenza pandemic had a significant impact on the rate of pneumococcal pneumonia hospitalizations, with the magnitude of this effect varying between age groups and states, mirroring observed variations in influenza activity. C1 [Weinberger, Daniel M.; Simonsen, Lone; Miller, Mark; Viboud, Cecile] NIH, Div Int Epidemiol & Populat Studies, Fogarty Int Ctr, Bethesda, MD 20892 USA. [Simonsen, Lone] George Washington Univ, Dept Global Hlth, Washington, DC USA. [Jordan, Richard] Social & Sci Syst Inc, Rockville, MD USA. [Jordan, Richard; Steiner, Claudia] Agcy Healthcare Res & Qual, Healthcare Cost & Utilizat Project, Rockville, MD USA. RP Weinberger, DM (reprint author), NIH, Div Int Epidemiol & Populat Studies, Fogarty Int Ctr, Bldg 16,16 Ctr Dr, Bethesda, MD 20892 USA. EM weinbergerdm@mail.nih.gov OI Simonsen, Lone/0000-0003-1535-8526; Weinberger, Daniel/0000-0003-1178-8086 FU International Influenza Unit, Office of Global Affairs, US Department of Health and Human Services; RAPIDD program (Research And Policy for Infectious Diseases Dynamics); Fogarty International Center, National Institutes of Health (NIH); Department of Homeland Security; Pfizer FX The MISMS study is funded by the International Influenza Unit, Office of Global Affairs, US Department of Health and Human Services. L. S. acknowledges support from the RAPIDD program (Research And Policy for Infectious Diseases Dynamics) funded by the Fogarty International Center, National Institutes of Health (NIH), and the Department of Homeland Security.; L. S. has received research support from Pfizer for an observational study of pneumococcal vaccine program benefits. All other authors report no conflicts. NR 42 TC 39 Z9 42 U1 0 U2 5 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0022-1899 J9 J INFECT DIS JI J. Infect. Dis. PD FEB 1 PY 2012 VL 205 IS 3 BP 458 EP 465 DI 10.1093/infdis/jir749 PG 8 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 876HA UT WOS:000299097200015 PM 22158564 ER PT J AU Clift, JB Kirby, J AF Clift, Joseph B. Kirby, James TI Health Care Access and Perceptions of Provider Care Among Individuals in Same-Sex Couples: Findings from the Medical Expenditure Panel Survey (MEPS) SO JOURNAL OF HOMOSEXUALITY LA English DT Article DE health care; gay; lesbian; MEPS; same-sex ID DISPARITIES; INSURANCE; WOMEN AB We compared individuals in same-sex couples to those in different-sex married couples on various health care indicators using the Medical Expenditure Panel Survey. Compared to individuals in different-sex married couples, individuals in same-sex couples were more likely to report difficulty seeing specialists, getting medical care when needed, and delays getting necessary prescription drugs. They were also more likely to report dissatisfaction with the level of respect shown by and time spent with providers. This study suggests that individuals in same-sex couples are more likely to face barriers to care and that individuals in same-sex couples have less positive perceptions of provider interactions. C1 [Kirby, James] US Dept HHS, AHRQ, Rockville, MD 20850 USA. [Clift, Joseph B.] US Dept HHS, HRSA, Rockville, MD 20850 USA. RP Kirby, J (reprint author), US Dept HHS, AHRQ, 540 Gaither Rd, Rockville, MD 20850 USA. EM James.Kirby@ahrq.hhs.gov NR 22 TC 15 Z9 15 U1 3 U2 8 PU ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD PI ABINGDON PA 4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXFORDSHIRE, ENGLAND SN 0091-8369 J9 J HOMOSEXUAL JI J. Homosex. PY 2012 VL 59 IS 6 SI SI BP 839 EP 850 DI 10.1080/00918369.2012.694766 PG 12 WC Psychology, Multidisciplinary; Social Sciences, Interdisciplinary SC Psychology; Social Sciences - Other Topics GA 982RR UT WOS:000307063600006 PM 22853183 ER PT J AU Zayas-Caban, T AF Zayas-Caban, Teresa TI Health information management in the home: A human factors assessment SO WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION LA English DT Article DE Case study; balance model; interviews; observations; household ID HOUSEHOLD HIMH AB Objective: Achieving optimal health outcomes requires that consumers maintain myriad health data and understand how to utilize appropriate health information management applications. This case study investigated four families' health information management tasks in their homes. Participants: Four different families participated in the study: a single parent household; two nuclear family households; and an extended family household. Methods: A work system model known as the balance model was used as a guiding framework for data collection. Data collection consisted of three stages: (1) primary health information manager interviews; (2) family interviews; and (3) task observations. Results: Overall, families reported 69 unique health information management tasks that took place in nine different locations, using 22 different information storage artifacts. Frequently occurring tasks related to health management or health coordination were conducted in public spaces. Less frequent or more time-consuming tasks, such as researching a health concern or storing medical history, were performed in private spaces such as bedrooms or studies. Conclusions: Similarities across households suggest potential foundational design elements that consumer health information technology application designers need to balance with tailored interventions to successfully support variations in individuals' health information management needs. C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Zayas-Caban, T (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd,Room 6115, Rockville, MD 20850 USA. EM Teresa.ZayasCaban@ahrq.hhs.gov NR 26 TC 3 Z9 3 U1 1 U2 13 PU IOS PRESS PI AMSTERDAM PA NIEUWE HEMWEG 6B, 1013 BG AMSTERDAM, NETHERLANDS SN 1051-9815 EI 1875-9270 J9 WORK JI Work PY 2012 VL 41 IS 3 BP 315 EP 328 DI 10.3233/WOR-2012-1306 PG 14 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 906PZ UT WOS:000301360400012 PM 22398501 ER PT J AU Rich, EC Lipson, D Libersky, J Peikes, DN Parchman, ML AF Rich, Eugene C. Lipson, Debra Libersky, Jenna Peikes, Deborah N. Parchman, Michael L. TI Organizing Care for Complex Patients in the Patient-Centered Medical Home SO ANNALS OF FAMILY MEDICINE LA English DT Review DE Primary health care; patient-centered care; chronic disease; frail older adults; persons with disabilities; health policy; Agency for Healthcare Research and Quality (US) C1 [Rich, Eugene C.; Lipson, Debra; Libersky, Jenna; Peikes, Deborah N.] Math Policy Res, Washington, DC 20024 USA. [Parchman, Michael L.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Rich, EC (reprint author), Math Policy Res, 600 Maryland Ave SW,Ste 550, Washington, DC 20024 USA. EM ERich@Mathematica-Mpr.com OI Parchman, Michael/0000-0001-7129-2889 FU Agency for Healthcare Research Quality [HHSA2902009000191 TO2] FX This paper was supported by the Agency for Healthcare Research & Quality contract number HHSA2902009000191 TO2. NR 2 TC 15 Z9 15 U1 0 U2 1 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672 USA SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD JAN-FEB PY 2012 VL 10 IS 1 BP 60 EP 62 DI 10.1370/afm.1351 PG 3 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 884QL UT WOS:000299722500011 PM 22230832 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Patient-centered outcomes research and nurse practitioners' role in shared decision making SO JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS LA English DT Article DE Evidence-based practice; health policy; healthcare collaboration; outcomes; effective healthcare program AB This article provides a brief overview of a new program from the Agency for Healthcare Research and Quality (AHRQ) called the Effective Healthcare Program. This program has supported more than 70 research projects since its inception and published more than 50 products, including guides for clinicians and patients that provide a comprehensive analysis of treatment options for common, chronic illnesses. Research summaries are also available for mobile devices. C1 US Dept HHS, AHRQ, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), US Dept HHS, AHRQ, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 6 TC 3 Z9 3 U1 1 U2 7 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1041-2972 J9 J AM ACAD NURSE PRAC JI J. Am. Acad. Nurse Pract. PD JAN PY 2012 VL 24 IS 1 BP 59 EP 61 DI 10.1111/j.1745-7599.2011.00692.x PG 3 WC Health Care Sciences & Services; Nursing SC Health Care Sciences & Services; Nursing GA 876IY UT WOS:000299102400009 PM 22243682 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Let the data be our guide: trends and tools for research on health care utilization SO HEALTH ECONOMICS LA English DT Article C1 AHRQ, Rockville, MD USA. RP Clancy, CM (reprint author), AHRQ, Rockville, MD USA. EM cathy.tokarski@ahrq.hhs.gov NR 11 TC 1 Z9 1 U1 1 U2 2 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1057-9230 J9 HEALTH ECON JI Health Econ. PD JAN PY 2012 VL 21 IS 1 BP 19 EP 23 DI 10.1002/hec.1809 PG 5 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 858LB UT WOS:000297797600004 PM 22147624 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Alleviating "Second Victim" Syndrome How We Should Handle Patient Harm SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID MEDICAL ERROR C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 19 TC 3 Z9 3 U1 1 U2 5 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 JAN-MAR PY 2012 VL 27 IS 1 BP 1 EP 5 DI 10.1097/NCQ.0b013e3182366b53 PG 5 WC Nursing SC Nursing GA 862TK UT WOS:000298116800001 PM 22124276 ER PT J AU Marquard, JL Zayas-Caban, T AF Marquard, Jenna L. Zayas-Caban, Teresa TI Commercial off-the-shelf consumer health informatics interventions: recommendations for their design, evaluation and redesign SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article AB Objective The goal of this paper is to describe the successful application of a use case-based evaluation approach to guide the effective design, evaluation and redesign of inexpensive, commercial, off-the-shelf consumer health informatics (CHI) interventions. Design Researchers developed four CHI intervention use cases representing two distinct patient populations (patients with diabetes with high blood pressure, post-bariatric surgery patients), two commercial off-the-shelf CHI applications (Microsoft HealthVault, Google Health), and related devices (blood pressure monitor, pedometer, weight scale). Three patient proxies tested each intervention for 10 days. Measurements The patient proxies recorded their challenges while completing use case tasks, rating the severity of each challenge based on how much it hindered their use of the intervention. Two independent evaluators categorized the challenges by human factors domain (physical, cognitive, macroergonomic). Results The use case-based approach resulted in the identification of 122 challenges, with 12% physical, 50% cognitive and 38% macroergonomic. Thirty-nine challenges (32%) were at least moderately severe. Nine of 22 use case tasks (41%) accounted for 72% of the challenges. Limitations The study used two patient proxies and addressed two specific patient populations and low-cost, off-the-shelf CHI interventions, which may not perfectly generalize to a larger number of proxies, actual patient populations, or other CHI interventions. Conclusion CHI designers can employ the use case-based evaluation approach to assess the fit of a CHI intervention with patients' health work, in the context of their daily activities and environment, which would be difficult or impossible to evaluate by laboratory-based studies. C1 [Marquard, Jenna L.] Univ Massachusetts, Engn Lab 219, Dept Mech & Ind Engn, Amherst, MA 01003 USA. [Zayas-Caban, Teresa] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Marquard, JL (reprint author), Univ Massachusetts, Engn Lab 219, Dept Mech & Ind Engn, 160 Governors Dr, Amherst, MA 01003 USA. EM jlmarquard@ecs.umass.edu NR 35 TC 10 Z9 10 U1 4 U2 15 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD JAN PY 2012 VL 19 IS 1 BP 137 EP 142 DI 10.1136/amiajnl-2011-000338 PG 6 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Health Care Sciences & Services; Information Science & Library Science; Medical Informatics SC Computer Science; Health Care Sciences & Services; Information Science & Library Science; Medical Informatics GA 872YT UT WOS:000298848100021 PM 21727206 ER PT J AU Trogdon, JG Finkelstein, EA Feagan, CW Cohen, JW AF Trogdon, Justin G. Finkelstein, Eric A. Feagan, Charles W. Cohen, Joel W. TI State- and Payer-Specific Estimates of Annual Medical Expenditures Attributable to Obesity SO OBESITY LA English DT Article AB The goal of this study is to expand prior analyses by presenting current state-level estimates of the costs of obesity in total and separately for Medicare and Medicaid. Quantifying current Medicare and Medicaid expenditures attributable to obesity is important because high public sector costs of obesity have been a primary motivation for publicly funded obesity prevention efforts at the state level. We also present estimates of the obesity-attributable fraction (OAF) of total, Medicare, and Medicaid expenditures and the percentage of total obesity costs within each state that is funded by the public sector. We used the 2006 Medical Expenditure Panel Survey, nationally representative data that include information on obesity and medical expenditures, to generate an equation that predicts annual medical expenditures as a function of obesity status. We used the 2006 Behavioral Risk Factor Surveillance System, state representative data, and the equation generated from the national model to predict state (and payer within state) expenditures and the fraction of expenditures attributable to obesity for each state. Across states, annual medical expenditures would be between 6.7 and 10.7% lower in the absence of obesity. Between 22% (Virginia) and 55% (Rhode Island) of the state-level costs of obesity are financed by the public sector via Medicare and Medicaid. The high costs of obesity at the state level emphasize the need to prevent and control obesity as a way to manage state medical costs. C1 [Trogdon, Justin G.; Feagan, Charles W.] RTI Int, Publ Hlth Econ Program, Res Triangle Pk, NC 27709 USA. [Finkelstein, Eric A.] Duke NUS Grad Med Sch, Hlth Serv & Syst Res Program, Singapore, Singapore. [Cohen, Joel W.] Agcy Healthcare Res & Qual, Div Social & Econ Res, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Trogdon, JG (reprint author), RTI Int, Publ Hlth Econ Program, Res Triangle Pk, NC 27709 USA. EM jtrogdon@rti.org FU CDC Foundation FX E.A.F. and J.G.T. received external support for this work through a contract with the CDC Foundation. The views expressed in this article are those of the authors, and no official endorsement by the Agency of Healthcare Research and Quality or the US Department of Health and Human Services is intended or should be inferred. NR 15 TC 31 Z9 31 U1 1 U2 12 PU NATURE PUBLISHING GROUP PI NEW YORK PA 75 VARICK ST, 9TH FLR, NEW YORK, NY 10013-1917 USA SN 1930-7381 J9 OBESITY JI Obesity PD JAN PY 2012 VL 20 IS 1 BP 214 EP 220 DI 10.1038/oby.2011.169 PG 7 WC Endocrinology & Metabolism; Nutrition & Dietetics SC Endocrinology & Metabolism; Nutrition & Dietetics GA 866SB UT WOS:000298401400026 PM 21681222 ER PT S AU Zayas-Caban, T Marquard, JL AF Zayas-Caban, Teresa Marquard, Jenna L. BE Augusto, JC Huch, M Kameas, A Maitland, J McCullagh, P Roberts, J Sixsmith, A Wichert, R TI Using Human Factors to Guide the Design and Implementation of Consumer Health Informatics Interventions SO HANDBOOK OF AMBIENT ASSISTED LIVING: TECHNOLOGY FOR HEALTHCARE, REHABILITATION AND WELL-BEING SE Ambient Intelligence and Smart Environments LA English DT Article; Book Chapter DE Consumer health informatics; human factors; design; implementation; evaluation ID TECHNOLOGY AB The use of consumer health informatics (CHI) interventions is proliferating rapidly with little consensus about how CHI interventions should be designed or implemented. While CHI interventions have been shown to improve clinical outcomes, barriers to their use remain. This chapter describes a well-developed conceptual model for program evaluation and suggests how it can be used to guide the design and implementation of CHI interventions, with the goal of supporting the intended outcomes of these interventions and minimizing the unintended outcomes. The chapter then provides an overview of how knowledge from three human factors domains can inform the CHI interventions design and implementation components of the evaluation model. By integrating human factors principles and methods into the evaluation model, developers can reduce barriers to use and minimize resulting unintended consequences of CHI interventions. C1 [Zayas-Caban, Teresa] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Marquard, Jenna L.] Univ Massachusetts, Amherst, MA 01003 USA. RP Zayas-Caban, T (reprint author), Agcy Healthcare Res & Qual, Hlth IT, 540 Gaither Rd,Room 6115, Rockville, MD 20850 USA. EM Teresa.ZayasCaban@ahrq.hhs.gov NR 54 TC 0 Z9 0 U1 0 U2 1 PU IOS PRESS PI AMSTERDAM PA NIEUWE HEMWEG 6B, 1013 BG AMSTERDAM, NETHERLANDS SN 1875-4163 BN 978-1-60750-837-3; 978-1-60750-836-6 J9 AMB INTELL SMART ENV PY 2012 VL 11 BP 22 EP 36 DI 10.3233/978-1-60750-837-3-22 PG 15 WC Computer Science, Artificial Intelligence SC Computer Science GA BC2WQ UT WOS:000351394900004 ER PT J AU Chou, R Croswell, JM Dana, T Bougatsos, C Blazina, I Fu, RW Gleitsmann, K Koenig, HC Lam, C Maltz, A Rugge, JB Lin, K AF Chou, Roger Croswell, Jennifer M. Dana, Tracy Bougatsos, Christina Blazina, Ian Fu, Rongwei Gleitsmann, Ken Koenig, Helen C. Lam, Clarence Maltz, Ashley Rugge, J. Bruin Lin, Kenneth TI Screening for Prostate Cancer: A Review of the Evidence for the US Preventive Services Task Force SO ANNALS OF INTERNAL MEDICINE LA English DT Review ID QUALITY-OF-LIFE; ANDROGEN DEPRIVATION THERAPY; RANDOMIZED CONTROLLED-TRIAL; POPULATION-BASED COHORT; COMPARING RADICAL PROSTATECTOMY; EXTERNAL-BEAM RADIOTHERAPY; FOLLOW-UP; CARDIOVASCULAR-DISEASE; 30-DAY MORTALITY; SYMPTOM BURDEN AB Background: Screening can detect prostate cancer at earlier, asymptomatic stages, when treatments might be more effective. Purpose: To update the 2002 and 2008 U.S. Preventive Services Task Force evidence reviews on screening and treatments for prostate cancer. Data Sources: MEDLINE (2002 to July 2011) and the Cochrane Library Database (through second quarter of 2011). Study Selection: Randomized trials of prostate-specific antigen-based screening, randomized trials and cohort studies of prostatectomy or radiation therapy versus watchful waiting, and large observational studies of perioperative harms. Data Extraction: Investigators abstracted and checked study details and quality using predefined criteria. Data Synthesis: Of 5 screening trials, the 2 largest and highest-quality studies reported conflicting results. One found that screening was associated with reduced prostate cancer-specific mortality compared with no screening in a subgroup of men aged 55 to 69 years after 9 years (relative risk, 0.80 [95% CI, 0.65 to 0.98]; absolute risk reduction, 0.07 percentage point). The other found no statistically significant effect after 10 years (relative risk, 1.1 [CI, 0.80 to 1.5]). After 3 or 4 screening rounds, 12% to 13% of screened men had false-positive results. Serious infections or urine retention occurred after 0.5% to 1.0% of prostate biopsies. There were 3 randomized trials and 23 cohort studies of treatments. One good-quality trial found that prostatectomy for localized prostate cancer decreased risk for prostate cancer-specific mortality compared with watchful waiting through 13 years of follow-up (relative risk, 0.62 [CI, 0.44 to 0.87]; absolute risk reduction, 6.1%). Benefits seemed to be limited to men younger than 65 years. Treating approximately 3 men with prostatectomy or 7 men with radiation therapy instead of watchful waiting would each result in 1 additional case of erectile dysfunction. Treating approximately 5 men with prostatectomy would result in 1 additional case of urinary incontinence. Prostatectomy was associated with perioperative death (about 0.5%) and cardiovascular events (0.6% to 3%), and radiation therapy was associated with bowel dysfunction. Limitations: Only English-language articles were included. Few studies evaluated newer therapies. Conclusion: Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary. Primary Funding Source: Agency for Healthcare Research and Quality. C1 [Chou, Roger] Oregon Hlth & Sci Univ, Mailcode BICC, Portland, OR 97239 USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Hosp Univ Penn, Philadelphia, PA 19104 USA. Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA. Stamford Hosp Ctr Integrat Med & Wellness, Stamford, CT USA. Georgetown Univ, Sch Med, Washington, DC 20017 USA. RP Chou, R (reprint author), Oregon Hlth & Sci Univ, Mailcode BICC, 3181 SW Sam Jackson Pk Rd, Portland, OR 97239 USA. EM chour@ohsu.edu FU Agency for Healthcare Research and Quality [HHSA-290-2007-10057-I-EPC3] FX By the Agency for Healthcare Research and Quality (contract number HHSA-290-2007-10057-I-EPC3, Task Order 3). NR 81 TC 292 Z9 299 U1 4 U2 33 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD DEC 6 PY 2011 VL 155 IS 11 BP 762 EP U94 DI 10.7326/0003-4819-155-11-201112060-00375 PG 22 WC Medicine, General & Internal SC General & Internal Medicine GA 860ZS UT WOS:000297988400005 PM 21984740 ER PT J AU Encinosa, WE Bae, J AF Encinosa, William E. Bae, Jaeyong TI Health Information Technology and Its Effects on Hospital Costs, Outcomes, and Patient Safety SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID ELECTRONIC MEDICAL-RECORDS; PHYSICIAN ORDER ENTRY; ADVERSE EVENTS; ADMINISTRATIVE DATA; ERRORS; CARE; COLORADO; QUALITY; IMPACT; UTAH AB Underlying many reforms in the Patient Protection and Affordable Care Act (ACA) is the use of electronic medical records (EMRs) to help contain costs. We use MarketScan (R) claims data and American Hospital Association information technology (IT) data to examine whether EMRs can contain costs in the ACA's reforms to reduce patient safety events. We find EMRs do not reduce the rate of patient safety events. However, once an event occurs, EMRs reduce death by 34%, readmissions by 39%, and spending by $4,850 (16%), a cost offset of $1.75 per $1 spent on IT capital. Thus, EMRs contain costs by better coordinating care to rescue patients from medical errors once they occur. C1 [Encinosa, William E.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. [Bae, Jaeyong] Emory Univ, Rollins Sch Publ Hlth, Dept Hlth Policy & Management, Atlanta, GA 30322 USA. RP Encinosa, WE (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM william.encinosa@ahrq.hhs.gov FU Agency for Healthcare Research and Quality FX This research was funded by the Agency for Healthcare Research and Quality. NR 58 TC 9 Z9 9 U1 3 U2 12 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 2011 VL 48 IS 4 SI SI BP 288 EP 303 DI 10.5034/inquiryjrnl_48.04.02 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 896BV UT WOS:000300541300004 PM 22397059 ER PT J AU Fee, C Hall, K Morrison, JB Stephens, R Cosby, K Fairbanks, RJ Youngberg, B Lenehan, G Abualenain, J O'Connor, K Wears, R AF Fee, Christopher Hall, Kendall Morrison, J. Bradley Stephens, Robert Cosby, Karen Fairbanks, Rollin (Terry) J. Youngberg, Barbara Lenehan, Gail Abualenain, Jameel O'Connor, Kevin Wears, Robert TI Consensus-based Recommendations for Research Priorities Related to Interventions to Safeguard Patient Safety in the Crowded Emergency Department SO ACADEMIC EMERGENCY MEDICINE LA English DT Article ID LENGTH-OF-STAY; ASSOCIATION; PNEUMONIA; MORTALITY; VISITS; TIME; PAIN AB This article describes the results of the Interventions to Safeguard Safety breakout session of the 2011 Academic Emergency Medicine (AEM) consensus conference entitled Interventions to Assure Quality in the Crowded Emergency Department. Using a multistep nominal group technique, experts in emergency department (ED) crowding, patient safety, and systems engineering defined knowledge gaps and priority research questions related to the maintenance of safety in the crowded ED. Consensus was reached for seven research priorities related to interventions to maintain safety in the setting of a crowded ED. Included among these are: 1) How do routine corrective processes and compensating mechanism change during crowding? 2) What metrics should be used to determine ED safety? 3) How can checklists ensure safer care and what factors contribute to their success or failure? 4) What constitutes safe staffing levels/ratios? 5) How can we align emergency medicine (EM)-specific patient safety issues with national patient safety issues? 6) How can we develop metrics and skills to recognize when an ED is getting close to catastrophic overload conditions? and 7) What can EM learn from experts and modeling from fields outside of medicine to develop innovative solutions? These priorities have the potential to inform future clinical and human factors research and extramural funding decisions related to this important topic. C1 [Fee, Christopher] Univ Calif San Francisco, Dept Emergency Med, San Francisco, CA 94143 USA. [Hall, Kendall] Agcy Healthcare Res & Qual, Rockville, MD USA. [Morrison, J. Bradley] Brandeis Univ, Waltham, MA USA. [Stephens, Robert; Fairbanks, Rollin (Terry) J.; Abualenain, Jameel] Georgetown Univ, Washington, DC USA. [Stephens, Robert; Fairbanks, Rollin (Terry) J.] MedStar Hlth, Columbia, MD USA. [Cosby, Karen] Rush Med Coll, Chicago, IL 60612 USA. Loyola Univ, Chicago, IL 60611 USA. [Lenehan, Gail] Emergency Nurses Assoc, Des Plaines, IL USA. [Lenehan, Gail] Massachusetts Gen Hosp, Boston, MA 02114 USA. [O'Connor, Kevin] Emergency Med Phys, Gastonia, NC USA. [Wears, Robert] Univ Florida, Gainesville, FL USA. RP Fee, C (reprint author), Univ Calif San Francisco, Dept Emergency Med, San Francisco, CA 94143 USA. EM Christopher.Fee@ucsf.edu OI Wears, Robert/0000-0001-9826-954X FU Agency for Healthcare Research and Quality (AHRQ) [1R13HS020139-01]; Robert Wood Johnson Foundation FX Funding for this conference was made possible (in part) by 1R13HS020139-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U. S. Government. This issue of Academic Emergency Medicine is funded by the Robert Wood Johnson Foundation. NR 22 TC 8 Z9 8 U1 0 U2 5 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD DEC PY 2011 VL 18 IS 12 SI SI BP 1283 EP 1288 DI 10.1111/j.1553-2712.2011.01234.x PG 6 WC Emergency Medicine SC Emergency Medicine GA 861IQ UT WOS:000298013000010 PM 22168192 ER PT J AU Henke, RM Marder, WD Friedman, BS Wong, HS AF Henke, Rachel Mosher Marder, William D. Friedman, Bernard S. Wong, Herbert S. TI Geographic Variation: A View From the Hospital Sector SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE variations; hospitals; insurance coverage; Medicare; resource utilization ID MEDICARE; RATES AB Efforts to characterize geographic variation in health care utilization and spending have focused on patterns observed with Medicare data. The authors analyzed the Healthcare Cost and Utilization Project national all-payer data for inpatient stays to assess variation in hospitalizations by age groups and, consequently, to understand how utilization of the Medicare population may differ from the population of other payers. The authors found that the correlation between inpatient discharges and costs per capita for the Medicare-eligible population over 65 and younger age groups increased from moderate to strong with age. These findings suggest examining Medicare inpatient data alone may provide a useful but not comprehensive understanding how hospital utilization and costs vary for the total population. C1 [Henke, Rachel Mosher; Marder, William D.] Thomson Reuters, Cambridge, MA 02140 USA. [Friedman, Bernard S.; Wong, Herbert S.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Henke, RM (reprint author), Thomson Reuters, 150 Cambridge Pk Dr, Cambridge, MA 02140 USA. EM rachel.henke@thomsonreuters.com OI Marder, William/0000-0002-7198-6933 FU Agency for Healthcare Research and Quality FX The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Agency for Healthcare Research and Quality. NR 20 TC 4 Z9 4 U1 1 U2 3 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 DEC PY 2011 VL 68 IS 6 BP 699 EP 711 DI 10.1177/1077558711408325 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 850UR UT WOS:000297225500005 PM 21602194 ER PT J AU Guyatt, GH Oxman, AD Sultan, S Glasziou, P Akl, EA Alonso-Coello, P Atkins, D Kunz, R Brozek, J Montori, V Jaeschke, R Rind, D Dahm, P Meerpohl, J Vist, G Berliner, E Norris, S Falck-Ytter, Y Murad, MH Schunemann, HJ AF Guyatt, Gordon H. Oxman, Andrew D. Sultan, Shahnaz Glasziou, Paul Akl, Elie A. Alonso-Coello, Pablo Atkins, David Kunz, Regina Brozek, Jan Montori, Victor Jaeschke, Roman Rind, David Dahm, Philipp Meerpohl, Joerg Vist, Gunn Berliner, Elise Norris, Susan Falck-Ytter, Yngve Murad, M. Hassan Schuenemann, Holger J. CA GRADE Working Grp TI GRADE guidelines: 9. Rating up the quality of evidence SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Article DE GRADE; Guidelines; Level of evidence; Observational studies; Large effects; Risk of bias ID VASOVAGAL SYNCOPE; RANDOMIZED-TRIAL; THERAPY; PREVENTION; PACEMAKER; SEROCONVERSION; ASSOCIATION; MULTICENTER; MORTALITY; DISEASE AB The most common reason for rating up the quality of evidence is a large effect. GRADE suggests considering rating up quality of evidence one level when methodologically rigorous observational studies show at least a two-fold reduction or increase in risk, and rating up two levels for at least a five-fold reduction or increase in risk. Systematic review authors and guideline developers may also consider rating up quality of evidence when a dose-response gradient is present, and when all plausible confounders or biases would decrease an apparent treatment effect, or would create a spurious effect when results suggest no effect. Other considerations include the rapidity of the response, the underlying trajectory of the condition, and indirect evidence. (C) 2011 Elsevier Inc. All rights reserved. C1 [Guyatt, Gordon H.] McMaster Univ, Dept Clin Epidemiol & Biostat, CLARITY Res Grp, W Hamilton, ON L8N 3Z5, Canada. [Guyatt, Gordon H.; Jaeschke, Roman; Schuenemann, Holger J.] McMaster Univ, Dept Med, W Hamilton, ON L8N 3Z5, Canada. [Oxman, Andrew D.; Vist, Gunn] Norwegian Knowledge Ctr Hlth Serv, N-0130 Oslo, Norway. [Sultan, Shahnaz] Univ Florida, Dept Med, Div Gastroenterol Hepatol & Nutr, Gainesville, FL USA. [Glasziou, Paul] Bond Univ, Fac Hlth Sci, Ctr Res Evidence Based Practice, Gold Coast, Qld 4229, Australia. [Akl, Elie A.] SUNY Buffalo, Dept Med, Buffalo, NY 14260 USA. [Alonso-Coello, Pablo] Univ Autonoma Barcelona, Iberoamer Cochrane Ctr, Serv Epidemiol Clin & Salud Publ, Barcelona 08041, Spain. [Alonso-Coello, Pablo] Univ Autonoma Barcelona, Hosp St Pau, CIBERESP, Barcelona 08041, Spain. [Atkins, David] US EPA, Off Res & Dev, QUERI Program, Dept Vet Affairs, Washington, DC 20460 USA. [Kunz, Regina] Univ Basel Hosp, Acad Swiss Insurance Med, CH-4031 Basel, Switzerland. [Kunz, Regina] Univ Basel Hosp, Basel Inst Clin Epidemiol, CH-4031 Basel, Switzerland. [Montori, Victor; Murad, M. Hassan] Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN USA. [Rind, David] Harvard Univ, Sch Med, Boston, MA USA. [Rind, David] UpToDate, Boston, MA USA. [Dahm, Philipp] Univ Florida, Dept Urol, Gainesville, FL USA. [Meerpohl, Joerg] Univ Med Ctr Freiburg, Inst Med Biometry & Med Informat, German Cochrane Ctr, D-79104 Freiburg, Germany. [Meerpohl, Joerg] Univ Med Ctr Freiburg, Dept Pediat & Adolescent Med, Div Pediat Hematol & Oncol, D-79106 Freiburg, Germany. [Berliner, Elise] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Technol Assessment Program, Rockville, MD 20850 USA. [Norris, Susan] Oregon Hlth & Sci Univ, Dept Med Informat & Clin Epidemiol, Portland, OR 97239 USA. [Falck-Ytter, Yngve] Case Western Reserve Univ, Div Gastroenterol, Case & VA Med Ctr, Cleveland, OH 44106 USA. RP Guyatt, GH (reprint author), McMaster Univ, Dept Clin Epidemiol & Biostat, CLARITY Res Grp, Room 2C12,1200 Main St, W Hamilton, ON L8N 3Z5, Canada. EM guyatt@mcmaster.ca RI Meerpohl, Joerg/J-4224-2013; Glasziou, Paul/A-7832-2008; OI Meerpohl, Joerg/0000-0002-1333-5403; Glasziou, Paul/0000-0001-7564-073X; Murad, Mohammad Hassan/0000-0001-5502-5975; Montori, Victor/0000-0003-0595-2898 NR 28 TC 239 Z9 245 U1 3 U2 14 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 DEC PY 2011 VL 64 IS 12 BP 1311 EP 1316 DI 10.1016/j.jclinepi.2011.06.004 PG 6 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 847TI UT WOS:000296995000009 PM 21802902 ER PT J AU Brousseau, DC Steiner, CA Owens, P Mosso, A Panepinto, JA AF Brousseau, David C. Steiner, Claudia A. Owens, Pamela Mosso, Andrew Panepinto, Julie A. TI Emergency Department Treat-and-Release Visits for Sickle Cell Disease: A sIgn of acute events to come SO BLOOD LA English DT Meeting Abstract CT 53rd Annual Meeting and Exposition of the American-Society-of-Hematology (ASH)/Symposium on the Basic Science of Hemostasis and Thrombosis CY DEC 10-13, 2011 CL San Diego, CA SP Amer Soc Hematol (ASH) C1 [Brousseau, David C.; Panepinto, Julie A.] Med Coll Wisconsin, Childrens Hosp Wisconsin, Childrens Res Inst, Milwaukee, WI 53226 USA. [Steiner, Claudia A.; Owens, Pamela] Agcy Healthcare Res & Qual, Rockville, MD USA. [Mosso, Andrew] Social & Sci Syst Inc, Silver Spring, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU AMER SOC HEMATOLOGY PI WASHINGTON PA 1900 M STREET. NW SUITE 200, WASHINGTON, DC 20036 USA SN 0006-4971 J9 BLOOD JI Blood PD NOV 18 PY 2011 VL 118 IS 21 BP 83 EP 83 PG 1 WC Hematology SC Hematology GA 882XL UT WOS:000299597100170 ER PT J AU Spector, WD Limcangco, R Mukamel, DB AF Spector, W. D. Limcangco, R. Mukamel, D. B. TI NURSING HOME OWNERSHIP: DIFFERENCES IN COSTS AND RESPONSE TO MARKET CHARACTERISTICS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Spector, W. D.] AHRQ, CDOM, Rockville, MD USA. [Limcangco, R.] Univ Calif Irvine, Irvine, CA USA. [Mukamel, D. B.] Social & Sci Syst, Silver Spring, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD NOV PY 2011 VL 51 SU 2 BP 207 EP 207 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 936PH UT WOS:000303602001259 ER PT J AU Resnick, HE Fielding, R Guralnik, J Spector, W Limcangco, R Parker, L Griswold, M Foster, GL AF Resnick, H. E. Fielding, R. Guralnik, J. Spector, W. Limcangco, R. Parker, L. Griswold, M. Foster, G. L. TI RESULTS OF THE STAYING HEALTHY THROUGH EDUCATION AND PREVENTION (STEP) STUDY SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Resnick, H. E.; Foster, G. L.] Amer Assoc Homes & Serv Aging, Washington, DC USA. [Fielding, R.] Tufts Univ, Boston, MA 02111 USA. [Spector, W.; Limcangco, R.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Parker, L.] Evangel Lutheran Good Samaritan Soc, Sioux Falls, SD USA. [Guralnik, J.] NIA, Bethesda, MD 20892 USA. [Resnick, H. E.] Georgetown Univ, Washington, DC USA. [Griswold, M.] Univ Mississippi, Oxford, MS USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD NOV PY 2011 VL 51 SU 2 BP 369 EP 369 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 936PH UT WOS:000303602002338 ER PT J AU Chang, SM AF Chang, Stephanie M. TI The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care (EHC) Program Methods Guide for Comparative Effectiveness Reviews: keeping up-to-date in a rapidly evolving field SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Review ID MEDICAL INTERVENTIONS AHRQ C1 AHRQ, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Chang, SM (reprint author), AHRQ, Ctr Outcomes & Evidence, 540 Gaither Rd,6228, Rockville, MD 20850 USA. EM Stephanie.chang@ahrq.gov NR 12 TC 4 Z9 4 U1 0 U2 4 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 NOV PY 2011 VL 64 IS 11 BP 1166 EP 1167 DI 10.1016/j.jclinepi.2011.08.004 PG 2 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 829SQ UT WOS:000295605000002 PM 21959053 ER PT J AU Norris, SL Atkins, D Bruening, W Fox, S Johnson, E Kane, R Morton, SC Oremus, M Ospina, M Randhawa, G Schoelles, K Shekelle, P Viswanathan, M AF Norris, Susan L. Atkins, David Bruening, Wendy Fox, Steven Johnson, Eric Kane, Robert Morton, Sally C. Oremus, Mark Ospina, Maria Randhawa, Gurvaneet Schoelles, Karen Shekelle, Paul Viswanathan, Meera TI Observational studies in systemic reviews of comparative effectiveness: AHRQ and the Effective Health Care Program SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Review DE Observational studies; Systematic reviews; Meta-analyses; Treatment outcome; Evidence-based medicine; Research design ID RANDOMIZED-TRIALS; QUALITY; INTERVENTIONS; STRENGTH; RECOMMENDATIONS; METAANALYSES; EPIDEMIOLOGY; INDIVIDUALS; CHALLENGES; OUTCOMES AB Objective: Systematic reviewers disagree about the ability of observational studies to answer questions about the benefits or intended effects of pharmacotherapeutic, device, or procedural interventions. This study provides a framework for decision making on the inclusion of observational studies to assess benefits and intended effects in comparative effectiveness reviews (CERs). Study Design and Setting: The conceptual model and recommendations were developed using a consensus process by members of the methods workgroup of the Effective Health Care Program of the Agency for Healthcare Research and Quality. Results: In considering whether to use observational studies in CERs for addressing beneficial effects, reviewers should answer two questions: (1) Are there gaps in the evidence from randomized controlled trials (RCTs)? (2) Will observational studies provide valid and useful information? The latter question involves the following: (a) refocusing the study questions on gaps in the evidence from RCTs, (b) assessing the risk of bias of the body of evidence of observational studies, and (c) assessing whether available observational studies address the gap review questions. Conclusions: Because it is unusual to find sufficient evidence from RCTs to answer all key questions concerning benefit or the balance of benefits and harms, comparative effectiveness reviewers should routinely assess the appropriateness of inclusion of observational studies for questions of benefit. Furthermore, reviewers should explicitly state the rationale for inclusion or exclusion of observational studies when conducting CERs. (C) 2011 Elsevier Inc. All rights reserved. C1 [Norris, Susan L.] Oregon Hlth & Sci Univ, Dept Med Informat & Clin Epidemiol, Portland, OR 97239 USA. [Atkins, David] VA Qual Enhancement Res Initiat QUERI, Washington, DC 20420 USA. [Bruening, Wendy; Schoelles, Karen] ECRI Inst, Plymouth Meeting, PA 19462 USA. [Fox, Steven; Randhawa, Gurvaneet] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Johnson, Eric] Kaiser Permanente NW, Ctr Hlth Res, Portland, OR 97227 USA. [Johnson, Eric] Oregon Evidence Based Practice Ctr, Portland, OR 97227 USA. [Kane, Robert] Minnesota Evidence Based Practice Ctr, Minneapolis, MN 55455 USA. [Morton, Sally C.; Viswanathan, Meera] RTI Int, Res Triangle Pk, NC 27709 USA. [Oremus, Mark] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8S 4L8, Canada. [Ospina, Maria] Univ Alberta, Evidence Based Practice Ctr, Edmonton, AB T6G 2R3, Canada. [Shekelle, Paul] RAND Corp, So Calif Evidence Based Practice Ctr, Santa Monica, CA 90407 USA. RP Norris, SL (reprint author), Oregon Hlth & Sci Univ, Dept Med Informat & Clin Epidemiol, 3181 SW Sam Jackson Pk Rd, Portland, OR 97239 USA. EM norriss@ohsu.edu OI Ospina, Maria/0000-0002-1627-4781; Ospina, Maria/0000-0001-9305-7521 NR 33 TC 25 Z9 27 U1 1 U2 4 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 NOV PY 2011 VL 64 IS 11 BP 1178 EP 1186 DI 10.1016/j.jclinepi.2010.04.027 PG 9 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 829SQ UT WOS:000295605000004 PM 21636246 ER PT J AU Fe, RW Gartlehner, G Grant, M Shamliyan, T Sedrakyan, A Wilt, TJ Griffith, L Oremus, M Raina, P Ismaila, A Santaguida, P Lau, J Trikalinos, TA AF Fe, Rongwei Gartlehner, Gerald Grant, Mark Shamliyan, Tatyana Sedrakyan, Art Wilt, Timothy J. Griffith, Lauren Oremus, Mark Raina, Parminder Ismaila, Afisi Santaguida, Pasqualina Lau, Joseph Trikalinos, Thomas A. TI Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Article DE Meta-analysis; Indirect comparison; Effect measure; Fixed/random effects model; Heterogeneity; Mixed design ID MIXED TREATMENT COMPARISONS; RANDOM-EFFECTS METAANALYSIS; CLINICAL-TRIALS; MYOCARDIAL-INFARCTION; COMPETING INTERVENTIONS; TREATMENT EFFICACY; META-REGRESSION; RARE EVENTS; SPARSE DATA; ROSIGLITAZONE AB Objective: This article is to establish recommendations for conducting quantitative synthesis, or meta-analysis, using study-level data in comparative effectiveness reviews (CERs) for the Evidence-based Practice Center (EPC) program of the Agency for Healthcare Research and Quality. Study Design and Setting: We focused on recurrent issues in the EPC program and the recommendations were developed using group discussion and consensus based on current knowledge in the literature. Results: We first discussed considerations for deciding whether to combine studies, followed by discussions on indirect comparison and incorporation of indirect evidence. Then, we described our recommendations on choosing effect measures and statistical models, giving special attention to combining studies with rare events; and on testing and exploring heterogeneity. Finally, we briefly presented recommendations on combining studies of mixed design and on sensitivity analysis. Conclusion: Quantitative synthesis should be conducted in a transparent and consistent way. Inclusion of multiple alternative interventions in CERs increases the complexity of quantitative synthesis, whereas the basic issues in quantitative synthesis remain crucial considerations in quantitative synthesis for a CER. We will cover more issues in future versions and update and improve recommendations with the accumulation of new research to advance the goal for transparency and consistency. (C) 2011 Elsevier Inc. All rights reserved. C1 [Fe, Rongwei] Oregon Hlth & Sci Univ, Oregon Evidence Based Practice Ctr, Dept Publ Hlth & Prevent Med, Portland, OR 97239 USA. [Gartlehner, Gerald] Danube Univ, Dept Evidence Based Med & Clin Epidemiol, A-3500 Krems, Austria. [Grant, Mark] Blue Cross Blue Shield Assoc, Technol Evaluat Ctr, Chicago, IL USA. [Wilt, Timothy J.] Univ Minnesota, Dept Med, Minneapolis, MN 55455 USA. [Sedrakyan, Art] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Wilt, Timothy J.] Minnesota Evidence Based Practice Ctr, Ctr Chron Dis Outcomes Res, Minneapolis, MN USA. [Shamliyan, Tatyana] Univ Minnesota, Div Hlth Policy & Management, Minnesota Evidence Based Practice Ctr, Minneapolis, MN 55455 USA. [Griffith, Lauren; Oremus, Mark; Raina, Parminder; Ismaila, Afisi; Santaguida, Pasqualina] McMaster Univ, Dept Clin Epidemiol & Biostat, McMaster Evidence Based Practice Ctr, Hamilton, ON, Canada. [Lau, Joseph; Trikalinos, Thomas A.] Tufts Med Ctr, Tufts Evidence Based Practice Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA USA. [Lau, Joseph; Trikalinos, Thomas A.] Tufts Med Ctr, Ctr Clin Evidence Synth, Inst Clin Res & Hlth Policy Studies, Boston, MA USA. RP Fe, RW (reprint author), Oregon Hlth & Sci Univ, Oregon Evidence Based Practice Ctr, Dept Publ Hlth & Prevent Med, 3181 SW Sam Jackson Pk Rd, Portland, OR 97239 USA. EM fur@ohsu.edu OI Gartlehner, Gerald/0000-0001-5531-3678 FU U.S. Agency for Healthcare Research and Quality FX This article was written with support from the Effective Health Care Program at the U.S. Agency for Healthcare Research and Quality. NR 62 TC 0 Z9 0 U1 3 U2 8 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0895-4356 EI 1878-5921 J9 J CLIN EPIDEMIOL JI J. Clin. Epidemiol. PD NOV PY 2011 VL 64 IS 11 BP 1187 EP 1197 DI 10.1016/j.jclinepi.2010.08.010 PG 11 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 829SQ UT WOS:000295605000005 ER PT J AU Atkins, D Chang, SM Gartlehner, G Buckley, DI Whitlock, EP Berliner, E Matchar, D AF Atkins, David Chang, Stephanie M. Gartlehner, Gerald Buckley, David I. Whitlock, Evelyn P. Berliner, Elise Matchar, David TI Assessing applicability when comparing medical interventions: AHRQ and the Effective Health Care Program SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Article DE Applicability; Generalizability; External validity; Heterogeneity of treatment effect; Comparative effectiveness; Systematic review ID RANDOMIZED CONTROLLED-TRIALS; CLINICAL-TRIALS; EXTERNAL VALIDITY; EFFICACY; QUALITY; WOMEN; RISK; TOOL AB Objective: To describe a systematic approach for identifying, reporting, and synthesizing information to allow consistent and transparent consideration of the applicability of the evidence in a systematic review according to the Population, Intervention, Comparator. Outcome, Setting domains. Study Design and Setting: Comparative effectiveness reviews need to consider whether available evidence is applicable to specific clinical or policy questions to be useful to decision makers. Authors reviewed the literature and developed guidance for the Effective Health Care program. Results: Because applicability depends on the specific questions and needs of the users, it is difficult to devise a valid uniform scale for rating the overall applicability of individual studies or body of evidence. We recommend consulting stakeholders to identify the factors most relevant to applicability for their decisions. Applicability should be considered separately for benefits and harms. Observational studies can help determine whether trial populations and interventions are representative of "real world" practice. Reviewers should describe differences between available evidence and the ideally applicable evidence for the question being asked and offer a qualitative judgment about the importance and potential effect of those differences. Conclusion: Careful consideration of applicability may improve the usefulness of systematic reviews in informing practice and policy. Published by Elsevier Inc. C1 [Chang, Stephanie M.; Berliner, Elise] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. [Atkins, David] US EPA, Off Res & Dev, Dept Vet Affairs, Hlth Serv Res & Dev, Washington, DC 20460 USA. [Gartlehner, Gerald] Danube Univ, Dept Evidence Based Med & Clin Epidemiol, Krems, Austria. [Buckley, David I.] Oregon Hlth & Sci Univ, Oregon Evidence Based Practice Ctr, Portland, OR 97201 USA. [Whitlock, Evelyn P.] Kaiser Permanente NW, Ctr Hlth Res, Oregon Evidence Based Practice Ctr, Portland, OR USA. [Matchar, David] Duke Ctr Clin Hlth Policy Res, Durham, NC USA. [Matchar, David] Duke NUS Med Sch, Singapore, Singapore. RP Chang, SM (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM stephanie.chang@ahrq.hhs.gov OI Matchar, David/0000-0003-3020-2108; Gartlehner, Gerald/0000-0001-5531-3678 FU Agency for Healthcare Research and Quality FX Funding support from the Agency for Healthcare Research and Quality's Effective Health Care Program. NR 42 TC 21 Z9 22 U1 0 U2 0 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 NOV PY 2011 VL 64 IS 11 BP 1198 EP 1207 DI 10.1016/j.jclinepi.2010.11.021 PG 10 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 829SQ UT WOS:000295605000006 PM 21463926 ER PT J AU Lugtenberg, M Burgers, JS Clancy, C Westert, GP Schneider, EC AF Lugtenberg, Marjolein Burgers, Jako S. Clancy, Carolyn Westert, Gert P. Schneider, Eric C. TI Current Guidelines Have Limited Applicability to Patients with Comorbid Conditions: A Systematic Analysis of Evidence-Based Guidelines SO PLOS ONE LA English DT Article ID MULTIPLE CHRONIC CONDITIONS; CLINICAL GUIDELINES; CARE; QUALITY; HEALTH; PREVALENCE; DISEASES; RECOMMENDATIONS; PERFORMANCE; ABSENCE AB Background: Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. Methodology/Principal Findings: We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. Conclusions/Significance: Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions. C1 [Lugtenberg, Marjolein; Westert, Gert P.] Tilburg Univ, Sci Ctr Care & Welf Tranzo, NL-5000 LE Tilburg, Netherlands. [Lugtenberg, Marjolein; Burgers, Jako S.; Westert, Gert P.] Radboud Univ Nijmegen, Med Ctr, Sci Inst Qual Healthcare IQ Healthcare, NL-6525 ED Nijmegen, Netherlands. [Burgers, Jako S.] Dutch Coll Gen Practitioners NHG, Utrecht, Netherlands. [Clancy, Carolyn] AHRQ, Rockville, MD USA. [Schneider, Eric C.] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Schneider, Eric C.] RAND Corp, Boston, MA USA. [Schneider, Eric C.] Brigham & Womens Hosp, Div Gen Med & Primary Care, Boston, MA 02115 USA. RP Lugtenberg, M (reprint author), Tilburg Univ, Sci Ctr Care & Welf Tranzo, NL-5000 LE Tilburg, Netherlands. EM m.lugtenberg@iq.umcn.nl RI Westert, G.P./H-8115-2014; OI Schneider, Eric/0000-0002-1132-5084 FU The Commonwealth Fund FX Support was provided by The Commonwealth Fund (http://www.commonwealthfund.org/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff. NR 30 TC 68 Z9 69 U1 1 U2 6 PU PUBLIC LIBRARY SCIENCE PI SAN FRANCISCO PA 185 BERRY ST, STE 1300, SAN FRANCISCO, CA 94107 USA SN 1932-6203 J9 PLOS ONE JI PLoS One PD OCT 20 PY 2011 VL 6 IS 10 AR e25987 DI 10.1371/journal.pone.0025987 PG 7 WC Multidisciplinary Sciences SC Science & Technology - Other Topics GA 841KI UT WOS:000296510800013 PM 22028802 ER PT J AU Januel, JM Couris, CM Luthi, JC Halfon, P Trombert-Paviot, B Quan, H Drosler, S Sundararajan, V Pradat, E Touzet, S Wen, E Shepheard, J Webster, G Romano, PS So, L Moskal, L Tournay-Lewis, L Sundaresan, L Kelley, E Klazinga, N Ghali, WA Colin, C Burnand, B AF Januel, J. -M. Couris, C. -M Luthi, J. -C. Halfon, P. Trombert-Paviot, B. Quan, H. Drosler, S. Sundararajan, V. Pradat, E. Touzet, S. Wen, E. Shepheard, J. Webster, G. Romano, P. S. So, L. Moskal, L. Tournay-Lewis, L. Sundaresan, L. Kelley, E. Klazinga, N. Ghali, W. A. Colin, C. Burnand, B. CA Investigateurs Grp Int Methodology TI ICD-10 adaptation of 15 Agency for Healthcare Research and Quality patient safety indicators SO REVUE D EPIDEMIOLOGIE ET DE SANTE PUBLIQUE LA French DT Article DE Patient safety; Indicators; Adverse events; Health services research; International classification of disease codes; ICD-9-CM; ICD-10 ID EUROPEAN HAEMOVIGILANCE NETWORK; PREVENTABLE ADVERSE EVENTS; PATIENTS AFTER-DISCHARGE; ADMINISTRATIVE DATA; HOSPITALIZED-PATIENTS; MEDICAL-RECORDS; INFECTION-CONTROL; SURVEILLANCE; IMPACT; PHARMACOVIGILANCE AB Background. - in the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed 20 Patient Safety Indicators (PSIs) to measure the occurrence of hospital adverse events from medico-administrative data coded according to the ninth revision of the international classification of disease (ICD-9-CM). The adaptation of these PSIs to the WHO version of ICD-10 was carried out by an international consortium. Methods. - Two independent teams transcoded ICD-9-CM diagnosis codes proposed by the AHRQ into ICD-10-WHO. Using a Delphi process, experts from six countries evaluated each code independently, stating whether it was "included", "excluded" or "uncertain". During a two-day meeting, the experts then discussed the codes that had not obtained a consensus, and the additional codes proposed. Results. - Fifteen PSIs were adapted. Among the 2569 proposed diagnosis codes, 1775 were unanimously adopted straightaway. The 794 remaining codes and 2541 additional codes were discussed. Three documents were prepared: (1) a list of ICD-10-WHO codes for the 15 adapted PSIs; (2) recommendations to the AHRQ for the improvement of the nosological frame and the coding of PSI with ICD-9-CM; (3) recommendations to the WHO to improve ICD-10. Conclusions. This work allows international comparisons of PSIs among the countries using ICD-10. Nevertheless, these PSIs must still be evaluated further before being broadly used. (C) 2011 Elsevier Masson SAS. All rights reserved. C1 [Januel, J. -M.; Couris, C. -M; Pradat, E.; Touzet, S.; Colin, C.] Hosp Civils Lyon, F-69424 Lyon 03, France. [Januel, J. -M.; Couris, C. -M; Touzet, S.; Colin, C.] Univ Lyon 1, EA 4129, Sante Individu Soc, F-69002 Lyon, France. [Januel, J. -M.; Luthi, J. -C.; Halfon, P.; Burnand, B.] Univ Lausanne, CHU Vaudois, Inst Univ Med Sociale & Prevent, Unite Evaluat Soins, CH-1005 Lausanne, Switzerland. [Trombert-Paviot, B.] CHU St Etienne, Dept Sante Publ & Informat Med, F-42000 St Etienne, France. [Quan, H.; So, L.; Ghali, W. A.] Univ Calgary, Ctr Hlth & Policy Studies, Calgary, AB, Canada. [Drosler, S.] Niederrhein Univ Appl Sci, Krefeld, Germany. [Sundararajan, V.; Sundaresan, L.] Dept Human Serv, Melbourne, Vic, Australia. [Wen, E.; Shepheard, J.; Webster, G.; Moskal, L.; Tournay-Lewis, L.] Inst Canadien Informat Sante, Toronto, ON, Canada. [Romano, P. S.] Univ Calif Davis, Sch Med, Davis, CA 95616 USA. [Kelley, E.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Klazinga, N.] OCDE, F-75775 Paris, France. RP Januel, JM (reprint author), Hosp Civils Lyon, 162 Ave Lacassagne, F-69424 Lyon 03, France. EM Jean-Marie.Januel@chuv.ch RI Hemmelgarn, Brenda/I-6894-2012; Romano, Patrick/N-4225-2014; Januel, Jean-Marie/P-9121-2015 OI Romano, Patrick/0000-0001-6749-3979; NR 81 TC 0 Z9 0 U1 2 U2 11 PU MASSON EDITEUR PI MOULINEAUX CEDEX 9 PA 21 STREET CAMILLE DESMOULINS, ISSY, 92789 MOULINEAUX CEDEX 9, FRANCE SN 0398-7620 J9 REV EPIDEMIOL SANTE JI Rev. Epidemiol. Sante Publique PD OCT PY 2011 VL 59 IS 5 BP 341 EP 350 DI 10.1016/j.respe.2011.04.004 PG 10 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 853PJ UT WOS:000297437900008 PM 21899967 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Kidney-related Diseases and Quality Improvement: AHRQ's Role SO CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM carolin.clancy@ahrq.hhs.gov NR 7 TC 2 Z9 2 U1 0 U2 1 PU AMER SOC NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1555-9041 J9 CLIN J AM SOC NEPHRO JI Clin. J. Am. Soc. Nephrol. PD OCT PY 2011 VL 6 IS 10 BP 2531 EP 2533 DI 10.2215/CJN.05880611 PG 3 WC Urology & Nephrology SC Urology & Nephrology GA 830KX UT WOS:000295657000029 PM 21836151 ER PT J AU Watt, AM Elshaug, AG Willis, CD Hiller, JE AF Watt, Amber M. Elshaug, Adam G. Willis, Cameron D. Hiller, Janet E. CA ASTUTE Hlth Study Grp TI Assisted reproductive technologies: A systematic review of safety and effectiveness to inform disinvestment policy SO HEALTH POLICY LA English DT Review DE Review; systematic; Reproductive techniques; assisted; Health policy; Disinvestment ID IN-VITRO FERTILIZATION; INTRACYTOPLASMIC SPERM INJECTION; CUMULATIVE PREGNANCY RATES; LIVE-BIRTH-RATES; OOCYTE DONATION PROGRAM; FEMALE AGE; RELEVANT STANDARD; EMBRYO-TRANSFER; REPEATED CYCLES; RETROSPECTIVE ANALYSIS AB Objective: Health policy relating to assisted reproductive technologies (ART) has been variably informed by clinical evidence, social values, political and fiscal considerations. This systematic review examined key factors associated with specific benefits and harms of ART to inform the development of a model for generating policy recommendations within an Australian disinvestment research agenda. Methods: Six databases were searched from 1994 to 2009. Included articles contained data on safety and/or effectiveness of in vitro fertilisation (IVF) or IVF with intracytoplasmic sperm injection with reference to female age, male age or cycle rank. Narrative descriptions of key outcomes (live birth, miscarriage) were constructed alongside tabular summaries. Results: Sixty-eight studies and one registry report were included. There was substantial heterogeneity present within the evidence-base which limited the strength and scope of conclusions that could be drawn. However, this review does affirm the differential effectiveness associated with the ageing of ART patients with regard to live birth and miscarriage. Conclusion: From the available evidence, it was not possible to determine an explicit age or cycle rank that could be used to formulate defensible policy responsive to identified differential effectiveness. Stakeholder interpretation of this evidence-base may assist in developing policy that can incorporate uncertainty and reflect social values. (C) 2011 Elsevier Ireland Ltd. All rights reserved. C1 [Hiller, Janet E.] Australian Catholic Univ, Fac Hlth Sci, Fitzroy MDC, Fitzroy, Vic 3065, Australia. [Watt, Amber M.; Elshaug, Adam G.; Willis, Cameron D.; Hiller, Janet E.] Univ Adelaide, Sch Populat Hlth & Clin Practice, Adelaide, SA 5005, Australia. [Elshaug, Adam G.] AHRQ, Ctr Outcomes & Evidence, Rockville, MD USA. RP Hiller, JE (reprint author), Australian Catholic Univ, Fac Hlth Sci, Fitzroy MDC, Locked Bag 4115, Fitzroy, Vic 3605, Australia. EM amber.watt@adelaide.edu.au; adam.elshaug@adelaide.edu.au; cameron.willis@adelaide.edu.au; janet.hiller@acu.edu.au RI Braunack-Mayer, Annette/A-7964-2008; Hiller, Janet/A-5633-2008; Elshaug, Adam/A-5714-2008; Merlin, Tracy/A-9789-2012; OI Braunack-Mayer, Annette/0000-0003-4427-0224; Hiller, Janet/0000-0002-8532-4033; Merlin, Tracy/0000-0002-7293-4262; Elshaug, Adam/0000-0002-4939-5379 FU National Health and Medical Research Council of Australia (NHMRC) [565327] FX The ASTUTE Health study is funded by the National Health and Medical Research Council of Australia (NHMRC Grant ID 565327), who had no role in determining study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. NR 102 TC 8 Z9 9 U1 1 U2 8 PU ELSEVIER IRELAND LTD PI CLARE PA ELSEVIER HOUSE, BROOKVALE PLAZA, EAST PARK SHANNON, CO, CLARE, 00000, IRELAND SN 0168-8510 J9 HEALTH POLICY JI Health Policy PD OCT PY 2011 VL 102 IS 2-3 BP 200 EP 213 DI 10.1016/j.healthpol.2011.07.007 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 831BR UT WOS:000295704200011 PM 21868120 ER PT J AU Yehia, BR Fleishman, JA Wilson, L Hicks, PL Gborkorquellie, TT Gebo, KA AF Yehia, B. R. Fleishman, J. A. Wilson, L. Hicks, P. L. Gborkorquellie, T. T. Gebo, K. A. CA HIV Res Network TI Incidence of and risk factors for bacteraemia in HIV-infected adults in the era of highly active antiretroviral therapy SO HIV MEDICINE LA English DT Article DE bacteraemia; highly active antiretroviral therapy; HIV; Staphylococcus aureus ID RESISTANT STAPHYLOCOCCUS-AUREUS; HUMAN-IMMUNODEFICIENCY-VIRUS; BLOOD-STREAM INFECTIONS; HOSPITALIZED-PATIENTS; MRSA BACTEREMIA; AIDS PATIENTS; DRUG-USERS; HAART ERA; MORTALITY; COHORT AB Background HIV-infected patients have an increased risk for bacteraemia compared with HIV-negative patients. Few data exist on the incidence of and risk factors for bacteraemia across time in the current era of highly active antiretroviral therapy (HAART). Methods We assessed the incidence of bacteraemia among patients followed between 2000 and 2008 at 10 HIV Research Network sites. This large multisite, multistate clinical cohort study collected demographic, clinical and therapeutic data longitudinally. International Statistical Classification of Diseases and Related Health Problems (ICD)-9 codes were examined to identify all cases of in-patient bacteraemia. Logistic regression analysis was used to assess risk factors for bacteraemia and trends over time in the odds of bacteraemia. Results A total of 39 318 patients were followed for 146 289 person-years (PY). During the study period, there were 2025 episodes of bacteraemia (incidence 13.8 events/1000 PY). The most common bacteraemia diagnosis was 'bacteraemia, not otherwise specified (NOS)' (51%) followed by Staphylococcus aureus (16%) and Streptococcus species (6.5%). In multivariate analysis, the likelihood of bacteraemia was found to have increased in 2005-2008, compared with 2000. Other factors associated with higher odds of bacteraemia included a history of injection drug use (IDU), age >= 50 years, Black race and greater immunosuppression. Conclusions The likelihood of bacteraemia has risen slightly in recent years. Patients who are Black or have a history of IDU are at higher risk. Further research is needed to identify reasons for this increase and to evaluate programmes designed to reduce the bacteraemia risk. C1 [Yehia, B. R.] Univ Penn, Sch Med, Dept Med, Philadelphia, PA 19104 USA. [Fleishman, J. A.] Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD USA. [Wilson, L.; Hicks, P. L.; Gebo, K. A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Gborkorquellie, T. T.] George Washington Univ, Sch Med, Washington, DC USA. RP Yehia, BR (reprint author), Univ Penn, Sch Med, Dept Med, 3400 Spruce St,3 Silverstein,Suite E, Philadelphia, PA 19104 USA. EM byehia@upenn.edu FU Agency for Healthcare Research and Quality [290-01-0012]; National Institute on Drug Abuse [K23-DA00523]; National Institute on Aging [R01 AG026250]; Johns Hopkins University; Johns Hopkins University School of Arts and Sciences; Agency for Healthcare Research and Quality, Rockville, MD; Health Resources and Services Administration, Rockville, MD FX The study was supported by the Agency for Healthcare Research and Quality (290-01-0012) and the National Institutes on Drug Abuse (K23-DA00523) and Aging (R01 AG026250). KAG also received support from the Johns Hopkins University Richard S. Ross Clinician Scientist Award. TTG received support from the Woodrow Wilson Research Fellowship Program from Johns Hopkins University School of Arts and Sciences.; Sponsoring agencies: Agency for Healthcare Research and Quality, Rockville, MD (Fred Hellinger, PhD, John Fleishman, PhD and Irene Fraser, PhD); Health Resources and Services Administration, Rockville, MD (Alice Kroliczak, PhD and Robert Mills, PhD). NR 29 TC 9 Z9 10 U1 0 U2 4 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1464-2662 J9 HIV MED JI HIV Med. PD OCT PY 2011 VL 12 IS 9 BP 535 EP 543 DI 10.1111/j.1468-1293.2011.00919.x PG 9 WC Infectious Diseases SC Infectious Diseases GA 825JX UT WOS:000295270800003 PM 21429066 ER PT J AU Vistnes, J Monheit, AC AF Vistnes, Jessica Monheit, Alan C. TI The Health Insurance Status of Low-Wage Workers: The Role of Workplace Composition and Marital Status SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE health insurance; low-wage workers; employment-related coverage ID PREFERENCES; COVERAGE AB Many of the provisions in the Affordable Care Act (ACA), such as tax credits and penalties for employers, vary by employer size and average wage level. Therefore, knowing the wage and firm size distribution of low-wage workers and how employer-sponsored insurance (ESI) characteristics vary by these dimensions is particularly important for understanding the extent to which low-wage workers and their employers may be affected by different provisions in the ACA. To inform this issue, the authors use data from the 2006 Medical Expenditure Panel Survey-Insurance Component to examine offers of coverage and cost-sharing requirements by the wage distribution and firm size dimensions of employers. They also draw on Medical Expenditure Panel Survey household-level data to describe the household circumstances of low-wage workers. The authors find that where low-wage workers are employed, who their colleagues are, and their spouses' wage levels are important factors in determining low-wage workers' access to coverage and the cost and generosity of such coverage. C1 [Vistnes, Jessica] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [Monheit, Alan C.] Univ Med & Dent New Jersey, Piscataway, NJ 08854 USA. RP Vistnes, J (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jessica.Vistnes@ahrq.hhs.gov NR 7 TC 1 Z9 1 U1 2 U2 7 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 OCT PY 2011 VL 68 IS 5 BP 607 EP 623 DI 10.1177/1077558711401918 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 817PQ UT WOS:000294686700006 PM 21536603 ER PT J AU Hill, SC Zuvekas, SH Zodet, MW AF Hill, Steven C. Zuvekas, Samuel H. Zodet, Marc W. TI Implications of the Accuracy of MEPS Prescription Drug Data for Health Services Research SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID EXPENDITURE PANEL SURVEY; PHARMACY DATA; PATIENT INTERVIEW; MEDICATION USE; SELF-REPORT; AGREEMENT; RECORDS; INFORMATION; CONCORDANCE; CONGRUENCE AB This paper assesses the quality of the Medical Expenditure Panel Survey (MEPS) drug data and the impact that misreporting prescription drug data has on descriptive and behavioral analyses. It does this by matching MEPS participants with Medicare Part D coverage during the period 2006-2007 to their Part D claims data. In the validation sample, the number of drug fills and total expenditures are reasonably accurate compared with claims. Household respondents tended to underreport the number of different drugs taken, but tended to overreport the number of fills of each drug. Behavioral analyses of the determinants of medication use and expenditures were largely unaffected because underreporting cut across most sociodemographic groups. C1 [Hill, Steven C.; Zuvekas, Samuel H.; Zodet, Marc W.] 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 steven.hill@ahrq.hhs.gov NR 31 TC 21 Z9 21 U1 0 U2 5 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 2011 VL 48 IS 3 BP 242 EP 259 DI 10.5034/inquiryjrnl_48.03.04 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 847RT UT WOS:000296990900006 PM 22235548 ER PT J AU Van Cleave, J Dougherty, D Perrin, JM AF Van Cleave, Jeanne Dougherty, Denise Perrin, James M. TI Strategies for Addressing Barriers to Publishing Pediatric Quality Improvement Research SO PEDIATRICS LA English DT Review DE quality improvement; publishing ID CHILDRENS HEALTH-CARE; PRACTICAL CLINICAL-TRIALS; PUBLICATION GUIDELINES; SERVICES RESEARCH; RANDOMIZED-TRIAL; INTENSIVE-CARE; UNITED-STATES; ASTHMA CARE; OUTCOMES; PROJECT AB BACKGROUND: Advancing the science of quality improvement (QI) requires dissemination of the results of QI. However, the results of few QI interventions reach publication. OBJECTIVE: To identify barriers to publishing results of pediatric QI research and provide practical strategies that QI researchers can use to enhance publishability of their work. METHODS: We reviewed and summarized a workshop conducted at the Pediatric Academic Societies 2007 meeting in Toronto, Ontario, Canada, on conducting and publishing QI research. We also interviewed 7 experts (QI researchers, administrators, journal editors, and health services researchers who have reviewed QI manuscripts) about common reasons that QI research fails to reach publication. We also reviewed recently published pediatric QI articles to find specific examples of tactics to enhance publishability, as identified in interviews and the workshop. RESULTS: We found barriers at all stages of the QI process, from identifying an appropriate quality issue to address to drafting the manuscript. Strategies for overcoming these barriers included collaborating with research methodologists, creating incentives to publish, choosing a study design to include a control group, increasing sample size through research networks, and choosing appropriate process and clinical quality measures. Several well-conducted, successfully published QI studies in pediatrics offer guidance to other researchers in implementing these strategies in their own work. CONCLUSION: Specific, feasible approaches can be used to improve opportunities for publication in pediatric, QI, and general medical journals. Pediatrics 2011; 128: e678-e686 C1 [Van Cleave, Jeanne; Perrin, James M.] Mass Gen Hosp Children, Ctr Child & Adolescent Hlth Policy, Boston, MA USA. [Dougherty, Denise] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Van Cleave, J (reprint author), MGH Ctr Child & Adolescent Hlth Policy, 50 Staniford St,901, Boston, MA 02114 USA. EM jvancleave@partners.org FU Agency for Healthcare Research and Quality (Rockville, MD) [HHS 07-R000192] FX This work was funded by the Agency for Healthcare Research and Quality (Rockville, MD) (contract HHS 07-R000192). NR 57 TC 8 Z9 8 U1 1 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 SEP PY 2011 VL 128 IS 3 BP E678 EP E686 DI 10.1542/peds.2010-0809 PG 9 WC Pediatrics SC Pediatrics GA 827DB UT WOS:000295406100025 PM 21844057 ER PT J AU Agwu, AL Fleishman, JA Korthuis, PT Siberry, GK Ellen, JM Gaur, AH Rutstein, R Gebo, KA AF Agwu, Allison L. Fleishman, John A. Korthuis, P. Todd Siberry, George K. Ellen, Jonathan M. Gaur, Aditya H. Rutstein, Richard Gebo, Kelly A. CA HIV Res Network TI Disparities in Antiretroviral Treatment: A Comparison of Behaviorally HIV-Infected Youth and Adults in the HIV Research Network SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE HIV; youth; adolescent; HAART; disparities ID HUMAN-IMMUNODEFICIENCY-VIRUS; UNITED-STATES; YOUNG-ADULTS; THERAPY; ADOLESCENTS; CARE; ADHERENCE; HAART; AGE; ASSOCIATION AB Objectives: Increasing numbers of youth are becoming HIV-infected and need highly active antiretroviral therapy (HAART). We hypothesized that behaviorally HIV-infected youth (BIY) ages 18 to 24 years are less likely than adults (25 years or older) to receive HAART and, once initiated, more likely to discontinue their first HAART regimen. Methods: Longitudinal analysis of treatment-naive patients (age 18 years or older) meeting criteria for HAART and followed at HIV Research Network sites (2002-2008). Time from meeting criteria to HAART initiation and duration on first regimen were assessed using Cox proportional hazards regression. Results: A total of 3127 (268 youth, 2859 adult) treatment-naive, HIV-infected patients met criteria. BIY were more likely to be black 66.8% vs 51.1%; P < 0.01) and less likely to identify injection drug use HIV risk (1.1% vs 8.8%; P < 0.01) than adults 25 years of age or older. Nearly 69% of BIY started HAART versus 79% of adults (P < 0.001). Adults 25 to 29 years of age (adjusted hazards ratio [AHR], 1.39; 95% confidence interval [CI], 1.12-1.73) and 50 years of age or older (AHR, 1.24; 95% CI, 1.00-1.54), but not 30 to 49 years (AHR, 1.19; 95% CI, 0.99-1.44) were more likely to initiate HAART than BIY. Attending four or more HIV provider visits within 1 year of meeting criteria was associated with HAART initiation (AHR, 1.91; 1.70-2.14). CD4 200 to 350 versus less than 200 cells/mm(3) (AHR, 0.57; 95% CI, 0.52-0.63), and injection drug use (AHR, 0.80; 95% CI, 0.69-0.92) were associated with a lower likelihood of HAART initiation. There were no age-related differences in duration of the first regimen. Conclusion: BIY are less likely to start HAART when meeting treatment criteria. Addressing factors associated with this disparity is critical to improving care for youth. C1 [Agwu, Allison L.] Johns Hopkins Sch Med, Dept Pediat, Div Pediat Infect Dis, Baltimore, MD USA. [Agwu, Allison L.; Gebo, Kelly A.] Johns Hopkins Sch Med, Dept Med, Div Infect Dis, Baltimore, MD USA. [Ellen, Jonathan M.] Johns Hopkins Sch Med, Dept Pediat, Div Adolescent Med, Baltimore, MD USA. [Fleishman, John A.] Agcy Hlth Care Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Korthuis, P. Todd] Oregon Hlth & Sci Univ, Dept Internal Med, Portland, OR 97201 USA. [Korthuis, P. Todd] Oregon Hlth & Sci Univ, Dept Publ Hlth & Prevent Med, Portland, OR 97201 USA. [Siberry, George K.] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Pediat Adolescent & Maternal AIDS Branch, NIH, Bethesda, MD USA. [Gaur, Aditya H.] St Jude Childrens Hosp, Dept Infect Dis, Memphis, TN USA. [Rutstein, Richard] Childrens Hosp Philadelphia, Div Gen Pediat, Philadelphia, PA 19104 USA. RP Agwu, AL (reprint author), 200 N Wolfe St,Room 3145, Baltimore, MD 21287 USA. EM ageorg10@jhmi.edu FU Agency for Healthcare Research and Quality [290-01-0012]; National Institute on Aging [R01 AG026250]; National Center for Research Resources (NCCR) of the National Institute of Health (NIH) Roadmap for Medical Research [1KL2RR025006-01]; National Institutes of Allergy and Infectious Diseases [1K23 AI084549]; National Institute on Drug Abuse [K23 DA019809]; Agency for Healthcare Research and Quality, Rockville, MD; Health Resources and Services Administration, Rockville, MD; Data Coordinating Center: Johns Hopkins University, Baltimore, MD FX Supported by the Agency for Healthcare Research and Quality (grant 290-01-0012) and the National Institute on Aging (R01 AG026250) (K. A. G.). A. L. A. was supported by the National Center for Research Resources (NCCR), a component of the National Institute of Health (NIH) Roadmap for Medical Research (1KL2RR025006-01) and the National Institutes of Allergy and Infectious Diseases (1K23 AI084549). P. T. K. was supported by the National Institute on Drug Abuse (K23 DA019809).; The sponsoring agencies are the Agency for Healthcare Research and Quality, Rockville, MD; Health Resources and Services Administration, Rockville, MD; and the Data Coordinating Center: Johns Hopkins University, Baltimore, MD (Kelly Gebo, MD). NR 41 TC 11 Z9 11 U1 1 U2 2 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 2011 VL 58 IS 1 BP 100 EP 107 DI 10.1097/QAI.0b013e31822327df PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 816OA UT WOS:000294610600019 PM 21637114 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI The Quality Improvement Marathon: Slow Pace for Overall Improvement While Access Remains Far Behind 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, 540 Gaither Rd, Rockville, MD 20850 USA. EM Carolyn.Clancy@ahrq.hhs.gov NR 5 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 SEP-OCT PY 2011 VL 26 IS 5 BP 405 EP 407 DI 10.1177/1062860611413968 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 809OZ UT WOS:000294067900010 PM 21856958 ER PT J AU Meyers, D AF Meyers, David TI A Tribute to Dr. David Lanier SO JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE LA English DT Biographical-Item C1 [Meyers, David] Agcy Healthcare Res & Qual, Ctr Primary Care, Rockville, MD USA. RP Meyers, D (reprint author), 540 Gaither Rd, Rockville, MD 20850 USA. EM David.Meyers@ahrq.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER BOARD FAMILY MEDICINE PI LEXINGTON PA 2228 YOUNG DR, LEXINGTON, KY 40505 USA SN 1557-2625 J9 J AM BOARD FAM MED JI J. Am. Board Fam. Med. PD SEP-OCT PY 2011 VL 24 IS 5 BP 494 EP 495 DI 10.3122/jabfm.2011.05.110135 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 817IC UT WOS:000294664300006 PM 21900431 ER PT J AU Ahmad, SR Elixhauser, A Sutton, JP AF Ahmad, Syed Rizwanuddin Elixhauser, Anne Sutton, Janet P. TI Hepatotoxicity in Association with Acetaminophen Poisonings in the US SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Ahmad, Syed Rizwanuddin] DEPI OSE FDA CDER, Silver Spring, MD USA. [Elixhauser, Anne] AHRQ, Rockville, MD USA. [Sutton, Janet P.] Social & Sci Syst, Silver Spring, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2011 VL 20 SU 1 MA 588 BP S256 EP S256 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 821AG UT WOS:000294946600567 ER PT J AU Lawrence, W AF Lawrence, William TI Starting the conversation SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Editorial Material ID HEALTH-CARE PROGRAM C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Lawrence, W (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM William.lawrence@ahrq.hhs.gov NR 9 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2011 VL 20 IS 8 BP 807 EP 809 DI 10.1002/pds.2173 PG 3 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 800PK UT WOS:000293375200004 PM 21681851 ER PT J AU Clancy, CM AF Clancy, C. M. TI Best practices in systems interventions to reduce the burden of fractures SO OSTEOPOROSIS INTERNATIONAL 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. EM carolyn.clancy@ahrq.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER LONDON LTD PI LONDON PA 236 GRAYS INN RD, 6TH FLOOR, LONDON WC1X 8HL, ENGLAND SN 0937-941X J9 OSTEOPOROSIS INT JI Osteoporosis Int. PD AUG PY 2011 VL 22 SU 3 BP S441 EP S444 DI 10.1007/s00198-011-1707-x PG 4 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA 012SV UT WOS:000309257800001 PM 21847762 ER PT J AU Noel, PH Zeber, JE Pugh, MJ Finley, EP Parchman, ML AF Noel, Polly H. Zeber, John E. Pugh, Mary J. Finley, Erin P. Parchman, Michael L. TI A pilot survey of post-deployment health care needs in small community-based primary care clinics SO BMC FAMILY PRACTICE LA English DT Article DE Primary care; Post-deployment health; PTSD; Depression ID OPERATION-IRAQI-FREEDOM; MENTAL-HEALTH; ENDURING FREEDOM; MILITARY PERSONNEL; COMBAT DUTY; US VETERANS; AFGHANISTAN; WAR; BARRIERS; SPOUSES AB Background: Relatively little is known regarding to what extent community-based primary care physicians are encountering post-deployment health care needs among veterans of the Afghanistan or Iraq conflicts and their family members. Methods: This pilot study conducted a cross-sectional survey of 37 primary care physicians working at small urban and suburban clinics belonging to a practice-based research network in the south central region of Texas. Results: Approximately 80% of the responding physicians reported caring for patients who have been deployed to the Afghanistan or Iraq war zones, or had a family member deployed. Although these physicians noted a variety of conditions related to physical trauma, mental illnesses and psychosocial disruptions such as marital, family, financial, and legal problems appeared to be even more prevalent among their previously deployed patients and were also noted among family members of deployed veterans. Conclusions: Community-based primary care physicians should be aware of common post-deployment health conditions and the resources that are available to meet these needs. C1 [Noel, Polly H.; Zeber, John E.; Pugh, Mary J.; Finley, Erin P.] Cent Texas Vet Hlth Care Syst Scott & White, VERDICT, San Antonio, TX 78229 USA. [Noel, Polly H.; Zeber, John E.; Pugh, Mary J.; Finley, Erin P.] Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA. [Parchman, Michael L.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Noel, PH (reprint author), Cent Texas Vet Hlth Care Syst Scott & White, VERDICT, 7400 Merton Minter Blvd, San Antonio, TX 78229 USA. EM noelp@uthscsa.edu OI Parchman, Michael/0000-0001-7129-2889; Finley, Erin/0000-0003-4497-7721 FU Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (HSRD) [LIP 66-014]; South Central Area Health Education Center FX The authors acknowledge the participation and commitment of the members of the South Texas Ambulatory Research Network (STARNet). Grant support; This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (HSR&D) project no. LIP 66-014 and the South Central Area Health Education Center. The funding sources had no role relating to study design; collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. Dr. Noel is a Research Psychologist at the South Texas Veterans Health Care System. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs. NR 35 TC 3 Z9 3 U1 0 U2 0 PU BIOMED CENTRAL LTD PI LONDON PA 236 GRAYS INN RD, FLOOR 6, LONDON WC1X 8HL, ENGLAND SN 1471-2296 J9 BMC FAM PRACT JI BMC Fam. Pract. PD JUL 29 PY 2011 VL 12 AR 79 DI 10.1186/1471-2296-12-79 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 812KD UT WOS:000294291400001 PM 21801356 ER PT J AU Bernard, DSM Farr, SL Fang, ZY AF Bernard, Didem S. M. Farr, Stacy L. Fang, Zhengyi TI National Estimates of Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults With Cancer: 2001 to 2008 SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Article ID UNITED-STATES; COSTS; IMPACT; INSURANCE AB Purpose To compare the prevalence of high out-of-pocket burdens among patients with cancer with other chronically ill and well patients, and to examine the sociodemographic characteristics associated with high burdens among patients with cancer. Methods The sample included persons 18 to 64 years of age who received treatment for cancer, taken from a nationally representative sample of the US population from the 2001 to 2008 Medical Expenditure Panel Survey. We examined the proportion of persons living in families with high out-of-pocket burdens associated with medical spending, including insurance premiums, relative to income, defining high health care (total) burden as spending more than 20% of income on health care (and premiums). Results The risk of high burdens is significantly greater for patients with cancer compared with other chronically ill and well patients. We find that 13.4% of patients with cancer had high total burdens, in contrast to 9.7% among those with other chronic conditions and 4.4% among those without chronic conditions. Among nonelderly persons with cancer, the following were associated with higher out-of-pocket burdens: private nongroup insurance, age 55 to 64 years, non-Hispanic black, never married or widowed, one child or no children, unemployed, lower income, lower education level, living in nonmetropolitan statistical areas, and having other chronic conditions. Conclusion High burdens may affect treatment choice and deter patients from getting care. Thus, although a detailed patient-physician discussion of costs of care may not be feasible, we believe that an awareness of out-of-pocket burdens among patients with cancer is useful for clinical oncologists. C1 [Bernard, Didem S. M.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD 20850 USA. [Farr, Stacy L.] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Fang, Zhengyi] Social & Sci Syst, Silver Spring, MD USA. RP Bernard, DSM (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, 540 Gaither Rd, Rockville, MD 20850 USA. EM didem.bernard@ahrq.hhs.gov NR 30 TC 55 Z9 55 U1 0 U2 2 PU AMER SOC CLINICAL ONCOLOGY PI ALEXANDRIA PA 2318 MILL ROAD, STE 800, ALEXANDRIA, VA 22314 USA SN 0732-183X J9 J CLIN ONCOL JI J. Clin. Oncol. PD JUL 10 PY 2011 VL 29 IS 20 BP 2821 EP 2826 DI 10.1200/JCO.2010.33.0522 PG 6 WC Oncology SC Oncology GA 789IH UT WOS:000292508500024 PM 21632508 ER PT J AU Friedman, B Berdahl, T Simpson, LA McCormick, MC Owens, PL Andrews, R Romano, PS AF Friedman, Bernard Berdahl, Terceira Simpson, Lisa A. McCormick, Marie C. Owens, Pamela L. Andrews, Roxanne Romano, Patrick S. TI Annual Report on Health Care for Children and Youth in the United States: Focus on Trends in Hospital Use and Quality SO ACADEMIC PEDIATRICS LA English DT Article DE patient safety; potentially avoidable admissions; trends in hospital utilization ID STAPHYLOCOCCUS-AUREUS INFECTIONS; DISPARITIES AB OBJECTIVE: The aim of this study was to describe selected trends in hospital inpatient care for children between 2000 and 2007. STUDY DESIGN: Analysis was conducted of administrative data from annual nationwide databases of hospital discharges from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, along with survey data from a nationally representative random sample of children from the Medical Expenditure Panel Survey. Hospital utilization rates and expenses, risk-adjusted rates of potentially avoidable hospitalization, and safety indicators in the hospital are calculated and tracked with established and downloadable software. RESULTS: The rate of hospital discharges for children aged 15 to 17 years declined significantly, mainly due to fewer maternity-related discharges. The leading principal conditions by age group were similar to the report for 1995 to 2000; however, the rate of admissions for skin infections doubled to 9 per 10 000. Hospital cost per discharge increased by an annual average of 4.5% per year compared with 2.6% annual growth in the gross domestic product deflator. Medicaid is increasingly important relative to private insurance as a payer for hospital care for children. The rate of potentially preventable hospitalizations for both acute and chronic conditions declined substantially (18%, adjusted for age and gender). Several measures of patient safety improved-the rates of postoperative sepsis, iatrogenic pneumothorax, and selected infections due to medical care declined by 14.2%, 17.8%, and 23.5%, respectively. However, the rate of accidental punctures and lacerations and the rate of decubitus ulcer increased by 25.6% and 34.5%, respectively. The trends in safety indicators varied somewhat by age group, income quartile of zip codes, insurance, region, and type of location without a consistent pattern. CONCLUSIONS/IMPLICATIONS: Although teenage pregnancy rates were declining, there was a worsening trend in skin infections. The latter may eventually be impacted by recent publication of new guidelines for treatment by office-based physicians. A gradually increasing role of Medicaid as a payer for hospital care for children will likely put an increasing strain on public resources in advance of the full implementation of the health insurance reforms recently enacted. The decline in potentially avoidable admissions reduces the use of the most expensive resources. For asthma and diabetes, children in the lowest income zip codes had persistently higher rates of admission, but the rate fell by one third during the period. Children in the South and West regions had substantial and significant declines in preventable admissions. Particular indicators of safety were improving, whereas others were worsening. Trends were not the same in all types of hospitals, all regions, and income categories. This is already a rich area for further research on the impact of quality improvement strategies; however, attention is needed to developing more tools to more thoroughly track quality of care for children. C1 [Friedman, Bernard; Berdahl, Terceira; Andrews, Roxanne] Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [Simpson, Lisa A.] Acad Hlth, Washington, DC USA. [McCormick, Marie C.] Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA. [Owens, Pamela L.] Washington Univ, Sch Med, Div Infect Dis, Dept Internal Med, St Louis, MO 63110 USA. [Romano, Patrick S.] Univ Calif Davis, Div Gen Pediat, Sacramento, CA 95817 USA. [Romano, Patrick S.] Univ Calif Davis, Ctr Healthcare Policy & Res, Sacramento, CA 95817 USA. RP Friedman, B (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM bernard.friedman@ahrq.hhs.gov RI Romano, Patrick/N-4225-2014; OI Romano, Patrick/0000-0001-6749-3979; McCormmick, Marie/0000-0002-3938-1707 NR 33 TC 26 Z9 27 U1 0 U2 6 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 J9 ACAD PEDIATR JI Acad. Pediatr. PD JUL-AUG PY 2011 VL 11 IS 4 BP 263 EP 279 DI 10.1016/j.acap.2011.04.002 PG 17 WC Pediatrics SC Pediatrics GA 797EJ UT WOS:000293107000004 PM 21640682 ER PT J AU Holman, RC Folkema, AM Singleton, RJ Redd, JT Christensen, KY Steiner, CA Schonberger, LB Hennessy, TW Cheek, JE AF Holman, Robert C. Folkema, Arianne M. Singleton, Rosalyn J. Redd, John T. Christensen, Krista Y. Steiner, Claudia A. Schonberger, Lawrence B. Hennessy, Thomas W. Cheek, James E. TI Disparities in Infectious Disease Hospitalizations for American Indian/Alaska Native People SO PUBLIC HEALTH REPORTS LA English DT Article ID UNITED-STATES; GENERAL-POPULATION; RESPIRATORY-TRACT; ALASKA NATIVES; CHILDREN; TRENDS; INFANTS; MORTALITY; ADULTS; RISK AB Objectives. We described disparities in infectious disease (ID) hospitalizations for American Indian/Alaska Native (Al/AN) people. Methods. We analyzed hospitalizations with an ID listed as the first discharge diagnosis in 1998-2006 for Al/AN people from the Indian Health Service National Patient Information Reporting System and compared them with records for the general U.S. population from the Nationwide Inpatient Survey. Results. The ID hospitalization rate for Al/AN people declined during the study period. The 2004-2006 mean annual age-adjusted ID hospitalization rate for Al/AN people (1,708 per 100,000 populiation) was slightly higher than that for the U.S. population (1,610 per 100,000 population). The rate for Al/AN people was highest in the Southwest (2,314 per 100,000 population), Alaska (2,063 per 100,000 population), and Northern Plains West (1,957 per 100,000 population) regions, and among infants (9,315 per 100,000 population). ID hospitalizations accounted for approximately 22% of all Al/AN hospitalizations. Lower-respiratory-tract infections accounted for the largest proportion of ID hospitalizations among Al/AN people (35%) followed by skin and soft tissue infections (19%), and infections of the kidney, urinary tract, and bladder (11%). Conclusions. Although the ID hospitalization rate for Al/AN people has declined, it remains higher than that for the U.S. general population, and is highest in the Southwest, Northern Plains West, and Alaska regions. Lower-respiratory-tract infections; skin and soft tissue infections; and kidney, urinary tract, and bladder infections contributed most to these health disparities. Future prevention strategies should focus on high-risk regions and age groups, along with illnesses contributing to health disparities. C1 [Holman, Robert C.; Folkema, Arianne M.; Christensen, Krista Y.; Schonberger, Lawrence B.] Ctr Dis Control & Prevent, Natl Ctr Emerging & Zoonot Infect Dis, Div High Consequence Pathogens & Pathol, Atlanta, GA 30333 USA. [Singleton, Rosalyn J.] Alaska Native Tribal Hlth Consortium, Anchorage, AK USA. [Singleton, Rosalyn J.; Hennessy, Thomas W.] Ctr Dis Control & Prevent, Natl Ctr Emerging & Zoonot Infect Dis, Arctic Invest Program, Anchorage, AK USA. [Redd, John T.; Cheek, James E.] Indian Hlth Serv, Div Epidemiol & Dis Prevent, Off Publ Hlth Support, Albuquerque, NM USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Healthcare Cost & Utilizat Project, Rockville, MD USA. RP Holman, RC (reprint author), Ctr Dis Control & Prevent, Natl Ctr Emerging & Zoonot Infect Dis, Div High Consequence Pathogens & Pathol, 1600 Clifton Rd NE,MS A-39, Atlanta, GA 30333 USA. EM RHolman@cdc.gov NR 35 TC 17 Z9 17 U1 0 U2 3 PU ASSOC SCHOOLS PUBLIC HEALTH PI WASHINGTON PA 1101 15TH ST NW, STE 910, WASHINGTON, DC 20005 USA SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD JUL-AUG PY 2011 VL 126 IS 4 BP 508 EP 521 PG 14 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 777ZS UT WOS:000291665600007 PM 21800745 ER PT J AU Machlin, SR Chevan, J Yu, WW Zodet, MW AF Machlin, Steven R. Chevan, Julia Yu, William W. Zodet, Marc W. TI Determinants of Utilization and Expenditures for Episodes of Ambulatory Physical Therapy Among Adults SO PHYSICAL THERAPY LA English DT Article ID QUALITY-OF-LIFE; LOW-BACK-PAIN; CARE UTILIZATION; UNITED-STATES; MEDICAL-CARE; HEALTH; GENDER; EPIDEMIOLOGY; MORBIDITY; PROGNOSIS AB Background. Comprehensive information on determinants and patterns of use and spending for ambulatory physical therapy services is needed to inform health planning and policy decisions. Most research in the literature on this topic is limited to specific payers, age groups, and conditions. Objective. The purpose of this study was to examine factors associated with the resource intensity of physical therapy episodes for adults in the United States as measured by number of visits and expenses per visit. Design. This study was a secondary analysis of longitudinal survey data from the Medical Expenditure Panel Survey (MEPS) panels 9, 10, and 11. Methods. An analytic file was created based on data from the longitudinal data files for 3 MEPS panels and the annual office-based and hospital outpatient event files. A total of 1,377 episodes of physical therapy care were identified. Variation in both the total number of visits per episode and expenses per visit was examined by fitting regression models to evaluate the effects of selected independent variables classified into 4 categories: episode-level variables, demographic characteristics, geographic variables, and health status indicators. Results. Average total expenses per episode (in 2007 dollars) were $ 1,184 (median = $ 651), with an average number of visits per episode of 9.6 (median = 6.0) and average expenses per visit of $ 130 (median = $ 95). Significant variation by geographic characteristics, sex, and one comorbid condition (high blood pressure) was found in the number of visits model. In the expenditures model, expenses per visit were associated with age/insurance coverage, setting (hospital outpatient versus office based), primary condition category, and mental health status. Limitations. Limitations include limited sample sizes of physical therapy users and lack of detailed clinical information. Conclusions. Variability in the resource intensity of physical therapy episodes is influenced to some degree by nonclinical variables. C1 [Chevan, Julia] Springfield Coll, Dept Phys Therapy, Springfield, MA 01109 USA. [Machlin, Steven R.; Yu, William W.; Zodet, Marc W.] US Dept HHS, Ctr Financing Access & Cost Trends, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Chevan, J (reprint author), Springfield Coll, Dept Phys Therapy, 263 Alden St, Springfield, MA 01109 USA. EM jchevan@spfldcol.edu NR 33 TC 17 Z9 17 U1 1 U2 8 PU AMER PHYSICAL THERAPY ASSOC PI ALEXANDRIA PA 1111 N FAIRFAX ST, ALEXANDRIA, VA 22314 USA SN 0031-9023 J9 PHYS THER JI Phys. Ther. PD JUL PY 2011 VL 91 IS 7 BP 1018 EP 1029 DI 10.2522/ptj.20100343 PG 12 WC Orthopedics; Rehabilitation SC Orthopedics; Rehabilitation GA 786FL UT WOS:000292288700004 PM 21566066 ER PT J AU Garman, AN McAlearney, AS Harrison, MI Song, PH McHugh, M AF Garman, Andrew N. McAlearney, Ann Scheck Harrison, Michael I. Song, Paula H. McHugh, Megan TI High-performance work systems in health care management, Part 1: Development of an evidence-informed model SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article DE efficiency; high-performance work practices; human resource management; quality ID HUMAN-RESOURCE MANAGEMENT; PATIENT MORTALITY; EMPLOYEE SATISFACTION; FINANCIAL PERFORMANCE; QUALITY IMPROVEMENT; VOLUNTARY TURNOVER; FIRM PERFORMANCE; NURSE BURNOUT; OUTCOMES; SERVICE AB Background: Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. Purpose: Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. Methodology/Approach: Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. Findings: The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. Practice Implications: Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically. C1 [Garman, Andrew N.] Rush Univ, Dept Hlth Syst Management, Chicago, IL 60612 USA. [McAlearney, Ann Scheck; Song, Paula H.] Ohio State Univ, Coll Publ Hlth, Columbus, OH USA. [Harrison, Michael I.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [McHugh, Megan] Amer Hosp Assoc, Hlth Res & Educ Trust, Chicago, IL USA. RP Garman, AN (reprint author), Rush Univ, Dept Hlth Syst Management, Chicago, IL 60612 USA. EM Andy_N_Garman@rush.edu RI McAlearney, Ann/J-3008-2013 OI McAlearney, Ann/0000-0001-9107-5419 NR 62 TC 26 Z9 28 U1 5 U2 30 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 2011 VL 36 IS 3 BP 201 EP 213 DI 10.1097/HMR.0b013e318201d1bf PG 13 WC Health Policy & Services SC Health Care Sciences & Services GA 773XR UT WOS:000291345500001 PM 21646880 ER PT J AU McAlearney, AS Garman, AN Song, PH McHugh, M Robbins, J Harrison, MI AF McAlearney, Ann Scheck Garman, Andrew N. Song, Paula H. McHugh, Megan Robbins, Julie Harrison, Michael I. TI High-performance work systems in health care management, Part 2: Qualitative evidence from five case studies SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article DE health care; human resources; organizational development; patient safety; qualitative; quality of care ID HUMAN-RESOURCE MANAGEMENT; ORGANIZATIONAL PERFORMANCE AB Background: A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety. Purpose: The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements. Methodology/Approach: Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U. S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis. Findings: In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e. g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e. g., improved recruitment, improved ability to address safety concerns, and lower turnover). Practice Implications: These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify which HPWPs and systems are of greatest potential for health care management. C1 [McAlearney, Ann Scheck; Robbins, Julie] Ohio State Univ, Coll Publ Hlth, Div Hlth Serv Management & Policy, Columbus, OH USA. [Garman, Andrew N.] Rush Univ, Med Ctr, Dept Hlth Syst Management, Chicago, IL 60612 USA. [McHugh, Megan] AHA, Hlth Res & Educ Trust, Chicago, IL USA. [McHugh, Megan] Northwestern Univ, Feinberg Sch Med, Inst Healthcare Studies, Chigaco, IL USA. [McHugh, Megan] Northwestern Univ, Feinberg Sch Med, Dept Emergency Med, Chigaco, IL USA. [Harrison, Michael I.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Washington, DC USA. RP McAlearney, AS (reprint author), Ohio State Univ, Coll Publ Hlth, Div Hlth Serv Management & Policy, Columbus, OH USA. EM mcalearney.1@osu.edu RI McAlearney, Ann/J-3008-2013; breidahl, emil/E-9170-2014 OI McAlearney, Ann/0000-0001-9107-5419; NR 27 TC 18 Z9 18 U1 3 U2 26 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 2011 VL 36 IS 3 BP 214 EP 226 DI 10.1097/HMR.0b013e3182100dc4 PG 13 WC Health Policy & Services SC Health Care Sciences & Services GA 773XR UT WOS:000291345500002 PM 21646881 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI New Research Highlights the Role of Patient Safety Culture and Safer Care SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID QUESTIONNAIRE; CLIMATE C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 9 TC 5 Z9 5 U1 1 U2 5 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 2011 VL 26 IS 3 BP 193 EP 196 DI 10.1097/NCQ.0b013e31821d0520 PG 4 WC Nursing SC Nursing GA 769PE UT WOS:000291028400001 PM 21623179 ER PT J AU Singleton, RJ Holman, RC Wenger, J Christensen, KY Bulkow, LR Zulz, T Steiner, CA Cheek, JE AF Singleton, Rosalyn J. Holman, Robert C. Wenger, Jay Christensen, Krista Yorita Bulkow, Lisa R. Zulz, Tammy Steiner, Claudia A. Cheek, James E. TI TRENDS IN HOSPITALIZATION FOR EMPYEMA IN ALASKA NATIVE CHILDREN YOUNGER THAN 10 YEARS OF AGE SO PEDIATRIC INFECTIOUS DISEASE JOURNAL LA English DT Article DE empyema; pleural effusions; Alaska Native; United States; hospitalizations; children ID PNEUMOCOCCAL CONJUGATE VACCINE; NONVACCINE SEROTYPES; CHILDHOOD EMPYEMA; US CHILDREN AB We analyzed hospitalizations for empyema among Alaska Native (AN) children and the general population of US children <10 years of age during the years 1998 to 2007. We also analyzed invasive pneumococcal disease in AN children. Between 1998 and 2000, the average annual hospitalization rate for empyema was higher for AN children (51.8 per 100,000/yr) than that for US children (24.2 [95% confidence interval: 20.4, 27.9right perpendicular per 100,000/yr), and had increased in 2004-2007 in both populations (59.6 and 36.0 [95% confidence interval: 30.1, 41.8], respectively). Pneumococcal empyema increased in AN children despite a decrease in invasive pneumococcal disease pneumonia. C1 [Singleton, Rosalyn J.] CDC, AIP, NCEZID, US Dept HHS, Anchorage, AK 99508 USA. [Holman, Robert C.; Christensen, Krista Yorita] CDC, Div High Consequence Pathogens & Pathol, NCEZID, US Dept HHS, Atlanta, GA 30333 USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Healthcare Cost & Utilizat Project, Rockville, MD USA. [Cheek, James E.] Indian Hlth Serv, Div Epidemiol & Prevent, Off Publ Hlth Support, US Dept HHS, Albuquerque, NM USA. RP Singleton, RJ (reprint author), CDC, AIP, NCEZID, US Dept HHS, 4055 Tudor Ctr Dr, Anchorage, AK 99508 USA. NR 16 TC 7 Z9 7 U1 0 U2 0 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 JUN PY 2011 VL 30 IS 6 BP 528 EP 530 DI 10.1097/INF.0b013e3182075e74 PG 3 WC Immunology; Infectious Diseases; Pediatrics SC Immunology; Infectious Diseases; Pediatrics GA 770OB UT WOS:000291095600022 PM 21164385 ER PT J AU Fitzner, K Dietz, DA Moy, E AF Fitzner, Karen Dietz, David A. Moy, Ernest TI How Innovative Treatment Models and Data Use are Improving Diabetes Care among Older African American Adults SO POPULATION HEALTH MANAGEMENT LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; SELF-MANAGEMENT EDUCATION; PATIENT EDUCATION; GLYCEMIC CONTROL; COMMUNITY; METAANALYSIS; MELLITUS; PROGRAM; SUPPORT; DISEASE AB By 2030, the number of older adults within the United States will have doubled to approximately 71.5 million. Included in this population estimate is the relative growth in the number of older adults of racial and ethnic minority descent. Research has indicated that these individuals, specifically African Americans, have a higher incidence of diabetes than whites, as well as a higher rate of hospitalization compared to whites. This is also true for the older African American. Unfortunately, those with the greatest need for diabetes-related care are least likely to access that care. Moreover, in spite of the indication of need, it is extremely difficult to fully identify strategies that would be optimal for these older minority populations. This paper addresses strategies and techniques to fill gaps in knowledge by detailing efforts, such as the use of health information technologies and multilevel diabetes education teams, to improve the health outcomes of older adult African Americans who have diabetes. (Population Health Management 2011; 14: 143-155) C1 [Fitzner, Karen] Amer Assoc Diabet Educators, Chicago, IL 60606 USA. [Dietz, David A.] US Dept HHS, Off Minor Hlth, Rockville, MD USA. [Moy, Ernest] Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Fitzner, K (reprint author), Amer Assoc Diabet Educators, 200 Madison St,Suite 800, Chicago, IL 60606 USA. EM kfitzner@aadenet.org NR 61 TC 4 Z9 4 U1 0 U2 1 PU MARY ANN LIEBERT, INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1942-7891 EI 1942-7905 J9 POPUL HEALTH MANAG JI Popul. Health Manag. PD JUN PY 2011 VL 14 IS 3 BP 143 EP 155 DI 10.1089/pop.2010.0012 PG 13 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 778QD UT WOS:000291718400006 PM 21323464 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Commentary: Precision Science and Patient-Centered Care SO ACADEMIC MEDICINE LA English DT Editorial Material ID QUALITY AB Patient-centered outcomes research (PCOR), also known as comparative effectiveness research, offers new opportunities and challenges for academic health centers (AHCs). The author of this commentary summarizes the contributions of some of the articles in this issue that focus on PCOR, and she emphasizes the unique features of this distinctive type of research, which are longitudinal patient follow-up, the inclusion of patient-reported outcomes, and the dynamic interaction among all stakeholders throughout all phases of research. The author advocates that researchers engaged in comparative effectiveness research make every effort, and explore innovative means, to accelerate the translation of their research findings into practice. The opportunities to close the gaps between what physicians and medical scientists do and what they know, to support clinicians and patients who are working together in order to rapidly identify the best option for a unique individual, and to lead the way in addressing barriers to achieving personalized, patient-centered care should engage key members of AHCs in comparative effectiveness research, so that these institutions become a vital link connecting biomedical innovation and its precision application in diverse communities and populations. C1 Agcy Healthcare Res & Qual, Rockville, MD 20840 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, John M Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20840 USA. EM carolyn.clancy@ahrq.hhs.gov RI liu, jing/D-9482-2012 NR 10 TC 5 Z9 5 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1040-2446 J9 ACAD MED JI Acad. Med. PD JUN PY 2011 VL 86 IS 6 BP 667 EP 670 DI 10.1097/ACM.0b013e3182179214 PG 4 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA 769IM UT WOS:000291006100008 PM 21613885 ER PT J AU Sorensen, AV Harrison, MI Kane, HL Roussel, AE Halpern, MT Bernard, SL AF Sorensen, A. V. Harrison, M. I. Kane, H. L. Roussel, A. E. Halpern, M. T. Bernard, S. L. TI From research to practice: factors affecting implementation of prospective targeted injury-detection systems SO BMJ QUALITY & SAFETY LA English DT Article ID ADVERSE DRUG EVENTS; COMPUTER-BASED MONITOR; INFORMATION-TECHNOLOGY; HOSPITALIZED-PATIENTS; PATIENT SAFETY; SURVEILLANCE; ORGANIZATIONS; INNOVATIONS; INFECTION; FRAMEWORK AB Aim: This paper describes key factors that shaped implementation of prospective targeted injury-detection systems (TIDS) for adverse drug events (ADEs) and nosocomial pressure ulcers (PrU). Methods: Using case-study methodology, the authors conducted semistructured interviews with implementation champions and TIDS users at five hospitals. Interviews focused on implementation experiences, assessment of TIDS' effectiveness and utility, and plans for sustainability. The authors used content analysis techniques to compare implementation experiences within and across organisations and triangulated data for explanation and confirmation of common themes. Findings: Participating hospitals were more successful in implementing the low-complexity PrU-TIDS, as compared with high-complexity ADE-TIDS. This pattern reflected the greater complexity of ADE-TIDS, its higher costs and poorer alignment with existing workflows. Complexity affected the innovations' perceived usability, the time needed to learn and install the trigger systems, and their costs. Local factors affecting implementation and sustainability of both innovations included turnover affecting champions and other staff, shifting organisational priorities, changing information infrastructures, and institutional constraints on adapting existing IT to the electronic TIDS. Conclusions: To facilitate implementation of complex healthcare innovations such as ADE-TIDS, staff in adopting organisations should give high priority to innovation implementation; allocate sufficient resources; effectively communicate with and involve local champions and users; and align innovations with workflows and information systems. In addition, they should monitor local factors, such as changes in organisational priorities and IT, availability of implementation staff and champions, and external regulations and constraints that may pose barriers to innovation implementation and sustainability. C1 [Sorensen, A. V.; Kane, H. L.; Roussel, A. E.; Halpern, M. T.; Bernard, S. L.] RTI Int, Res Triangle Pk, NC 27709 USA. [Harrison, M. I.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Sorensen, AV (reprint author), RTI Int, 3040 Cornwallis Rd,POB 12194, Res Triangle Pk, NC 27709 USA. EM asorensen@rti.org FU Agency for Healthcare Research and Quality (AHRQ) [290-00-0018, 290-00-0011] FX This study was funded by the Agency for Healthcare Research and Quality (AHRQ) Task Order Contracts No 290-00-0018 and No 290-00-0011. The content is solely the responsibility of the authors and does not represent the official views or practice recommendations of AHRQ or of the Department of Health and Human Services. NR 41 TC 3 Z9 3 U1 3 U2 6 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 2044-5415 J9 BMJ QUAL SAF JI BMJ Qual. Saf. PD JUN PY 2011 VL 20 IS 6 BP 527 EP 533 DI 10.1136/bmjqs.2010.045039 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 768DB UT WOS:000290910600009 PM 21292693 ER PT J AU Mukamel, DB Li, Y Harrington, C Spector, WD Weimer, DL Bailey, L AF Mukamel, Dana B. Li, Yue Harrington, Charlene Spector, William D. Weimer, David L. Bailey, Lauren TI Does State Regulation of Quality Impose Costs on Nursing Homes? SO MEDICAL CARE LA English DT Article DE nursing homes; costs; regulation; quality; cost functions ID COMPARE REPORT CARD; LONG-TERM-CARE; PUBLICATION; ENFORCEMENT; TRENDS AB Background: Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs. Objectives: To estimate the costs associated with the regulation of quality of the nursing home industry. Sample: This study includes 11,168 free-standing nursing homes nationally, between 2004 and 2006. Research Design: Data included information from the Medicare cost reports, Minimum Data Set, Medicare Denominator file, OSCAR, and a survey of States' Certification and Licensing Offices conducted by the authors. These data were used to create variables measuring nursing homes costs, outputs, wages, competition, adjusted deficiency citations, ownership, state-fixed effects, and an index of each state's regulatory stringency. We estimated hybrid cost functions which included the regulatory stringency index. Results: The estimated cost functions demonstrated the typical behavior expected of nursing home cost functions. The stringency index was positively and significantly associated with costs, indicating that nursing homes located in states with more stringent regulatory requirements face higher costs, ceteris paribus. The average incremental costs of a 1 standard deviation increase in the stringency index resulted in a 1.1% increase in costs. Conclusions: This study for the first time places a price tag on the regulation of quality in nursing homes. It offers an order of magnitude on the costs to the industry of complying with the current set of standards and given the current level of enforcement. Complementary studies of the benefits that these regulations entail are needed to gain a comprehensive assessment of the effect of the regulation. C1 [Mukamel, Dana B.] Univ Calif Irvine, Dept Med, Hlth Policy Res Inst, Irvine, CA 92697 USA. [Li, Yue] Univ Iowa, Div Gen Internal Med, Iowa City, IA USA. [Li, Yue] Iowa City VA Med Ctr, Iowa City, IA USA. [Harrington, Charlene] Univ Calif San Francisco, Dept Social & Behav Sci, San Francisco, CA 94143 USA. [Spector, William D.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Weimer, David L.] Univ Wisconsin, LaFollette Sch Publ Affairs, Madison, WI USA. [Bailey, Lauren] Univ Calif Irvine, Hlth Policy Res Inst, Irvine, CA USA. RP Mukamel, DB (reprint author), Univ Calif Irvine, Dept Med, Hlth Policy Res Inst, 100 Theory,Suite 110, Irvine, CA 92697 USA. EM dmukamel@uci.edu FU National Institutes of Aging [AG027420] FX The authors acknowledge the funding from the National Institutes of Aging, Grant No. AG027420. NR 39 TC 11 Z9 11 U1 1 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 EI 1537-1948 J9 MED CARE JI Med. Care PD JUN PY 2011 VL 49 IS 6 BP 529 EP 534 DI 10.1097/MLR.0b013e318207ef9e PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 763MS UT WOS:000290563600002 PM 21558967 ER PT J AU Hill, SC AF Hill, Steven C. TI Individual Insurance and Access to Care SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID NONGROUP HEALTH-INSURANCE; MARKET; COVERAGE AB Starting in 2014, more Americans will have private, nonemployment-related insurance ("individual insurance"). Using the nationally representative Medical Expenditure Panel Survey for 2002 through 2007, this paper compares access to care between nonelderly adults with individual insurance and those with employment-related insurance. Adults with individual and employment-related insurance report similar, often good, access to care. The study employs bivariate probit models to account for omitted variables correlated with access and type of insurance, and controls for differences in health status, attitudes, and socioeconomic characteristics. Results show that individual insurance may reduce access in some dimensions, but all effects are imprecisely estimated, so that none is statistically significant. 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 steven.hill@ahrq.hhs.gov NR 19 TC 5 Z9 5 U1 1 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 2011 VL 48 IS 2 BP 155 EP 168 DI 10.5034/inquiryjrnl_48.02.04 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 811UG UT WOS:000294241000006 PM 21898986 ER PT J AU Clancy, CM Berwick, DM AF Clancy, Carolyn M. Berwick, Donald M. TI The Science of Safety Improvement: Learning While Doing SO ANNALS OF INTERNAL MEDICINE LA English DT Editorial Material ID QUALITY IMPROVEMENT; PATIENT SAFETY; RANDOMIZED-TRIAL; CARE; ORGANIZATIONS; HARM C1 [Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Berwick, Donald M.] Ctr Medicare, Washington, DC 20201 USA. [Berwick, Donald M.] Ctr Medicaid Serv, Washington, DC 20201 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 22 TC 13 Z9 13 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 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAY 17 PY 2011 VL 154 IS 10 BP 699 EP + DI 10.7326/0003-4819-154-10-201105170-00013 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 764HK UT WOS:000290620300021 PM 21576540 ER PT J AU Karaca, Z Wong, H Mutter, R AF Karaca, Z. Wong, H. Mutter, R. TI CHARACTERISTICS OF HOMELESS INDIVIDUALS USING INPATIENT AND EMERGENCY DEPARTMENT SERVICES SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Karaca, Z.; Wong, H.; Mutter, R.] AHRQ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2011 VL 14 IS 3 BP A25 EP A25 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 876JY UT WOS:000299105000130 ER PT J AU Karaca, Z Wong, H Mutter, R AF Karaca, Z. Wong, H. Mutter, R. TI DURATION OF PATIENTS VISITS TO THE EMERGENCY DEPARTMENT SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Karaca, Z.; Wong, H.; Mutter, R.] AHRQ, Rockville, MD USA. NR 0 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 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2011 VL 14 IS 3 BP A19 EP A19 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 876JY UT WOS:000299105000097 ER PT J AU Maeda, JL Parlato, J Levit, K Andrews, RM Jiang, HJ AF Maeda, J. L. Parlato, J. Levit, K. Andrews, R. M. Jiang, H. J. TI AN EXAMINATION OF HOSPITAL-ACQUIRED CONDITIONS BY AGE AND PAYER IN FIFTEEN STATES, 2008 SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Maeda, J. L.; Levit, K.] Thomson Reuters, Washington, DC USA. [Parlato, J.] Thomson Reuters, Cambridge, MA USA. [Andrews, R. M.; Jiang, H. J.] AHRQ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2011 VL 14 IS 3 BP A28 EP A28 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 876JY UT WOS:000299105000145 ER PT J AU Croswell, JM Kramer, BS Crawford, ED AF Croswell, Jennifer M. Kramer, Barnett S. Crawford, E. David TI Screening for Prostate Cancer With PSA Testing: Current Status and Future Directions SO ONCOLOGY-NEW YORK LA English DT Review ID RANDOMIZED CONTROLLED-TRIAL; FOLLOW-UP; RADICAL PROSTATECTOMY; MORTALITY; ANTIGEN; OUTCOMES; MEN; POPULATION; CARCINOMA; TRENDS AB The ultimate utility of the serum prostate specific antigen (PSA) assay as a screening test for reducing prostate cancer mortality has been an area of intense controversy since its introduction. PSA testing was not initially envisioned as a screening tool, but as a way to evaluate treatment responses in men with prostate cancer. Far in advance of evidence from randomized trials, the rapid and widespread uptake of PSA screening into US practice was initially driven by the intuitively logical assumption that the earlier one detects a malignancy, the more likely treatment is to be curative while minimizing associated harms. However, a growing body of observational evidence began to point to a substantial burden of associated overdiagnosis and overtreatment triggered by PSA testing. The interim results of several randomized clinical trials specifically designed to evaluate the impact of PSA testing on prostate cancer mortality have recently become available, but their incongruent results seem to have added fuel to the debate. This article presents a review of the literature on screening for prostate cancer with PSA testing; we include a detailed discussion of potential explanations for the contradictory results of the two largest randomized trials as well as reflections on the future of prostate cancer screening. C1 [Croswell, Jennifer M.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Kramer, Barnett S.] NCI, Rockville, MD USA. [Crawford, E. David] Univ Colorado, Ctr Canc, Hlth Sci Ctr, Denver, CO 80262 USA. RP Croswell, JM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM jennifer.croswell@ahrq.hhs.gov NR 57 TC 17 Z9 19 U1 0 U2 5 PU UBM MEDICA PI NORWALK PA 535 CONNECTICUT AVE, STE 300, NORWALK, CT 06854 USA SN 0890-9091 J9 ONCOLOGY-NY JI Oncology-NY PD MAY PY 2011 VL 25 IS 6 BP 452 EP 463 PG 10 WC Oncology SC Oncology GA 800EW UT WOS:000293343600002 PM 21717898 ER PT J AU Dougherty, D Schiff, J Mangione-Smith, R AF Dougherty, Denise Schiff, Jeffrey Mangione-Smith, Rita TI The Children's Health Insurance Program Reauthorization Act Quality Measures Initiatives: Moving Forward to Improve Measurement, Care, and Child and Adolescent Outcomes SO ACADEMIC PEDIATRICS LA English DT Editorial Material DE CHIP; CHIPRA; health care quality; measures; policy ID SICKLE-CELL-DISEASE; PRIVATELY INSURED POPULATION; UNITED-STATES; PATIENT SAFETY; OF-LIFE; EXPENDITURES; MEDICAID; DISPARITIES; CHIPRA; READMISSION AB In 2009, a publicly transparent evidence-informed process responded to the requirement of the Children's Health Insurance Program Reauthorization Act (CHIPRA) legislation to identify an initial core set of recommended children's health care quality measures for voluntary use by Medicaid and the Children's Health Insurance Program, which together cover almost 40 million of America's children and adolescents. Future efforts under CHIPRA will be used to improve and strengthen the initial core set, develop new measures as needed, and post improved core measure sets annually beginning in January 2013. This supplement aims to make available useful information about issues surrounding the initial core set and key concepts for moving forward toward improvement of children's health care quality measures, children's health care quality, and children's health outcomes. The set of articles in this supplement includes a detailed description of how the identification of a balanced, grounded, and parsimonious core set of children's health care quality measures was accomplished by means of an open, public process combined with an evidence-informed evaluation methodology. Additional articles note that Medicaid and Children's Health Insurance Program (CHIP) officials put a high priority on children's health care quality and desire better measures; that publicly insured children are more likely than privately insured children to experience severe, complex chronic conditions and experience poorer quality in some respects; and that some key CHIPRA topics did not yet have valid, feasible measures (eg, availability of services, duration of enrollment and coverage, most integrated health care settings, and some aspects of family experiences of care). Key stakeholders and observers provide commentary noting the unprecedented scope and nature of the CHIPRA legislation as well as noting areas in which the nation still needs to move to improve health care quality, including its measurement. These areas include greater engagement of families and health care providers in the quality measurement and improvement enterprises, collaboration across federal agencies, more emphasis on clinical effectiveness research to enhance the validity of children's health care services and quality measures, and a need to maintain an emphasis on children as the nation expands health care coverage and attention to quality for all populations. This overview also notes areas of future priorities for measure enhancement and development, including inpatient specialty, health outcomes, and a focus on inequity. We and others contributing to this supplement consider the identification of the initial core set to be a significant initial accomplishment under CHIPRA. With sufficient attention to making the measures feasible for use across Medicaid and CHIP programs, and with technical assistance, voluntary use should be facilitated. However, the initial core set is but one step on the road toward improved quality for children. The identification of future challenges and opportunities for measure enhancement will be helpful in setting and implementing a future pediatric quality research agenda. C1 [Dougherty, Denise] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Schiff, Jeffrey] Minnesota Dept Human Serv, Hlth Care Serv, St Paul, MN USA. [Schiff, Jeffrey] Minnesota Dept Human Serv, Med Management Div, St Paul, MN USA. [Mangione-Smith, Rita] Univ Washington, Ctr Child Hlth Behav & Dev, Seattle, WA 98195 USA. [Mangione-Smith, Rita] Seattle Childrens Hosp, Res Inst, Seattle, WA USA. RP Dougherty, D (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Denise.Dougherty@ahrq.hhs.gov NR 84 TC 30 Z9 30 U1 0 U2 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 J9 ACAD PEDIATR JI Acad. Pediatr. PD MAY-JUN PY 2011 VL 11 IS 3 SU S BP S1 EP S10 PG 10 WC Pediatrics SC Pediatrics GA 768IX UT WOS:000290928700001 PM 21570012 ER PT J AU Mangione-Smith, R Schiff, J Dougherty, D AF Mangione-Smith, Rita Schiff, Jeffrey Dougherty, Denise TI Identifying Children's Health Care Quality Measures for Medicaid and CHIP: An Evidence-Informed, Publicly Transparent Expert Process SO ACADEMIC PEDIATRICS LA English DT Editorial Material DE children's health care quality measurement; CHIP; CHIPRA; Medicaid AB OBJECTIVE: To describe the process used to identify the recommended core set of quality measures as mandated by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and provide an overview of the measures selected. METHODS: In May 2009, the multidisciplinary Agency for Healthcare Research and Quality (AHRQ) National Advisory Council for Healthcare Research and Quality Subcommittee on Children's Healthcare Quality Measures for Medicaid and CHIP Programs (SNAC) was formed. The SNAC established criteria to evaluate quality measures on the basis of their validity, feasibility, and importance. Subsequently, AHRQ implemented a measure nomination process. Nominators supplied key information related to measure validity, feasibility, and importance. Oxford Centre for Evidence-Based Medicine (CEBM) criteria were used to assess evidence supporting the validity/scientific soundness of nominated measures. SNAC members applied an adaptation of the RAND-UCLA modified Delphi process to all nominated measures. Measures passing the Delphi process were further assessed on the basis of criteria pertaining to legislative priorities. RESULTS: Seventy of 119 nominated measures met criteria for validity, feasibility, and importance according to Delphi scoring. After further prioritization, 25 measures were recommended for the initial core set. Twelve of the recommended measures focus on preventive care and health promotion including prenatal/perinatal care (4), well-child care (1), immunizations (2), screening for: developmental delays (1), obesity (1), and sexually transmitted infections (1), and receipt of preventive dental services (2). Five acute care measures were recommended which focus on management of upper respiratory illnesses (2), receipt of acute care dental services (1), emergency department utilization (1), and inpatient rates of central line associated bloodstream infections (1). Five of the recommended measures focus on chronic care, specifically asthma (1), attention-deficit/hyperactivity disorder (1), diabetes (1), and care for children with mental health conditions (2). Two of the measures focus on family experiences with care, and one of the measures assesses utilization of outpatient primary care services. Thirteen (52%) of the measures were derived from the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS). Eighteen of the measures were supported by relatively high levels of evidence (Oxford CEBM grade A or B). CONCLUSIONS: An open national public process combined with an evidence-informed evaluation methodology resulted in identification of a balanced, grounded, and parsimonious core set of measures that should become feasible to implement on a widespread scale over time. C1 [Mangione-Smith, Rita] Univ Washington, Dept Pediat, Seattle Childrens Hosp, Ctr Child Hlth Behav & Dev,Res Inst, Seattle, WA 98101 USA. [Mangione-Smith, Rita] Univ Washington, Dept Pediat, Seattle, WA 98101 USA. [Schiff, Jeffrey] Minnesota Dept Human Serv, Hlth Serv Med Management, St Paul, MN USA. [Dougherty, Denise] Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, Rockville, MD USA. RP Mangione-Smith, R (reprint author), Univ Washington, Dept Pediat, Seattle Childrens Hosp, Ctr Child Hlth Behav & Dev,Res Inst, 1100 Olive Way,Suite 500, Seattle, WA 98101 USA. EM Rita.Mangione-Smith@seattlechildrens.org NR 31 TC 29 Z9 29 U1 0 U2 12 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 J9 ACAD PEDIATR JI Acad. Pediatr. PD MAY-JUN PY 2011 VL 11 IS 3 SU S BP S11 EP S21 PG 11 WC Pediatrics SC Pediatrics GA 768IX UT WOS:000290928700002 PM 21570013 ER PT J AU Garfield, RL Zuvekas, SH Lave, JR Donohue, JM AF Garfield, Rachel L. Zuvekas, Samuel H. Lave, Judith R. Donohue, Julie M. TI The Impact of National Health Care Reform on Adults With Severe Mental Disorders SO AMERICAN JOURNAL OF PSYCHIATRY LA English DT Article ID UNITED-STATES; OUTPATIENT TREATMENT; INSURANCE; TRENDS; DEPRESSION; DISPARITIES; ILLNESS; PSYCHOTHERAPY; COMORBIDITY; POPULATION AB Objective: Little is known about the effect recent health care reform legislation will have on coverage of individuals with severe mental disorders. The authors examined current and predicted sources of insurance coverage and use of mental health services among adults with and without severe mental disorders and modeled postreform changes. Method: The authors obtained sociode-mographic, health status, mental health care use, and insurance coverage data from the 2004-2006 Medical Expenditure Panel Surveys to estimate changes that will occur after reform is fully implemented in 2019. Results: Adults with severe mental disorders, identified as self-reported severe depression or other psychological distress, were more likely than those without such disorders to be uninsured (21.0% compared with 16.5%). Only one-fifth of individuals with severe mental disorders who lacked full-year insurance coverage had any mental health service use in the 2004-2006 period, compared with approximately half of those who had coverage. The authors estimate that the expansion of insurance coverage under reform will lead to 1.15 million new users of mental health services, which represents a 4.5% increase. The authors estimate an increase of 2.3 million users of mental health services in Medicaid and nearly 2 million in private insurance. Conclusions: Public insurance programs that currently play a major role in financing mental health services will play an even greater role after reform is implemented. Significant increases can be expected both in the overall number of users of mental health services and in their resources to pay for care. C1 Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Policy & Management, Pittsburgh, PA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Garfield, RL (reprint author), Henry J Kaiser Family Fdn, Kaiser Commiss Medicaid & Uninsured, 1330 G St NW, Washington, DC 20005 USA. EM rachelg@kff.org OI Donohue, Julie/0000-0003-2418-6017 FU Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services [HHSP23320095642WC]; NIMH [1R34 MH082682-01A1]; National Center for Research Resources at NIH [KL2 RR024154-04] FX Supported by the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services through contract HHSP23320095642WC with Mathematica Policy Research (Drs. Garfield, Lave, and Donohue); by NIMH grant 1R34 MH082682-01A1 (Dr. Donohue); and by grant KL2 RR024154-04 from the National Center for Research Resources at NIH (Dr. Donohue). NR 39 TC 67 Z9 67 U1 4 U2 16 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 MAY PY 2011 VL 168 IS 5 BP 486 EP 494 DI 10.1176/appi.ajp.2010.10060792 PG 9 WC Psychiatry SC Psychiatry GA 757MG UT WOS:000290089000009 PM 21285138 ER PT J AU Hoeksema, LJ Bazzy-Asaad, A Lomotan, EA Edmonds, DE Ramirez-Garnica, G Shiffman, RN Horwitzi, LI AF Hoeksema, Laura J. Bazzy-Asaad, Alia Lomotan, Edwin A. Edmonds, Diana E. Ramirez-Garnica, Gabriela Shiffman, Richard N. Horwitzi, Leora I. TI Accuracy of a computerized clinical decision-support system for asthma assessment and management SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article ID RANDOMIZED CONTROLLED TRIAL; EVIDENCE-BASED MEDICINE; EMERGENCY-DEPARTMENT; PATIENT OUTCOMES; GUIDELINE IMPLEMENTATION; UNITED-STATES; PRIMARY-CARE; OF-CARE; IMPROVE; CHILDREN AB Objective To evaluate the accuracy of a computerized clinical decision-support system (CDSS) designed to support assessment and management of pediatric asthma in a subspecialty clinic. Design Cohort study of all asthma visits to pediatric pulmonology from January to December, 2009. Measurements CDSS and physician assessments of asthma severity, control, and treatment step. Results Both the clinician and the computerized CDSS generated assessments of asthma control in 767/1032 (74.3%) return patients, assessments of asthma severity in 100/167 (59.9%) new patients, and recommendations for treatment step in 66/167(39.5%) new patients. Clinicians agreed with the CDSS in 543/767 (70.8%) of control assessments, 37/100 (37%) of severity assessments, and 19/66 (29%) of step recommendations. External review classified 72% of control disagreements (21% of all control assessments), 56% of severity disagreements (37% of all severity assessments), and 76% of step disagreements (54% of all step recommendations) as CDSS errors. The remaining disagreements resulted from pulmonologist error or ambiguous guidelines. Many CDSS flaws, such as attributing all 'cough' to asthma, were easily remediable. Pediatric pulmonologists failed to follow guidelines in 8% of return visits and 18% of new visits. Limitations The authors relied on chart notes to determine clinical reasoning. Physicians may have changed their assessments after seeing CDSS recommendations. Conclusions A computerized CDSS performed relatively accurately compared to clinicians for assessment of asthma control but was inaccurate for treatment. Pediatric pulmonologists failed to follow guideline-based care in a small proportion of patients. C1 [Horwitzi, Leora I.] Yale Univ, Sch Med, Dept Med, Sect Genera Internal Med, New Haven, CT 06520 USA. [Hoeksema, Laura J.] Natl Ctr fcr Patient Safety, Ann Arbor, MI USA. [Bazzy-Asaad, Alia] Yale Univ, Sch Med, Dept Pediat, Sect Pediat Resp Med, New Haven, CT 06520 USA. [Lomotan, Edwin A.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Edmonds, Diana E.; Shiffman, Richard N.] Yale Univ, Sch Med, Yale Ctr Med Informat, New Haven, CT 06520 USA. [Ramirez-Garnica, Gabriela] Nemours, Nemours Clin Management Program, Orlando, FL USA. [Horwitzi, Leora I.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. RP Horwitzi, LI (reprint author), Yale Univ, Sch Med, Dept Med, Sect Genera Internal Med, POB 208093, New Haven, CT 06520 USA. EM leora.horwitz@yale.edu OI Horwitz, Leora/0000-0003-1800-6040 FU Agency for Healthcare Research and Quality [HHSA 290200810011]; National Library of Medicine [T15-LM07065]; CTSA [UL1 RR024139]; National Center for Research Resources (NCRR), National Institutes of Health [KL2 RR024138]; National Institutes of Health roadmap for Medical Research FX This work was supported by contract HHSA 290200810011 from the Agency for Healthcare Research and Quality and grant T15-LM07065 from the National Library of Medicine. At the time this study was conducted, LIH was supported by the CTSA Grant UL1 RR024139 and KL2 RR024138 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health, and National Institutes of Health roadmap for Medical Research. NR 32 TC 16 Z9 16 U1 1 U2 9 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD MAY PY 2011 VL 18 IS 3 BP 243 EP 250 DI 10.1136/amiajnl-2010-000063 PG 8 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Health Care Sciences & Services; Information Science & Library Science; Medical Informatics SC Computer Science; Health Care Sciences & Services; Information Science & Library Science; Medical Informatics GA 755TT UT WOS:000289960600006 PM 21486882 ER PT J AU Seidman, E Chorpita, BF Reay, WE Stelk, W Garland, AF Kutash, K Mullican, C Ringeisen, H AF Seidman, Edward Chorpita, Bruce F. Reay, William E. Stelk, Wayne Garland, Ann F. Kutash, Krista Mullican, Charlotte Ringeisen, Heather TI A Framework for Measurement Feedback to Improve Decision-Making in Mental Health (vol 37, pg 128, 2009) SO ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH LA English DT Correction C1 [Seidman, Edward] William T Grant Fdn, New York, NY 10022 USA. [Chorpita, Bruce F.] Univ Calif Los Angeles, Los Angeles, CA USA. [Reay, William E.] OMNI Behav Hlth, Omaha, NE USA. [Garland, Ann F.] Univ Calif San Diego, San Diego, CA 92103 USA. [Kutash, Krista] Univ S Florida, Res & Training Ctr Childrens Mental Hlth, Tampa, FL USA. [Mullican, Charlotte] AHRQ, Ctr Primary Care Prevent & Clin Partnerships, Washington, DC USA. [Ringeisen, Heather] RTI Int, Res Triangle Pk, NC USA. [Seidman, Edward] NYU, New York, NY 10022 USA. [Reay, William E.] Northcent Univ, Omaha, NE USA. [Stelk, Wayne] Massachusetts Behav Hlth Partnership ValueOpt, Boston, MA USA. RP Seidman, E (reprint author), William T Grant Fdn, 570 Lexington Ave,18th Floor, New York, NY 10022 USA. EM eseidman@wtgrantfdn.org RI Chorpita, Bruce/J-8203-2012 NR 1 TC 0 Z9 0 U1 0 U2 4 PU MAIK NAUKA/INTERPERIODICA/SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013-1578 USA SN 0894-587X J9 ADM POLICY MENT HLTH JI Adm. Policy. Ment. Health PD MAY PY 2011 VL 38 IS 3 BP 215 EP 215 DI 10.1007/s10488-010-0287-y PG 1 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 750PB UT WOS:000289559400009 ER PT J AU Finkelstein, J Barr, MS Kothari, PP Nace, DK Quinn, M AF Finkelstein, Joseph Barr, Michael S. Kothari, Pranav P. Nace, David K. Quinn, Matthew TI Patient-Centered Medical Home Cyberinfrastructure Current and Future Landscape SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID HEALTH INFORMATION-TECHNOLOGY; RANDOMIZED CONTROLLED-TRIAL; DECISION-SUPPORT-SYSTEMS; PRIMARY-CARE PHYSICIANS; CHRONIC ILLNESS; UNITED-STATES; QUALITY; RECORDS; CHALLENGES; TELEMANAGEMENT AB The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization. (Am J Prev Med 2011;40(5S2):S225-S233) (C) 2011 American Journal of Preventive Medicine C1 [Finkelstein, Joseph] Johns Hopkins Univ, Sch Med, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD 21205 USA. [Quinn, Matthew] Agcy Healthcare Res & Qual, Rockville, MD USA. [Barr, Michael S.] Amer Coll Physicians, Washington, DC USA. [Kothari, Pranav P.] Renaissance Hlth, Cambridge, MA USA. [Nace, David K.] McKesson Hlth Solut, Newton, MA USA. RP Finkelstein, J (reprint author), Johns Hopkins Univ, Sch Med, Welch Ctr Prevent Epidemiol & Clin Res, 2024 E Monument St,Room 2-615, Baltimore, MD 21205 USA. EM jfinkel9@jhmi.edu FU AHRQ [HHSA-290-2007-10061]; National Institutes of Health FX We extend sincere thanks and appreciation to Teresa Zayas Caban, PhD, for reviewing the article and providing valuable feedback. JF was supported in part by AHRQ contract HHSA-290-2007-10061. Opinions and recommendations expressed in the paper are those of the authors and do not necessarily reflect the policies of their respective organizations.; Publication of this article was supported by the National Institutes of Health. NR 68 TC 21 Z9 21 U1 0 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 MAY PY 2011 VL 40 IS 5 SU 2 BP S225 EP S233 DI 10.1016/j.amepre.2011.01.003 PG 9 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 754DR UT WOS:000289833200019 PM 21521598 ER PT J AU Metersky, ML Hunt, DR Kliman, R Wang, Y Curry, M Verzier, N Lyder, CH Moy, E AF Metersky, Mark L. Hunt, David R. Kliman, Rebecca Wang, Yun Curry, Maureen Verzier, Nancy Lyder, Courtney H. Moy, Ernest TI Racial Disparities in the Frequency of Patient Safety Events Results From the National Medicare Patient Safety Monitoring System SO MEDICAL CARE LA English DT Article DE healthcare disparities; safety; safety management; medical errors; quality improvement; quality indicators; healthcare ID CARE; QUALITY; OUTCOMES; RACE AB Background: Although there is extensive evidence of racial disparities in processes and outcomes of medical care, there has been limited investigation of disparities in patient safety. Objective: To determine whether there are racial disparities in the frequency of adverse events studied in the Medicare Patient Safety Monitoring System. Design and Subjects: Abstraction of 102,623 randomly selected charts from hospital discharges of non-Hispanic white and black Medicare patients between January 1, 2004 and December 31, 2007 to assess frequency of patient safety events in 4 domains: general (pressure ulcers and falls), selected nosocomial infections, selected procedure-related adverse events, and adverse drug events due to anticoagulants and hypoglycemic agents. Measures: Racial disparities in risk of patient safety events, and differences in adverse event rates among hospital groups stratified by percentage of black patients. Results: Blacks had higher adjusted risk than whites of suffering one of the measured nosocomial infections (1.34; 95% confidence interval, 1.17-1.55; P < 0.001) and one of the measured adverse drug events (1.29; 95% confidence interval, 1.19-1.40; P < 0.001). After adjustment for patient and hospital factors, patients in hospitals with the highest percentages of black patients were at increased risk of experiencing one of the measured nosocomial infections (1.9% vs. 1.5%; P < 0.001) and adverse drug events (8.7% vs. 7.8%; P < 0.01). Conclusions: Hospitalized blacks are at higher risk than whites of experiencing certain patient safety events. In addition, hospitals serving high percentages of black patients have higher risk-adjusted rates of selected patient safety events. C1 [Metersky, Mark L.] Univ Connecticut, Ctr Hlth, Div Pulm & Crit Care Med, Sch Med, Farmington, CT 06030 USA. [Metersky, Mark L.; Wang, Yun; Curry, Maureen; Verzier, Nancy] Qualidigm, New Haven, CT USA. [Hunt, David R.] Off Natl Coordinator Hlth IT, Off Hlth Informat Technol Adopt, Washington, DC USA. [Kliman, Rebecca] Ctr Medicare Serv, Off Clin Stand & Qual, Baltimore, MD USA. [Kliman, Rebecca] Ctr Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. [Wang, Yun] Yale Univ, Ctr Outcomes Res & Evaluat, New Haven, CT USA. [Wang, Yun] Yale New Haven Med Ctr, New Haven, CT 06504 USA. [Lyder, Courtney H.] Univ Calif Los Angeles, Sch Nursing, Los Angeles, CA 90024 USA. [Moy, Ernest] Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Metersky, ML (reprint author), Univ Connecticut, Ctr Hlth, Div Pulm & Crit Care Med, Sch Med, 263 Farmington Ave, Farmington, CT 06030 USA. EM Metersky@nso.uchc.edu FU Centers for Medicare & Medicaid Services, Department of Health and Human Services [500-2006-CT002C] FX The analyses upon which this publication is based were performed under Contract Number 500-2006-CT002C, entitled "Utilization and Quality Control: Quality Improvement Organization for the State of Connecticut" sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. NR 26 TC 13 Z9 13 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 2011 VL 49 IS 5 BP 504 EP 510 DI 10.1097/MLR.0b013e31820fc218 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 750MQ UT WOS:000289551800011 PM 21494115 ER PT J AU Dougherty, D Clancy, C AF Dougherty, Denise Clancy, Carolyn TI Transforming Children's Health Care Quality and Outcomes-A Not-So-Random Non-linear Walk Across the Translational Continuum SO ACADEMIC PEDIATRICS LA English DT Editorial Material ID PEDIATRIC RESEARCH; CLINICAL-RESEARCH; STATE; DISPARITIES; MEDICAID; SCIENCE C1 [Dougherty, Denise; Clancy, Carolyn] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Dougherty, D (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM denise.dougherty@ahrq.hhs.gov NR 31 TC 6 Z9 6 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 J9 ACAD PEDIATR JI Acad. Pediatr. PD MAY-JUN PY 2011 VL 11 IS 3 SU S BP S91 EP S94 PG 4 WC Pediatrics SC Pediatrics GA 768IX UT WOS:000290928700013 PM 21570024 ER PT J AU Gellad, WF Donohue, JM Zhao, XH Banthin, JS AF Gellad, Walid F. Donohue, Julie M. Zhao, Xinhua Banthin, Jessica S. TI TRENDS IN THE FINANCIAL BURDEN OF PRESCRIPTION DRUGS AMONG THE NON-ELDERLY, 1999-2007 SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 [Gellad, Walid F.; Zhao, Xinhua] Univ Pittsburgh, VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA. [Donohue, Julie M.] Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA USA. [Banthin, Jessica S.] AHRQ, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD MAY PY 2011 VL 26 SU 1 BP S96 EP S96 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA V30JQ UT WOS:000208812700170 ER PT J AU Gray, D AF Gray, Darryl TI THE QUALITY OF INPATIENT CARE PROVIDED FOR PATIENTS WITH ACUTE MYOCARDIAL INFARCTION (AMI): FINDINGS FROM THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)'S ANNUAL NATIONAL HEALTHCARE QUALITY REPORT (NHQR) SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Meeting Abstract CT 60th Annual Scientific Session and Expo of the American-College-of-Cardiology CY APR 03-05, 2011 CL New Orleans, LA SP Amer Coll Cardiol C1 [Gray, Darryl] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 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 APR 5 PY 2011 VL 57 IS 14 SU 1 BP E1277 EP E1277 PG 1 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 778HR UT WOS:000291695101280 ER PT J AU Sharkey, S Hudak, S Horn, SD Spector, W AF Sharkey, Siobhan Hudak, Sandra Horn, Susan D. Spector, William TI Leveraging Certified Nursing Assistant Documentation and Knowledge to Improve Clinical Decision Making: The On-Time Quality Improvement Program to Prevent Pressure Ulcers SO ADVANCES IN SKIN & WOUND CARE LA English DT Article DE On-Time Quality Improvement for Long-term Care Program; certified nursing assistant documentation; improve clinical decision making ID LONG-TERM-CARE; RESIDENTS AB The goal of this article was to enhance understanding of the On-Time Quality Improvement for Long-term Care Program, a practical approach to embed health information technology into quality improvement in long-term-care facilities that leverages certified nursing assistant documentation and knowledge, supports frontline clinical decision making, and establishes proactive intervention for pressure ulcer prevention. C1 [Sharkey, Siobhan; Hudak, Sandra] Hlth Management Strategies, Austin, TX USA. [Horn, Susan D.] Inst Clin Outcomes Res, Salt Lake City, UT USA. [Spector, William] US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Sharkey, S (reprint author), Hlth Management Strategies, Austin, TX USA. FU Agency for Healthcare Research and Quality, US Department of Health Human Services [HHSA290-2005-0020] FX This work was supported by the Agency for Healthcare Research and Quality, US Department of Health & Human Services, contract #HHSA290-2005-0020. NR 15 TC 11 Z9 11 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1527-7941 J9 ADV SKIN WOUND CARE JI Adv. Skin Wound Care PD APR PY 2011 VL 24 IS 4 BP 182 EP 188 DI 10.1097/01.ASW.0000396244.65415.7f PG 7 WC Dermatology; Nursing; Surgery SC Dermatology; Nursing; Surgery GA 833EK UT WOS:000295864400006 PM 21407045 ER PT J AU McCormack, LA Treiman, K Rupert, D Williams-Piehota, P Nadler, E Arora, NK Lawrence, W Street, RL AF McCormack, Lauren A. Treiman, Katherine Rupert, Douglas Williams-Piehota, Pamela Nadler, Eric Arora, Neeraj K. Lawrence, William Street, Richard L., Jr. TI Measuring patient-centered communication in cancer care: A literature review and the development of a systematic approach SO SOCIAL SCIENCE & MEDICINE LA English DT Review DE Patient-centered communication; Conceptual framework; Measurement; Cancer care; Review; USA ID SELF-DETERMINATION THEORY; SHARED DECISION-MAKING; BREAST-CANCER; PHYSICIAN COMMUNICATION; PATIENTS PERSPECTIVES; STANDARDIZED PATIENTS; PATIENTS PREFERENCES; PATIENTS PERCEPTIONS; AFRICAN-AMERICAN; HUMAN CONNECTION AB Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute's Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph (Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773. (C) 2011 Elsevier Ltd. All rights reserved. C1 [McCormack, Lauren A.; Rupert, Douglas; Williams-Piehota, Pamela] RTI Int, Hlth Commun Program, Res Triangle Pk, NC 27709 USA. [Treiman, Katherine] RTI Int, Hlth Commun Program, Rockville, MD 20852 USA. [Nadler, Eric] Baylor Univ, Med Ctr, Charles Sammons Canc Ctr, Dallas, TX 75246 USA. [Arora, Neeraj K.] NCI, Outcomes Res Branch, ARP, DCCPS, Bethesda, MD 20892 USA. [Lawrence, William] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. [Street, Richard L., Jr.] Texas A&M Univ, Dept Commun, College Stn, TX 77843 USA. RP McCormack, LA (reprint author), RTI Int, Hlth Commun Program, 3040 Cornwallis Rd, Res Triangle Pk, NC 27709 USA. EM Lmac@rti.org; Ktreiman@rti.org; drupert@rti.org; ppiehota@rti.org; Eric.Nadler@oncologytoday.com; aroran@mail.nih.gov; william.lawrence@ahrq.hhs.gov; r-street@tamu.edu NR 84 TC 63 Z9 63 U1 4 U2 33 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0277-9536 J9 SOC SCI MED JI Soc. Sci. Med. PD APR PY 2011 VL 72 IS 7 BP 1085 EP 1095 DI 10.1016/j.socscimed.2011.01.020 PG 11 WC Public, Environmental & Occupational Health; Social Sciences, Biomedical SC Public, Environmental & Occupational Health; Biomedical Social Sciences GA 757DN UT WOS:000290065000011 PM 21376443 ER PT J AU Honore, PA Wright, D Berwick, DM Clancy, CM Lee, P Nowinski, J Koh, HK AF Honore, Peggy A. Wright, Donald Berwick, Donald M. Clancy, Carolyn M. Lee, Peter Nowinski, Juleigh Koh, Howard K. TI Creating A Framework For Getting Quality Into The Public Health System SO HEALTH AFFAIRS LA English DT Article ID CARE AB The US health care system has undertaken concerted efforts to improve the quality of care that Americans receive, using well-documented strategies and new incentives found in the Affordable Care Act of 2010. Applying quality concepts to public health has lagged these efforts, however. This article describes two reports from the Department of Health and Human Services: Consensus Statement on Quality in the Public Health System and Priority Areas for Improvement of Quality in Public Health. These reports define what is meant by public health quality, establish quality aims, and highlight priority areas needing improvement. We describe how these developments relate to the Affordable Care Act and serve as a call to action for ensuring a better future for population health. We present real-world examples of how a framework of quality concepts can be applied in the National Vaccine Safety Program and in a state office of minority health. C1 [Honore, Peggy A.] Dept Hlth & Human Serv HHS, Publ Hlth Syst Finance & Qual Program, Off Healthcare Qual, Off Assistant Secretary Hlth, Washington, DC USA. [Berwick, Donald M.] Ctr Medicare Serv, Baltimore, MD USA. [Berwick, Donald M.] Ctr Medicaid Serv, Baltimore, MD USA. [Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Honore, PA (reprint author), Dept Hlth & Human Serv HHS, Publ Hlth Syst Finance & Qual Program, Off Healthcare Qual, Off Assistant Secretary Hlth, Washington, DC USA. EM peggy.honore@hhs.gov NR 46 TC 34 Z9 34 U1 0 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 APR PY 2011 VL 30 IS 4 BP 737 EP 745 DI 10.1377/hlthaff.2011.0129 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 746HE UT WOS:000289233400027 PM 21471496 ER PT J AU Duncan, JR Balter, S Becker, GJ Brady, J Brink, JA Bulas, D Chatfield, MB Choi, S Connolly, BL Dixon, RG Gray, JE Kee, ST Miller, DL Robinson, DW Sands, MJ Schauer, DA Steele, JR Street, M Thornton, RH Wise, RA AF Duncan, James R. Balter, Stephen Becker, Gary J. Brady, Jeffrey Brink, James A. Bulas, Dorothy Chatfield, Mythreyi B. Choi, Simon Connolly, Bairbre L. Dixon, Robert G. Gray, Joel E. Kee, Stephen T. Miller, Donald L. Robinson, Donald W. Sands, Mark J. Schauer, David A. Steele, Joseph R. Street, Mandie Thornton, Raymond H. Wise, Robert A. TI Optimizing Radiation Use during Fluoroscopic Procedures: Proceedings from a Multidisciplinary Consensus Panel SO JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY LA English DT Article ID INTERVENTIONAL RADIOLOGY PROCEDURES; BOARD-OF-RADIOLOGY; COMPUTED-TOMOGRAPHY; IONIZING-RADIATION; PEDIATRIC CT; CANCER-RISKS; RAD-IR; DIAGNOSTIC-RADIOLOGY; QUALITY IMPROVEMENT; DOSE AWARENESS C1 [Duncan, James R.; Street, Mandie] Washington Univ, Mallinckrodt Inst Radiol, Sch Med, St Louis, MO 63110 USA. [Balter, Stephen] Columbia Univ, Dept Med, Med Ctr, New York, NY 10027 USA. [Thornton, Raymond H.] Mem Sloan Kettering Canc Ctr, Dept Med Phys, New York, NY 10021 USA. [Becker, Gary J.] Amer Board Radiol, Tucson, AZ USA. [Brady, Jeffrey] Agcy Healthcare Res & Qual, Rockville, MD USA. [Choi, Simon] US FDA, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [Miller, Donald L.] Natl Naval Med Ctr, Dept Radiol, Bethesda, MD USA. [Miller, Donald L.] Uniformed Serv Univ Hlth Sci, Dept Radiol & Radiol Sci, F Edward Hebert Sch Med, Bethesda, MD USA. [Schauer, David A.] Natl Council Radiat Protect & Measurements, Bethesda, MD USA. [Brink, James A.] Yale Univ, Dept Diagnost Radiol, New Haven, CT 06510 USA. [Bulas, Dorothy] Childrens Natl Med Ctr, Div Diagnost Imaging, Washington, DC USA. [Robinson, Donald W.] US Dept Def, Patient Safety Program, Washington, DC 20305 USA. [Chatfield, Mythreyi B.] Amer Coll Radiol, Reston, VA USA. [Connolly, Bairbre L.] Hosp Sick Children, Dept Diagnost Imaging, Toronto, ON M5G 1X8, Canada. [Dixon, Robert G.] Univ N Carolina, Dept Vasc & Intervent Radiol, Chapel Hill, NC USA. [Gray, Joel E.] Mayo Clin, Coll Med, Rochester, MN USA. [Kee, Stephen T.] Ronald Regan Univ Calif Los Angeles, Dept Radiol, Med Ctr, Los Angeles, CA USA. [Sands, Mark J.] Cleveland Clin, Sect Intervent Radiol, Imaging Inst, Cleveland, OH 44106 USA. [Steele, Joseph R.] Univ Texas MD Anderson Canc Ctr, Dept Intervent Radiol, Houston, TX 77030 USA. [Wise, Robert A.] Joint Commiss, Div Stand & Survey Methods, Oak Brook Terrace, IL USA. RP Duncan, JR (reprint author), Washington Univ, Mallinckrodt Inst Radiol, Sch Med, 510 S Kingshighway Blvd, St Louis, MO 63110 USA. EM duncanj@mir.wustl.edu OI Duncan, James/0000-0002-0337-8805 NR 52 TC 7 Z9 7 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1051-0443 EI 1535-7732 J9 J VASC INTERV RADIOL JI J. Vasc. Interv. Radiol. PD APR PY 2011 VL 22 IS 4 BP 425 EP 429 DI 10.1016/j.jvir.2010.12.008 PG 5 WC Radiology, Nuclear Medicine & Medical Imaging; Peripheral Vascular Disease SC Radiology, Nuclear Medicine & Medical Imaging; Cardiovascular System & Cardiology GA 747SQ UT WOS:000289340100001 PM 21463753 ER PT J AU Conway, P Goodrich, K Machlin, S Sasse, B Cohen, J AF Conway, Patrick Goodrich, Kate Machlin, Steven Sasse, Benjamin Cohen, Joel TI Patient-Centered Care Categorization of U.S. Health Care Expenditures SO HEALTH SERVICES RESEARCH LA English DT Article DE National medical expenditures; patient-centered care; health policy ID BENEFICIARIES; MEDICARE; QUALITY AB Objective To categorize national medical expenditures into patient-centered categories. Data Sources The 2007 Medical Expenditure Panel Survey (MEPS), a nationally representative annual survey of the civilian noninstitutionalized population. Study Design Descriptive statistics categorizing expenditures into seven patient-centered care categories: chronic conditions, acute illness, trauma/injury or poisoning, dental, pregnancy/birth-related, routine preventative health care, and other. Data Collection Methods MEPS cohort. Principal Findings Nearly half of expenditures were for chronic conditions. The remaining expenditures were as follows: acute illness (25 percent), trauma/poisoning (8 percent), dental (7 percent), routine preventative health care (6 percent), pregnancy/birth-related (4 percent), and other (3 percent). Hospital-based expenditures accounted for the majority for acute illness, trauma/injury, and pregnancy/birth and over a third for chronic conditions. Conclusions This patient-centered viewpoint may complement other methods to examine health care expenditures and may better represent how patients interact with the health care system and expend resources. C1 [Conway, Patrick] Cincinnati Childrens Hosp Med Ctr, Hosp Med, Div Gen Pediat, Anderson Ctr Hlth Syst Excellence, Cincinnati, OH 45229 USA. [Goodrich, Kate] Dept Hlth & Human Serv, Off Assistant Secretary Planning & Evaluat, Washington, DC USA. [Machlin, Steven; Cohen, Joel] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Sasse, Benjamin] Midland Univ, Presidents Off, Fremont, NE USA. RP Conway, P (reprint author), Cincinnati Childrens Hosp Med Ctr, Hosp Med, Div Gen Pediat, Anderson Ctr Hlth Syst Excellence, 3333 Burnet Ave,MLC 2011, Cincinnati, OH 45229 USA. EM Patrick.Conway@CCHMC.org NR 10 TC 8 Z9 8 U1 1 U2 5 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2011 VL 46 IS 2 BP 479 EP 490 DI 10.1111/j.1475-6773.2010.01212.x PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 729QL UT WOS:000287965600008 PM 21091472 ER PT J AU Shapiro, M Murray-Kolb, L Chang, S Hamadani, J El Arifeen, S Baqui, A Black, R AF Shapiro, Myra Murray-Kolb, Laura Chang, Stephanie Hamadani, Jena El Arifeen, Shams Baqui, Abdullah Black, Robert TI Maternal depressive symptoms and infant diarrhea in Bangladesh SO FASEB JOURNAL LA English DT Meeting Abstract CT Experimental Biology Meeting 2011 CY APR 09-13, 2011 CL Washington, DC SP Amer Assoc Anatomists (AAA), Amer Physiolog Soc (APS), Amer Soc Biochem & Mol Biol (ASBMB), Amer Soc Investigat Pathol (ASIP), Amer Soc Nutrit (ASN), Amer Soc Pharmacol & Expt Therapeut (ASPET) C1 [Shapiro, Myra; Murray-Kolb, Laura; Baqui, Abdullah; Black, Robert] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Murray-Kolb, Laura] Penn State Univ, University Pk, PA 16802 USA. [Chang, Stephanie] Johns Hopkins Med Inst, Agcy Healthcare Res & Qual, Rockville, MD USA. [Hamadani, Jena; El Arifeen, Shams] ICDDR B, Dhaka, Bangladesh. NR 0 TC 0 Z9 0 U1 0 U2 0 PU FEDERATION AMER SOC EXP BIOL PI BETHESDA PA 9650 ROCKVILLE PIKE, BETHESDA, MD 20814-3998 USA SN 0892-6638 J9 FASEB J JI Faseb J. PD APR PY 2011 VL 25 PG 1 WC Biochemistry & Molecular Biology; Biology; Cell Biology SC Biochemistry & Molecular Biology; Life Sciences & Biomedicine - Other Topics; Cell Biology GA 032IE UT WOS:000310708405126 ER PT J AU Meyers, D AF Meyers, David TI Using the evidence: PCMH and patient-centered outcomes research SO JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. RP Meyers, D (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. NR 4 TC 0 Z9 0 U1 0 U2 1 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 MAR-APR PY 2011 VL 51 IS 2 BP 155 EP 155 DI 10.1331/JAPhA.2011.11516 PG 1 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 857VV UT WOS:000297752100005 PM 21382803 ER PT J AU Vistnes, J Selden, T AF Vistnes, Jessica Selden, Thomas TI Premium growth and its effect on employer-sponsored insurance SO INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE & ECONOMICS LA English DT Article DE Employer-sponsored health insurance; Premium growth; Employer decisions ID HEALTH; BENEFITS AB We use variation in premium inflation and general inflation across geographic areas to identify the effects of downward nominal wage rigidity on employers' health insurance decisions. Using employer level data from the 2000 to 2005 Medical Expenditure Panel Survey-Insurance Component, we examine the effect of premium growth on the likelihood that an employer offers insurance, eligibility rates among employees, continuous measures of employee premium contributions for both single and family coverage, and deductibles. We find that small, low-wage employers are less likely to offer health insurance in response to increased premium inflation, and if they do offer coverage they increase employee contributions and deductible levels. In contrast, larger, low-wage employers maintain their offers of coverage, but reduce eligibility for such coverage. They also increase employee contributions for single and family coverage, but not deductibles. Among high-wage employers, all but the largest increase deductibles in response to cost pressures. C1 [Vistnes, Jessica; Selden, Thomas] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Vistnes, J (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM jvistnes@ahrq.gov NR 18 TC 2 Z9 2 U1 0 U2 2 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1389-6563 J9 INT J HEALTH CARE FI JI Int. J. Health Care Financ. Econ. PD MAR PY 2011 VL 11 IS 1 BP 55 EP 81 DI 10.1007/s10754-011-9088-4 PG 27 WC Business, Finance; Economics; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 765CF UT WOS:000290680300003 PM 21331581 ER PT J AU Elixhauser, A Andrews, R AF Elixhauser, Anne Andrews, Roxanne TI A Tool For Reporting Hospital Data On Care SO HEALTH AFFAIRS LA English DT Letter C1 [Elixhauser, Anne; Andrews, Roxanne] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Elixhauser, A (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 0 TC 1 Z9 1 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 PY 2011 VL 30 IS 3 BP 538 EP 538 DI 10.1377/hlthaff.2011.0205 PG 1 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 731NV UT WOS:000288117000038 PM 21383381 ER PT J AU Meyers, D Quinn, M Clancy, CM AF Meyers, David Quinn, Matt Clancy, Carolyn M. TI Health Information Technology: Turning the Patient-Centered Medical Home From Concept to Reality SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 [Meyers, David; Quinn, Matt; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Meyers, D (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM David.Meyers@AHRQ.hhs.gov NR 11 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 MAR-APR PY 2011 VL 26 IS 2 BP 154 EP 156 DI 10.1177/1062860610396165 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 734MK UT WOS:000288338000010 PM 21403178 ER PT J AU Andrews, RM AF Andrews, Roxanne M. TI Race and Ethnicity Reporting in Statewide Hospital Data: Progress and Future Challenges in a Key Resource for Local and State Monitoring of Health Disparities SO JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE LA English DT Article DE ethnicity; hospital administrative data; local data; race; state data ID DISCHARGE DATA; RACE/ETHNICITY; RELIABILITY; SELF AB Objectives: Statewide hospital discharge data are a major source of information to monitor population health, including racial-ethnic disparities. This study examined the extent and quality of race-ethnicity coding in statewide hospital data. Methods: Information on statewide race-ethnicity reporting and data quality was obtained through the Healthcare Cost and Utilization Project State Inpatient Databases and supplemental documents. Results: Race data collection increased from 14 to 43 states between 1991 and 2008. In 2008, 20 states conform to the 1997 Office of Management and Budget directive standard, 4 do not collect Hispanic ethnicity, 19 use the 1977 Office of Management and Budget standard, 10 collect multiracial data, and 3 collect detailed racial-ethnic categories. Data quality problems were found in 6% of studied hospitals overall, but varied by state. Conclusions: Substantial progress was made in the last 2 decades in the collection of race-ethnicity data. However, the current national standards are often not used. The recent inclusion of race-ethnicity in the hospital claim standard and electronic health care record should improve standardized collection. Improving accuracy and locally relevant detailed coding will likely be the major challenges for the future. C1 Agcy Healthcare Res & Qual, Ctr Delivery Organ & Markets, Rockville, MD 20850 USA. RP Andrews, RM (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Organ & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM roxanne.andrews@ahrq.hhs.gov NR 35 TC 7 Z9 7 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1078-4659 EI 1550-5022 J9 J PUBLIC HEALTH MAN JI J. Public Health Manag. Pract. PD MAR-APR PY 2011 VL 17 IS 2 BP 167 EP 173 DI 10.1097/PHH.0b013e3181f5426c PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 716MV UT WOS:000286975200012 PM 21297413 ER PT J AU Rosen, AK Mull, HJ Kaafarani, H Nebeker, J Shimada, S Helwig, A Nordberg, B Long, B Savitz, LA Shanahan, CW Itani, K AF Rosen, Amy K. Mull, Hillary J. Kaafarani, Haytham Nebeker, Jonathan Shimada, Stephanie Helwig, Amy Nordberg, Brian Long, Brenna Savitz, Lucy A. Shanahan, Christopher W. Itani, Kamal TI Applying Trigger Tools to Detect Adverse Events Associated With Outpatient Surgery SO JOURNAL OF PATIENT SAFETY LA English DT Article DE patient safety; adverse events; triggers; outpatient surgery; quality AB Objective: The objective of this study is to evaluate the performance of 5 triggers to detect adverse events (AEs) associated with outpatient surgery. Triggers use surveillance algorithms derived from clinical logic to flag cases where AEs have most likely occurred. Current efforts to detect AEs have focused primarily on the inpatient setting, despite the increase in outpatient surgery in all health care settings. Methods: Using trigger logic, we retrospectively evaluated data from 3 large health care systems' electronic medical records. Patients were eligible for inclusion if they had an outpatient (same-day) surgery in 2007 and at least 1 clinical note in the 6 months after the surgery. Two nurse abstractors reviewed a sample of trigger-flagged cases from each health care system. After reaching interrater reliability targets (k > 0.60), we calculated the positive predictive value (PPV) of each trigger and the confidence interval of the estimate. Results: The surgical triggers flagged between 1% and 22% of the outpatient surgery cases, with a wide range in PPVs (6.0%-62.0%). The pulmonary embolism and deep vein thrombosis and emergency department triggers had the lowest proportion of flagged cases along with the highest PPVs, showing the most promise for screening cases with a high probability of AE occurrence. Conclusions: Triggers may be useful in identifying a narrow set of surgeries for further review to determine if a surgical AE occurred, complementing existing tools and initiatives used to detect AEs. Improved detection of AEs in outpatient surgery should help target potential areas for quality improvement. C1 [Rosen, Amy K.; Mull, Hillary J.] VA Boston Healthcare Syst, Ctr Org, Leadership, Management Res, Boston, MA USA. [Rosen, Amy K.; Mull, Hillary J.; Shimada, Stephanie] Boston Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA. [Kaafarani, Haytham] Tufts Med Ctr, Dept Surg, Boston, MA USA. [Kaafarani, Haytham] Tufts Univ, Sch Med, Boston, MA 02111 USA. [Nebeker, Jonathan; Nordberg, Brian; Long, Brenna] VA Salt Lake City Geriatr Res Educ & Clin Ctr, Salt Lake City, UT USA. [Nebeker, Jonathan; Savitz, Lucy A.] Univ Utah, Salt Lake City, UT USA. [Shimada, Stephanie] Bedford VAMC, Ctr Hlth Qual Outcomes & Econ Res, Bedford, MA USA. [Helwig, Amy] Agcy Healthcare Res & Qual, Rockville, MD USA. [Savitz, Lucy A.] Intermt Healthcare, Salt Lake City, UT USA. [Shanahan, Christopher W.] Boston Univ, Sch Med, Boston, MA 02118 USA. [Shanahan, Christopher W.] Boston Med Ctr, Boston, MA USA. [Itani, Kamal] VA Boston Healthcare Syst, Dept Surg, W Roxbury, MA USA. [Itani, Kamal] Harvard Univ, Sch Med, Boston, MA USA. RP Rosen, AK (reprint author), VA Boston Healthcare Syst 152M, 150 S Huntington Ave, Boston, MA 02130 USA. EM akrosen@bu.edu RI Shanahan, Christopher/H-6592-2015 OI Shanahan, Christopher/0000-0001-9067-5922 FU Agency for Healthcare Research and Quality [HHSA290200600012] FX This project was supported by the Agency for Healthcare Research and Quality (Contract No. HHSA290200600012). NR 32 TC 7 Z9 7 U1 1 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1549-8417 J9 J PATIENT SAF JI J. Patient Saf. PD MAR PY 2011 VL 7 IS 1 BP 45 EP 59 DI 10.1097/PTS.0b013e31820d164b PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA V27KL UT WOS:000208612000008 PM 21921867 ER PT J AU DeWalt, DA Broucksou, KA Hawk, V Brach, C Hink, A Rudd, R Callahan, L AF DeWalt, Darren A. Broucksou, Kimberly A. Hawk, Victoria Brach, Cindy Hink, Ashley Rudd, Rima Callahan, Leigh TI Developing and testing the health literacy universal precautions toolkit SO NURSING OUTLOOK LA English DT Article DE Health literacy; Quality improvement ID MORTALITY; QUALITY; CARE AB The health literacy demands of the healthcare system often exceed the health literacy skills of Americans. This article reviews the development of the Health Literacy Universal Precautions (HLUP) Toolkit, commissioned by the Agency for Healthcare Research and Quality and designed to help primary care practices structure the delivery of care as if every patient may have limited health literacy. The development of the toolkit spanned 2 years and consisted of 3 major tasks: (1) developing individual tools (modules explaining how to use or implement a strategy to minimize the effects of low health literacy), using existing health literacy resources when possible, (2) testing individual tools in clinical practice and assembling them into a prototype toolkit, and (3) testing the prototype toolkit in clinical practice. Testing revealed that practices will use tools that are concise and actionable and are not perceived as being resource intensive. Conducting practice self-assessments and generating enthusiasm among staff were key elements for successful implementation. Implementing practice changes required more time than anticipated and some knowledge of quality improvement techniques. In sum, the HLUP Toolkit holds promise as a means of improving primary care for people with limited health literacy, but further testing is needed. C1 [DeWalt, Darren A.; Broucksou, Kimberly A.; Hawk, Victoria] Univ N Carolina, Div Gen Internal Med, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC 27599 USA. [Brach, Cindy] US Dept HHS, Agcy Hlth Care Policy & Res, Rockville, MD 20852 USA. [Hink, Ashley] E Carolina Univ, Brody Sch Med, Greenville, NC USA. [Rudd, Rima] Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA. [Callahan, Leigh] Univ N Carolina, Dept Med, Thurston Arthrit Res Ctr, Chapel Hill, NC 27599 USA. RP DeWalt, DA (reprint author), Univ N Carolina, Div Gen Internal Med, Cecil G Sheps Ctr Hlth Serv Res, 5041 Old Clin Bldg,CB 7110, Chapel Hill, NC 27599 USA. EM dewaltd@med.unc.edu OI DeWalt, Darren/0000-0003-2270-751X FU Agency for Healthcare Research and Quality [HHSA290200710014] FX This research project was funded by the Agency for Healthcare Research and Quality Contract No: HHSA290200710014. NR 20 TC 41 Z9 43 U1 3 U2 9 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0029-6554 J9 NURS OUTLOOK JI Nurs. Outlook PD MAR-APR PY 2011 VL 59 IS 2 SI SI BP 85 EP 94 DI 10.1016/j.outlook.2010.12.002 PG 10 WC Nursing SC Nursing GA 742GY UT WOS:000288930500006 PM 21402204 ER PT J AU Barton, M AF Barton, Mary TI Vision Screening for Children 1 to 5 Years of Age: US Preventive Services Task Force Recommendation Statement SO PEDIATRICS LA English DT Article DE vision screening; preventive services; children ID RANDOMIZED CONTROLLED-TRIAL; MODERATE AMBLYOPIA; VISUAL IMPAIRMENT; PRESCHOOLERS; REGIMENS; ATROPINE; TESTS AB OBJECTIVE: The goal was to provide an update of the 2004 US Preventive Services Task Force (USPSTF) statement about screening for visual impairment in children <5 years of age. METHODS: The USPSTF examined evidence on the association of screening for visual impairment in children 1 to 5 years of age with improved health outcomes, the accuracy of risk factor assessment and screening tests, the effectiveness of early detection and treatment, and the harms of screening and treatment. RECOMMENDATION: The USPSTF recommends vision screening for all children at least once between the ages of 3 and 5 years, to detect the presence of amblyopia or its risk factors (grade B recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of vision screening for children <3 years of age (I statement). Pediatrics 2011; 127:340-346 C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Barton, M (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM mary.barton@ahrg.hhs.gov NR 19 TC 27 Z9 28 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 FEB PY 2011 VL 127 IS 2 BP 340 EP 346 DI 10.1542/peds.2010-3177 PG 7 WC Pediatrics SC Pediatrics GA 714JF UT WOS:000286805200052 ER PT J AU Spector, WD Limcangco, MR Ladd, H Mukamel, DA AF Spector, William D. Limcangco, Maria Rhona Ladd, Heather Mukamel, Dana A. TI Incremental Cost of Postacute Care in Nursing Homes SO HEALTH SERVICES RESEARCH LA English DT Article DE Health care costs; Medicare; instrumental variables ID RUG-III; REIMBURSEMENT; FACILITIES AB Objectives To determine whether the case mix index (CMI) based on the 53-Resource Utilization Groups (RUGs) captures all the cross-sectional variation in nursing home (NH) costs or whether NHs that have a higher percent of Medicare skilled care days (%SKILLED) have additional costs. Data and Sample Nine hundred and eighty-eight NHs in California in 2005. Data are from Medicaid cost reports, the Minimum Data Set, and the Economic Census. Research Design We estimate hybrid cost functions, which include in addition to outputs, case mix, ownership, wages, and %SKILLED. Two-stage least-square (2SLS) analysis was used to deal with the potential endogeneity of %SKILLED and CMI. Results On average 11 percent of NHs days were due to skilled care. Based on the 2SLS model, %SKILLED is associated with costs even when controlling for CMI. The marginal cost of a one percentage point increase in %SKILLED is estimated at U.S.$70,474 or about 1.2 percent of annual costs for the average cost facility. Subanalyses show that the increase in costs is mainly due to additional expenses for nontherapy ancillaries and rehabilitation. Conclusion The 53-RUGs case mix does not account completely for all the variation in actual costs of care for postacute patients in NHs. C1 [Spector, William D.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Limcangco, Maria Rhona] Social & Sci Syst Inc, Silver Spring, MD USA. [Ladd, Heather; Mukamel, Dana A.] Univ Calif Irvine, Irvine, CA USA. RP Spector, WD (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM william.spector@ahrq.hhs.gov FU National Institute on Aging [AG027420] FX The research was partially supported by grant AG027420 from the National Institute on Aging. NR 22 TC 2 Z9 2 U1 0 U2 2 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD FEB PY 2011 VL 46 IS 1 BP 105 EP 119 DI 10.1111/j.1475-6773.2010.01189.x PN 1 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 701OZ UT WOS:000285831600006 PM 21029085 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI As Obesity Epidemic Escalates, Need for More Screening and Counseling Grows SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 Agcy Hlth Care Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Hlth Care Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 7 TC 1 Z9 1 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 JAN-MAR PY 2011 VL 26 IS 1 BP 1 EP 3 DI 10.1097/NCQ.0b013e3181fa5451 PG 3 WC Nursing SC Nursing GA 692FF UT WOS:000285137700001 PM 22914665 ER PT J AU Basu, J AF Basu, Jayasree TI Admissions for CABG Procedure in the Elderly: Was There a Change in Access to Teaching Hospitals After 1997? SO SOCIAL WORK IN PUBLIC HEALTH LA English DT Article DE Elderly; access; health care organization; hospital performance; cardiac procedure ID QUALITY-OF-CARE; BYPASS GRAFT-SURGERY; NONTEACHING HOSPITALS; MEDICARE PATIENTS; MANAGED CARE; MORTALITY AB The purpose of the study is to identify patient attributes associated with teaching hospital admissions in the elderly for coronary artery bypass graft (CABG), and to determine whether admission patterns in teaching hospitals by vulnerable subgroups of the elderly changed during 1997 to 2001, a period with significant changes in CABG admission patterns and financial situation faced by teaching hospitals. The study sample comprises elderly residents in two states, New York and Pennsylvania, and uses Healthcare Cost and Utilization Project State Inpatient data of the Agency for Health Care Research and Quality. Patient characteristics in major teaching hospitals are compared with those in rest of hospitals in a logistic regression framework using a pre-/postdesign, and controlling for county characteristics and resources, distance to hospitals, and hospital size and volume of procedures. Significant patient characteristics associated with a higher likelihood of admission to teaching hospitals included racial/ethnic minority status, transfer cases, Medicaid and private health maintenance organization insurance. A lower volume of CABG cases and an increased propensity to admit more complex cases characterized the admission patterns in teaching hospitals during 1997 to 2001. Although higher use of teaching hospitals by racial/ethnic minorities persisted, access for Medicaid patients disproportionately declined. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Basu, J (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jbasu@ahrq.gov NR 25 TC 0 Z9 0 U1 0 U2 0 PU ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD PI ABINGDON PA 4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXFORDSHIRE, ENGLAND SN 1937-1918 EI 1937-190X J9 SOC WORK PUBLIC HLTH JI Soc. Work Public Health PY 2011 VL 26 IS 6 BP 605 EP 620 DI 10.1080/19371911003748778 PG 16 WC Public, Environmental & Occupational Health; Social Work SC Public, Environmental & Occupational Health; Social Work GA 838FO UT WOS:000296272700004 PM 21932980 ER PT J AU Leipzig, RM Whitlock, EP Wolff, TA Barton, MB Michael, YL Harris, R Petitti, D Wilt, T Siu, A AF Leipzig, Rosanne M. Whitlock, Evelyn P. Wolff, Tracy A. Barton, Mary B. Michael, Yvonne L. Harris, Russell Petitti, Diana Wilt, Timothy Siu, Al CA US Preventive Serv Task Force Geri TI Reconsidering the Approach to Prevention Recommendations for Older Adults SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID SERVICES-TASK-FORCE; RISK-FACTORS; ELDERLY-PEOPLE; COMMUNITY; INTERVENTION; FALLS AB The U.S. Preventive Services Task Force (USPSTF) bases its recommendations on an evidence-based model of clinical prevention that focuses on specific diseases, well-defined preventive interventions, and evidence of improved health outcomes. Applying this model to prevention for very old patients has been problematic for several reasons: Many geriatric disorders have multiple risk factors, interventions, and expected outcomes; older adults are not often represented in clinical trials; and important outcomes may not be measured and reported in ways that are conducive to evidence synthesis and interpretation. In 2005, the USPSTF convened a geriatrics workgroup to refine USPSTF methodology and processes to better address the preventive needs of older adults. The USPSTF has begun to apply these new approaches to the review and recommendation on interventions to prevent falls in older adults. C1 [Leipzig, Rosanne M.] Mt Sinai Sch Med, Brookdale Dept Geriatr & Adult Dev, New York, NY 10029 USA. Kaiser Permanente NW, Ctr Hlth Res, Oregon Evidence Based Practice Ctr, Portland, OR USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ N Carolina, Chapel Hill, NC 27599 USA. Arizona State Univ, Phoenix, AZ 85004 USA. Minneapolis Vet Affairs Med Ctr, Minneapolis, MN 55417 USA. Univ Minnesota, Minneapolis, MN 55417 USA. RP Leipzig, RM (reprint author), Mt Sinai Sch Med, Brookdale Dept Geriatr & Adult Dev, 1468 Madison Ave,Box 1070, New York, NY 10029 USA. FU Agency for Healthcare Research and Quality FX The general work of the USPSTF is supported by the Agency for Healthcare Research and Quality. This specific manuscript did not receive separate funding. NR 13 TC 26 Z9 26 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 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD DEC 21 PY 2010 VL 153 IS 12 BP 809 EP + DI 10.7326/0003-4819-153-12-201012210-00007 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 696PL UT WOS:000285453700004 PM 21173415 ER PT J AU Glickman, SW Delgado, MK Hirshon, JM Hollander, JE Iwashyna, TJ Jacobs, AK Kilaru, AS Lorch, SA Mutter, RL Myers, SR Owens, PL Phelan, MP Pines, JM Seymour, CW Wang, NE Branas, CC AF Glickman, Seth W. Delgado, M. Kit Hirshon, Jon Mark Hollander, Judd E. Iwashyna, Theodore J. Jacobs, Alice K. Kilaru, Austin S. Lorch, Scott A. Mutter, Ryan L. Myers, Sage R. Owens, Pamela L. Phelan, Michael P. Pines, Jesse M. Seymour, Christopher W. Wang, N. Ewen Branas, Charles C. TI Defining and Measuring Successful Emergency Care Networks: A Research Agenda SO ACADEMIC EMERGENCY MEDICINE LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; PRIMARY ANGIOPLASTY VOLUME; CRITICAL ILLNESS; TRAUMA CENTER; HOSPITAL PERFORMANCE; QUALITY IMPROVEMENT; HEART-FAILURE; OUTCOMES; MORTALITY; INTERVENTION AB The demands on emergency services have grown relentlessly, and the Institute of Medicine (IOM) has asserted the need for "regionalized, coordinated, and accountable emergency care systems throughout the country." There are large gaps in the evidence base needed to fix the problem of how emergency care is organized and delivered, and science is urgently needed to define and measure success in the emerging network of emergency care. In 2010, Academic Emergency Medicine convened a consensus conference entitled "Beyond Regionalization: Integrated Networks of Emergency Care." This article is a product of the conference breakout session on "Defining and Measuring Successful Networks"; it explores the concept of integrated emergency care delivery and prioritizes a research agenda for how to best define and measure successful networks of emergency care. The authors discuss five key areas: 1) the fundamental metrics that are needed to measure networks across time-sensitive and non-time-sensitive conditions; 2) how networks can be scalable and nimble and can be creative in terms of best practices; 3) the potential unintended consequences of networks of emergency care; 4) the development of large-scale, yet feasible, network data systems; and 5) the linkage of data systems across the disease course. These knowledge gaps must be filled to improve the quality and efficiency of emergency care and to fulfill the IOM's vision of regionalized, coordinated, and accountable emergency care systems. ACADEMIC EMERGENCY MEDICINE 2010; 17:1297-1305 (C) 2010 by the Society for Academic Emergency Medicine. C1 [Glickman, Seth W.] Univ N Carolina, Sch Med, Dept Emergency Med, Chapel Hill, NC 27515 USA. [Delgado, M. Kit] Stanford Univ, Sch Med, Ctr Primary Care & Outcomes Res, Palo Alto, CA 94304 USA. [Delgado, M. Kit] Stanford Univ, Sch Med, Div Emergency Med, Palo Alto, CA 94304 USA. [Wang, N. Ewen] Stanford Univ, Sch Med, Div Pediat Emergency Med, Palo Alto, CA 94304 USA. [Hirshon, Jon Mark] Univ Maryland, Sch Med, Dept Emergency Med, Baltimore, MD 21201 USA. [Hollander, Judd E.] Hosp Univ Penn, Dept Emergency Med, Philadelphia, PA 19104 USA. [Jacobs, Alice K.] Boston Univ, Med Ctr, Dept Med, Boston, MA USA. [Iwashyna, Theodore J.] Univ Michigan, Sch Med, Div Pulm & Crit Care, Ann Arbor, MI USA. [Lorch, Scott A.] Childrens Hosp Philadelphia, Dept Pediat, Div Neonatol, Philadelphia, PA 19104 USA. [Lorch, Scott A.] Childrens Hosp Philadelphia, Ctr Outcomes Res, Philadelphia, PA 19104 USA. [Mutter, Ryan L.; Owens, Pamela L.] Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD USA. [Phelan, Michael P.] Cleveland Clin, Emergency Serv Inst, Cleveland, OH 44106 USA. [Pines, Jesse M.] George Washington Univ, Dept Emergency Med, Sch Med, Washington, DC USA. [Pines, Jesse M.] George Washington Univ, Sch Med, Dept Hlth Policy, Washington, DC USA. [Seymour, Christopher W.] Univ Washington, Sch Med, Div Pulm & Crit Care Med, Seattle, WA USA. [Lorch, Scott A.; Branas, Charles C.] Univ Penn, Sch Med, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA. RP Glickman, SW (reprint author), Univ N Carolina, Sch Med, Dept Emergency Med, Chapel Hill, NC 27515 USA. EM swglick@med.unc.edu RI lyp, maggie/G-1471-2011; OI Hollander, Judd/0000-0002-1318-2785; Hirshon, Jon Mark/0000-0002-5247-529X; Iwashyna, Theodore/0000-0002-4226-9310 FU AHRQ HHS [R01 HS010914, R01 HS018362]; NCIPC CDC HHS [R01 CE001615] NR 66 TC 20 Z9 20 U1 1 U2 4 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD DEC PY 2010 VL 17 IS 12 BP 1297 EP 1305 DI 10.1111/j.1553-2712.2010.00930.x PG 9 WC Emergency Medicine SC Emergency Medicine GA 688KL UT WOS:000284848100007 PM 21122011 ER PT J AU Elixhauser, A Andrews, RM AF Elixhauser, Anne Andrews, Roxanne M. TI Profile of Inpatient Operating Room Procedures in US Hospitals in 2007 SO ARCHIVES OF SURGERY LA English DT Article ID UNITED-STATES; GENERAL-SURGERY; EPIDEMIOLOGY AB Objective: To provide an overview of inpatient operating room (OR) procedures in the United States. Design, Setting, and Patients: Healthcare Cost and Utilization Project 2007 Nationwide Inpatient Sample discharge data from a sample of US short-term, acute-care, nonfederal hospitals. Main Outcome Measures: National volume of OR procedures overall and by type of procedure, resource use and costs, most frequent and expensive procedures, and trends. Results: Fifteen million OR procedures were performed in 2007 (495 procedures/10 000 population). Only 26.4% of hospitalizations involved an OR procedure; however, OR related stays were responsible for 46.8% of hospital costs ($161 billion). Patients aged 65 years and older were 2 to 3 times more likely to experience OR procedures (eg, 1327 procedures/10 000 persons among those aged 65-84 years vs 626 procedures/10 000 persons for those aged 45-64 years). Compared with non-OR inpatients, OR patients were less severely ill (20.5% had the highest severity of illness vs 24.6% for non-OR patients) and used more resources ($2900/day for OR patients vs $1400/day for non-OR patients). The 15 most expensive procedures accounted for half of all procedure-related hospitalization costs and one-fourth of total hospital costs. Volumes for 4 of the most expensive procedures increased between 1997 and 2007: 20% for percutaneous transluminal coronary angioplasty, 46% for cesarean delivery, 46% for knee replacement, and 45% for spinal fusion. The volume of percutaneous transluminal coronary angioplasty declined 20% from 2006 to 2007, compared with a 56% increase in the prior decade. Conclusions: Procedures in the OR represent a large portion of hospital costs, and these costs are concentrated in few procedure types. C1 [Elixhauser, Anne; Andrews, Roxanne M.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Elixhauser, A (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM anne.elixhauser@ahrq.hhs.gov FU Agency for Healthcare Research and Quality FX Financial support for the study was provided by the Agency for Healthcare Research and Quality, which employs Drs Elixhauser and Andrews. NR 29 TC 21 Z9 22 U1 1 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610-0946 USA SN 0004-0010 J9 ARCH SURG-CHICAGO JI Arch. Surg. PD DEC PY 2010 VL 145 IS 12 BP 1201 EP 1208 DI 10.1001/archsurg.2010.269 PG 8 WC Surgery SC Surgery GA 696VZ UT WOS:000285470800021 PM 21173295 ER PT J AU Li, Y Harrington, C Spector, WD Mukamel, DB AF Li, Yue Harrington, Charlene Spector, William D. Mukamel, Dana B. TI State Regulatory Enforcement and Nursing Home Termination from the Medicare and Medicaid Programs SO HEALTH SERVICES RESEARCH LA English DT Article DE Nursing home regulation; Medicare and Medicaid; termination; state variation ID LONG-TERM-CARE; QUALITY; REIMBURSEMENT; PERFORMANCE; FACILITIES; DETERMINANTS; COMPETITION; RESIDENTS; CLOSURES; INDUSTRY AB Objectives Nursing homes certified by the Medicare and/or Medicaid program are subject to federally mandated and state-enforced quality and safety standards. We examined the relationship between state quality enforcement and nursing home terminations from the two programs. Study Design Using data from a survey of state licensure and certification agencies and other secondary databases, we performed bivariate and multivariate analyses on the strength of state quality regulation in 2005, and nursing home voluntary terminations (decisions made by the facility) or involuntary terminations (imposed by the state) in 2006-2007. Principal Findings Involuntary terminations were rarely imposed by state regulators, while voluntary terminations were relatively more common (2.16 percent in 2006-2007) and varied considerably across states. After controlling for facility, market, and state covariates, nursing homes in states implementing stronger quality enforcement were more likely to voluntarily terminate from the Medicare and Medicaid programs (odds ratio=1.53, p=.018). Conclusions Although involuntary nursing home terminations occurred rarely in most states, nursing homes in states with stronger quality regulations tend to voluntarily exit the publicly financed market. Because of the consequences of voluntary terminations on patient care and access, state regulators need to consider the effects of increased enforcement on both enhanced quality and the costs of termination. C1 [Li, Yue] Univ Iowa, Dept Internal Med, Iowa City, IA 52242 USA. [Li, Yue] Iowa City VA Med Ctr, Iowa City, IA 52242 USA. [Mukamel, Dana B.] Univ Calif Irvine, Hlth Policy Res Inst, Irvine, CA USA. [Mukamel, Dana B.] Univ Calif Irvine, Dept Med, Irvine, CA 92717 USA. [Harrington, Charlene] Univ Calif San Francisco, Dept Social & Behav Sci, San Francisco, CA 94143 USA. [Spector, William D.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Li, Y (reprint author), Univ Iowa, Dept Internal Med, SE610 GH,200 Hawkins Dr, Iowa City, IA 52242 USA. EM yue-li@uiowa.edu FU National Institute on Aging [AG027420] FX The authors greatly acknowledge the funding by the National Institute on Aging under grant AG027420. NR 41 TC 15 Z9 15 U1 1 U2 4 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 EI 1475-6773 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2010 VL 45 IS 6 BP 1796 EP 1814 DI 10.1111/j.1475-6773.2010.01164.x PN 1 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 678HS UT WOS:000284065300013 PM 20819106 ER PT J AU Fraser, I Encinosa, W Baker, L AF Fraser, Irene Encinosa, William Baker, Laurence TI Payment Reform SO HEALTH SERVICES RESEARCH LA English DT Article C1 [Fraser, Irene; Encinosa, William] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. [Baker, Laurence] Stanford Univ, Dept Hlth Res & Policy, Stanford, CA 94305 USA. RP Fraser, I (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM irene.fraser@ahrq.hhs.gov OI Baker, Laurence/0000-0001-5032-794X NR 12 TC 3 Z9 3 U1 1 U2 7 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2010 VL 45 IS 6 BP 1847 EP 1853 DI 10.1111/j.1475-6773.2010.01208.x PN 2 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 678IC UT WOS:000284066300001 PM 21058946 ER PT J AU Basu, J Mobley, LR AF Basu, Jayasree Mobley, Lee R. TI Impact of Local Resources on Hospitalization Patterns of Medicare Beneficiaries and Propensity to Travel Outside Local Markets SO JOURNAL OF RURAL HEALTH LA English DT Article DE Elderly access to care; federal programs; HCUP-SID; hospitalization patterns; preventable hospitalization; rural areas; travel patterns ID CRITICAL ACCESS HOSPITALS; OF-AREA TRAVEL; URBAN COMMUNITIES; BYPASS BEHAVIOR; HEALTH-CARE; ILLNESS; PHYSICIAN; SEVERITY; COUNTIES; CHILDREN AB Purpose: To examine how local health care resources impact travel patterns of patients age 65 and older across the rural urban continuum. Methods: Information on inpatient hospital discharges was drawn from complete 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for New York, California, and Florida, and the 2003 hospital discharge file for Pennsylvania. The study population was Medicare patients with admissions for ambulatory care sensitive conditions. Analysis was at the patient-level, and area contextual variables were developed at the Primary Care Service Area (PCSA) level. Local resources considered included inpatient supply, provider supply, supply of international medical graduates, and critical access hospitals (CAHs) in the patient's PCSA. Findings: Findings generally confirmed enhanced retention of the elderly in local markets with greater availability of community resources, although we observed considerable heterogeneity across states. Community resource variables such as median household income or inpatient hospital capacity were stronger and more consistent predictors along the urban rural continuum than any of the provider or CAH variables. Only in California and New York did we see significant effects for provider supply or CAH, but they were robust across the 2 states and models of travel propensity, always reducing the travel propensity. Conclusions: Findings support policies aimed at augmenting supplies of critical access hospitals in rural communities, and increasing primary care physicians and hospital resources in both rural and urban communities. C1 [Basu, Jayasree] Ctr Primary Care Prevent & Clin Partnerships, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Mobley, Lee R.] RTI Int, Res Triangle Pk, NC USA. RP Basu, J (reprint author), Ctr Primary Care Prevent & Clin Partnerships, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jayasree.basu@ahrq.hhs.gov FU Agency for Healthcare Research and Quality; RTI International FX This research is funded wholly by the authors' employers, the Agency for Healthcare Research and Quality and RTI International. The views expressed in this paper are those of the authors. No official endorsement by any agency of the federal government is intended or should be inferred. The authors would like to acknowledge the state data organizations that participate in the Healthcare Cost and Utilization Project State Inpatient Databases: the California Office of Statewide Health Planning and Development; the Florida Agency for Health Care Administration; the New York State Department of Health; and the Pennsylvania Health Care Cost Containment Council. NR 43 TC 9 Z9 9 U1 2 U2 6 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0890-765X EI 1748-0361 J9 J RURAL HEALTH JI J. Rural Health PD WIN PY 2010 VL 26 IS 1 BP 20 EP 29 DI 10.1111/j.1748-0361.2009.00261.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 540EJ UT WOS:000273313500004 PM 20105264 ER PT J AU Fleishman, JA Yehia, BR Moore, RD Gebo, KA AF Fleishman, John A. Yehia, Baligh R. Moore, Richard D. Gebo, Kelly A. CA HIV Res Network TI The Economic Burden of Late Entry Into Medical Care for Patients With HIV Infection SO MEDICAL CARE LA English DT Article DE HIV; AIDS; expenditures; late presentation ID ACTIVE ANTIRETROVIRAL THERAPY; LATE DIAGNOSIS; CELL COUNT; HIV-1-INFECTED PATIENTS; COLLABORATIVE ANALYSIS; AIDS; ERA; CONSEQUENCES; STRATEGIES; INITIATION AB Context: A large proportion of people with human immunodeficiency virus (HIV) infection enter care late in the HIV disease course. Late entry can increase expenditures for care. Objective: To estimate direct medical care expenditures for HIV patients as a function of disease status at initial presentation to care. Late entry is defined as initial CD4 test result <= 200 cells/mm(3), intermediate entry as initial CD4 counts >200, and <= 500 cells/mm(3); and early entry as initial CD4 count >500. Patients: The study included 8348 patients who received HIV primary care and who were newly enrolled between 2000 and 2006 at one of 10 HIV clinics participating in the HIV Research Network. Design: We reviewed medical record data from 2000 to 2007. We estimated costs per outpatient visit and inpatient day, and monthly medication costs (antiretroviral and opportunistic illness prophylaxis). We multiplied unit costs by utilization measures to estimate expenditures for inpatient days, outpatient visits, HIV medications, and laboratory tests. We analyzed the association between cumulative expenditures and initial CD4 count, stratified by years in care. Results: Late entrants comprised 43.1% of new patients. The number of years receiving care after enrollment did not differ significantly across initial CD4 groups. Mean cumulative treatment expenditures ranged from $27,275 to $61,615 higher for late than early presenters. After 7 to 8 years in care, the difference was still substantial. Conclusions: Patients who enter medical care late in their HIV disease have substantially higher direct medical treatment expenditures than those who enter at earlier stages. Successful efforts to link patients with medical care earlier in the disease course may yield cost savings. C1 [Fleishman, John A.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [Yehia, Baligh R.] Univ Penn, Sch Med, Dept Med, Philadelphia, PA 19104 USA. [Moore, Richard D.; Gebo, Kelly A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM john.fleishman@ahrq.hhs.gov FU Agency for Healthcare Research and Quality [290-01-0012]; National Institutes of Aging [R01 AG026250]; National Institutes of Drug Abuse [K23-DA00523, K24 DA 00432]; Agency for Healthcare Research and Quality, Rockville, MD FX Supported by the Agency for Healthcare Research and Quality (290-01-0012) and the National Institutes of Aging (R01 AG026250) and Drug Abuse (K23-DA00523 and K24 DA 00432). Johns Hopkins Clinician Scientist Award (to K. A. G.). Supported by Agency for Healthcare Research and Quality, Rockville, MD (Fred Hellinger, PhD, John Fleishman, PhD, Irene Fraser, PhD); Health Resources and Services Administration, Rockville, MD (Robert Mills, PhD). NR 34 TC 63 Z9 65 U1 0 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 2010 VL 48 IS 12 BP 1071 EP 1079 DI 10.1097/MLR.0b013e3181f81c4a PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 682DN UT WOS:000284380200005 PM 21063228 ER PT J AU Panepinto, JA Owens, PL Mosso, A Steiner, CA Brousseau, DC AF Panepinto, Julie A. Owens, Pamela L. Mosso, Andrew Steiner, Claudia A. Brousseau, David C. TI Continuity of Care for Acute Visits In Sickle Cell Disease: Do Patients Go to More Than One Site? SO BLOOD LA English DT Meeting Abstract CT 52nd Annual Meeting of the American-Society-of-Hematology (ASH) CY DEC 04-07, 2010 CL Orlando, FL SP Amer Soc Hematol C1 [Panepinto, Julie A.; Brousseau, David C.] Med Coll Wisconsin, Childrens Hosp Wisconsin, Childrens Res Inst, Milwaukee, WI 53226 USA. [Owens, Pamela L.; Steiner, Claudia A.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Mosso, Andrew] Social & Sci Syst In, Silver Spring, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU AMER SOC HEMATOLOGY PI WASHINGTON PA 1900 M STREET. NW SUITE 200, WASHINGTON, DC 20036 USA SN 0006-4971 J9 BLOOD JI Blood PD NOV 19 PY 2010 VL 116 IS 21 BP 324 EP 325 PG 2 WC Hematology SC Hematology GA 752BH UT WOS:000289662200736 ER PT J AU Gebo, KA Fleishman, JA Conviser, R Hellinger, J Hellinger, FJ Josephs, JS Keiser, P Gaist, P Moore, RD AF Gebo, Kelly A. Fleishman, John A. Conviser, Richard Hellinger, James Hellinger, Fred J. Josephs, Joshua S. Keiser, Philip Gaist, Paul Moore, Richard D. CA HIV Res Network TI Contemporary costs of HIV healthcare in the HAART era SO AIDS LA English DT Article DE CD4 cell count; cost; HAART; HIV; HIV Research Network; utilization ID ACTIVE ANTIRETROVIRAL THERAPY; INFECTED PATIENTS; UNITED-STATES; MEDICAL-CARE; HOSPITALIZATION RATES; INPATIENT ADMISSIONS; SERVICES UTILIZATION; EXPENDITURES; MODELS; TRENDS AB Background: The delivery of HIV healthcare historically has been expensive. The most recent national data regarding HIV healthcare costs were from 1996-1998. We provide updated estimates of expenditures for HIV management. Methods: We performed a cross-sectional review of medical records at 10 sites in the HIV Research Network, a consortium of high-volume HIV care providers across the United States. We assessed inpatient days, outpatient visits, and prescribed antiretroviral and opportunistic illness prophylaxis medications for 14 691 adult HIV-infected patients in primary HIV care in 2006. We estimated total care expenditures, stratified by the median CD4 cell count obtained in 2006 (<= 50, 51-200, 201-350, 351-500, >500 cells/mu l). Per-unit costs of care were based on Healthcare Cost and Utilization Project (HCUP)data for inpatient care, discounted average wholesale prices for medications, and Medicare physician fees for outpatient care. Results: Averaging over all CD4 strata, the mean annual total expenditures per person for HIV care in 2006 in three sites was US $19 912, with an interquartile range from US $11 045 to 22 626. Average annual per-person expenditures for care were greatest for those with CD4 cell counts 50 cell/mu l or less (US $40 678) and lowest for those with CD4 cell counts more than 500 cells/ml (US $16 614). The majority of costs were attributable to medications, except for those with CD4 cell counts 50 cells/ml or less, for whom inpatient costs were highest. Conclusion: HIV healthcare in the United States continues to be expensive, with the majority of expenditures attributable to medications. With improved HIV survival, costs may increase and should be monitored in the future. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins C1 [Gebo, Kelly A.; Josephs, Joshua S.; Moore, Richard D.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA. [Fleishman, John A.; Hellinger, Fred J.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Conviser, Richard] Global Hlth Policy Partners, Missoula, MT USA. [Hellinger, James] Community Med Alliance, Boston, MA USA. [Keiser, Philip] Univ Texas Galveston, Galveston, TX 77555 USA. [Gaist, Paul] 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 FU Agency for Healthcare Research and Quality [290-01-0012]; National Institutes of Aging [R01 AG026250]; Drug Abuse, NIH [K23-DA00523, K24-DA00432]; Johns Hopkins University; AHRQ FX This work was supported by the Agency for Healthcare Research and Quality (290-01-0012) and National Institutes of Aging (R01 AG026250) and Drug Abuse, NIH (K23-DA00523, and K24-DA00432). K. A. G. was also supported by the Johns Hopkins University Richard Ross Clinician Scientist Award. These agencies had no role in the collection, analysis, or interpretation of the data or in the decision to submit the paper for publication.; The authors would like to acknowledge the state data organizations that participate in the HCUP: California Office of Statewide Health Planning and Development; Colorado Health and Hospital Association; Florida Agency for Healthcare Administration; Iowa Hospital Association; Illinois Healthcare Cost Containment Council; Kansas Hospital Association; Maryland Health Services Cost Review Commission; New Jersey Department of Health and Senior Services; New York State Department of Health; Washington State Department of Health. HCUP is sponsored by AHRQ. NR 43 TC 62 Z9 65 U1 2 U2 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0269-9370 J9 AIDS JI Aids PD NOV 13 PY 2010 VL 24 IS 17 BP 2705 EP 2715 DI 10.1097/QAD.0b013e32833f3c14 PG 11 WC Immunology; Infectious Diseases; Virology SC Immunology; Infectious Diseases; Virology GA 672KV UT WOS:000283582800013 PM 20859193 ER PT J AU Evon, DM Simpson, KM Esserman, D Verma, A Smith, S Fried, MW AF Evon, D. M. Simpson, K. M. Esserman, D. Verma, A. Smith, S. Fried, M. W. TI Barriers to accessing care in patients with chronic hepatitis C: the impact of depression SO ALIMENTARY PHARMACOLOGY & THERAPEUTICS LA English DT Article ID INJECTION-DRUG USERS; VIRUS-INFECTION; CES-D; PSYCHIATRIC-ILLNESS; ANTIVIRAL THERAPY; HEALTH BELIEFS; UNITED-STATES; RISK-FACTORS; OUTCOMES; PREVALENCE AB P>Background Patients with hepatitis C viral (HCV) may perceive barriers to accessing speciality care for HCV, and these barriers may be related to depressive symptoms. Aim To evaluate the relationship between barriers to care, demographics, and depressive symptoms. Methods A cross-sectional analysis of 126 patients referred for HCV at two speciality HCV clinics. Barriers to care, depressive symptoms and sociodemographics were measured using standardized instruments. A retrospective chart review was conducted to collect clinical outcome data. Results Depressive symptoms were reported in 26%. Common barriers included lack of personal financial resources; lack of HCV knowledge in the community; lack of professionals competent in HCV care; stigmatization of HCV; and long distances to clinics offering care. After we controlled for sociodemographics, depression accounted for an additional 7-18% of variability in all barriers (all p values < 0.01). Lower depression, marital and employment status were associated with subsequent receipt of HCV treatment in 38% (45/120) of patients; perceived barriers were not. Conclusions Depression is independently associated with perceived barriers to care. Higher depressive scores, but not perceived barriers, were associated with nontreatment. Healthcare providers who diagnose HCV need to be cognizant of numerous perceived barriers to accessing HCV care, and the impact that depression may have on these perceptions and receipt of treatment. C1 [Evon, D. M.; Simpson, K. M.; Verma, A.; Fried, M. W.] Univ N Carolina, Div Gastroenterol & Hepatol, Chapel Hill, NC 27599 USA. [Esserman, D.] Univ N Carolina, Div Gen Med & Clin Epidemiol, Chapel Hill, NC 27599 USA. [Esserman, D.] Univ N Carolina, Dept Biostat, Chapel Hill, NC 27599 USA. [Smith, S.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Evon, DM (reprint author), Univ N Carolina, Div Gastroenterol & Hepatol, CB 7584, Chapel Hill, NC 27599 USA. EM donna_evon@med.unc.edu FU Roche; Merck; Human Genome Sciences; Vertex; Tibotec; Bristol Myers Squibb; Anadys; Hoffman LaRoche [PEG228]; NIH [K24 DK066144, KL2RR025746, UL1RR025747] FX We thank Dr. Morris Weinberger of the UNC School of Public Health for providing a critical review and suggestions for this manuscript. Declaration of personal interests: M. W. Fried has served as a consultant and advisory board member for Roche, Tibotec, Vertex, Pharmasset, Merck, GlaxoSmithKline, Novartis; receives grant support from Roche, Merck, Human Genome Sciences, Vertex, Tibotec, Bristol Myers Squibb and Anadys', and owns stock in Pharmasset. Other authors have nothing to disclose. Declaration of funding interests: This investigator-initiated study was funded, in part, by a research grant from Hoffman LaRoche (PEG228; Evon). The preparation, writing and data analyses of this paper were supported, in part, by NIH grants: K24 DK066144 (Fried), KL2RR025746 (Evon), and UL1RR025747 (Esserman). Disclaimer: The authors of this article are solely responsible for its content. Statements in the presentation should not be construed as endorsement by the Agency for Healthcare Research and Quality, the US Department of Health and Human Services, the National Center for Research Resources or the National Institutes of Health. NR 46 TC 19 Z9 20 U1 4 U2 7 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0269-2813 J9 ALIMENT PHARM THER JI Aliment. Pharmacol. Ther. PD NOV 1 PY 2010 VL 32 IS 9 BP 1163 EP 1173 DI 10.1111/j.1365-2036.2010.04460.x PG 11 WC Gastroenterology & Hepatology; Pharmacology & Pharmacy SC Gastroenterology & Hepatology; Pharmacology & Pharmacy GA 659MO UT WOS:000282570800013 PM 21039678 ER PT J AU Kirby, JB Kaneda, T AF Kirby, James B. Kaneda, Toshiko TI UNHEALTHY AND UNINSURED: EXPLORING RACIAL DIFFERENCES IN HEALTH AND HEALTH INSURANCE COVERAGE USING A LIFE TABLE APPROACH SO DEMOGRAPHY LA English DT Article ID SELF-RATED HEALTH; MEDICAL-CARE; EMERGENCY-DEPARTMENTS; BREAST-CANCER; ACCESS; RACE; INEQUALITY; MORTALITY; OUTCOMES; CHILDREN AB Millions of people in the United States do not have health insurance, and wide racial and ethnic disparities exist in coverage. Current research provides a limited description of this problem, focusing on the number or proportion of individuals without insurance at a single time point or for a short period. Moreover: the literature provides no sense of the joint risk of being uninsured and in need of medical care. In this article, we use a life table approach to calculate health- and insurance-specific life expectancies for whites and blacks, thereby providing estimates of the duration of exposure to different insurance and health states over a typical lifetime. We find that, on average, Americans can expect to spend well over a decade without health insurance during a typical lifetime and that 40% of these years are spent in less-healthy categories. Findings also reveal a significant racial gap: despite their shorter overall life expectancy, blacks have a longer uninsured life expectancy than whites, and this racial gap consists entirely of less-healthy years. Racial disparities in insurance coverage are thus likely more severe than indicated by previous research. C1 [Kirby, James B.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM jkirby@ahrq.gov NR 53 TC 25 Z9 25 U1 0 U2 4 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0070-3370 J9 DEMOGRAPHY JI Demography PD NOV PY 2010 VL 47 IS 4 BP 1035 EP 1051 DI 10.1007/BF03213738 PG 17 WC Demography SC Demography GA 700KP UT WOS:000285738000010 PM 21308569 ER PT J AU Freedman, AN Sansbury, LB Figg, WD Potosky, AL Smith, SRW Khoury, MJ Nelson, SA Weinshilboum, RM Ratain, MJ McLeod, HL Epstein, RS Ginsburg, GS Schilsky, RL Liu, G Flockhart, DA Ulrich, CM Davis, RL Lesko, LJ Zineh, I Randhawa, G Ambrosone, CB Relling, MV Rothman, N Xie, H Spitz, MR Ballard-Barbash, R Doroshow, JH Minasian, LM AF Freedman, Andrew N. Sansbury, Leah B. Figg, William D. Potosky, Arnold L. Smith, Sheila R. Weiss Khoury, Muin J. Nelson, Stefanie A. Weinshilboum, Richard M. Ratain, Mark J. McLeod, Howard L. Epstein, Robert S. Ginsburg, Geoffrey S. Schilsky, Richard L. Liu, Geoffrey Flockhart, David A. Ulrich, Cornelia M. Davis, Robert L. Lesko, Lawrence J. Zineh, Issam Randhawa, Gurvaneet Ambrosone, Christine B. Relling, Mary V. Rothman, Nat Xie, Heng Spitz, Margaret R. Ballard-Barbash, Rachel Doroshow, James H. Minasian, Lori M. TI Cancer Pharmacogenomics and Pharmacoepidemiology: Setting a Research Agenda to Accelerate Translation SO JOURNAL OF THE NATIONAL CANCER INSTITUTE LA English DT Editorial Material ID RECEIVING ADJUVANT TAMOXIFEN; BREAST-CANCER; COLORECTAL-CANCER; LUNG-CANCER; THERAPY; CYP2D6; SURVIVAL; CYP2D6-ASTERISK-10; ASSOCIATION; MUTATIONS AB Recent advances in genomic research have demonstrated a substantial role for genomic factors in predicting response to cancer therapies. Researchers in the fields of cancer pharmacogenomics and pharmacoepidemiology seek to understand why individuals respond differently to drug therapy, in terms of both adverse effects and treatment efficacy. To identify research priorities as well as the resources and infrastructure needed to advance these fields, the National Cancer Institute (NCI) sponsored a workshop titled "Cancer Pharmacogenomics: Setting a Research Agenda to Accelerate Translation" on July 21, 2009, in Bethesda, MD. In this commentary, we summarize and discuss five science-based recommendations and four infrastructure-based recommendations that were identified as a result of discussions held during this workshop. Key recommendations include 1) supporting the routine collection of germline and tumor biospecimens in NCI-sponsored clinical trials and in some observational and population-based studies; 2) incorporating pharmacogenomic markers into clinical trials; 3) addressing the ethical, legal, social, and biospecimen- and data-sharing implications of pharmacogenomic and pharmacoepidemiologic research; and 4) establishing partnerships across NCI, with other federal agencies, and with industry. Together, these recommendations will facilitate the discovery and validation of clinical, sociodemographic, lifestyle, and genomic markers related to cancer treatment response and adverse events, and they will improve both the speed and efficiency by which new pharmacogenomic and pharmacoepidemiologic information is translated into clinical practice. C1 [Freedman, Andrew N.] NCI, Div Canc Control & Populat Sci, NIH, Bethesda, MD 20892 USA. [Figg, William D.] NCI, Med Oncol Branch, Ctr Canc Res, Bethesda, MD 20892 USA. [Rothman, Nat] NCI, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA. [Doroshow, James H.] NCI, Div Canc Treatment & Diag, Bethesda, MD 20892 USA. [Minasian, Lori M.] NCI, Canc Prevent Div, Bethesda, MD 20892 USA. [Potosky, Arnold L.] Georgetown Univ, Lombardi Comprehens Canc Ctr, Hlth Serv Res, Washington, DC USA. [Smith, Sheila R. Weiss] Univ Maryland, Sch Pharm, Ctr Drug Safety, Baltimore, MD 21201 USA. [Khoury, Muin J.] Ctr Dis Control & Prevent, Off Publ Hlth Genom, Atlanta, GA USA. [Weinshilboum, Richard M.] Mayo Clin, Coll Med, Div Clin Pharmacol, Rochester, MN USA. [Ratain, Mark J.] Univ Chicago, Med Ctr, Canc Res Ctr, Chicago, IL 60637 USA. [McLeod, Howard L.] Univ N Carolina, UNC Inst Pharmacogenom & Individualized Therapy, Chapel Hill, NC USA. [Epstein, Robert S.] Medco Hlth Solut Inc, Franklin Lakes, NJ USA. [Ginsburg, Geoffrey S.] Duke Univ, Duke Inst Genome Sci & Policy, Ctr Genom Med, Durham, NC USA. [Schilsky, Richard L.] Univ Chicago, Med Ctr, Hematol Oncol Sect, Chicago, IL 60637 USA. [Liu, Geoffrey] Univ Toronto, Ontario Canc Inst, Princess Margaret Hosp, Toronto, ON, Canada. [Flockhart, David A.] Indiana Univ, Sch Med, Indianapolis, IN USA. [Ulrich, Cornelia M.] German Canc Res Ctr, Div Prevent Oncol, D-6900 Heidelberg, Germany. [Ulrich, Cornelia M.] Natl Ctr Tumor Dis, Heidelberg, Germany. [Ulrich, Cornelia M.] Fred Hutchinson Canc Res Ctr, Div Publ Hlth Sci, Seattle, WA 98104 USA. [Davis, Robert L.] Kaiser Permanente, Ctr Hlth Res, Atlanta, GA USA. [Lesko, Lawrence J.; Zineh, Issam] US FDA, Off Clin Pharmacol & Biopharmaceut, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Randhawa, Gurvaneet] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Ambrosone, Christine B.] Roswell Pk Canc Inst, Dept Canc Prevent & Control, Buffalo, NY 14263 USA. [Relling, Mary V.] St Jude Childrens Hosp, Dept Pharmaceut Sci, Memphis, TN 38105 USA. [Xie, Heng] NIH, Natl Ctr Res Resources, Div Clin Res Resources, Bethesda, MD 20892 USA. [Spitz, Margaret R.] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA. RP Freedman, AN (reprint author), NCI, Div Canc Control & Populat Sci, NIH, 6130 Execut Blvd,Rm 5128, Bethesda, MD 20892 USA. EM andrew_freedman@nih.gov RI Figg Sr, William/M-2411-2016 FU NCI NIH HHS [R01 CA132780] NR 22 TC 26 Z9 26 U1 0 U2 4 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 NOV PY 2010 VL 102 IS 22 BP 1698 EP 1705 DI 10.1093/jnci/djq390 PG 8 WC Oncology SC Oncology GA 682VW UT WOS:000284432100008 PM 20944079 ER PT J AU Yen, C Steiner, CA Barrett, M Curns, AT Hunter, K Wilson, E Parashar, UD AF Yen, Catherine Steiner, Claudia A. Barrett, Marguerite Curns, Aaron T. Hunter, Katherine Wilson, Emily Parashar, Umesh D. TI Racial disparities in diarrhea-associated hospitalizations among children in five US States, before and after introduction of rotavirus vaccine SO VACCINE LA English DT Article DE Gastroenteritis; Rotavirus; Vaccines; Health disparities ID UNITED-STATES; GASTROENTERITIS; REDUCTION; INFANTS; YOUNGER; DEATHS; VISITS; AGE AB Racial differences in diarrheal disease have not been systematically examined and the impact of rotavirus vaccine on these differences has not been assessed We compared diarrhea-associated hospitalizations by race/ethnicity among children <5 years pre- (2000-2006) and post- (2007 and 2008) rotavirus vaccine introduction in five US states Pre-vaccine hospitalization rates were greater among whites versus blacks and Hispanics However black (versus non-black) infants <6 months and white (versus non-white) children 21 year had higher rates In 2008 racial disparities for children 12-35 months resolved but higher hospitalization rates among black infants <6 months persisted highlighting the need for timely vaccination Published by Elsevier Ltd C1 [Yen, Catherine; Curns, Aaron T.; Parashar, Umesh D.] Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, Atlanta, GA 30333 USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Healthcare Cost & Utilizat Project, Rockville, MD USA. [Barrett, Marguerite] ML Barrett Inc, Del Mar, CA USA. [Hunter, Katherine; Wilson, Emily] Thomson Reuters, Santa Barbara, CA USA. RP Yen, C (reprint author), Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, 1600 Clifton Rd NE MS A-47, Atlanta, GA 30333 USA. FU Arizona Department of Health Services Office of Statewide Health Planning and Development (CA); Florida Agency for Health Care Administration; Georgia Hospital Association; Hawaii Health Information Corporation; Indiana Hospital Association; Iowa Hospital Association Kentucky Cabinet for Health and Family Services; Maine Health Data Organization; Maryland Health Services Cost Review Commission; Michigan Health & Hospital Association; Minnesota Hospital Association Hospital Industry Data Institute (MO); Nevada Department of Health and Human Services New York State Department of Health; South Carolina State Budget & Control Board Washington; State Department of Health and West Virginia Health Care Authority; West Virginia Health Care Authority FX We sincerely would like to thank and acknowledge the following HCUP state partners for their active support of this study Arizona Department of Health Services Office of Statewide Health Planning and Development (CA) Florida Agency for Health Care Administration Georgia Hospital Association Hawaii Health Information Corporation Indiana Hospital Association Iowa Hospital Association Kentucky Cabinet for Health and Family Services Maine Health Data Organization Maryland Health Services Cost Review Commission Michigan Health & Hospital Association Minnesota Hospital Association Hospital Industry Data Institute (MO) Nevada Department of Health and Human Services New York State Department of Health South Carolina State Budget & Control Board Washington State Department of Health and West Virginia Health Care Authority NR 17 TC 4 Z9 4 U1 0 U2 1 PU ELSEVIER SCI LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, OXON, ENGLAND SN 0264-410X J9 VACCINE JI Vaccine PD OCT 28 PY 2010 VL 28 IS 46 BP 7423 EP 7426 DI 10.1016/j.vaccine.2010.08.094 PG 4 WC Immunology; Medicine, Research & Experimental SC Immunology; Research & Experimental Medicine GA 683TY UT WOS:000284499300012 PM 20837080 ER PT J AU Wilkinson, A Matzo, M Gatto, M Lynn, J Phillips, S AF Wilkinson, A. Matzo, M. Gatto, M. Lynn, J. Phillips, S. TI PALLIATIVE CARE FOR MASS CASUALTY EVENTS WITH SCARCE RESOURCES SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Wilkinson, A.] Edith Cowan Univ, Sch Nursing Midwifery & Postgrad Med, Joondalup, WA, Australia. [Matzo, M.] Univ Oklahoma, Coll Nursing, Norman, OK 73019 USA. [Gatto, M.] Bon Secours Hlth Syst, Marriotsville, MD USA. [Lynn, J.] Dept Hlth, Washington, DC USA. [Phillips, S.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2010 VL 50 SU 1 BP 94 EP 94 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 703UL UT WOS:000286006701451 ER PT J AU Seitz, AE Olivier, KN Steiner, CA de Oca, RM Holland, SM Prevots, DR AF Seitz, Amy E. Olivier, Kenneth N. Steiner, Claudia A. de Oca, Ruben Montes Holland, Steven M. Prevots, D. Rebecca TI Trends and Burden of Bronchiectasis-Associated Hospitalizations in the United States, 1993-2006 SO CHEST LA English DT Article ID ORPHAN DISEASE; COST AB Background: Current data on bronchiectasis prevalence, trends, and risk factors are lacking; such data are needed to estimate the burden of disease and for improved medical care and public health resource allocation. The objective of the present study was to estimate the trends and burden of bronchiectasis-associated hospitalizations in the United States. Methods: We extracted hospital discharge records containing International Classification of Diseases, 9th Revision, Clinical Modification codes for bronchiectasis (494, 494.0, and 494.1) as any discharge diagnosis from the State Inpatient Databases from the Agency for Healthcare Research and Quality. Discharge records were extracted for 12 states with complete and continuous reporting from 1993 to 2006. Results: The average annual age-adjusted hospitalization rate from 1993 to 2006 was 16.5 hospitalizations per 100,000 population. From 1993 to 2006, the age-adjusted rate increased significantly, with an average annual percentage increase of 2.4% among men and 3.0% among women. Women and persons aged >60 years had the highest rate of bronchiectasis-associated hospitalizations. The median cost for inpatient care was 7,827 US dollars (USD) (range, 13-543,914 USD). Conclusions: The average annual age-adjusted rate of bronchiectasis-associated hospitalizations increased from 1993 to 2006. This study furthers the understanding of the impact of bronchiectasis and demonstrates the need for further research to identify risk factors and reasons for the increasing burden. CHEST 2010; 138(4):944-949 C1 [Seitz, Amy E.; Olivier, Kenneth N.; de Oca, Ruben Montes; Holland, Steven M.; Prevots, D. Rebecca] NIAID, NIH, Bethesda, MD 20892 USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Prevots, DR (reprint author), NIAID, NIH, 8 W Dr,MSC 2665, Bethesda, MD 20892 USA. EM rprevots@niaid.nih.gov FU National Institutes of Health, National Institute of Allergy and Infectious Diseases FX This research was supported by the Intramural Research Program of the National Institutes of Health, National Institute of Allergy and Infectious Diseases. NR 21 TC 64 Z9 71 U1 1 U2 3 PU AMER COLL CHEST PHYSICIANS PI NORTHBROOK PA 3300 DUNDEE ROAD, NORTHBROOK, IL 60062-2348 USA SN 0012-3692 J9 CHEST JI Chest PD OCT PY 2010 VL 138 IS 4 BP 944 EP 949 DI 10.1378/chest.10-0099 PG 6 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA 664YQ UT WOS:000283000500031 PM 20435655 ER PT J AU Wu, AW Snyder, C Clancy, CM Steinwachs, DM AF Wu, Albert W. Snyder, Claire Clancy, Carolyn M. Steinwachs, Donald M. TI Adding The Patient Perspective To Comparative Effectiveness Research SO HEALTH AFFAIRS LA English DT Article ID QUALITY-OF-LIFE; NATIONAL-CANCER-INSTITUTE; REPORTED OUTCOMES; CLINICAL-TRIALS; CHALLENGES; POLICY AB Comparative effectiveness research generates evidence that helps consumers, clinicians, purchasers, and policy makers make better decisions about health care. Capturing the patient's perspective is central to this research because it provides a complete picture of treatment impact. This can be done with standardized questionnaires that ask patients to report on their functioning, well-being, symptoms, and satisfaction with care. These data, however, are not collected routinely in either clinical research or practice. Strategies and incentives to link patient-reported outcomes to data from conventional sources-including clinical research, electronic health records, and administrative data-will accelerate the development of useful evidence. C1 [Wu, Albert W.; Steinwachs, Donald M.] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Snyder, Claire] Johns Hopkins Sch Med, Div Gen Internal Med, Baltimore, MD USA. [Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Wu, AW (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. EM awu@jhsph.edu NR 31 TC 54 Z9 56 U1 3 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 OCT PY 2010 VL 29 IS 10 BP 1863 EP 1871 DI 10.1377/hlthaff.2010.0660 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 658TZ UT WOS:000282513600017 PM 20921487 ER PT J AU Kirby, JB Lau, DT AF Kirby, James B. Lau, Denys T. TI Community and Individual Race/Ethnicity and Home Health Care Use among Elderly Persons in the United States SO HEALTH SERVICES RESEARCH LA English DT Article DE Elderly; home care; race and ethnicity; MEPS ID LONG-TERM-CARE; INFORMAL CARE; RESIDENTIAL SEGREGATION; SERVICE USE; ETHNICITY; RACE; PATTERNS; MORTALITY; AMERICANS; COUNTY AB Objective To investigate whether the interaction between individual race/ethnicity and community racial/ethnic composition is associated with health-related home care use among elderly persons in the United States. Data Sources A nationally representative sample of community-dwelling elders aged 65+ from the 2000 to 2006 Medical Expenditure Panel Survey (N=23,792) linked to block group-level racial/ethnic information from the 2000 Decennial Census. Design We estimated the likelihood of informal and formal home health care use for four racial/ethnic elderly groups (non-Hispanic [NH] whites, NH-blacks, NH-Asians, and Hispanics) living in communities with different racial/ethnic compositions. Principal Findings NH-Asian and Hispanic elders living in block groups with >= 25 percent of residents being NH-Asian or Hispanic, respectively, were more likely to use informal home health care than their counterparts in other block groups. No such effect was apparent for formal home health care. Conclusions NH-Asian and Hispanic elders are more likely to use informal home care if they live in communities with a higher proportion of residents who share their race/ethnicity. A better understanding of how informal care is provided in different communities may inform policy makers concerned with promoting informal home care, supporting informal caregivers, or providing formal home care as a substitute or supplement to informal care. C1 [Lau, Denys T.] Northwestern Univ, Dept Med, Chicago, IL 60611 USA. [Lau, Denys T.] Northwestern Univ, Feinberg Sch Med, Buehler Ctr Aging Hlth & Soc, Chicago, IL 60611 USA. [Kirby, James B.] Agcy Hlth Care Res & Qual, Rockville, MD USA. RP Lau, DT (reprint author), Northwestern Univ, Dept Med, 750 N Lake Shore Dr,Suite 601, Chicago, IL 60611 USA. EM DenysTLau@yahoo.com FU National Institute on Aging [K01AG027295] FX There were no funding sources for this project. During this study, D. T. Lau was supported by a K01 research award from the National Institute on Aging (K01AG027295). NR 43 TC 7 Z9 7 U1 1 U2 6 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 2010 VL 45 IS 5 BP 1251 EP 1267 DI 10.1111/j.1475-6773.2010.01135.x PN 1 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 648RU UT WOS:000281712400007 PM 20662950 ER PT J AU Mukamel, DB Spector, WD Zinn, J Weimer, DL Ahn, R AF Mukamel, Dana B. Spector, William D. Zinn, Jacqueline Weimer, David L. Ahn, Richard TI Changes in Clinical and Hotel Expenditures Following Publication of the Nursing Home Compare Report Card SO MEDICAL CARE LA English DT Article DE nursing homes; report cards; quality; expenditures; incentives ID QUALITY MEASURES; INFORMATION AB Background: Nursing Home Compare first published clinical quality measures at the end of 2002. It is a quality report card that for the first time offers consumers easily accessible information about the clinical quality of nursing homes. It led to changes in consumers' demand, increasing the relative importance of clinical versus hotel aspects of quality in their search and choice of a nursing home. Objectives: To examine the hypothesis that nursing homes responding to these changes in demand shifted the balance of resources from hotel to clinical activities. Subjects: The study included 10,022 free-standing nursing homes nationwide during 2001 to 2006. Research Design and Data: A retrospective multivariate statistical analysis of trends in the ratio of clinical to hotel expenditures, using Medicare cost reports, Minimum Data Set and Online Survey, Certification and Reporting data, controlling for changes in residents' acuity and facility fixed effects. Inference is based on robust standard errors. Results: The ratio of clinical to hotel expenditures averaged 1.78. It increased significantly (P < 0.001) by 5% following the publication of the report card. The increase was larger and more significant among nursing homes with worse reported quality, lower occupancy, those located in more competitive markets, for-profit ownership and owned by a chain. Conclusions: The increase in the ratio of clinical to hotel expenditures following publication of the report card suggests that nursing homes responded as expected to the changes in the elasticity of demand with respect to clinical quality brought about by the public reporting of clinical quality measures. The response was stronger among nursing homes facing stronger incentives. C1 [Mukamel, Dana B.; Ahn, Richard] Univ Calif Irvine, Hlth Policy Res Inst, Dept Med, Irvine, CA 92697 USA. [Spector, William D.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Zinn, Jacqueline] Temple Univ, Fox Sch Business, Philadelphia, PA 19122 USA. [Weimer, David L.] Univ Wisconsin, Dept Polit Sci, LaFollette Sch Publ Affairs, Madison, WI USA. RP Mukamel, DB (reprint author), Univ Calif Irvine, Hlth Policy Res Inst, Dept Med, 100 Theory,Suite 110, Irvine, CA 92697 USA. EM dmukamel@uci.edu OI Ahn, Richard/0000-0002-9698-2752 FU National Institutes on Aging [AG023177] FX Supported by the National Institutes on Aging, grant AG023177. NR 26 TC 15 Z9 15 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 OCT PY 2010 VL 48 IS 10 BP 869 EP 874 DI 10.1097/MLR.0b013e3181eaf6e1 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 653DU UT WOS:000282068900003 PM 20733531 ER PT J AU Gibbons, MC Casale, CR AF Gibbons, Michael Chris Casale, Cecilia Rivera TI Reducing Disparities in Health Care Quality: The Role of Health IT in Underresourced Settings SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Editorial Material DE disparities; health care quality; health information technology; safety net providers; underresourced health care settings AB Health information technology (health IT) and the Internet have tremendous potential to transform health care. The implications of the adoption of health IT within the context of underresourced health care settings have not been adequately evaluated. For this reason, the Agency for Healthcare Research and Quality sponsored a 2-day invitational expert meeting in October 2009. The theme of the meeting was "Reducing Disparities in Healthcare Quality in Under Resourced Settings Using HIT and Other Quality Improvement Strategies." In preparation for the meeting, five background manuscripts were commissioned, presented, and discussed. Attendees also participated in one of three breakout sessions. Several overarching themes, key recommendations, and research topics emerged across five general categories of (a) the health care delivery setting, (b) research and evaluation methodologies, (c) patients and target populations, (d) technology applications and platforms, and (e) providers and clinicians. This article outlines the process, findings, and key recommendations of this expert workshop. C1 [Casale, Cecilia Rivera] Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [Gibbons, Michael Chris] Johns Hopkins Urban Hlth Inst, Baltimore, MD USA. RP Casale, CR (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, 540 Gaither Rd,Room 2216, Rockville, MD 20850 USA. EM Cecilia.casale@ahrq.hhs.gov FU PHS HHS [P233200900421P] NR 10 TC 10 Z9 10 U1 1 U2 5 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 OCT PY 2010 VL 67 IS 5 BP 155S EP 162S DI 10.1177/1077558710376202 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 649TU UT WOS:000281797600001 PM 20829238 ER PT J AU Kaafarani, HMA Rosen, AK Nebeker, JR Shimada, S Mull, HJ Rivard, PE Savitz, L Helwig, A Shin, MH Itani, KMF AF Kaafarani, Haytham M. A. Rosen, Amy K. Nebeker, Jonathan R. Shimada, Stephanie Mull, Hillary J. Rivard, Peter E. Savitz, Lucy Helwig, Amy Shin, Marlena H. Itani, Kamal M. F. TI Development of trigger tools for surveillance of adverse events in ambulatory surgery SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID RETURN HOSPITAL VISITS; POSTDISCHARGE SYMPTOMS; ANALGESIA; DISCHARGE; QUALITY; PROGRAM AB Background The trigger tool methodology uses clinical algorithms applied electronically to 'flag' medical records where adverse events (AEs) have most likely occurred. The authors sought to create surgical triggers to detect AEs in the ambulatory care setting. Methods Four consecutive steps were used to develop ambulatory surgery triggers. First, the authors conducted a comprehensive literature review for surgical triggers. Second, a series of multidisciplinary focus groups (physicians, nurses, pharmacists and information technology specialists) provided user input on trigger selection. Third, a clinical advisory panel designed an initial set of 10 triggers. Finally, a three-phase Delphi process (surgical and trigger tool experts) evaluated and rated the suggested triggers. Results The authors designed an initial set of 10 surgical triggers including five global triggers (flagging medical records for the suspicion of any AE) and five AE-specific triggers (flagging medical records for the suspicion of specific AEs). Based on the Delphi rating of the trigger's utility for system-level interventions, the final triggers were: (1) emergency room visit(s) within 21 days from surgery; (2) unscheduled readmission within 30 days from surgery; (3) unscheduled procedure (interventional radiological, urological, dental, cardiac or gastroenterological) or reoperation within 30 days from surgery; (4) unplanned initial hospital length of stay more than 24 h; and (5) lower-extremity Doppler ultrasound order entry and ICD code for deep vein thrombosis or pulmonary embolus within 30 days from surgery. Conclusion The authors therefore propose a systematic methodology to develop trigger tools that takes into consideration previously published work, end-user preferences and expert opinion. C1 [Kaafarani, Haytham M. A.; Itani, Kamal M. F.] VA Boston Healthcare Syst, Dept Surg, W Roxbury, MA USA. [Kaafarani, Haytham M. A.; Rosen, Amy K.; Shimada, Stephanie; Mull, Hillary J.; Rivard, Peter E.; Shin, Marlena H.] CHQOER, Bedford, MA USA. [Kaafarani, Haytham M. A.] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Rosen, Amy K.; Shimada, Stephanie; Mull, Hillary J.; Shin, Marlena H.] Boston Univ, Sch Publ Hlth, Boston, MA USA. [Nebeker, Jonathan R.] VA Salt Lake City Geriatr Res Educ & Clin Ctr, Salt Lake City, UT USA. [Nebeker, Jonathan R.] Univ Utah, Salt Lake City, UT USA. [Rivard, Peter E.] Suffolk Univ, Boston, MA 02114 USA. [Savitz, Lucy] Intermt Healthcare, Salt Lake City, UT USA. [Helwig, Amy] Agcy Healthcare Res & Qual, Rockville, MD USA. [Itani, Kamal M. F.] Boston Univ, Sch Med, Boston, MA 02118 USA. [Itani, Kamal M. F.] Harvard Univ, Sch Med, Boston, MA USA. RP Itani, KMF (reprint author), VABHCS 112, Dept Surg, 1400 VFW Pkwy, W Roxbury, MA 02132 USA. EM kitani@va.gov FU Agency for Healthcare Research and Quality (AHRQ) [HHSA290200600012540] FX Funding was provided by the Agency for Healthcare Research and Quality (AHRQ), contract no HHSA290200600012540. NR 17 TC 13 Z9 13 U1 1 U2 6 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 2010 VL 19 IS 5 BP 425 EP 429 DI 10.1136/qshc.2008.031591 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 690UB UT WOS:000285032700013 PM 20513790 ER PT J AU Pham, JC Gianci, S Battles, J Beard, P Clarke, JA Coates, H Donaldson, L Eldridge, N Fletcher, M Goeschel, CA Heitmiller, E Hensen, J Kelley, E Loeb, J Runciman, W Sheridan, S Wu, AW Pronovost, PJ AF Pham, Julius Cuong Gianci, Sebastiana Battles, James Beard, Paula Clarke, John A. Coates, Hilary Donaldson, Liam Eldridge, Noel Fletcher, Martin Goeschel, Christine A. Heitmiller, Eugenie Hensen, Jorgen Kelley, Edward Loeb, Jerod Runciman, William Sheridan, Susan Wu, Albert W. Pronovost, Peter J. TI Establishing a global learning community for incident-reporting systems SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID PATIENT SAFETY; CARE; QUALITY; IMPROVEMENT; MANAGEMENT; COMPLAINTS; FRAMEWORK; LESSONS; RISK AB Background Incident-reporting systems (IRS) collect snapshots of hazards, mistakes and system failures occurring in healthcare. These data repositories are a cornerstone of patient safety improvement. Compared with systems in other high-risk industries, healthcare IRS are fragmented and isolated, and have not established best practices for implementation and utilisation. Discussion Patient safety experts from eight countries convened in 2008 to establish a global community to advance the science of learning from mistakes. This convenience sample of experts all had experience managing large incident-reporting systems. This article offers guidance through a presentation of expert discussions about methods to identify, analyse and prioritise incidents, mitigate hazards and evaluate risk reduction. C1 [Pham, Julius Cuong; Gianci, Sebastiana] Johns Hopkins Univ, Sch Med, WHO, World Alliance Patient Safety, Baltimore, MD 21231 USA. [Battles, James] Agcy Healthcare Res & Qual, Rockville, MD USA. [Beard, Paula] Canadian Patient Safety Inst, Edmonton, AB, Canada. [Clarke, John A.] Drexel Univ, ECRI Inst, Plymouth Meeting, PA USA. [Coates, Hilary] Royal Coll Surg, Dublin, Ireland. [Donaldson, Liam] World Alliance Patient Safety, Geneva, Switzerland. [Eldridge, Noel] Vet Hlth Adm, Washington, DC USA. [Fletcher, Martin] Natl Patient Safety Agcy, London, England. [Goeschel, Christine A.; Pronovost, Peter J.] Johns Hopkins Univ, Sch Nursing, Baltimore, MD 21231 USA. [Goeschel, Christine A.; Wu, Albert W.; Pronovost, Peter J.] Johns Hopkins Univ, Sch Publ Hlth, Baltimore, MD 21231 USA. [Hensen, Jorgen] Natl Board Hlth, Copenhagen, Denmark. [Kelley, Edward] WHO, CH-1211 Geneva, Switzerland. [Loeb, Jerod] Joint Commiss, Oak Brook Terrace, IL USA. [Runciman, William] Australian Patient Safety Fdn, Adelaide, SA, Australia. [Sheridan, Susan] Consumers Adv Patient Safety, Chicago, IL USA. RP Pham, JC (reprint author), Johns Hopkins Univ, Sch Med, WHO, World Alliance Patient Safety, 1909 Thames St,2nd Floor, Baltimore, MD 21231 USA. EM jpham3@jhmi.edu RI Runciman, William (Bill)/F-3202-2013 OI Runciman, William (Bill)/0000-0001-8489-0693 FU WHO World Alliance for Patient Safety (WAPS) FX The WHO World Alliance for Patient Safety (WAPS) did not directly influence the meeting agenda, the drafting of the manuscript or the content of the manuscript. NR 34 TC 19 Z9 19 U1 1 U2 6 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 2010 VL 19 IS 5 BP 446 EP 451 DI 10.1136/qshc.2009.037739 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 690UB UT WOS:000285032700017 PM 20977995 ER PT J AU Hall, KK Schenkel, SM Hirshon, JM Xiao, Y Noskin, GA AF Hall, Kendall K. Schenkel, Stephen M. Hirshon, Jon Mark Xiao, Yan Noskin, Gary A. TI Incidence and types of non-ideal care events in an emergency department SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID ADVERSE EVENTS; HEALTH-CARE; MEDICINE; ERRORS; IMPROVEMENT; DIAGNOSES; QUALITY; SAFETY; WORK AB Aim To identify and characterise hazardous conditions in an Emergency Department (ED) using active surveillance. Methods This study was conducted in an urban, academic, tertiary care medical centre ED with over 45 000 annual adult visits. Trained research assistants interviewed care givers at the discharge of a systematically sampled group of patient visits across all shifts and days of the week. Care givers were asked to describe any part of the patient's care that they considered to be 'not ideal.' Reports were categorised by the segment of emergency care in which the event occurred and by a broad event category and specific event type. The occurrence of harm was also determined. Results Surveillance was conducted for 656 h with 487 visits sampled, representing 15% of total visits. A total of 1180 care giver interviews were completed (29 declines), generating 210 non-duplicative event reports for 153 visits. Thirty-two per cent of the visits had at least one non-ideal care event. Segments of care with the highest percentage of events were: Diagnostic Testing (29%), Disposition (21%), Evaluation (18%) and Treatment (14%). Process-related delays were the most frequently reported events within the categories of medication delivery (53%), laboratory testing (88%) and radiology testing (79%). Fourteen (7%) of the reported events were associated with patient harm. Conclusions A significant number of non-ideal care events occurred during ED visits and involved failures in medication delivery, radiology testing and laboratory testing processes, and resulted in delays and patient harm. C1 [Hall, Kendall K.] US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. [Hirshon, Jon Mark] Univ Maryland, Sch Med, Dept Emergency Med, Natl Study Ctr Trauma & EMS, Baltimore, MD 21201 USA. [Schenkel, Stephen M.] St Johns Mercy Med Ctr, Baltimore, MD USA. [Hirshon, Jon Mark] Univ Maryland, Sch Med, Dept Epidemiol & Prevent Med, Natl Study Ctr Trauma & EMS, Baltimore, MD 21201 USA. [Xiao, Yan] Baylor Hlth Care Syst, Patient Safety Res, Dallas, TX USA. [Noskin, Gary A.] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA. [Noskin, Gary A.] NW Mem Hosp, NW Ctr Patient Safety, Chicago, IL 60611 USA. RP Hall, KK (reprint author), US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, 540 Gaither Rd, Rockville, MD 20850 USA. EM kendall.hall@ahrq.hhs.gov FU University of Maryland; Northwestern University; Agency for Healthcare Research and Quality [P20HS017111] FX The authors would like to thank B Browne (University of Maryland) and JG Adams (Northwestern University), for their support and guidance with the project, and K Henriksen and JB Battles, for their review of the manuscript.; This project was supported by grant no P20HS017111 from the Agency for Healthcare Research and Quality. NR 28 TC 5 Z9 6 U1 0 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 OCT PY 2010 VL 19 SU 3 BP I20 EP I25 DI 10.1136/qshc.2010.040246 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 667JD UT WOS:000283188300005 PM 20724393 ER PT J AU Henriksen, K AF Henriksen, Kerm TI Partial truths in the pursuit of patient safety SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID HEALTH-CARE; ERRORS; OPPORTUNITIES; MEDICINE; WORK AB The paper explores several issues in the form of partial truths that dominate current thinking as investigators continue their pursuit of patient safety. Among the partial truths examinedd-cast as bipolar orientationsd-are evidence-based medicine versus quality improvement, 'knowledge in the head' versus 'knowledge in the world', sharp end versus blunt end, reporting systems versus local knowledge, changing beliefs versus changing behaviour and system components versus system interdependencies. The paper provides a cautionary note regarding the downside of creating dichotomies that tend to assert too much. An enhanced understanding of patient safety will likely result from rising above bipolar orientations and valuing them as partial approaches to a complex and dynamic problem space. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Henriksen, K (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM kerm.henriksen@ahrq.hhs.gov NR 31 TC 1 Z9 1 U1 0 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 OCT PY 2010 VL 19 SU 3 BP I3 EP I7 DI 10.1136/qshc.2010.041293 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 667JD UT WOS:000283188300002 PM 20959315 ER PT J AU Henriksen, K Albolino, S AF Henriksen, Kerm Albolino, Sara TI Towards a safer healthcare system SO QUALITY & SAFETY IN HEALTH CARE LA English DT Editorial Material C1 [Henriksen, Kerm] US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Albolino, Sara] Clin Risk Management & Patient Safety Ctr, Florence, Italy. RP Henriksen, K (reprint author), US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM kerm.henriksen@ahrq.hhs.gov NR 1 TC 1 Z9 1 U1 2 U2 4 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 2010 VL 19 SU 3 BP I1 EP I2 DI 10.1136/qshc.2010.045849 PG 2 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 667JD UT WOS:000283188300001 PM 20959313 ER PT J AU Zayas-Caban, T Dixon, BE AF Zayas-Caban, Teresa Dixon, Brian E. TI Considerations for the design of safe and effective consumer health IT applications in the home SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID PATIENT SAFETY; INFORMATION-TECHNOLOGY; SYSTEM; CARE; QUALITY; FUTURE; IMPACT AB Introduction Consumer health IT applications have the potential to improve quality, safety and efficiency of consumers' interactions with the healthcare system. Yet little attention has been paid to human factors and ergonomics in the design of consumer health IT, potentially limiting the ability of health IT to achieve these goals. This paper presents the results of an analysis of human factors and ergonomics issues encountered by five projects during the design and implementation of home-based consumer health IT applications. Methods Agency for Healthcare Research and Quality-funded consumer health IT research projects, where patients used the IT applications in their homes, were reviewed. Project documents and discussions with project teams were analysed to identify human factors and ergonomic issues considered or addressed by project teams. The analysis focused on system design and design processes used as well as training, implementation and use of the IT intervention. Results A broad range of consumer health IT applications and diverse set of human factors and ergonomics issues were identified. The design and implementation processes used resulted in poor fit with some patients' healthcare tasks and the home environment and, in some cases, resulted in lack of use. Clinician interaction with patients and the information provided through health IT applications appeared to positively influence adoption and use. Conclusions Consumer health IT application design would benefit from the use of human factors and ergonomics design and evaluation methods. Considering the context in which home-based consumer health IT applications are used will likely affect the ability of these applications to positively impact the quality, safety and efficiency of patient care. C1 [Zayas-Caban, Teresa] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Dixon, Brian E.] Indiana Univ Purdue Univ, Regenstrief Inst, Indianapolis, IN 46202 USA. RP Zayas-Caban, T (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd,Room 6115, Rockville, MD 20850 USA. EM zayascaban@ahrq.hhs.gov RI Dixon, Brian/A-9494-2013 OI Dixon, Brian/0000-0002-1121-0607 FU AHRQ National Resource Center for Health IT [290-04-0016] FX This work was supported in part by the AHRQ National Resource Center for Health IT, contract no 290-04-0016. NR 30 TC 7 Z9 8 U1 3 U2 12 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 2010 VL 19 SU 3 BP I61 EP I67 DI 10.1136/qshc.2010.041897 PG 7 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 667JD UT WOS:000283188300013 PM 20959321 ER PT J AU Boivin, A Currie, K Fervers, B Gracia, J James, M Marshall, C Sakala, C Sanger, S Strid, J Thomas, V van der Weijden, T Grol, R Burgers, J AF Boivin, Antoine Currie, Kay Fervers, Beatrice Gracia, Javier James, Marian Marshall, Catherine Sakala, Carol Sanger, Sylvia Strid, Judi Thomas, Victoria van der Weijden, Trudy Grol, Richard Burgers, Jako CA G-I-N Public TI Patient and public involvement in clinical guidelines: international experiences and future perspectives SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID DECISION AIDS; HEALTH-CARE; PREFERENCES; PARTICIPATION; PROGRAMS; SCIENCE AB Background Clinical practice guidelines (CPG) are important tools for improving patient care. Patient and public involvement is recognised as an essential component of CPG development and implementation, The Guideline International Network Patient and Public Involvement Working Group (G-I-N PUBLIC) aims to support the development, implementation and evaluation of guideline-oriented patient and public involvement programmes (PPIPs). Objective To develop an international practice and research agenda on patient and public involvement in CPG. Method 56 CPG developers, researchers, and patient/public representatives from 14 different countries, were consulted in an international workshop. Recommendations were validated with G-I-N PUBLIC steering committee members. Results Many CPG organisations have set up PPIPs that use a range of participation, consultation and communication methods. Current PPIPs aim to improve the quality and responsiveness of CPGs to public expectations and needs, or to foster individual healthcare decisions. Some organisations use structured involvement methods, including providing training for patient and public representatives. A number of financial, organisational and sociopolitical barriers limit patient and public involvement. The paucity of process and impact evaluations limits our current understanding of the conditions under which patient and public involvement is most likely to be effective. Conclusion Greater international collaboration and research are needed to strengthen existing knowledge, development and evaluation of patient and public involvement in CPG. C1 [Boivin, Antoine; Grol, Richard; Burgers, Jako] Radboud Univ Nijmegen, Ctr Med, Sci Inst Qual Healthcare, NL-6525 ED Nijmegen, Netherlands. [Currie, Kay] Natl Hlth & Med Res Council, Canberra, ACT, Australia. [Fervers, Beatrice] Univ Lyon, Ctr Leon Berard, Lyon, France. [Gracia, Javier] Unidad Evaluac Tecnol Sanitarias, Madrid, Spain. [James, Marian] Agcy Healthcare Res & Qual, Rockville, MD USA. [Sakala, Carol] Childbirth Connect, New York, NY USA. [Sanger, Sylvia] Agcy Qual Med, Berlin, Germany. [Strid, Judi] Natl Consumer Advocacy Serv, Auckland, New Zealand. [Thomas, Victoria] Natl Inst Hlth & Clin Excellence, London, England. [van der Weijden, Trudy] Maastricht Univ, Maastricht, Netherlands. RP Boivin, A (reprint author), Radboud Univ Nijmegen, Ctr Med, Sci Inst Qual Healthcare, NL-6525 ED Nijmegen, Netherlands. EM antoine.boivin@gmail.com RI Grol, Richard/C-8523-2013; OI Boivin, Antoine/0000-0001-7824-8602 FU Canadian Institute of Health Research; Agence do Sante et des Services Sociaux do TAbitibi-Temiscamingue FX AB holds a joint doctoral scholarship horn the Canadian Institute of Health Research (AnEIS programme) and the Agence do Sante et des Services Sociaux do TAbitibi-Temiscamingue. NR 41 TC 45 Z9 46 U1 0 U2 18 PU BMJ 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 2010 VL 19 IS 5 AR e22 DI 10.1136/qshc.2009.034835 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 690UB UT WOS:000285032700042 PM 20427302 ER PT J AU Lin, K Sharangpani, R AF Lin, Kenneth Sharangpani, Ruta TI Screening for Testicular Cancer: An Evidence Review for the US Preventive Services Task Force SO ANNALS OF INTERNAL MEDICINE LA English DT Review ID FOLLOW-UP; MICROLITHIASIS; MEN AB Background: Testicular cancer is the most common type of cancer in men aged 15 to 34 years. Because treatment produces favorable outcomes even in advanced stages, the U. S. Preventive Services Task Force (USPSTF) concluded in 2004 that screening asymptomatic men for testicular cancer is unlikely to produce additional benefits over clinical detection. Purpose: To search for new evidence on the benefits and harms of screening for testicular cancer to assist the USPSTF in updating its 2004 recommendation. Data Sources: English-language articles indexed in PubMed and the Cochrane Library and published between 1 January 2001 and 11 November 2009. Study Selection: Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; and case-control studies were selected to determine the benefits of screening for testicular cancer. Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; case-control studies; and case series of large, multisite databases were selected to determine the harms of screening. Each author independently reviewed titles, abstracts, and full-text articles for possible inclusion. Data Extraction: One author abstracted information on the benefits and harms of screening for testicular cancer. Data Synthesis: No studies met the inclusion criteria. Three studies were considered for inclusion at the full-text stage of review. These inconclusive studies addressed testicular microlithiasis, XIST gene testing, and testis-sparing surgery. Limitation: The focused search strategy may have missed some smaller studies or studies published in languages other than English on the benefits or harms of testicular cancer screening. Conclusion: No new evidence was found on the benefits or harms of screening for testicular cancer that would affect the USPSTF's previous recommendation against screening. C1 [Lin, Kenneth] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Lin, K (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd,RM 6107, Rockville, MD 20850 USA. EM Kenneth.Lin@ahrq.hhs.gov FU Agency for Healthcare Research and Quality FX Primary Funding Source: Agency for Healthcare Research and Quality. NR 10 TC 27 Z9 27 U1 0 U2 3 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD SEP 21 PY 2010 VL 153 IS 6 BP 396 EP 399 DI 10.7326/0003-4819-153-6-201009210-00007 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 652WY UT WOS:000282043100006 PM 20855803 ER PT J AU Greenberg, LG Battles, JB Haskell, H AF Greenberg, Linda G. Battles, James B. Haskell, Helen TI Learning from Patients' Experiences: Enhancing Patient Safety Event Reporting Systems SO CIRUGIA Y CIRUJANOS LA English DT Article DE healthcare quality; patients' experience; adverse events; medical responsibility ID MALPRACTICE RISK; ADVERSE EVENTS; COMPLAINTS AB Background: Everyone has a personal story of an incident in which the healthcare system has caused harm to a family member, friend, or work colleague. In 2004, one in three Americans (34%) said that they or a family member had experienced a preventable medical error; among them, 21% said the error caused "serious health consequences" such as death (8%), long-term disability (11%) or severe pain (16%). Discussion: The information patients give is important and can be part of a strategic model to make systemic changes to improve health outcomes and patient safety. It has been identified that one of these shortcomings is that patients' complaints are not considered able to judge technical quality in their experience with care. We argue for an approach which should actively engage patients and their caregivers in contemplating and describing their experiences as a means to gather evidence about risks and hazards in the healthcare setting. Conclusions: Patients ought to be viewed as partners with health care providers to improve patient safety; self-reports on adverse events can provide useful information that may be incorporated into patient safety event. Data obtained from this strategy should be useful to improve general changes in health care and a better clinical practice based on evidence. C1 [Greenberg, Linda G.; Battles, James B.] US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Greenberg, LG (reprint author), Off Consumer Informat & Insurance Oversight, 7501 Wisconsin Ave, Bethesda, MD 20814 USA. EM linda.greenberg@hhs.gov NR 23 TC 0 Z9 0 U1 0 U2 0 PU MEXICAN ACAD SURGERY PI MEXICO D G PA CENTRO MED NAC SIGLO XXI, EDIFICIO BLOQUE B, SOTANO, AVE CUAUHTEMOC NO 330, MEXICO D G, 06700, MEXICO SN 0009-7411 J9 CIR CIR JI Cir. Cir. PD SEP-OCT PY 2010 VL 78 IS 5 BP 460 EP 465 PG 6 WC Surgery SC Surgery GA 679FY UT WOS:000284148400016 ER PT J AU Porterfield, DS Hinnant, L Stevens, DM Moy, E AF Porterfield, Deborah S. Hinnant, Laurie Stevens, David M. Moy, Ernest CA DPPI-IFA Case Study Grp TI The Diabetes Primary Prevention Initiative Interventions Focus Area A Case Study and Recommendations SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID IMPAIRED GLUCOSE-TOLERANCE; LIFE-STYLE; TRANSLATIONAL RESEARCH; COST-EFFECTIVENESS; REAL-WORLD; ADULTS; POPULATION; METFORMIN AB Background: In 2005, CDC began the Diabetes Primary Prevention Initiative Interventions Focus Area (DPPI-IFA), which funded five state Diabetes Prevention and Control Programs (DPCPs) to translate diabetes primary prevention trials into real-world settings by developing and implementing a framework for state-level diabetes primary prevention. Purpose: The purpose of this case study, conducted in 2007, was to describe DPPI-IFA implementation, including facilitators and challenges to the initiative. Methods: Case studies of the five DPCPs in the DPPI-IFA involving site visits with key informant interviews of state staff and partners and archival record collection. Results: Partners recruited for DPPI-IFA activities included local or state public health agencies (three of five DPCPs); regional or state nonprofit organizations (five DPCPs); businesses or employers (three DPCPs); and healthcare organizations (four DPCPs). The DPCPs implemented a variety of interventions in three main domains: diabetes primary prevention and prediabetes awareness, screening activities and lifestyle interventions, and prediabetes-related health policy efforts. Preliminary outcomes are described at the individual and organization/partnership levels. Results suggest the importance of utilizing preexisting partnerships to extend work into diabetes prevention, providing even small amounts of funding to partners, and prior program planning for diabetes prevention. Challenges for the DPPI-IFA included recruiting participants, establishing links with providers to obtain diagnostic testing for people screened for prediabetes, and offering a lifestyle intervention. Conclusions: The DPPI-IFA represents a unique effort by state public health programs in the translation of diabetes primary prevention trials into real-world settings. The experiences of the DPPI-IFA programs offer valuable lessons for future community-based diabetes prevention initiatives, especially regarding the need to strengthen clinical-community partnerships for referral of people with prediabetes to evidence-based lifestyle programs. (Am J Prey Med 2010;39(3):235-242) (C) 2010 American Journal of Preventive Medicine C1 [Porterfield, Deborah S.; Hinnant, Laurie] RTI Int, Res Triangle Pk, NC 27709 USA. [Stevens, David M.] George Washington Univ, Washington, DC USA. [Moy, Ernest] Agcy Healthcare Res & Qual, Washington, DC USA. RP Porterfield, DS (reprint author), RTI Int, 3040 Cornwallis Rd, Res Triangle Pk, NC 27709 USA. EM dporterfield@rti.org OI Herr, Amy/0000-0002-6906-2985 FU Agency for Healthcare Research and Quality [HHSA290200600001I] FX The authors acknowledge the contributions of DPPI-IFA staff (Patricia Daly, Massachusetts Department of Public Health; Kristi Pier, Michigan Department of Community Health; Jeanne Harmon, Washington State Department of Health) who contributed to this work through participation in interviews and reviews of the manuscript. This project was supported by a contract from the Agency for Healthcare Research and Quality (HHSA290200600001I #3). NR 26 TC 0 Z9 0 U1 2 U2 8 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 SEP PY 2010 VL 39 IS 3 BP 235 EP 242 DI 10.1016/j.amepre.2010.05.005 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 642NN UT WOS:000281221900006 PM 20709255 ER PT J AU McHugh, M Van Dyke, K Yonek, J Moss, D AF McHugh, M. Van Dyke, K. Yonek, J. Moss, D. TI A Collaborative to Improve Patient Flow and Reduce Emergency Department Crowding: The Urgent Matters Learning Network II Experience SO ANNALS OF EMERGENCY MEDICINE LA English DT Meeting Abstract CT Conference on American-College-of-Emergency-Physicians-Research-Forum CY SEP 28-29, 2010 CL Las Vegas, NV SP Amer Coll Emergency Phys Res Forum C1 Hlth Res & Educ Trust, Chicago, IL USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD SEP PY 2010 VL 56 IS 3 SU S BP S92 EP S92 PG 1 WC Emergency Medicine SC Emergency Medicine GA 645FY UT WOS:000281438000280 ER PT J AU Feinstein, LB Holman, RC Christensen, KLY Steiner, CA Swerdlow, DL AF Feinstein, Lydia B. Holman, Robert C. Christensen, Krista L. Yorita Steiner, Claudia A. Swerdlow, David L. TI Trends in Hospitalizations for Peptic Ulcer Disease, United States, 1998-2005 SO EMERGING INFECTIOUS DISEASES LA English DT Article ID HELICOBACTER-PYLORI INFECTION; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; TIME TRENDS; MORTALITY-RATES; ADMISSIONS; ERADICATION; COMPLICATIONS; ENGLAND AB Infection with Helicobacter pylori increases the risk for peptic ulcer disease (PUD) and its complications. To determine whether hospitalization rates for PUD have declined since antimicrobial drugs to eradicate H. pylori became available, we examined 1998-2005 hospitalization records (using the Nationwide Inpatient Sample) in which the primary discharge diagnosis was PUD. Hospitalizations for which the diagnosis was H. pylori infection were also considered. The age-adjusted hospitalization rate for PUD decreased 21% from 71.1/100,000 population (95% confidence interval [Cl] 68.9-73.4) in 1998 to 56.5/100,000 in 2005 (95% Cl 54.6-58.3). The hospitalization rate for PUD was highest for adults >= 65 years of age and was higher for men than for women. The age-adjusted rate was lowest for whites and declined for all racial/ethnic groups, except Hispanics. The age-adjusted H. pylori hospitalization rate also decreased. The decrease in PUD hospitalization rates suggests that the incidence of complications caused by H. pylori infection has declined. C1 [Feinstein, Lydia B.; Holman, Robert C.; Christensen, Krista L. Yorita; Swerdlow, David L.] Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Swerdlow, DL (reprint author), Ctr Dis Control & Prevent, 1600 Clifton Rd NE,Mailstop A38, Atlanta, GA 30333 USA. EM dswerdlow@cdc.gov NR 36 TC 19 Z9 22 U1 0 U2 0 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1080-6040 J9 EMERG INFECT DIS JI Emerg. Infect. Dis PD SEP PY 2010 VL 16 IS 9 BP 1410 EP 1418 DI 10.3201/eid1609.091126 PG 9 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 643YT UT WOS:000281338000010 PM 20735925 ER PT J AU Zuvekas, SH Cohen, JW AF Zuvekas, Samuel H. Cohen, Joel W. TI Paying Physicians By Capitation: Is The Past Now Prologue? SO HEALTH AFFAIRS LA English DT Article ID MANAGED CARE; PAYMENT; INCENTIVES AB In the 1980s and 1990s, physician capitation-in which participating physicians received a fixed sum for each insured patient regardless of how much care the patient received-was widely touted as a way to restrain costs and encourage more-efficient care. Capitation remained prevalent in markets with a substantial health maintenance organization (HMO) presence but virtually disappeared elsewhere as HMO enrollment declined. By 2007, only 7 percent of all physician office visits were covered under capitation arrangements. Given this history, markets that now lack infrastructure to handle physician risk sharing will probably be challenged by current proposals for payment reform, many of which incorporate components of capitation. C1 [Zuvekas, Samuel H.] Ctr Financing Access & Cost Trends, Rockville, MD USA. [Cohen, Joel W.] AHRQ, Div Social & Econ Res, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Zuvekas, SH (reprint author), Ctr Financing Access & Cost Trends, Rockville, MD USA. EM samuel.zuvekas@ahrq.hhs.gov NR 25 TC 8 Z9 8 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 SEP PY 2010 VL 29 IS 9 BP 1661 EP 1666 DI 10.1377/hlthaff.2009.0361 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 647ET UT WOS:000281601300016 PM 20820023 ER PT J AU Dor, A Encinosa, W AF Dor, Avi Encinosa, William TI How Does Cost-Sharing Affect Drug Purchases? Insurance Regimes in the Private Market for Prescription Drugs SO JOURNAL OF ECONOMICS & MANAGEMENT STRATEGY LA English DT Article ID HEALTH-INSURANCE; PROPENSITY SCORE; MORAL HAZARD; MEDICAL-CARE; PREVENTION; SERVICES; BENEFITS; DEMAND; PRICES AB Insurance for prescription drugs is characterized by two types of cost-sharing: flat copayments and variable coinsurance. We develop a theoretical model to show that refill purchases of drugs are lower under coinsurance due to the consumer's exposure to variation in drug prices. We test this empirically using claims data from eight large firms. Propensity score methods are used to create matched samples for the two insurance regimes. We find that when coinsurance and copayments have the same expected out-of-pocket of $9, at least 34% of patients under copayments would fully refill their medication over 90 days, compared to only 24% under coinsurance. C1 [Dor, Avi] George Washington Univ, Washington, DC 20037 USA. [Dor, Avi] NBER, Cambridge, MA 02138 USA. [Encinosa, William] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Dor, A (reprint author), George Washington Univ, 2021 K St NW,Suite 800, Washington, DC 20037 USA. EM avidor@gwu.edu; wencinos@ahrq.gov NR 44 TC 2 Z9 2 U1 1 U2 4 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1058-6407 EI 1530-9134 J9 J ECON MANAGE STRAT JI J. Econ. Manage. Strategy PD FAL PY 2010 VL 19 IS 3 BP 545 EP 574 PG 30 WC Economics; Management SC Business & Economics GA 635QM UT WOS:000280671200001 ER PT J AU Ng, JH Kaftarian, SJ Tilson, WM Gorrell, P Chen, XH Chesley, FD Scholle, SH AF Ng, Judy H. Kaftarian, Shakeh J. Tilson, Wilma M. Gorrell, Paul Chen, Xiuhua Chesley, Francis D., Jr. Scholle, Sarah Hudson TI Self-Reported Delays in Receipt of Health Care among Women with Diabetes and Cardiovascular Conditions SO WOMENS HEALTH ISSUES LA English DT Article ID PREVIOUSLY UNINSURED ADULTS; MEDICARE COVERAGE; DISPARITIES; SERVICES; GENDER AB Purpose: Midlife and older adults have high rates of chronic conditions, and differences in health insurance coverage may affect their access to care. Women may be particularly at risk for access problems. This study examines the association of gender and health insurance status with delays in care, a dimension of access to care, among midlife (age 45-64) and older (age >= 65) adults with diabetes and cardiovascular conditions. Methods: Data were from the 2004 through 2006 national Medical Expenditure Panel Survey. A total of 4,706 adults with self-identified diabetes and 17,636 adults with self-identified cardiovascular conditions, aged 45 years and older, were included. The analyses examined associations of gender and insurance status with self-reported delays in medical care, dental care, prescription medication, and illness/injury care, using bivariate and multivariate analyses adjusted for race/ethnicity, education, income, and perceived health status. Main Findings: Midlife women with diabetes or cardiovascular conditions were more likely to report delays in care than men, even after adjusting for key factors (85%-111% higher odds of delays among diabetes patients, 56%-84% higher odds of delays among cardiovascular patients; all p <.01). Many, but not all, of these gender differences were eliminated among Medicare-insured older adults. Among midlife adults, health insurance coverage differences were also significantly associated with delays in care. Conclusion: Women are more likely to experience delays in health care, even after adjusting for health coverage. Efforts are needed to understand factors that influence gender differences in these delays and to determine whether policy reforms eliminate or exacerbate these differences. Copyright (C) 2010 by the Jacobs Institute of Women's Health. Published by Elsevier Inc. C1 [Ng, Judy H.; Scholle, Sarah Hudson] Natl Comm Qual Assurance, Washington, DC 20005 USA. [Kaftarian, Shakeh J.; Chesley, Francis D., Jr.] US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD USA. [Tilson, Wilma M.] US Dept HHS, Off Assistant Secretary Planning & Evaluat, Washington, DC 20201 USA. [Gorrell, Paul; Chen, Xiuhua] Social & Sci Syst Inc, Silver Spring, MD USA. RP Ng, JH (reprint author), Natl Comm Qual Assurance, 1100 13th St NW,Suite 1000, Washington, DC 20005 USA. EM ng@ncqa.org NR 19 TC 6 Z9 6 U1 1 U2 6 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 SEP-OCT PY 2010 VL 20 IS 5 BP 316 EP 322 DI 10.1016/j.whi.2010.06.002 PG 7 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 647AX UT WOS:000281588900004 PM 20800767 ER PT J AU Owens, PL Barrett, ML Gibson, TB Andrews, RM Weinick, RM Mutter, RL AF Owens, Pamela L. Barrett, Marguerite L. Gibson, Teresa B. Andrews, Roxanne M. Weinick, Robin M. Mutter, Ryan L. TI Emergency Department Care in the United States: A Profile of National Data Sources SO ANNALS OF EMERGENCY MEDICINE LA English DT Article ID SURVEILLANCE; VISITS AB Study objective: Emergency departments (EDs) are an integral part of the US health care system, and yet national data sources on the care received in the ED are poorly understood, thereby limiting their usefulness for analyses. We provide a comparison of data sources that can be used to examine utilization and quality of care in the ED nationally. Data sources and comparisons: This article compares 7 data sources available in 2005 for conducting analyses of ED encounters. the American Hospital Association Annual Survey Database (TM), Hospital Market Profiling Solution (c), National Emergency Department Inventory, Nationwide Emergency Department Sample, National Hospital Ambulatory Medical Care Survey, National Electronic Injury Surveillance System All-Injury Program, and the National Health Interview Survey. In addition to describing the type and scope of data collection, available characteristics, and sponsor of the ED data sources, we compare (where possible) estimates of the total number of EDs, national and regional volume of ED visits, national and regional admission rates (percentage of ED visits resulting in hospital admission), patient characteristics, hospital characteristics, and reasons for visit generated by the various data sources. Major findings: The different data sources yielded estimates of the number of EDs that ranged from 4,609 to 4,884 and the number of ED encounters from more than 109 million to more than 116 million. Admission rates across data sources varied from 12.0% to 15.3%. Although comparisons of the 7 data sources were somewhat limited by differences in available information and operational definitions, variation in estimates of utilization and patterns of care existed by region, expected payer, and patient and hospital characteristics. The rankings and estimates of the top 5 first-listed conditions seen in the ED are relatively consistent between the 2 data sources with diagnoses, although the Nationwide Emergency Department Sample estimates 1.3 to 5.8 times more ED visits for each chronic and acute all-listed condition examined relative to the National Hospital Ambulatory Medical Care Survey. Conclusion: Each of the data sources described in this article has unique advantages and disadvantages when used to examine patterns of ED care, making the different data sources appropriate for different applications. Analysts should select a data source according to its construction and should bear in mind its strengths and weaknesses in drawing conclusions based on the estimates it yields. [Ann Emerg Med 2010;56:150-165.] C1 [Owens, Pamela L.; Andrews, Roxanne M.; Mutter, Ryan L.] US Dept HHS, Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. [Barrett, Marguerite L.] ML Barrett Inc, Del Mar, CA USA. [Gibson, Teresa B.] Thomson Reuters, Ann Arbor, MI USA. [Weinick, Robin M.] RAND, Arlington, VA USA. RP Mutter, RL (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM ryan.mutter@ahrq.hhs.gov FU Agency for Healthcare Research and Quality [HHSA-290-2006-00009-C] FX By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement The work on which this article is based was supported by the Agency for Healthcare Research and Quality under contract number (HHSA-290-2006-00009-C) NR 28 TC 55 Z9 55 U1 0 U2 4 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD AUG PY 2010 VL 56 IS 2 BP 150 EP 165 DI 10.1016/j.annemergmed.2009.11.022 PG 16 WC Emergency Medicine SC Emergency Medicine GA 635ZM UT WOS:000280697000013 PM 20074834 ER PT J AU Russ, SA Dougherty, D Jagadish, P AF Russ, Shirley A. Dougherty, Denise Jagadish, Padmini TI Accelerating Evidence Into Practice for the Benefit of Children With Early Hearing Loss SO PEDIATRICS LA English DT Article DE deaf; hard-of-hearing; early intervention; newborn hearing screening ID EARLY INTERVENTION; COCHLEAR IMPLANTATION; MEDICAL HOME; IMPAIRMENT; QUALITY; CARE; PERSPECTIVES; VOCABULARY; EXPERIENCE; STATEMENT AB Over the years, multiple groups have issued recommendations for newborn hearing screening, diagnosis, and intervention. In January 2008, the US Department of Health and Human Services held an invitational workshop at which more than 50 national experts met for 2 days to consider ways to accelerate the movement of evidence-based recommendations into practice. Participants set priorities among existing recommendations, identified areas with the most promise and created a national blueprint to accelerate evidence into practice. Workshop participants adopted the "3T's Roadmap to Transform US Health Care" as the conceptual model for this work and used a modified Delphi process to identify high-priority recommendations in 5 areas (diagnosis, treatment, parental and public awareness, continuous quality improvement, and stewardship). A matrix of responsibility was developed to specify entities that could take action to implement these recommendations. Participants placed a high priority on measurement and recommended improved data-tracking of newborns after screening and creation of a limited set of national indicators to monitor progress toward evidence-based system goals. They also identified a greater role for parents and families in contributing to system transformation and a need for more culturally and linguistically appropriate resources. Targeting infants in the NICU for early testing and creating guidelines and resources for early intervention were additional priorities. Finally, the workgroup noted the need to create a stewardship function to monitor the progress of the entire system of care, disseminate reports, consider future research directions, and continue to develop critical cross-agency and public-private coordination of activities. Pediatrics 2010;126:S7-S18 C1 [Russ, Shirley A.] Cedars Sinai Med Ctr, Dept Acad Primary Care Pediat, Los Angeles, CA USA. [Russ, Shirley A.] UCLA Ctr Healthier Children Families & Commun, Los Angeles, CA USA. [Dougherty, Denise; Jagadish, Padmini] US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Russ, SA (reprint author), Div Acad Primary Care Pediat, 8700 Beverly Blvd,Room 1165W, Los Angeles, CA 90048 USA. EM shirlyruss@aol.com FU AHRQ professional services [HHSP-233200800294P]; AHRQ [290-07-10046] FX Dr Russ was supported by AHRQ professional services contract HHSP-233200800294P. The workshop was supported by AHRQ BPA contract 290-07-10046. NR 61 TC 7 Z9 10 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 AUG PY 2010 VL 126 SU S BP S7 EP S18 DI 10.1542/peds.2010-0354E PG 12 WC Pediatrics SC Pediatrics GA 634FP UT WOS:000280565900003 PM 20679322 ER PT J AU Russ, SA White, K Dougherty, D Forsman, I AF Russ, Shirley A. White, Karl Dougherty, Denise Forsman, Irene TI Preface: Newborn Hearing Screening in the United States: Historical Perspective and Future Directions SO PEDIATRICS LA English DT Editorial Material ID IMPAIRMENT; PREVALENCE; EXPERIENCE; CHILDREN; CARE C1 [Russ, Shirley A.] Cedars Sinai Med Ctr, Dept Acad Primary Care Pediat, Los Angeles, CA 90048 USA. [Russ, Shirley A.] UCLA Ctr Healthier Children Families & Commun, Los Angeles, CA USA. [White, Karl] Utah State Univ, Natl Ctr Hearing Assessment & Management, Logan, UT USA. [Dougherty, Denise] Agcy Healthcare Res & Qual, Rockville, MD USA. [Forsman, Irene] US Dept HHS, Maternal & Child Hlth Bur, Rockville, MD USA. RP Russ, SA (reprint author), Div Acad Primary Care Pediat, 8700 Beverly Blvd,Room 1165W, Los Angeles, CA 90048 USA. EM shirlyruss@aol.com FU PHS HHS [HHSP233200800294P, U52MC04391] NR 22 TC 5 Z9 8 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 AUG PY 2010 VL 126 SU S BP S3 EP S6 DI 10.1542/peds.2010-0354D PG 4 WC Pediatrics SC Pediatrics GA 634FP UT WOS:000280565900002 PM 20679318 ER PT J AU Ahmad, SR Elixhauser, A AF Ahmad, Syed Rizwanuddin Elixhauser, Anne TI Hospitalizations Associated with Acetaminophen Poisoning in the United States SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract CT 26th International Conference on Pharmacoepidemiology and Therapeutic Risk Management CY AUG 19-22, 2010 CL Brighton, ENGLAND C1 [Ahmad, Syed Rizwanuddin] US FDA, Div Epidemiol, Off Surveillance & Epidemiol, CDER, Silver Spring, MD USA. [Elixhauser, Anne] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2010 VL 19 SU 1 MA 641 BP S271 EP S272 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA V45OP UT WOS:000209826200615 ER PT J AU Gliklich, R Leavy, MB Mack, CD Whiteside, L Campion, D Bartman, B AF Gliklich, Richard Leavy, Michelle B. Mack, Christina D. Whiteside, Laura Campion, Dan Bartman, Barbara TI Current and Potential Uses of Clinical Registries for Comparative Effectiveness Research SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract CT 26th International Conference on Pharmacoepidemiology and Therapeutic Risk Management CY AUG 19-22, 2010 CL Brighton, ENGLAND C1 [Gliklich, Richard; Leavy, Michelle B.; Mack, Christina D.; Whiteside, Laura; Campion, Dan] Outcome Sci, Cambridge, MA USA. [Bartman, Barbara] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2010 VL 19 SU 1 MA 453 BP S192 EP S192 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA V45OP UT WOS:000209826200435 ER PT J AU Brousseau, DC Panepinto, JA Steiner, CA AF Brousseau, David C. Panepinto, Julie A. Steiner, Claudia A. TI Transition From Pediatric to Adult Care for Patients With Sickle Cell Disease Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 [Brousseau, David C.; Panepinto, Julie A.] Med Coll Wisconsin, Dept Pediat, Milwaukee, WI 53226 USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Healthcare Cost & Utilizat Project, Rockville, MD USA. RP Brousseau, DC (reprint author), Med Coll Wisconsin, Dept Pediat, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA. EM dbrousse@mcw.edu NR 2 TC 0 Z9 0 U1 0 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 28 PY 2010 VL 304 IS 4 BP 409 EP 409 DI 10.1001/jama.2010.1027 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 631MA UT WOS:000280350100020 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Getting to Zero: New Resources Aim to Reduce Health Care-Associated Infections SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material ID BLOOD-STREAM INFECTIONS; UNIT C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Carolyn.Clancy@ahrq.hhs.gov NR 13 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 JUL-AUG PY 2010 VL 25 IS 4 BP 319 EP 321 DI 10.1177/1062860610370395 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 621CU UT WOS:000279552300012 PM 20498385 ER PT J AU Carr, BG Conway, PH Meisel, ZF Steiner, CA Clancy, C AF Carr, Brendan G. Conway, Patrick H. Meisel, Zachary F. Steiner, Claudia A. Clancy, Carolyn TI Defining the Emergency Care Sensitive Condition: A Health Policy Research Agenda in Emergency Medicine SO ANNALS OF EMERGENCY MEDICINE LA English DT Editorial Material ID ACUTE MYOCARDIAL-INFARCTION; HOSPITAL CARDIAC-ARREST; TO-BALLOON TIME; PNEUMONIA; PERFORMANCE; HYPOTHERMIA; MORTALITY; STROKE C1 [Carr, Brendan G.; Meisel, Zachary F.] Univ Penn, Dept Emergency Med, Philadelphia, PA 19104 USA. [Carr, Brendan G.; Meisel, Zachary F.] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA. [Carr, Brendan G.] Univ Penn, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Dept Hlth & Human Serv, Cincinnati, OH USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Ctr Hlth Care Qual, Cincinnati, OH USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Div Hlth Policy & Clin Effectiveness, Cincinnati, OH USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Div Gen Pediat, Cincinnati, OH USA. [Meisel, Zachary F.] Robert Wood Johnson Fdn Clin Scholars Program, Chapel Hill, NC USA. [Steiner, Claudia A.; Clancy, Carolyn] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Carr, BG (reprint author), Univ Penn, Dept Emergency Med, 929 Blockley Hall,423 Guardian Dr, Philadelphia, PA 19104 USA. EM carrb@upenn.edu FU AHRQ HHS [K08HS017960] NR 21 TC 21 Z9 21 U1 0 U2 0 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD JUL PY 2010 VL 56 IS 1 BP 49 EP 51 DI 10.1016/j.annemergmed.2009.12.013 PG 3 WC Emergency Medicine SC Emergency Medicine GA 622KB UT WOS:000279660200013 PM 20045577 ER PT J AU Zinn, JS Weimer, DL Spector, W Mukamel, DB AF Zinn, Jacqueline S. Weimer, David L. Spector, William Mukamel, Dana B. TI Factors influencing nursing home response to quality measure publication: A resource dependence perspective SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article DE Medicaid; Medicare; Nursing Home Compare; nursing homes; quality report cards ID REPORT CARDS; MARKET SHARE; IMPACT; PERFORMANCE; OUTCOMES; TRENDS; MILES AB Background: The Centers for Medicare and Medicaid Services provides a report card on nursing homes at a Web site called Nursing Home Compare (NHC) that includes information on 19 clinical quality measures (QMs). The information is intended to inform consumer choice, to provide a focus for state regulatory initiatives, and to promote nursing home quality improvement efforts. Purpose: This study aimed to determine what factors were associated with nursing homes' investment in quality after publication of the NHC report card. Methodology: A 2007 survey sent to nursing home administrators nationally inquired about their response to publication of QMs on NHC. Survey data were merged with data on QMs and organizational characteristics from NHC. The dependent variables represent actions requiring a significant investment of resources in staffing and/or equipment. Independent variables tested hypotheses regarding the influence of constituent groups, competition, and managed care participation on investment. We estimated logistic regression models adjusting for clustering within states. Findings: The degree to which nursing homes perceive that the report card influences key constituencies (professional referral sources, consumers, and state surveyors) is associated with the odds of committing substantial resources to improve report card performance. Facilities with lower reported QM scores were three times more likely to make certain investments than high-quality facilities in competitive markets. Perceived QM validity and close monitoring of scores also motivates investment. Practice Implications: A substantial proportion of nursing homes now perceive that the report card influences professional referrals, consumer choice, and state survey investigatory process. This suggests that QM publication may indeed have a competitive impact as it concerns these constituencies, thus increasing the stakes in improving the scores and making substantial investments much more likely. C1 [Zinn, Jacqueline S.] Temple Univ, Fox Sch Business & Management, Philadelphia, PA 19122 USA. [Weimer, David L.] Univ Wisconsin Madison, LaFollette Sch Publ Affairs, Madison, WI USA. [Spector, William] Agcy Healthcare Res & Qual, Rockville, MD USA. [Mukamel, Dana B.] Univ Calif Irvine, Dept Med, Irvine, CA 92717 USA. RP Zinn, JS (reprint author), Temple Univ, Fox Sch Business & Management, Philadelphia, PA 19122 USA. EM Jacqueline.Zinn@temple.edu FU NIA NIH HHS [AG023177] NR 34 TC 6 Z9 6 U1 0 U2 6 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 2010 VL 35 IS 3 BP 256 EP 265 DI 10.1097/HMR.0b013e3181e23d64 PG 10 WC Health Policy & Services SC Health Care Sciences & Services GA 611NO UT WOS:000278823200007 PM 20551773 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Getting to Zero Our Effort to Eliminate Infections Nationwide SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID BLOOD-STREAM INFECTIONS C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Carolyn.Clancy@ahrq.hhs.gov NR 12 TC 4 Z9 4 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 JUL PY 2010 VL 25 IS 3 BP 189 EP 192 DI 10.1097/NCQ.0b013e3181dd9d2e PG 4 WC Nursing SC Nursing GA 604NT UT WOS:000278286400001 PM 20516813 ER PT J AU Berdahl, TA Zodet, M AF Berdahl, Terceira A. Zodet, Marc TI Medical Care Utilization for Work-Related Injuries in the United States 2002-2006 SO MEDICAL CARE LA English DT Article DE occupation; work injuries; healthcare; disparities; utilization; health status ID OCCUPATIONAL INJURY; HEALTH-CARE; ETHNIC DISPARITIES; AFRICAN-AMERICAN; RISK; RACE; CLEANERS; ILLNESS; GENDER; MEN AB Objective: To examine racial-ethnic/gender differences in the odds of injury and in the odds of seeking medical treatment among workers in the United States. Methods: Logistic regression models were used to estimate the odds of having a work injury and the odds of seeking medical treatment for these injuries in a sample of non-Latino Black, Latino, and non-Latino white workers from the Medical Expenditure Panel Survey (2002-2006). Results: Significant variation in the odds of injury was observed across racial-ethnic/gender groups. Although race-gender groups had significant variation in the odds of experiencing a work injury, we found few differences in treatment seeking. Among the 6 subgroups, we found that white women were significantly less likely to report an injury and significantly more likely to seek treatment when injured. Having health insurance played a key role in utilization among injured workers. The odds of seeking treatment were 33% lower for uninsured workers compared with those with private insurance. Publicly insured workers were no different from privately insured workers. Conclusions: Our study sheds light on current trends in work injuries and associated medical care utilization among a nationally representative sample of workers. C1 [Berdahl, Terceira A.; Zodet, Marc] AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Berdahl, TA (reprint author), AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. EM terceira.berdahl@ahrq.hhs.gov NR 29 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 EI 1537-1948 J9 MED CARE JI Med. Care PD JUL PY 2010 VL 48 IS 7 BP 645 EP 651 DI 10.1097/MLR.0b013e3181dbdc1c PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 619KD UT WOS:000279428200012 PM 20548257 ER PT J AU Clancy, C Collins, FS AF Clancy, Carolyn Collins, Francis S. TI Patient-Centered Outcomes Research Institute: The Intersection of Science and Health Care SO SCIENCE TRANSLATIONAL MEDICINE LA English DT Article AB The Patient Protection and Affordable Care Act created the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit corporation that is neither an agency nor an establishment of the U.S. government. PCORI's mission is to support the production of well-validated scientific evidence to assist the nation in making informed decisions about a broad range of health care-related issues. In this Commentary, the directors of the Agency for Healthcare Research and Quality and the National Institutes of Health discuss PCORI's opportunities to contribute to a robust portfolio of scientific inquiry that builds on their agencies' investment in comparative effectiveness research. C1 [Collins, Francis S.] NIH, Off Director, Bethesda, MD 20892 USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Collins, FS (reprint author), NIH, Off Director, Bldg 10, Bethesda, MD 20892 USA. EM collinsf@mail.nih.gov FU Patient-Centered Outcomes Research Trust Fund FX PCORI will be funded through the Patient-Centered Outcomes Research Trust Fund, which will receive money from a variety of funding streams, the mix of which will change over the course of time. For fiscal years (FYs) 2010-2012, the trust fund will receive only direct appropriations from general federal revenues. For FYs 2013-2019, the funding will come from $150 million in annual appropriations, along with an annual per-capita charge per enrollee from Medicare and other health insurance plans. The per-capita charge, which will start at $1 and rise to $2, is expected to raise approximately $2.6 billion through FY 2019, according to the Congressional Budget Office (8). That would place PCORI's annual funding level in the realm of $500 million or more. NR 8 TC 51 Z9 52 U1 0 U2 8 PU AMER ASSOC ADVANCEMENT SCIENCE PI WASHINGTON PA 1200 NEW YORK AVE, NW, WASHINGTON, DC 20005 USA SN 1946-6234 J9 SCI TRANSL MED JI Sci. Transl. Med. PD JUN 23 PY 2010 VL 2 IS 37 AR 37cm18 DI 10.1126/scitranslmed.3001235 PG 3 WC Cell Biology; Medicine, Research & Experimental SC Cell Biology; Research & Experimental Medicine GA 735PC UT WOS:000288428400001 PM 20574065 ER PT J AU Friedman, B Jiang, HJ AF Friedman, Bernard Jiang, H. Joanna TI Do Medicare Advantage enrollees tend to be admitted to hospitals with better or worse outcomes compared with fee-for-service enrollees? SO INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE & ECONOMICS LA English DT Article DE Medicare Advantage; Hospital mortality rates; Patient safety ID PATIENT SAFETY AB The hospitals selected by or for Medicare beneficiaries might depend on whether the patient is enrolled in a Medicare Advantage (MA) plan. A theoretical model of profit maximization by MA plans takes into account the tradeoffs of consumer preferences for annual premium versus outcomes of care in the hospital and other attributes of the plan. Hospital discharge databases for 13 states in 2006, maintained by the Agency for Healthcare Research and Quality, are the main source of data. Risk-adjusted mortality rates are available for all non-maternity adult patients in each of 15 clinical categories in about 1,500 hospitals. All-adult postoperative safety event rates covering 9 categories of events are calculated for surgical cases in about 900 hospitals. Instrumental variables are used to address potential endogeneity of the choice of a MA plan. The key findings are these: enrollees in MA plans tend to be treated in hospitals with lower resource cost and higher risk-adjusted mortality compared to Fee-for-Service (FFS) enrollees. The risk-adjusted mortality measure is about 1.5 percentage points higher for MA plan enrollees than the overall mean of 4%. However, the rate of safety events in surgical patients favors MA plan enrollees-the rate is 1 percentage point below the average of 3.5%. These discrepant results are noteworthy and are plausibly due to greater discretion by the health plan in approving patients for elective surgery and as well as selecting hospitals for surgical patients. Emergency patients are generally excluded for the safety outcome measures. In addition, the current mortality measures may not adequately represent all surgical patients. Such caveats should be prominently highlighted when presenting comparative data. With that proviso, the study justifies informing Medicare beneficiaries about the mortality and safety outcome measures for hospitals being used by a MA plan compared to hospitals used by FFS enrollees. C1 [Friedman, Bernard; Jiang, H. Joanna] AHRQ, Rockville, MD 20850 USA. RP Friedman, B (reprint author), AHRQ, 540 Gaither Rd, Rockville, MD 20850 USA. EM bernard.friedman@ahrq.hhs.gov; joanna.jiang@ahrq.hhs.gov NR 19 TC 5 Z9 5 U1 0 U2 4 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1389-6563 J9 INT J HEALTH CARE FI JI Int. J. Health Care Financ. Econ. PD JUN PY 2010 VL 10 IS 2 BP 171 EP 185 DI 10.1007/s10754-010-9076-0 PG 15 WC Business, Finance; Economics; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 575MR UT WOS:000276071700003 PM 20140642 ER PT J AU Korthuis, P Fleishman, J Gebo, K Cameron, B Hickam, D Hellinger, J Mathews, W AF Korthuis, Philip Fleishman, John Gebo, Kelly Cameron, Bonnie Hickam, David Hellinger, James Mathews, William TI PREVALENCE AND CORRELATES OF NON-RECOMMENDED ANTIRETROVIRAL THERAPY IN A MULTICENTER HIV COHORT SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 33rd Annual Meeting of the Society-of-General-Internal-Medicine CY APR 18-MAY 01, 2010 CL Minneapolis, MN SP Soc Gen Internal Med C1 [Fleishman, John] Agcy Healthcare Res & Qual, Rockville, MD USA. [Gebo, Kelly] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Cameron, Bonnie] Johns Hopkins Univ, Sch Med, Baltimore, MD USA. [Hickam, David] Oregon Hlth & Sci Univ, Portland VA Med Ctr, Portland, OR 97201 USA. [Hellinger, James] Tufts Univ, Sch Med, Boston, MA 02111 USA. [Mathews, William] UCSD, Dept Med, San Diego, CA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2010 VL 25 SU 3 BP 361 EP 362 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 591EO UT WOS:000277282300340 ER PT J AU Curns, AT Steiner, CA Barrett, M Hunter, K Wilson, E Parashar, UD AF Curns, Aaron T. Steiner, Claudia A. Barrett, Marguerite Hunter, Katherine Wilson, Emily Parashar, Umesh D. TI Reduction in Acute Gastroenteritis Hospitalizations among US Children After Introduction of Rotavirus Vaccine: Analysis of Hospital Discharge Data from 18 US States SO JOURNAL OF INFECTIOUS DISEASES LA English DT Article ID IMMUNIZATION PRACTICES ACIP; UNITED-STATES; ADVISORY-COMMITTEE; SURVEILLANCE; DIARRHEA; TRENDS; COVERAGE; IMPACT; CODE; AGE AB Background. In 2006, RotaTeq (RV5) was recommended for routine vaccination of United States (US) infants. We compared hospitalization rates for acute gastroenteritis among US children aged <5 years during pre-RV5 rotavirus seasons from 2000 through 2006 with those during the post-RV5 2007 and 2008 seasons. Methods. Using 100% hospital discharge data from 18 states, accounting for 49% of the US population, we calculated acute gastroenteritis hospitalization rates for children aged <5 years by rotavirus season, 8 age groups (0-2, 3-5, 6-11, 12-17, 18-23, 24-35, 36-47, and 48-59 months), and state. Results. Compared with the median rate for the 2000-2006 rotavirus seasons (101.1 hospitalizations per 10,000 children), the rates for 2007 and 2008 (85.5 and 55.5 hospitalizations per 10,000 children) were 16% and 45% lower, respectively. Children aged 0-2 months had a 28% reduction, those aged 6-23 months had a reduction of 50%, and children aged 3-5 months and 24-59 months had reductions ranging between 42% and 45% during the 2008 rotavirus season, compared with the median rate for 2000-2006 rotavirus seasons. Conclusions. The introduction of the RV5 vaccine was associated with a dramatic reduction in hospitalizations for acute gastroenteritis among US children during the 2008 rotavirus season. C1 [Curns, Aaron T.; Parashar, Umesh D.] Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, Atlanta, GA 30329 USA. [Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Healthcare Cost & Utilizat Project, Rockville, MD USA. [Barrett, Marguerite] ML Barrett, Del Mar, CA USA. [Hunter, Katherine; Wilson, Emily] Thomson Reuters, Santa Barbara, CA USA. RP Curns, AT (reprint author), Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, 1600 Clifton Rd MS A47, Atlanta, GA 30329 USA. EM agc8@cdc.gov FU Centers for Disease Control and Prevention; Agency for Healthcare Research and Quality; Arizona Department of Health Services; Office of Statewide Health Planning and Development; Florida Agency for Health Care Administration; Georgia Hospital Association; Hawaii Health Information Corporation; Indiana Hospital Association; Iowa Hospital Association; Kentucky Cabinet for Health and Family Services; Maine Health Data Organization; Health Services Cost Review Commission; Michigan Health & Hospital Association; Minnesota Hospital Association; Hospital Industry Data Institute; Nevada Department of Health and Human Services; New York State Department of Health; South Carolina State Budget Control Board; Washington State Department of Health; West Virginia Health Care Authority FX Financial support: The Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality.; We thank and acknowledge the following HCUP state partners for their active support of this study: Arizona Department of Health Services, Office of Statewide Health Planning and Development (CA), Florida Agency for Health Care Administration, Georgia Hospital Association, Hawaii Health Information Corporation, Indiana Hospital Association, Iowa Hospital Association, Kentucky Cabinet for Health and Family Services, Maine Health Data Organization, Health Services Cost Review Commission (MD), Michigan Health & Hospital Association, Minnesota Hospital Association, Hospital Industry Data Institute (MO), Nevada Department of Health and Human Services, New York State Department of Health, South Carolina State Budget & Control Board, Washington State Department of Health, and West Virginia Health Care Authority. We also thank Claudia Chesley for her editorial assistance. NR 27 TC 130 Z9 132 U1 0 U2 2 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0022-1899 J9 J INFECT DIS JI J. Infect. Dis. PD JUN 1 PY 2010 VL 201 IS 11 BP 1617 EP 1624 DI 10.1086/652403 PG 8 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 589TH UT WOS:000277176200004 PM 20402596 ER PT J AU Manski, RJ Cooper, PF AF Manski, Richard J. Cooper, Phillip F. TI Characteristics of employers offering dental coverage in the United States SO JOURNAL OF THE AMERICAN DENTAL ASSOCIATION LA English DT Article DE Dental care; dental care utilization; dental economics; dental insurance; dental public health AB Background. The authors conducted a study to describe the current market for dental benefit offerings by employers and to describe the number and percentage of establishments that offer dental care coverage. Methods. The authors examined the 2006 Medical Expenditure Panel Survey-Insurance Component and describe the number and percentage of establishments that offered at least one health insurance plan; establishments that offered dental insurance; and, of those establishments that offered at least one health insurance plan, the percentage that offered a dental insurance plan. Results. The study results show that 56 percent of all establishments offered health insurance in 2006. Approximately 35 percent of all establishments and 63 percent of establishments that offered health insurance offered dental insurance in 2006. Conclusions. The difference in employee coverage rates between health insurance and dental insurance is reflected largely in the rates at which employers offered health insurance and dental insurance coverage in 2006. Practice Implications. By understanding these analyses, practitioners will be better positioned to provide care, improve access and respond to changes in the health care coverage marketplace. C1 [Manski, Richard J.] Univ Maryland, Div Hlth Serv Res, Dept Hlth Promot & Policy, Sch Dent, Baltimore, MD 21201 USA. [Cooper, Phillip F.] Ctr Financing Access & Cost Trends, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Manski, RJ (reprint author), Univ Maryland, Div Hlth Serv Res, Dept Hlth Promot & Policy, Sch Dent, 650 W Baltimore St,Room 2209, Baltimore, MD 21201 USA. EM rmanski@umaryland.edu NR 17 TC 3 Z9 3 U1 0 U2 1 PU AMER DENTAL ASSOC 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 JUN PY 2010 VL 141 IS 6 BP 700 EP 711 PG 12 WC Dentistry, Oral Surgery & Medicine SC Dentistry, Oral Surgery & Medicine GA 608GM UT WOS:000278571500023 PM 20516103 ER PT J AU O'Leary, TJ Slutsky, JR Bernard, MA AF O'Leary, Timothy J. Slutsky, Jean R. Bernard, Marie A. TI Comparative Effectiveness Research Priorities at Federal Agencies: The View from the Department of Veterans Affairs, National Institute on Aging, and Agency for Healthcare Research and Quality SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE patient outcomes; comparative effectiveness; research ID LIPID-LOWERING TREATMENT; ATTACK TRIAL ALLHAT; MAJOR OUTCOMES AB In the last year, attention has been focused on translating federally sponsored health research into better health for Americans. Since the passage of the American Recovery and Reinvestment Act (ARRA) on February 17, 2009, ARRA funds to support Comparative Effectiveness Research (CER) have increased this focus. A large proportion of topical areas of interest in CER affects the older segment of the population. The Department of Veterans Affairs (VA), the National Institute on Aging (NIA), and the Agency for Healthcare Research and Quality (AHRQ) have supported robust research portfolios focused on aging populations that meet the varying definitions of CER. This short article briefly describes the research missions of the AHRQ, NIA, and VA. The various definitions of CER as the Congressional Budget Office, the Institute of Medicine, and the ARRA-established Federal Coordinating Council have put forward, as well as important topics for which CER is particularly needed, are then reviewed. Finally, approaches in which the three agencies support CER involving the aging population are set forth and opportunities for future CER research outlined. J Am Geriatr Soc 58: 1187-1192, 2010. C1 [Bernard, Marie A.] NIA, Dept Hlth & Human Serv, NIH, Bethesda, MD 20892 USA. [O'Leary, Timothy J.] US EPA, Off Res & Dev, Dept Vet Affairs, Washington, DC 20460 USA. [Slutsky, Jean R.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. RP Bernard, MA (reprint author), NIA, Dept Hlth & Human Serv, NIH, Bldg 31,5C-35,31 Ctr Dr,MSC 2292, Bethesda, MD 20892 USA. EM mbernard@nia.nih.gov FU Intramural NIH HHS [Z99 AG999999] NR 13 TC 7 Z9 7 U1 0 U2 0 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD JUN PY 2010 VL 58 IS 6 BP 1187 EP 1192 DI 10.1111/j.1532-5415.2010.02939.x PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 604WO UT WOS:000278309400025 PM 20936736 ER PT J AU Shah, RK Stocks, C AF Shah, Rahul K. Stocks, Carol TI Epiglottitis in the United States: National Trends, Variances, Prognosis, and Management SO LARYNGOSCOPE LA English DT Article DE Haemophilus influenza type b; stridor; deep neck space infection; nationwide inpatient sample ID ADULT EPIGLOTTITIS; AIRWAY MANAGEMENT; PERSPECTIVE; EXPERIENCE; CHILDREN; TRACHEOTOMY; INFECTIONS; VACCINE; INFANTS; DISEASE AB Objectives/Hypothesis: To study national trends, variances, and outcomes in patients admitted with epiglottitis in the United States. We hypothesize that the incidence of epiglottitis has decreased, mortality has decreased, and that there has been a shift toward older patients being admitted with epiglottitis. Study Design: Retrospective review of a dataset for years 1998, 2000, 2002, 2004, and 2006. Methods: The Nationwide Inpatient Sample was searched using 1CD-9 CM codes for epiglottitis with obstruction (464.30) and without obstruction (464.31). Characteristics studied included patient demographics, hospital information, and admission variables. Weighted admissions were analyzed to facilitate national estimates. Results: There was a trend toward decreasing admissions over the study period, from 4587.17 cases (1998) to 3772.49 cases (2006); the mean over the study period was 4062.52 cases/year. The mean age of a patient with epiglottitis has remained relatively constant at 44.94 years over the study period; there are less frequent admissions in the 18 years and younger age cohorts, with an increase in the ages 45 to 64 years old and in patients over 85 years old. Mean length of stay is 4.15 days. Mean total charges for an admission of epiglottitis was $17,204.02 (standard deviation, $5,894). There was a trend toward increased total charges for the management of epiglottitis from total charges of $10,738.60 (1998) to $25,071.62 (2006). The South had a predominantly higher proportion of epiglottitis admissions during the study period. The gender distribution remained consistent over the study years at approximately 60:40 for males:female. Mortality remained constant at approximately 36 cases per year for a national mortality rate from epiglottitis of 0.89%. The month with the highest percentage of admissions was December; April was the month with the lowest. The majority of admissions were via the emergency department; patients were transferred in 2.88% of admissions. Over two thirds of admissions were Caucasian patients. Hospital level measures included the majority of patients were treated in an urban hospital location (82%); a minority (41%) were treated at a teaching hospital. Insurance status was private insurance in 50.02%, Medicare 20.84%, and Medicaid 12.46%. The proportion of patients that were intubated was 13.18%; 3.62% underwent a tracheotomy. Additional diagnoses in admitted patients included concomitant cardiovascular (38.75%), infectious (27.17%), respiratory (22.88%), diabetes (13.26%), and substance abuse (18.86%) diagnoses. Conclusions: An 8-year retrospective review of epiglottitis admissions revealed that epiglottitis continues to be a significant clinical entity in the United States. The portrait of a typical patient that will be admitted with epiglottitis is a mid-40-year-old, Caucasian, urban, male, with comorbid medical conditions, who will remain in the hospital on average for 4 days, resulting in total charges of $25,072 (2006 dollars). The majority of the mortalities are in adult patients. The majority of patients with epiglottitis has significant medical comorbid conditions and will be managed at the admitting hospital and not be transferred. This series identifies two newly recognized and uniquely vulnerable populations for epiglottitis: infants (<1 year old) and the elderly (patients >85 years old). C1 [Shah, Rahul K.] George Washington Univ, Div Otolaryngol, Childrens Natl Med Ctr, Med Ctr, Washington, DC 20010 USA. [Stocks, Carol] Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. [Stocks, Carol] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA. RP Shah, RK (reprint author), George Washington Univ, Div Otolaryngol, Childrens Natl Med Ctr, Med Ctr, 111 Michigan Ave NW, Washington, DC 20010 USA. EM rshah@cnmc.org OI Stocks, Carol/0000-0003-3440-3193 NR 22 TC 20 Z9 20 U1 0 U2 4 PU JOHN WILEY & SONS INC PI HOBOKEN PA 111 RIVER ST, HOBOKEN, NJ 07030 USA SN 0023-852X J9 LARYNGOSCOPE JI Laryngoscope PD JUN PY 2010 VL 120 IS 6 BP 1256 EP 1262 DI 10.1002/lary.20921 PG 7 WC Medicine, Research & Experimental; Otorhinolaryngology SC Research & Experimental Medicine; Otorhinolaryngology GA 607DS UT WOS:000278479600029 PM 20513048 ER PT J AU Smith, SR AF Smith, Scott R. TI Advancing Methods for Comparative Effectiveness Research SO MEDICAL CARE LA English DT Editorial Material C1 US Dept HHS, Agcy Healthcare Res & Qual, DEcIDE Program, Rockville, MD 20850 USA. RP Smith, SR (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, DEcIDE Program, 540 Gaither Rd, Rockville, MD 20850 USA. EM Scott.Smith@ahrq.hhs.gov NR 0 TC 2 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 JUN PY 2010 VL 48 IS 6 SU 1 BP S1 EP S2 DI 10.1097/MLR.0b013e3181e1cde5 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 603SG UT WOS:000278227800001 PM 20473186 ER PT J AU Rivard, PE Elixhauser, A Christiansen, CL Zhao, S Rosen, AK AF Rivard, Peter E. Elixhauser, Anne Christiansen, Cindy L. Zhao, Shibei Rosen, Amy K. TI Testing the Association Between Patient Safety Indicators and Hospital Structural Characteristics in VA and Nonfederal Hospitals SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE hospital; organizational factors; teaching hospitals; hospital size; nurse staffing; patient safety; patient safety indicators; adverse events ID QUALITY-OF-CARE; ACUTE MYOCARDIAL-INFARCTION; ADMINISTRATIVE DATA; ADVERSE EVENTS; US HOSPITALS; MEDICARE PATIENTS; NONTEACHING HOSPITALS; TEACHING HOSPITALS; UNITED-STATES; MORTALITY AB This study tested the association between hospital structural characteristics-teaching status, bedsize, and nurse staffing-and potentially preventable adverse events. The authors calculated 14 Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) and a PSI composite, using discharge databases from VA and nonfederal hospitals. This study compared the likelihood of PSI events in hospitals, controlling for structural and other characteristics, including patients' case-mix. Additional controls were employed to account for differences in VA versus nonfederal patients and data. The study found some associations, most notably a positive (unfavorable) association between status as a major teaching hospital and six PSIs. However, for most PSIs, the authors found no association between the structural characteristics tested and likelihood of PSI events. The study's findings extend previous research showing a lack of consistent relationship between structural characteristics and patient safety. However, the results also suggest continued need for examination of the relationship between teaching status and potentially preventable adverse events. C1 [Rivard, Peter E.] Suffolk Univ, Sawyer Business Sch, Boston, MA 02108 USA. [Elixhauser, Anne] Agcy Healthcare Res & Qual, Rockville, MD USA. [Christiansen, Cindy L.] Boston Univ, Sch Publ Hlth, Boston, MA USA. [Zhao, Shibei; Rosen, Amy K.] VA Ctr Healthcare Qual Outcomes & Econ Res, Bedford, MA USA. RP Rivard, PE (reprint author), Suffolk Univ, Sawyer Business Sch, 8 Ashburton Pl, Boston, MA 02108 USA. EM privard@suffolk.edu OI Christiansen, Cindy/0000-0001-9951-480X NR 65 TC 17 Z9 17 U1 5 U2 10 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 2010 VL 67 IS 3 BP 321 EP 341 DI 10.1177/1077558709347378 PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 597QB UT WOS:000277772600006 PM 19880671 ER PT J AU Kirby, JB Hudson, J Miller, GE AF Kirby, James B. Hudson, Julie Miller, G. Edward TI Explaining Racial and Ethnic Differences in Antidepressant Use Among Adolescents SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE adolescents; antidepressant; race and ethnicity ID EXPENDITURE PANEL SURVEY; PSYCHOTROPIC MEDICATIONS; NATIONAL-HEALTH; MENTAL-HEALTH; CHILDREN; YOUTHS; PREVALENCE; INFORMATION; DISPARITIES; IMPAIRMENT AB We investigate the extent to which antidepressant use among adolescents varies across racial and ethnic subgroups. Using a representative sample of U.S. adolescents, we find that non-Hispanic White adolescents are over twice as likely as Hispanic adolescents, and over five times as likely as non-Hispanic Black adolescents to use antidepressants. Results from a decomposition analysis indicate that racial/ethnic differences in characteristics, including household income, parental education, health insurance, and having a usual source of care explain between one half and two thirds of the gap in antidepressant use between Hispanics and non-Hispanic Whites. In contrast, none of the gap between Whites and Blacks in antidepressant use is explained by differences in observed characteristics. Further analysis suggests that there are large racial/ethnic differences in the extent to which behavioral and mental health problems prompt antidepressant use and that this may, in part, account for the large differences across race/ethnicity observed in our study. C1 [Kirby, James B.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM jkirby@ahrq.gov NR 41 TC 6 Z9 6 U1 1 U2 2 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 2010 VL 67 IS 3 BP 342 EP 363 DI 10.1177/1077558709350884 PG 22 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 597QB UT WOS:000277772600007 PM 19915066 ER PT J AU Holman, RC Belay, ED Christensen, KY Folkema, AM Steiner, CA Schonberger, LB AF Holman, Robert C. Belay, Ermias D. Christensen, Krista Y. Folkema, Arianne M. Steiner, Claudia A. Schonberger, Lawrence B. TI Hospitalizations for Kawasaki Syndrome Among Children in the United States, 1997-2007 SO PEDIATRIC INFECTIOUS DISEASE JOURNAL LA English DT Article DE Kawasaki syndrome; Kawasaki disease; hospitalizations; epidemiology; children; infants; United States ID LYMPH-NODE SYNDROME; DISEASE; COLORADO; HAWAII; JAPAN AB Background: The present study describes the rate and trends of childhood hospitalizations with Kawasaki syndrome (KS) in the United States. Methods: Retrospective analysis of hospitalizations with KS among children <18 years of age in the United States using the Kids' Inpatient Database (1997, 2000, 2003, and 2006) and the Nationwide Inpatient Sample (1998-2007). Results: The KS-associated hospitalization rate for children <5 years of age was 20.8 (95% CI: 18.5-23.1) per 100,000 children in 2006. Annual rates remained constant during the study period, except for a peak in 2005. In 2006, 76.8% (SE = 0.9%) of an estimated 5523 (SE = 289) KS-associated hospitalizations among children <18 years of age were <5 years of age. The mean age for all children at hospitalization was 3.0 years (SE < 0.1); 25.7 months (SE = 0.3) for children <5 years of age, and 24.8 months (SE = 0.4) and 27.1 months (SE = 0.5) for boys and girls, respectively. The rate for boys was higher than that for girls (24.2 [95% CI: 21.3-27.1] and 16.8 [95% CI: 14.7-18.9], respectively). The rate for Asian/Pacific Islander children (30.3 [95% CI: 20.2-40.4]) was the highest among the racial groups. Conclusions: The national KS-associated annual hospitalization rate for children <5 years of age from 1997 to 2007 was relatively stable and was similar to previously published rates, except for an increase in 2005. Most hospitalizations were in children <3 years of age with few hospitalizations during the first 2 months of age. Children of Asian/Pacific Islander descent had the highest hospitalization rate. C1 [Holman, Robert C.; Belay, Ermias D.; Christensen, Krista Y.; Folkema, Arianne M.; Schonberger, Lawrence B.] Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Emerging & Zoonot Infect Dis, US Dept Hlth & Human Serv, Atlanta, GA 30333 USA. [Steiner, Claudia A.] Ctr Delivery Org & Markets, Healthcare Cost & Utilizat Project, Agcy Healthcare Res & Qual, US Dept Hlth & Human Serv, Rockville, MD USA. RP Holman, RC (reprint author), Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Emerging & Zoonot Infect Dis, US Dept Hlth & Human Serv, MS A-39, Atlanta, GA 30333 USA. EM RHolman@cdc.gov RI Belay, Ermias/A-8829-2013 NR 38 TC 81 Z9 83 U1 0 U2 5 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 JUN PY 2010 VL 29 IS 6 BP 483 EP 488 DI 10.1097/INF.0b013e3181cf8705 PG 6 WC Immunology; Infectious Diseases; Pediatrics SC Immunology; Infectious Diseases; Pediatrics GA 605UK UT WOS:000278372300001 PM 20104198 ER PT J AU Mark, TL Vandivort-Warren, R Owens, PL Buck, JA Levit, KR Coffey, RM Stocks, C AF Mark, Tami L. Vandivort-Warren, Rita Owens, Pamela L. Buck, Jeffrey A. Levit, Katharine R. Coffey, Rosanna M. Stocks, Carol TI Psychiatric Discharges in Community Hospitals With and Without Psychiatric Units: How Many and for Whom? SO PSYCHIATRIC SERVICES LA English DT Article ID GENERAL HOSPITALS; CARE; FUTURE AB Objective: This study sought to describe the extent to which community hospitals, in a sample of states, are caring for patients with psychiatric disorders in medical-surgical beds (scatter beds) and to compare the characteristics of patients treated in scatter beds with those of patients treated in psychiatric units in community hospitals. Methods: Information on hospital discharges in 12 states for patients with a principal psychiatric diagnosis was gathered from the Healthcare Cost and Utilization Project State Inpatient Databases. Discharges of patients who were treated in community hospital psychiatric units (N=370,984) were compared with those of patients who were treated in scatter beds (N=26,969). Results: Overall, only 6.8% of discharges were from scatter beds. The rate of total psychiatric discharges per 10,000 total state population ranged from a high of 62.3 in one study state to a low of 9.6 in another. The average rate of scatter bed discharges per 10,000 state population ranged from 1.6 to 5.8, whereas the average rate of psychiatric unit discharges ranged from 7.4 to 58.9. A comparison of discharges of patients treated in scatter beds with discharges of patients treated in psychiatric units indicated that patients in scatter beds were more likely to have somatic conditions and were half as likely to have an accompanying substance use disorder. Discharge codes indicated that almost 40% of patients from scatter beds had a diagnosis of schizophrenia, episodic mood disorder, or depression; about two-thirds were admitted from emergency rooms; and about one-fifth were transferred to another facility. Conclusions: More research is needed to determine the optimal supply of psychiatric unit beds across regions and whether and how scatter beds should be used to address the lack of psychiatric beds. (Psychiatric Services 61:562-568, 2010) C1 [Mark, Tami L.; Levit, Katharine R.; Coffey, Rosanna M.] Thomson Reuters, Healthcare & Sci Div, Washington, DC 20008 USA. [Vandivort-Warren, Rita] Subst Abuse & Mental Hlth Serv Adm, Ctr Subst Abuse Treatment, Rockville, MD USA. [Buck, Jeffrey A.] Subst Abuse & Mental Hlth Serv Adm, Ctr Mental Hlth Serv, Rockville, MD USA. [Stocks, Carol] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Mark, TL (reprint author), Thomson Reuters, Healthcare & Sci Div, 4301 Connecticut Ave NW,Suite 330, Washington, DC 20008 USA. EM tami.mark@thomsonreuters.com FU Substance Abuse and Mental Health Services Administration (SAMHSA) [HHSA-290-2006-00009-C]; Agency for Healthcare Research and Quality (AHRQ) [HHSA-290-2006-00009-C] FX This work was jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Agency for Healthcare Research and Quality (AHRQ) under contract number HHSA-290-2006-00009-C. The authors acknowledge the state data organizations that participated in the 2003 Healthcare Cost and Utilization Project State Inpatient Databases. Partners for the 12 states that provided data for this analysis were as follows: Kentucky Cabinet for Health and Family Services, Maine Health Data Organization, Massachusetts Division of Health Care Finance and Policy, Nebraska Hospital Association, Nevada Department of Health and Human Services, New York State Department of Health, North Carolina Department of Health and Human Services, Pennsylvania Health Care Cost Containment Council, Tennessee Hospital Association, Texas Department of State Health Services, Washington State Department of Health, and West Virginia Health Care Authority. The authors also acknowledge the programming support of Daniel Whalen, B. A., and the editorial support of Cheryl Kassed, Ph.D. This article does not necessarily reflect the views or policies of SAMHSA, AHRQ, or the Department of Health and Human Services, and the authors are solely responsible for its content. NR 21 TC 3 Z9 3 U1 1 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 JUN PY 2010 VL 61 IS 6 BP 562 EP 568 PG 7 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA 602UT UT WOS:000278165100006 PM 20513678 ER PT J AU Hill, SC Miller, GE AF Hill, Steven C. Miller, G. Edward TI HEALTH EXPENDITURE ESTIMATION AND FUNCTIONAL FORM: APPLICATIONS OF THE GENERALIZED GAMMA AND EXTENDED ESTIMATING EQUATIONS MODELS SO HEALTH ECONOMICS LA English DT Article DE expenditures; generalized linear models; link and variance function ID RETRANSFORMATION; TRANSFORMATION; ADO AB Health-care expenditure regressions are used in a wide variety of economic analyses including risk adjustment and program and treatment evaluations. Recent articles demonstrated that generalized gamma models (GGMs) and extended estimating equations (EEE) models provide flexible approaches to deal with a variety of data problems encountered in expenditure estimation. To date there have been few empirical applications of these models to expenditures. We use data from the US Medical Expenditure Panel Survey to compare the bias, predictive accuracy, and marginal effects of GGM and EEE models with other commonly used regression models in a cross-validation study design. Health-care expenditure distributions vary in the degree of heteroskedasticity, skewness, and kurtosis by type of service and population. To examine the ability of estimators to address a range of data problems, we estimate models of total health expenditures and prescription drug expenditures for two populations, the elderly and privately insured adults. Our findings illustrate the need for researchers to examine their assumptions about link functions: the appropriate link function varies across our four distributions. The EEE model, which has a flexible link function, is a robust estimator that performs as well, or better, than the other models in each distribution. Published in 2009 by John Wiley & Sons, Ltd. C1 [Hill, Steven C.; Miller, G. Edward] 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 18 TC 23 Z9 23 U1 0 U2 9 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 MAY PY 2010 VL 19 IS 5 BP 608 EP 627 DI 10.1002/hec.1498 PG 20 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 592AM UT WOS:000277346800008 PM 19434646 ER PT J AU Slutsky, J Atkins, D Chang, S Sharp, BAC AF Slutsky, Jean Atkins, David Chang, Stephanie Sharp, Beth A. Collins TI AHRQ Series Paper 1: Comparing medical interventions: AHRQ and the Effective Health-Care Program SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Article DE Comparative effectiveness; Systematic review methods; Evidence-based medicine; AHRQ; Effective health care AB In 2005, the Agency for Healthcare Research and Quality established the Effective Health Care (EHC) Program. The EHC Program aims to provide understandable and actionable information for patients, clinicians, and policy makers. The Evidence-based Practice Centers are one of the cornerstones of the EHC Program. Three key elements guide the EHC Program and thus, the conduct of Comparative Effectiveness Reviews by the EPC Program. Comparative Effectiveness Reviews introduce several specific challenges in addition to the familiar issues raised in a systematic review or meta-analysis of a single intervention. The articles in this series together form the current Methods Guide for Comparative Effectiveness Reviews of the EHC Program. Published by Elsevier Inc. C1 [Slutsky, Jean; Chang, Stephanie; Sharp, Beth A. Collins] AHRQ, Ctr Outcomes & Evidence, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [Atkins, David] Vet Hlth Adm, Off Res & Dev, Hlth Serv Res & Dev, Washington, DC USA. RP Chang, S (reprint author), AHRQ, Ctr Outcomes & Evidence, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM stephanie.chang@ahrq.gov NR 4 TC 32 Z9 32 U1 0 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 MAY PY 2010 VL 63 IS 5 BP 481 EP 483 DI 10.1016/j.jclinepi.2008.06.009 PG 3 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 581OY UT WOS:000276534800005 PM 18834715 ER PT J AU Whitlock, EP Lopez, SA Chang, S Helfand, M Eder, M Floyd, N AF Whitlock, Evelyn P. Lopez, Sarah A. Chang, Stephanie Helfand, Mark Eder, Michelle Floyd, Nicole TI AHRQ Series Paper 3: Identifying, selecting, and refining topics for comparative effectiveness systematic reviews: AHRQ and the Effective Health-Care program SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Article DE Comparative effectiveness; Evidence-based practice; Systematic review; Priority setting; Methods; Decision making ID CLINICAL-PRACTICE GUIDELINES; SETTING PRIORITIES; CHALLENGES AB Objective: This article discusses the identification, selection, and refinement of topics for comparative effectiveness systematic reviews within the Agency for Healthcare Research and Quality's Effective Health Care (EHC) program. Study Design and Setting: The EHC program seeks to align its research topic selection with the overall goals of the program, impartially and consistently apply predefined criteria to potential topics, involve stakeholders to identify high-priority topics, be transparent and accountable, and continually evaluate and improve processes. Results: A topic prioritization group representing stakeholder and scientific perspectives evaluates topic nominations that fit within the EHC program (are "appropriate") to determine how "important" topics are as considered against seven criteria. The group then judges whether a new comparative effectiveness systematic review would be a duplication of existing research syntheses, and if not duplicative, if there is adequate type and volume of research to conduct a new systematic review. Finally, the group considers the "potential value and impact" of a comparative effectiveness systematic review. Conclusion: As the EHC program develops, ongoing challenges include ensuring the program addresses truly unmet needs for synthesized research because national and international efforts in this arena are uncoordinated, as well as engaging a range of stakeholders in program decisions while also achieving efficiency and timeliness. (C) 2010 Elsevier Inc. All rights reserved. C1 [Whitlock, Evelyn P.; Helfand, Mark; Eder, Michelle; Floyd, Nicole] Oregon Evidence Based Practice Ctr, Portland, OR 97227 USA. [Whitlock, Evelyn P.; Eder, Michelle] Kaiser Permanente Ctr Hlth Res, Portland, OR 97227 USA. [Lopez, Sarah A.; Floyd, Nicole] Oregon Hlth & Sci Univ, Portland, OR 97239 USA. [Chang, Stephanie] Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [Helfand, Mark] Portland VA Med Ctr, Portland, OR 97239 USA. RP Whitlock, EP (reprint author), Oregon Evidence Based Practice Ctr, Portland, OR 97227 USA. EM evelyn.whitlock@kpchr.org NR 23 TC 45 Z9 46 U1 2 U2 5 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 MAY PY 2010 VL 63 IS 5 BP 491 EP 501 DI 10.1016/j.jclinepi.2009.03.008 PG 11 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 581OY UT WOS:000276534800007 PM 19540721 ER PT J AU Owens, DK Lohr, KN Atkins, D Treadwell, JR Reston, JT Bass, EB Chang, S Helfand, M AF Owens, Douglas K. Lohr, Kathleen N. Atkins, David Treadwell, Jonathan R. Reston, James T. Bass, Eric B. Chang, Stephanie Helfand, Mark TI AHRQ Series Paper 5: Grading the strength of a body of evidence when comparing medical interventions-Agency for Healthcare Research and Quality and the Effective Health-Care Program SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Article DE Comparative effectiveness; Evidence-based medicine; Methods; Strength of evidence; Systematic reviews ID RECOMMENDATIONS AB Objective: To establish guidance on grading strength of evidence for the Evidence-based Practice Center (EPC) program of the U.S. Agency for Healthcare Research and Quality. Study Design and Setting: Authors reviewed authoritative systems for grading strength of evidence, identified domains and methods that should be considered when grading bodies of evidence in systematic reviews, considered public comments on an earlier draft, and discussed the approach with representatives of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. Results: The EPC approach is conceptually similar to the GRADE system of evidence rating; it requires assessment of four domains: risk of bias, consistency, directness, and precision. Additional domains to be used when appropriate include dose response association, presence of confounders that would diminish an observed effect, strength of association, and publication bias. Strength of evidence receives a single grade: high, moderate, low, or insufficient. We give definitions, examples, mechanisms for scoring domains, and an approach for assigning strength of evidence. Conclusion: EPCs should grade strength of evidence separately for each major outcome and, for comparative effectiveness reviews, all major comparisons. We will collaborate with the GRADE group to address ongoing challenges in assessing the strength of evidence. (C) 2010 Elsevier Inc. All rights reserved. C1 [Owens, Douglas K.] Stanford Univ, Ctr Primary Care & Outcomes Res, Stanford UCSF Evidence Based Practice Ctr, Stanford, CA 94305 USA. [Owens, Douglas K.] VA Palo Alto Healthcare Syst, Palo Alto, CA 94304 USA. [Owens, Douglas K.] Stanford Univ, Ctr Primary Care & Outcomes Res, Palo Alto, CA 94304 USA. [Lohr, Kathleen N.] RTI Int, Res Triangle Pk, NC 27709 USA. [Atkins, David] Dept Vet Affairs, Hlth Serv Res & Dev Serv, Qual Enhancement Res Initiat, Washington, DC 20420 USA. [Treadwell, Jonathan R.; Reston, James T.] ECRI Inst, Evidence Based Practice Ctr, Plymouth Meeting, PA 19462 USA. [Bass, Eric B.] Johns Hopkins Univ, Evidence Based Practice Ctr, Baltimore, MD 21287 USA. [Chang, Stephanie] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. [Helfand, Mark] Oregon Hlth & Sci Univ, Evidence Based Practice Ctr, Portland, OR 97207 USA. [Helfand, Mark] Portland VA Med Ctr, Portland, OR 97207 USA. RP Owens, DK (reprint author), Stanford Univ, Ctr Primary Care & Outcomes Res, Stanford UCSF Evidence Based Practice Ctr, 117 Encina Commons, Stanford, CA 94305 USA. EM owens@stanford.edu FU AHRQ FX This research was funded through contracts from the AHRQ to the following EPCs: ECRI Institute (290-02-0019); Johns Hopkins University (290-02-0018), Oregon Health & Science University (290-02-0009); RTI International (290-02-0016); and Stanford University (290-02-0017). The opinions expressed here are those of the authors and do not necessarily represent the views of the AHRQ, the Department of Health and Human Services, or the Department of Veterans Affairs. The authors thank Valerie King, MD, MPH, of the John M. Eisenberg Center at Oregon Health & Science University for her insightful comments on an earlier draft; and Loraine Monroe, of RTI International, for superior assistance with manuscript preparation. We thank Gordon Guyatt, Holger Schunemann, and the members of the GRADE working group for their work on rating quality of evidence, for very helpful discussions about our approach, and for comments on the manuscript. NR 15 TC 232 Z9 235 U1 0 U2 10 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 MAY PY 2010 VL 63 IS 5 BP 513 EP 523 DI 10.1016/j.jclinepi.2009.03.009 PG 11 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 581OY UT WOS:000276534800009 PM 19595577 ER PT J AU Basu, J Thumula, V Mobley, LR AF Basu, J. Thumula, V Mobley, L. R. TI TRENDS IN PREVENTABLE HOSPITALIZATION PATTERNS IN THE US: EXAMINING SMALL AREA VARIATION IN PRIMARY CARE PERFORMANCE IN THE LAST DECADE SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Basu, J.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Thumula, V] Univ Mississippi, Oxford, MS USA. [Mobley, L. R.] RTI Int, Res Triangle Pk, NC USA. NR 0 TC 0 Z9 0 U1 1 U2 5 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2010 VL 13 IS 3 BP A99 EP A99 DI 10.1016/S1098-3015(10)72476-1 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 589CJ UT WOS:000277121900493 ER PT J AU Stranges, E Russo, A Friedman, B AF Stranges, E. Russo, A. Friedman, B. TI PROCEDURES WITH THE MOST RAPIDLY INCREASING HOSPITAL COSTS, 2004-2007 SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Stranges, E.; Russo, A.] Thomson Reuters, Cambridge, MA USA. [Friedman, B.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 2 U2 2 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2010 VL 13 IS 3 BP A89 EP A89 DI 10.1016/S1098-3015(10)72424-4 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 589CJ UT WOS:000277121900441 ER PT J AU Wong, H Levit, K Sun, YC AF Wong, H. Levit, K. Sun, Y. C. TI NEW FINDINGS FROM INTEGRATING ADMINISTRATIVE AND FINANCIAL DATABASES TO ESTIMATE PRICE OF HOSPITALIZATIONS SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Wong, H.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Levit, K.] Thomson Reuters, Washington, DC USA. [Sun, Y. C.] Thomson Reuters, Santa Barbara, CA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2010 VL 13 IS 3 BP A10 EP A10 DI 10.1016/S1098-3015(10)72028-3 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 589CJ UT WOS:000277121900045 ER PT J AU Brousseau, DC Owens, PL Mosso, AL Panepinto, JA Steiner, CA AF Brousseau, David C. Owens, Pamela L. Mosso, Andrew L. Panepinto, Julie A. Steiner, Claudia A. TI Acute Care Utilization and Rehospitalizations for Sickle Cell Disease SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID RISK-FACTORS; HOSPITAL READMISSION; VASOOCCLUSIVE CRISES; HEART-FAILURE; CHILDREN; QUALITY; LENGTH; STATE AB Context Published rates of health care utilization and rehospitalization by people with sickle cell disease have had limited generalizability and are not population based. Objective To provide benchmark data for rates of acute care utilization and rehospitalizations for patients with sickle cell disease. Design Retrospective cohort of sickle cell disease-related emergency department (ED) visits and hospitalizations from select states in the 2005 and 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and State Emergency Department Databases. Setting Eight geographically dispersed states (Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina, and Tennessee) that provide encrypted identifiers and have sufficient numbers of patients with sickle cell disease; together these states have 33% of the US population with sickle cell disease. Patients A total of 21 112 patients with sickle cell-related treat-and-release ED visits or inpatient hospitalizations. Main Outcome Measures Rates of acute care utilization and rehospitalizations. Population-based utilization rates were also calculated. Results The 21 112 people with sickle cell disease had 109 344 encounters, a mean of 2.59 (95% confidence interval [CI], 2.53-2.65) encounters per patient per year, 1.52 (95% CI, 1.48-1.55) encounters for hospitalizations and 1.08 (95% CI, 1.04-1.11) for treat-and-release ED visits. Utilization was highest for 18- to 30-year-olds, 3.61 (95% CI, 3.47-3.75) encounters per patient per year, and those with public insurance, 3.22 (95% CI, 3.13-3.31) encounters per patient per year. Publicly insured 18- to 30-year-olds had 4.80 (95% CI, 4.58-5.02) encounters per patient per year. Approximately 29% of the population had no encounters while 16.9% had 3 or more encounters per year. The 30-day and 14-day rehospitalization rates were 33.4% (95% CI, 33.0%-33.8%) and 22.1% (95% CI, 21.8%-22.4%), respectively. The rehospitalization rate was highest for 18- to 30-year-olds, with 41.1% (95% CI, 40.5%-41.7%) rehospitalized within 30 days and 28.4% (95% CI, 27.8%-29.0%) within 14 days. Rehospitalizations were also highest for publicly insured patients. Conclusion Among patients with sickle cell disease, acute care encounters and rehospitalizations were frequent, particularly for 18- to 30-year-olds. JAMA. 2010; 303(13): 1288-1294 C1 [Brousseau, David C.] Med Coll Wisconsin, Dept Pediat, Sect Emergency Med, Milwaukee, WI 53226 USA. [Panepinto, Julie A.] Med Coll Wisconsin, Sect Hematol Oncol Bone Marrow Transplant, Milwaukee, WI 53226 USA. [Owens, Pamela L.; Steiner, Claudia A.] Agcy Healthcare Res & Qual, Healthcare Cost & Utilizat Project, Rockville, MD USA. [Owens, Pamela L.; Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Owens, Pamela L.] Washington Univ, Sch Med, Dept Internal Med, Div Infect Dis, St Louis, MO 63110 USA. [Mosso, Andrew L.] Social & Sci Syst Inc, Silver Spring, MD USA. [Brousseau, David C.; Panepinto, Julie A.] Childrens Res Inst, Milwaukee, WI USA. RP Brousseau, DC (reprint author), Med Coll Wisconsin, Dept Pediat, Sect Emergency Med, 999 N 92nd St,CCC 550, Milwaukee, WI 53226 USA. EM dbrousse@mcw.edu FU Agency for Healthcare Research and Quality FX Work on this study was funded in part by a Career Development Award (D.C.B.) from the Agency for Healthcare Research and Quality. NR 29 TC 151 Z9 152 U1 0 U2 9 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD APR 7 PY 2010 VL 303 IS 13 BP 1288 EP 1294 DI 10.1001/jama.2010.378 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 579FM UT WOS:000276353700029 PM 20371788 ER PT J AU Parekh, AK Barton, MB AF Parekh, Anand K. Barton, Mary B. TI The Challenge of Multiple Comorbidity for the US Health Care System SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID PREVALENCE; QUALITY C1 [Parekh, Anand K.] US Dept HHS, Off Assistant Secretary Hlth, Washington, DC 20201 USA. [Barton, Mary B.] US Dept HHS, Agcy Healthcare Res & Qual, Washington, DC 20201 USA. RP Parekh, AK (reprint author), US Dept HHS, Off Assistant Secretary Hlth, 200 Independence Ave SW, Washington, DC 20201 USA. EM anand.parekh@hhs.gov NR 10 TC 93 Z9 93 U1 0 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD APR 7 PY 2010 VL 303 IS 13 BP 1303 EP 1304 DI 10.1001/jama.2010.381 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 579FM UT WOS:000276353700031 PM 20371790 ER PT J AU White, CM Talati, R Phung, OJ Baker, WL Reinhart, K Sedrakyan, A Kluger, J Coleman, CI AF White, C. Michael Talati, Ripple Phung, Olivia J. Baker, William L. Reinhart, Kurt Sedrakyan, Art Kluger, Jeffrey Coleman, Craig I. TI Benefits and risks associated with beta-blocker prophylaxis in noncardiac surgery SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article DE Bradycardia; Hypotension; Mortality; Myocardial infarction; Myocardial ischemia; Protocols; Stroke; Surgery; Sympatholytic agents; Toxicity ID RANDOMIZED CONTROLLED-TRIAL; SPINAL-ANESTHESIA; VASCULAR-SURGERY; POSTOPERATIVE MORTALITY; SUBSTRATE METOPROLOL; HEART-FAILURE; MORBIDITY; MULTICENTER; CARVEDILOL; BISOPROLOL AB Purpose. The benefits and risks associated with use of beta-blocker prophylaxis in non-cardiac surgery (NCS) are described. Summary. Perioperative beta-blockade is recommended by the American College of Cardiology and the American Heart Association for use in patients already on beta-blockers or in high-risk patients undergoing NCS to reduce myocardial ischemia and myocardial infarction (MI); however, the recommendations are not as clear for patients undergoing intermediate- or low-risk NCS. Numerous trials have evaluated the effect of perioperative beta-blockers on MI, stroke, bradycardia, hypotension, overall mortality, and cardiovascular mortality in patients undergoing NCS. Several trials suggest that dosing, patient population, type of NCS, genetic polymorphisms, and type of anesthesia may be important in determining the benefits and risks of perioperative beta-blockade in these patients. In the meta-analyses evaluating beta-blockers in NCS, the balance of benefits to harms associated with aggressive perioperative beta-blocker therapy was not favorable. However, the largest, most recent trial drove the meta-analyses results and has some methodological caveats and limitations that must be considered. Recent meta-analyses have found that the use of beta-blockers reduces the rate of MI but increases the frequency of stroke, and these MIs and strokes can occur with differing severities. Conclusion. Perioperative use of beta-blockers in NCS can protect against postoperative MI but increases the risk of stroke, severe hypotension, and severe bradycardia. Although less common, the strokes are severe, and the troubling trend toward increasing cardiovascular and total mortality precludes the recommendation for their use in patients not previously treated with beta-blockers. C1 [White, C. Michael; Baker, William L.; Coleman, Craig I.] Univ Connecticut, Hartford Hosp, Evidence Based Practice Ctr, Hartford, CT 06102 USA. [Sedrakyan, Art] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Kluger, Jeffrey] Univ Connecticut, Hartford Hosp, Heart Rhythm Serv, Hartford, CT 06102 USA. RP Coleman, CI (reprint author), Univ Connecticut, Hartford Hosp, Evidence Based Practice Ctr, 80 Seymour St, Hartford, CT 06102 USA. EM ccolema@harthosp.org RI Baker, William/H-7977-2016 OI Baker, William/0000-0003-2172-0931 NR 24 TC 6 Z9 6 U1 0 U2 1 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 APR 1 PY 2010 VL 67 IS 7 BP 523 EP 530 DI 10.2146/ajhp090088 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 573AP UT WOS:000275881100009 PM 20237379 ER PT J AU Fleishman, JA Cohen, JW AF Fleishman, John A. Cohen, Joel W. TI Using Information on Clinical Conditions to Predict High-Cost Patients SO HEALTH SERVICES RESEARCH LA English DT Article DE Health care expenditures; prediction models; DCG models; chronic conditions ID CHARLSON COMORBIDITY INDEX; ADMINISTRATIVE CLAIMS DATA; FORM HEALTH SURVEY; RISK-ADJUSTMENT; EXPENDITURE PREDICTION; CHRONIC DISEASE; CARE COSTS; MODEL; PERFORMANCE; MORTALITY AB Objective To compare the ability of different models to predict prospectively whether someone will incur high medical expenditures. Data Source Using nationally representative data from the Medical Expenditure Panel Survey (MEPS), prediction models were developed using cohorts initiated in 1996-1999 (N=52,918), and validated using cohorts initiated in 2000-2003 (N=61,155). Study Design We estimated logistic regression models to predict being in the upper expenditure decile in Year 2 of a cohort, based on data from Year 1. We compared a summary risk score based on diagnostic cost group (DCG) prospective risk scores to a count of chronic conditions and indicators for 10 specific high-prevalence chronic conditions. We examined whether self-rated health and functional limitations enhanced prediction, controlling for clinical conditions. Models were evaluated using the Bayesian information criterion and the c-statistic. Principal Findings Medical condition information substantially improved prediction of high expenditures beyond gender and age, with the DCG risk score providing the greatest improvement in prediction. The count of chronic conditions, self-reported health status, and functional limitations were significantly associated with future high expenditures, controlling for DCG score. A model including these variables had good discrimination (c=0.836). Conclusions The number of chronic conditions merits consideration in future efforts to develop expenditure prediction models. While significant, self-rated health and indicators of functioning improved prediction only slightly. C1 [Fleishman, John A.; Cohen, Joel W.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM john.fleishman@ahrq.hhs.gov FU Agency for Healthcare Research and Quality, Rockville, MD FX Joint Acknowledgment/Disclosure Statement: The authors are Federal Government employees and received no external financial support for this project. They have no conflicts of interest to report. The authors thank Arlene Ash for her detailed and thoughtful comments on a previous version of this manuscript. This study was supported by the Agency for Healthcare Research and Quality, Rockville, MD. The views expressed in this article are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services is intended or should be inferred. NR 41 TC 34 Z9 34 U1 3 U2 8 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2010 VL 45 IS 2 BP 532 EP 552 DI 10.1111/j.1475-6773.2009.01080.x PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 565YT UT WOS:000275335900011 PM 20132341 ER PT J AU Kreuter, F Olson, K Wagner, J Yan, T Ezzati-Rice, TM Casas-Cordero, C Lemay, M Peytchev, A Groves, RM Raghunathan, TE AF Kreuter, F. Olson, K. Wagner, J. Yan, T. Ezzati-Rice, T. M. Casas-Cordero, C. Lemay, M. Peytchev, A. Groves, R. M. Raghunathan, T. E. TI Using proxy measures and other correlates of survey outcomes to adjust for non-response: examples from multiple surveys SO JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES A-STATISTICS IN SOCIETY LA English DT Article DE Interviewer observations; Non-response adjustment; Non-response bias; Paradata; Response propensity weights ID TELEPHONE SURVEY; RATES; PARTICIPATION; PRIVACY; BIAS AB Non-response weighting is a commonly used method to adjust for bias due to unit non-response in surveys. Theory and simulations show that, to reduce bias effectively without increasing variance, a covariate that is used for non-response weighting adjustment needs to be highly associated with both the response indicator and the survey outcome variable. In practice, these requirements pose a challenge that is often overlooked, because those covariates are often not observed or may not exist. Surveys have recently begun to collect supplementary data, such as interviewer observations and other proxy measures of key survey outcome variables. To the extent that these auxiliary variables are highly correlated with the actual outcomes, these variables are promising candidates for non-response adjustment. In the present study, we examine traditional covariates and new auxiliary variables for the National Survey of Family Growth, the Medical Expenditure Panel Survey, the American National Election Survey, the European Social Surveys and the University of Michigan Transportation Research Institute survey. We provide empirical estimates of the association between proxy measures and response to the survey request as well as the actual survey outcome variables. We also compare unweighted and weighted estimates under various non-response models. Our results from multiple surveys with multiple recruitment protocols from multiple organizations on multiple topics show the difficulty of finding suitable covariates for non-response adjustment and the need to improve the quality of auxiliary data. C1 [Kreuter, F.] Univ Maryland, Joint Program Survey Methodol, College Pk, MD 20742 USA. [Olson, K.] Univ Nebraska, Lincoln, NE USA. [Wagner, J.; Groves, R. M.; Raghunathan, T. E.] Univ Michigan, Ann Arbor, MI 48109 USA. [Yan, T.] Univ Chicago, Natl Opin Res Ctr, Chicago, IL 60637 USA. [Ezzati-Rice, T. M.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Peytchev, A.] RTI Int, Res Triangle Pk, NC USA. RP Kreuter, F (reprint author), Univ Maryland, Joint Program Survey Methodol, 1218 LeFrak Hall, College Pk, MD 20742 USA. EM fkreuter@survey.umd.edu OI Wagner, James/0000-0002-8823-3110 FU Robert Groves and Trivellore Raghunathan; Michigan Program in Survey Methodology FX The paper resulted from a research seminar run by Robert Groves and Trivellore Raghunathan at the Joint Program in Survey Methodology and the Michigan Program in Survey Methodology. We thank Katharine Abraham, Jill Dever, Stephanie Eckman, Jenna Fulton, Susan McCulloch, Elizabeth Stuart, Richard Valliant, the Joint Editor and three reviewers for comments and helpful suggestions, and we thank Lap-Ming Wun of the Agency for Healthcare Research and Quality for computer programming assistance. The views that are expressed in this paper are those of the authors and carry no official endorsement by the Department of Health and Human Services or the Agency for Healthcare Research and Quality. NR 37 TC 41 Z9 41 U1 2 U2 11 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0964-1998 J9 J R STAT SOC A STAT JI J. R. Stat. Soc. Ser. A-Stat. Soc. PD APR PY 2010 VL 173 BP 389 EP 407 PN 2 PG 19 WC Social Sciences, Mathematical Methods; Statistics & Probability SC Mathematical Methods In Social Sciences; Mathematics GA 563DU UT WOS:000275108800007 ER PT J AU Zuvekas, SH Selden, TM AF Zuvekas, Samuel H. Selden, Thomas M. TI Mental Health and Family Out-of-Pocket Expenditure Burdens SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE medical utilization; mental health; expenditures; burdens ID METHODOLOGICAL BIASES; PSYCHIATRIC-DISORDERS; PRESCRIPTION DRUGS; CARE EXPENDITURES; UNITED-STATES; COVERAGE; EXPENSES; ADULTS; IMPACT AB A growing literature finds that a significant fraction of American families experience high or "catastrophic" burdens of medical spending. Families facing mental health problems may be especially vulnerable to high burdens. This study uses data from the Medical Expenditure Panel Survey to determine the annual and within-year concentration of medical spending and the extent to which mental health treatment contributes to high out-of-pocket burdens among families with and without mental health problems. On average, families incurred 44% of non-mental health and 37% of out-of-pocket mental health treatment expenditures in a single month. Families with one or more members experiencing mental health problems were more likely to have periods of high out-of-pocket spending burdens. However, this study found that mental health treatment itself contributes little to high out-of-pocket spending burdens. Most of the burden was due to other medical conditions and lower average incomes among families with mental health problems. C1 [Zuvekas, Samuel H.] 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 samuel.zuvekas@ahrq.hhs.gov NR 33 TC 6 Z9 6 U1 1 U2 4 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 APR PY 2010 VL 67 IS 2 BP 194 EP 212 DI 10.1177/1077558709345499 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 563ZJ UT WOS:000275179600004 PM 19773590 ER PT J AU Conway, PH Clancy, C AF Conway, Patrick H. Clancy, Carolyn TI Charting a Path From Comparative Effectiveness Funding to Improved Patient-Centered Health Care SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Conway, Patrick H.; Clancy, Carolyn] Dept Hlth & Human Serv, Washington, DC USA. [Clancy, Carolyn] Agcy Healthcare Res & Qual, Rockville, MD USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA. RP Conway, PH (reprint author), 200 Independence Ave,Room 415-F, Washington, DC 20201 USA. EM patrick.conway@hhs.gov NR 7 TC 28 Z9 29 U1 0 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAR 10 PY 2010 VL 303 IS 10 BP 985 EP 986 DI 10.1001/jama.2010.259 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 565UC UT WOS:000275319300029 PM 20215615 ER PT J AU Slutsky, JR Clancy, CM AF Slutsky, Jean R. Clancy, Carolyn M. TI Patient-Centered Comparative Effectiveness Research Essential for High-Quality Care SO ARCHIVES OF INTERNAL MEDICINE LA English DT Editorial Material C1 [Slutsky, Jean R.; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd,John M Eisenberg Bldg, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 4 TC 12 Z9 12 U1 0 U2 1 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 MAR 8 PY 2010 VL 170 IS 5 BP 403 EP 404 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 565PU UT WOS:000275307300001 PM 20212173 ER PT J AU Berdahl, T Owens, PL Dougherty, D McCormick, MC Pylypchuk, Y Simpson, LA AF Berdahl, Terceira Owens, Pamela L. Dougherty, Denise McCormick, Marie C. Pylypchuk, Yuriy Simpson, Lisa A. TI Annual Report on Health Care for Children and Youth in the United States: Racial/Ethnic and Socioeconomic Disparities in Children's Health Care Quality SO ACADEMIC PEDIATRICS LA English DT Article DE children; community; disparities; health insurance; income; poverty; race/ethnicity; socioeconomic status ID ETHNIC DISPARITIES; PATIENT SAFETY; DENTAL-HEALTH; US CHILDREN; ACCESS; EXPENDITURES; SERVICES; AGENCY; INTERVENTION; INDICATORS AB Objective.-The aim of this study was to explore the joint effect of race/ethnicity and insurance status/expected payer or income on children's health care quality. Methods.-The analyses are based on data from a nationally representative random sample of children in the United States in 2004 and 2005 from the Medical Expenditure Panel Survey (MEPS) and pediatric hospitalizations from a nationwide sample of hospitals in 2005 from the State Inpatient Databases disparities analysis file from the Healthcare Cost and Utilization Project (HCUP). We provide estimates of differences in race/ethnicity within income and insurance/expected payer categories on key pediatric quality indicators to provide a more nuanced understanding of disparities in care for children. Our indicators of quality cover several domains from the Institute of Medicine report, including effectiveness, patient centeredness, timeliness, and patient safety. Results.-Across a broad set of 23 quality indicators, findings indicate that racial/ethnic disparities vary by income levels and types of insurance. Key highlights include the finding that racial/ethnic differences within income or insurance/payer groups are more pronounced for some racial/ethnic groups than others. Hispanic children followed by Asian children had worse quality than whites as measured by the majority of quality indicators. Exceptions included rates of admissions for diabetes, admissions for gastroenteritis, accidental puncture during procedures, and decubitus ulcers. Many indicators showed less than ideal quality for all subgroups of children, even whites with private insurance. Conclusions.-The extensive findings in this report make clear that patterns of racial/ethnic disparity vary by income and insurance/expected payer subgroup. However, disparities in quality are not similar across all measures of quality, and strategies to address these disparities need to be designed with these nuances in mind. C1 [Berdahl, Terceira; Owens, Pamela L.; Dougherty, Denise] Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [McCormick, Marie C.] Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA. [Pylypchuk, Yuriy] Social Sci Syst, Rockville, MD USA. [Simpson, Lisa A.] Cincinnati Childrens Hosp Med Ctr, Child Policy Res Ctr, Cincinnati, OH USA. RP Berdahl, T (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM terceira.berdahl@ahrq.hhs.gov OI McCormmick, Marie/0000-0002-3938-1707 NR 65 TC 29 Z9 29 U1 1 U2 16 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 J9 ACAD PEDIATR JI Acad. Pediatr. PD MAR-APR PY 2010 VL 10 IS 2 BP 95 EP 118 PG 24 WC Pediatrics SC Pediatrics GA 616DI UT WOS:000279188300006 PM 20206909 ER PT J AU Horwitz, SM Chamberlain, P Landsverk, J Mullican, C AF Horwitz, Sarah McCue Chamberlain, Patricia Landsverk, John Mullican, Charlotte TI Improving the Mental Health of Children in Child Welfare Through the Implementation of Evidence-Based Parenting Interventions SO ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH LA English DT Article; Proceedings Paper CT Conference on Child Adolescent Mental Health Services CY SEP 23-24, 2009 CL Vanderbilt Univ, Nashville, TN HO Vanderbilt Univ DE Child welfare; Implementation; Effective interventions ID BEHAVIORAL FAMILY INTERVENTION; RANDOMIZED CONTROLLED-TRIAL; ONSET CONDUCT PROBLEMS; 2-YEAR FOLLOW-UP; FOSTER-CARE; INTERACTION THERAPY; ORGANIZATIONAL INNOVATION; DISRUPTIVE BEHAVIOR; SERVICE SYSTEMS; SOCIAL-WORK AB Any comprehensive approach to children's mental health should consider services systems such as Child Welfare that provide services to children with high rates of emotional and behavioral disorders. This paper will review what is known about efficacious parent-focused interventions that can improve the lives of children in Child Welfare and explore possible reasons why such interventions are rarely used by Child Welfare agencies. Data from a pilot study suggest key features for increasing the implementation of efficacious practices to improve children's mental health. C1 [Horwitz, Sarah McCue] Stanford Univ, Dept Pediat, Stanford, CA 94305 USA. [Horwitz, Sarah McCue] Stanford Univ, Ctr Primary Care & Outcomes Res, Stanford, CA 94305 USA. [Horwitz, Sarah McCue] Stanford Univ, Ctr Hlth Policy, Stanford, CA 94305 USA. [Chamberlain, Patricia] Ctr Res Practice, Eugene, OR USA. [Chamberlain, Patricia] Oregon Social Learning Ctr, Eugene, OR 97401 USA. [Landsverk, John] Rady Childrens Hosp, Child & Adolescent Serv Res Ctr, San Diego, CA USA. [Landsverk, John] Univ So Calif, Sch Social Work, Los Angeles, CA 90089 USA. [Landsverk, John] Washington Univ, George Warren Brown Sch Social Work, St Louis, MO 63130 USA. [Mullican, Charlotte] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Dept Hlth & Human Serv, Rockville, MD USA. RP Horwitz, SM (reprint author), Stanford Univ, Dept Pediat, 117 Encina Commons, Stanford, CA 94305 USA. EM sarah.horwitz@stanford.edu FU NIMH NIH HHS [P30-MH74678-01A2] NR 94 TC 41 Z9 41 U1 3 U2 23 PU MAIK NAUKA/INTERPERIODICA/SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013-1578 USA SN 0894-587X J9 ADM POLICY MENT HLTH JI Adm. Policy. Ment. Health PD MAR PY 2010 VL 37 IS 1-2 SI SI BP 27 EP 39 DI 10.1007/s10488-010-0274-3 PG 13 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 602AJ UT WOS:000278110200004 PM 20143150 ER PT J AU Seidman, E Chorpita, BF Reay, WE Stelk, W Garland, AF Kutash, K Mullican, C Ringeisen, H AF Seidman, Edward Chorpita, Bruce F. Reay, William E. Stelk, Wayne Garland, Ann F. Kutash, Krista Mullican, Charlotte Ringeisen, Heather TI A Framework for Measurement Feedback to Improve Decision-Making in Mental Health SO ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH LA English DT Article; Proceedings Paper CT Conference on Child Adolescent Mental Health Services CY SEP 23-24, 2009 CL Vanderbilt Univ, Nashville, TN HO Vanderbilt Univ ID ADOLESCENTS; OUTCOMES; CHILDREN; MODEL; CARE AB The authors present a multi-level framework for conceptualizing and designing measurement systems to improve decision-making in the treatment and prevention of child and adolescent mental health problems as well as the promotion of well-being. Also included is a description of the recommended drivers of the development and refinement of these measurement systems and the importance of the architecture upon which these measurement systems are built. The authors conclude with a set of recommendations for the next steps for the field. It has been documented across a wide array of domains that knowledge of results is a critical ingredient in facilitating change (e.g., Kluger and Denisi 1996). However, for knowledge of results to be fed back to change agents (i.e., practitioners and policymakers), a rigorous, reliable, and valid measurement system must be in place and routinely utilized. Recently, Bickman (2008) made a compelling argument for a measurement feedback system (MFS) for individual child and adolescent mental health practitioners and underscored the barriers to large-scale adoption. In this paper, we build on Bickman's work by describing a framework for the different levels for which measurement systems are needed, the features or characteristics that should drive the development or refinement of such systems, and the importance of the architecture upon which these measurement systems are built. Throughout, we make recommendations for the next steps that will be needed before we are able to make significant progress in the accomplishment of these goals. C1 [Seidman, Edward] William T Grant Fdn, New York, NY 10022 USA. [Seidman, Edward] NYU, New York, NY 10022 USA. [Chorpita, Bruce F.] Univ Calif Los Angeles, Los Angeles, CA USA. [Reay, William E.] OMNI Behav Hlth, Omaha, NE USA. [Reay, William E.] Northcent Univ, Omaha, NE USA. [Stelk, Wayne] Massachusetts Behav Hlth Partnership ValueOpt, Botson, MA USA. [Garland, Ann F.] Univ Calif San Diego, San Diego, CA 92103 USA. [Kutash, Krista] Univ S Florida, Res & Training Ctr Childrens Mental Hlth, Tampa, FL USA. [Mullican, Charlotte] AHRQ, Ctr Primary Care Prevent & Clin Partnerships, Washington, DC USA. [Ringeisen, Heather] RTI Int, Res Triangle Pk, NC USA. RP Seidman, E (reprint author), William T Grant Fdn, 570 Lexington Ave,18th Floor, New York, NY 10022 USA. EM eseidman@wtgrantfdn.org RI Chorpita, Bruce/J-8203-2012 NR 11 TC 10 Z9 10 U1 0 U2 6 PU MAIK NAUKA/INTERPERIODICA/SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013-1578 USA SN 0894-587X J9 ADM POLICY MENT HLTH JI Adm. Policy. Ment. Health PD MAR PY 2010 VL 37 IS 1-2 SI SI BP 128 EP 131 DI 10.1007/s10488-009-0260-9 PG 4 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 602AJ UT WOS:000278110200016 PM 20041342 ER PT J AU Horn, SD Sharkey, SS Hudak, S Gassaway, J James, R Spector, W AF Horn, Susan D. Sharkey, Siobhan S. Hudak, Sandra Gassaway, Julie James, Roberta Spector, William TI Pressure Ulcer Prevention in Long-Term-Care Facilities: A Pilot Study Implementing Standardized Nurse Aide Documentation and Feedback Reports SO ADVANCES IN SKIN & WOUND CARE LA English DT Article ID HOME CARE; QUALITY AB OBJECTIVE: To design and facilitate implementation of practice-based evidence changes associated with decreases in pressure ulcer (PrU) development in long-term-care (LTC) facilities and promote these practices as part of routine care. DESIGN: Pre/post observational study. SETTINGS AND PARTICIPANTS: Frail older adult residents in 11 US LTC facilities. INTERVENTION: Project facilitators assisted frontline multidisciplinary teams (certified nurse aides [CNAs], nurses, and dietitians/dietary aides) to develop streamlined standardized CNA documentation and weekly reports to identify high-risk residents and to integrate clinical reports into day-to-day practice and clinical decision making. The program was called "Real-Time Optimal Care Plans for Nursing Home QI'' (Real-Time). MAIN OUTCOME MEASURES: Prevalence of PrUs using Centers for Medicare & Medicaid Services (CMS) quality measures (QMs), number of in-house-acquired PrUs, and number and completeness of CNA documentation forms. MAIN RESULTS: Seven study LTC facilities that reported data to CMS experienced a combined 33% (SD, 36.1%) reduction in the CMS high-risk PrU QM in 18 months and reduction in newly occurring PrUs (number of ulcers in the fourth quarter of 2003: range, 2-19; and in the third quarter of 2005: range, 1-6). Five of these LTC facilities that fully implemented Real-Time experienced a combined 48.1% (SD, 23.4%) reduction in the CMS high-risk PrU QM. Ten facilities reduced by an average of 2 to 5 their number of CNA documentation forms; CNA weekly documentation completeness reached a consistent level of 90% to 95%, and 8 facilities integrated the use of 2 to 4 weekly project reports in routine clinical decision making. CONCLUSIONS: Quality improvement efforts that provide access to focused and timely clinical information, facilitate change, and promote staff working together in multidisciplinary teams impacted clinical outcomes. Prevention of PrUs showed a trend of improvement in facilities that fully integrated tools to identify high-risk residents into day-to-day practice. CNA documentation facilitated better information for clinical decision making. More than 70 additional LTC facilities across the United States are implementing this QI program. C1 [Horn, Susan D.; Gassaway, Julie] Int Sever Informat Syst Inc, Inst Clin Outcomes Res, Projects Prod Dev, Salt Lake City, UT USA. [Sharkey, Siobhan S.; Hudak, Sandra] Hlth Management Strategies, Austin, TX USA. [James, Roberta] Int Sever Informat Syst Inc, Inst Clin Outcomes Res, Data Syst, Salt Lake City, UT USA. [Spector, William] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Horn, SD (reprint author), Int Sever Informat Syst Inc, Inst Clin Outcomes Res, Projects Prod Dev, Salt Lake City, UT USA. FU Agency for Healthcare Research and Quality [5 U18 HS013696] FX The "Real-Time Optimal Care Plans for Nursing Home QI'' (Real-Time) project was supported by grant 5 U18 HS013696 from the Agency for Healthcare Research and Quality. NR 17 TC 21 Z9 21 U1 1 U2 7 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1527-7941 J9 ADV SKIN WOUND CARE JI Adv. Skin Wound Care PD MAR PY 2010 VL 23 IS 3 BP 120 EP 131 DI 10.1097/01.ASW.0000363516.47512.67 PG 12 WC Dermatology; Nursing; Surgery SC Dermatology; Nursing; Surgery GA 832YJ UT WOS:000295846500004 PM 20177165 ER PT J AU Calonge, N Green, NS Rinaldo, P Lloyd-Puryear, M Dougherty, D Boyle, C Watson, M Trotter, T Terry, SF Howell, RR AF Calonge, Ned Green, Nancy S. Rinaldo, Piero Lloyd-Puryear, Michele Dougherty, Denise Boyle, Coleen Watson, Michael Trotter, Tracy Terry, Sharon F. Howell, R. Rodney CA Advisory Comm Heritable Disorders TI Committee report: Method for evaluating conditions nominated for population-based screening of newborns and children SO GENETICS IN MEDICINE LA English DT Editorial Material DE newborn screening; evidence review; nomination; rare condition; advisory committee AB The Secretary's Advisory Committee on Heritable Disorders in Newborns and Children is charged with evaluating conditions nominated for addition to the uniform screening panel and consequently making recommendations to the secretary of the US Department of Health and Human Services. This report describes the framework by which the committee approaches its task. Key decision nodes include initial review of every nomination to determine whether conditions are amenable for systematic evidence review, review of systematic evidence reviews conducted by the committee's external review group, and deliberation and formal recommendation for addition or exclusion to the uniform panel. Data analyzed include the accuracy and specificity of screening and diagnostic tests for nominated disorders, the extent of predicted health benefits, harms impact on disease course, and cost from early diagnosis and treatment. The committee process is guided by approaches used by similar entities, but more flexible criteria are sometimes needed to accommodate data limitations stemming from the rarity of many of these conditions. Possible outcomes of committee review range from recommendation to add a nominated condition to the uniform panel; provide feedback on specific gaps in evidence that must be addressed before making a decision; or rejection of a nomination (e. g., because of identified harms). The committee's structured evidence-based assessment of nominated conditions supports a consistently rigorous, iterative and transparent approach to its making recommendations regarding broad population-based screening programs for rare conditions in infants and children. Genet Med 2010:12(3):153-159. C1 [Green, Nancy S.] Columbia Univ, Med Ctr, Dept Pediat, New York, NY 10032 USA. [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Rinaldo, Piero] Mayo Clin, Coll Med, Dept Lab Med & Pathol, Rochester, MN USA. [Lloyd-Puryear, Michele] US Hlth Resources & Serv Adm, US Dept HHS, Rockville, MD 20857 USA. [Dougherty, Denise] Agcy Healthcare Res & Qual, HHS, Rockville, MD USA. [Boyle, Coleen] Ctr Dis Control & Prevent, HHS, Rockville, MD USA. [Watson, Michael] Amer Coll Med Genet, Bethesda, MD USA. [Trotter, Tracy] San Ramon Valley Primary Care Med Grp, San Ramon, CA USA. [Terry, Sharon F.] Genet Alliance, Washington, DC USA. [Howell, R. Rodney] Univ Miami, Miller Sch Med, Dept Pediat, Miami, FL 33136 USA. RP Green, NS (reprint author), Columbia Univ, Med Ctr, Dept Pediat, 630 W 168 St,Black Bldg 2-241, New York, NY 10032 USA. EM nsg11@columbia.edu OI Green, Nancy/0000-0002-9877-1561 NR 11 TC 39 Z9 40 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1098-3600 J9 GENET MED JI Genet. Med. PD MAR PY 2010 VL 12 IS 3 BP 153 EP 159 DI 10.1097/GIM.0b013e3181d2af04 PG 7 WC Genetics & Heredity SC Genetics & Heredity GA 574VU UT WOS:000276023100004 PM 20154628 ER PT J AU Meyerhoefer, CD Zuvekas, SH AF Meyerhoefer, Chad D. Zuvekas, Samuel H. TI NEW ESTIMATES OF THE DEMAND FOR PHYSICAL AND MENTAL HEALTH TREATMENT SO HEALTH ECONOMICS LA English DT Article DE health care demand; mental health; panel data; demand systems ID MEDICAL-CARE; MANAGED CARE; INSURANCE; SERVICES; REFORM; MODEL; DEDUCTIBLES; BENEFITS; PATTERNS; COVERAGE AB Consumers' price responsiveness is central to US health-care reform proposals, but the best available estimates are now more than 25 years old. We estimate health-care demands by calculating expected end-of-year prices and incorporating them into a zero-inflated ordered probit model applied to several overlapping panels of data from 1996 to 2003. Results from our correlated random effects specification indicate that the price responsiveness of ambulatory mental health treatment has decreased substantially and is now slightly lower than physical health treatment. This Suggests that concerns over moral hazard alone do not warrant less generous coverage for mental health. However, prescription drug demand is more price elastic. Published in 2009 by John Wiley & Sons, Ltd. C1 [Meyerhoefer, Chad D.] Lehigh Univ, Dept Econ, Rauch Business Ctr, Bethlehem, PA 18015 USA. [Zuvekas, Samuel H.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Meyerhoefer, CD (reprint author), Lehigh Univ, Dept Econ, Rauch Business Ctr, 621 Taylor St, Bethlehem, PA 18015 USA. EM chad.meyerhoefer@lehigh.edu NR 37 TC 8 Z9 8 U1 0 U2 3 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 MAR PY 2010 VL 19 IS 3 BP 297 EP 315 DI 10.1002/hec.1476 PG 19 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 569KG UT WOS:000275594700005 PM 19350688 ER PT J AU Yehia, BR Fleishman, JA Hicks, PL Ridore, M Moore, RD Gebo, KA AF Yehia, Baligh R. Fleishman, John A. Hicks, Perrin L. Ridore, Michelande Moore, Richard D. Gebo, Kelly A. CA HIV Res Network TI Inpatient Health Services Utilization Among HIV-Infected Adult Patients in Care 2002-2007 SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE HIV; hospitalization; utilization; highly active antiretroviral therapy; length of stay ID ACTIVE ANTIRETROVIRAL THERAPY; RECONSTITUTION INFLAMMATORY SYNDROME; HOSPITALIZATION RATES; PROTEASE INHIBITORS; UNITED-STATES; RISK-FACTORS; ADVANCED AGE; DRUG-USERS; COHORT; IMMUNE AB Objective: This study examines the frequency of inpatient hospitalization, the number of inpatient days, and factors associated with inpatient utilization in a multistate HIV cohort between 2002 and 2007. Design: A prospective cohort study of HIV-infected adults in care at 11 US HIV primary and specialty care sites located in different geographic regions. Methods: Demographic, clinical, and resource utilization data were collected from medical records for the years 2002-2007. Rates of resource use were calculated for number of hospital admissions, total inpatient days, and mean length of stay per admission. Results: Annual inpatient hospitalization rates significantly decreased from 35 to 27 per 100 persons from 2002 to 2007. The number of inpatient days per year significantly decreased over time, whereas mean length of stay per admission was stable. Women, patients 50 years or older, blacks, injection drug users, and patients without private insurance had higher hospitalization rates than their counterparts. Admission rates were lower for patients with high CD4 counts and low HIV-1 RNA levels. Conclusions: Inpatient hospitalization rates and number of inpatient days decreased for HIV patients in this multistate cohort between 2002 and 2007. Sociodemographic disparities in inpatient utilization persist. C1 [Yehia, Baligh R.; Hicks, Perrin L.; Ridore, Michelande; Moore, Richard D.; Gebo, Kelly A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA. [Fleishman, John A.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Yehia, BR (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, 1830 E Monument St,Room 435, Baltimore, MD 21287 USA. EM byehia@jhmi.edu FU Agency for Healthcare Research and Quality [290-01-0012]; National Institutes of Aging [R01 AG026250]; Drug Abuse [K23-DA00523, K24 DA 00432]; Johns Hopkins Clinician Scientist Award FX Supported by the Agency for Healthcare Research and Quality (290-01-0012) and the National Institutes of Aging (R01 AG026250) and Drug Abuse (K23-DA00523 and K24 DA 00432). Dr. Gebo also received support from a Johns Hopkins Clinician Scientist Award. NR 42 TC 26 Z9 26 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 MAR 1 PY 2010 VL 53 IS 3 BP 397 EP 404 DI 10.1097/QAI.0b013e3181bcdc16 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 565VX UT WOS:000275324500015 PM 19841589 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Comparative effectiveness research: Promising area of study for pharmacists SO JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION 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. EM carolyn.clancy@ahrq.hhs.gov NR 6 TC 1 Z9 1 U1 0 U2 1 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 MAR-APR PY 2010 VL 50 IS 2 BP 131 EP 133 DI 10.1331/JAPhA.2010.10501 PG 3 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 585EG UT WOS:000276806600004 PM 20199952 ER PT J AU Kumar, V Encinosa, W AF Kumar, Virender Encinosa, William TI Effects of HIV Medication Complexity and Depression on Adherence to HIV Medication SO PATIENT-PATIENT CENTERED OUTCOMES RESEARCH LA English DT Article ID HUMAN-IMMUNODEFICIENCY-VIRUS; ACTIVE ANTIRETROVIRAL THERAPY; NATIONAL PROBABILITY SAMPLES; LOW-PREVALENCE DISEASES; LESS-THAN 95-PERCENT; REGIMEN COMPLEXITY; INFECTED PATIENTS; IMMUNOLOGICAL RESPONSE; SERVICES UTILIZATION; REPORTED ADHERENCE AB Background: While much is known about the association between drug regimen complexity and drug adherence, little is known about how this association is affected by patient depression. Objective: To examine whether the relationship between medication adherence and highly active antiretroviral therapy (HAART) regimen complexity varied with mental health status. Methods: The analysis included 1192 respondents to HCSUS who were receiving HAART at the second HCSUS follow-up interview (1997-8). Self-reported past-week HAART adherence, current mental health status, and an aggregate measure of regimen complexity were used in the analysis. Regression models with interactions between mental health status and medication complexity were estimated to assess differential associations with adherence. Results: Patients with high depressive/anxiety symptoms had lower odds of adherence to HAART medication (odds ratio [OR] = 0.78; p < 0.05) than those with low depressive symptoms at mean medication complexity. However, this association was found to vary by HAART medication complexity. Under high depressive symptoms, odds of adhering to a low-complexity regimen were 9% lower than odds of adhering to a regimen of mean complexity (OR = 0.91). Under low depressive symptoms, odds of adhering to a low-complexity regimen were 44% higher than for a regimen of mean complexity (OR = 1.44). In contrast, odds of adhering to a highly complex regimen compared with a regimen of mean complexity were 10% higher under high depressive symptoms (OR = 1.10) and 30% lower for low depressive symptoms (OR = 0.70). Thus, high levels of depression have ORs for adherence that increase with HIV drug complexity, while low levels of depression have ORs for adherence that decline with HIV drug complexity (the two trends differ by p = 0.10). In a second measure of mental health, similar results were found between low and high emotional well-being (the two trends differ by p < 0.05). Conclusion: While individuals with poorer mental health generally have poor adherence, these individuals may have been preferentially targeted with adherence support interventions as the medication regimen complexity increased. Physicians should now begin to target adherence interventions to patients with less complex HIV regimens. C1 [Encinosa, William] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Kumar, Virender] WESTAT Corp, Rockville, MD 20850 USA. RP Encinosa, W (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM William.Encinosa@ahrq.hhs.gov NR 42 TC 6 Z9 6 U1 2 U2 2 PU ADIS INT LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 1311, NEW ZEALAND SN 1178-1653 J9 PATIENT JI Patient PD MAR 1 PY 2010 VL 3 IS 1 BP 59 EP 69 DI 10.2165/11531090-000000000-00000 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 797KV UT WOS:000293127500006 PM 22273276 ER PT J AU Fleishman, JA Selim, AJ Kazis, LE AF Fleishman, John A. Selim, Alfredo J. Kazis, Lewis E. TI Deriving SF-12v2 physical and mental health summary scores: a comparison of different scoring algorithms SO QUALITY OF LIFE RESEARCH LA English DT Article DE SF-12v2; Summary scores; PCS; MCS; Factor analysis ID COMMON FACTOR-ANALYSIS; QUALITY-OF-LIFE; COMPONENT ANALYSIS; SF-36; POPULATION; VALIDITY; SCALES; RELIABILITY; VERSION AB Purpose Summary scores for the SF-12, version 2 (SF-12v2) health status measure are based on scoring coefficients derived for version 1 of the SF-36, despite changes in item wording and response scales and despite the fact that SF-12 scales only contain a subset of SF-36 items. This study derives new summary scores based directly on SF-12v2 data from a recent U.S. sample and compares the new summary scores to the standard ones. Due to controversy regarding methods for developing scoring coefficients for the summary score, we compare summary scores produced by different methods. Methods We analyzed nationally representative U.S. data, which provided 53,399 observations for the SF-12v2 in 2003-2005. In addition to the standard SF-12V2 scoring algorithm, summary scores were generated using exploratory factor analysis (EFA), principal components analysis (PCA), and confirmatory factor analysis (CFA), with orthogonal and oblique rotation. We examined correlations among different summary scores, their associations with demographic and clinical variables, and the consistency between changes in scale scores and in summary scores over time. Results The 8 scale means in the current data were similar to the 1998 SF-12v2 means, with the exception of the vitality scale. Correlations among the scales based on SF-12v2 data differed slightly from correlations derived from scales based on the SF-36 data. Correlations among summary scores derived using different methods were high (a parts per thousand yen0.84). However, changes in summary scores derived using orthogonal rotation of components or factors were not consistent with changes in sub-scales, whereas changes in summary scores derived using oblique rotation were more consistent with patterns of change in sub-scales. Conclusions Although the basic structure of the SF-12 is stable, summary scores derived from oblique rotation are preferable and more consistent with changes in individual scales. On empirical and conceptual grounds, we suggest using summary scores based on oblique CFA. C1 [Fleishman, John A.] Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. [Selim, Alfredo J.; Kazis, Lewis E.] VA Med Ctr, Hlth Serv Res & Dev Ctr Excellence, CHQOER, Bedford, MA USA. [Selim, Alfredo J.; Kazis, Lewis E.] Boston Univ, Sch Publ Hlth, Dept Hlth Policy & Management, CAPP, Boston, MA USA. [Selim, Alfredo J.] Boston VA Hlth Care Syst, Sect Emergency Serv, W Roxbury, MA USA. [Selim, Alfredo J.] Boston Univ, Sch Med, Boston, MA 02118 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20852 USA. EM john.fleishman@ahrq.hhs.gov OI Kazis, Lewis/0000-0003-1800-5849 NR 32 TC 39 Z9 40 U1 1 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. PD MAR PY 2010 VL 19 IS 2 BP 231 EP 241 DI 10.1007/s11136-009-9582-z PG 11 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 552OX UT WOS:000274303800010 PM 20094805 ER PT J AU Chang, S El Arifeen, S Bari, S Wahed, MA Rahman, KM Rahman, MT Mahmud, ABA Begum, N Zaman, K Baqui, AH Black, RE AF Chang, S. El Arifeen, S. Bari, S. Wahed, M. A. Rahman, K. M. Rahman, M. T. Mahmud, A. B. A. Begum, N. Zaman, K. Baqui, A. H. Black, R. E. TI Supplementing iron and zinc: double blind, randomized evaluation of separate or combined delivery SO EUROPEAN JOURNAL OF CLINICAL NUTRITION LA English DT Article DE iron; zinc; supplement; delivery; interaction; diarrhea ID ROUTINE PROPHYLACTIC SUPPLEMENTATION; PLACEBO-CONTROLLED TRIAL; FOLIC-ACID; DEVELOPING-COUNTRIES; INDONESIAN INFANTS; EARLY-CHILDHOOD; CHILDREN; MORTALITY; DIARRHEA; GROWTH AB Background/Objectives: Many children have diets deficient in both iron and zinc, but there has been some evidence of negative interactions when they are supplemented together. The optimal delivery approach would maximize clinical benefits of both nutrients. We studied the effectiveness of different iron and zinc supplement delivery approaches to improve diarrhea and anemia in a rural Bangladesh population. Study Design: Randomized, double blind, placebo-controlled factorial community trial. Results: Iron supplementation alone increased diarrhea, but adding zinc, separately or together, attenuated these harmful effects. Combined zinc and iron was as effective as iron alone for iron outcomes. All supplements were vomited <1% of the time, but combined iron and zinc were vomited significantly more than any of the other supplements. Children receiving zinc and iron (together or separately) had fewer hospitalizations. Separating delivery of iron and zinc may have some additional benefit in stunted children. Conclusions: Separate and combined administration of iron and zinc are equally effective for reducing diarrhea, hospitalizations and improving iron outcomes. There may be some benefit in separate administration in stunted children. European Journal of Clinical Nutrition (2010) 64, 153-160; doi: 10.1038/ejcn.2009.127; published online 11 November 2009 C1 [Chang, S.] Agcy Healthcare Res & Qual, Johns Hopkins Med Inst, Rockville, MD 20850 USA. [El Arifeen, S.; Bari, S.; Wahed, M. A.; Rahman, K. M.; Rahman, M. T.; Mahmud, A. B. A.; Begum, N.; Zaman, K.] ICDDR B, Dhaka, Bangladesh. [Baqui, A. H.; Black, R. E.] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. RP Chang, S (reprint author), Agcy Healthcare Res & Qual, Johns Hopkins Med Inst, 540 Gaither Rd, Rockville, MD 20850 USA. EM Stephanie.chang@ahrq.gov OI Black, Robert/0000-0001-9926-7984 FU US Agency for International Development through the Global Research [HRN-A-00-96-90006-00]; Johns Hopkins Bloomberg School of Public Health FX This study was funded by the US Agency for International Development through the Global Research Activity award #HRN-A-00-96-90006-00 to the Johns Hopkins Bloomberg School of Public Health. We thank Saifuddin Ahmed (Johns Hopkins Bloomberg School of Public Health) and Parivash Nourjah (Johns Hopkins Medical Institutions, Agency for Healthcare Research and Quality) for their statistical assistance, Herve'-Pierre Le Goascoz (Nutriset) and Neal Brandes (USAID) for their assistance and support through this project, and most of all the entire ICDDR, B team, the Kumudini hospital staff, and the Mirzapur community. NR 20 TC 21 Z9 21 U1 0 U2 2 PU NATURE PUBLISHING GROUP PI LONDON PA MACMILLAN BUILDING, 4 CRINAN ST, LONDON N1 9XW, ENGLAND SN 0954-3007 EI 1476-5640 J9 EUR J CLIN NUTR JI Eur. J. Clin. Nutr. PD FEB PY 2010 VL 64 IS 2 BP 153 EP 160 DI 10.1038/ejcn.2009.127 PG 8 WC Nutrition & Dietetics SC Nutrition & Dietetics GA 551TI UT WOS:000274232800006 PM 19904293 ER PT J AU Li, Y Schnelle, J Spector, WD Glance, LG Mukamel, DB AF Li, Yue Schnelle, John Spector, William D. Glance, Laurent G. Mukamel, Dana B. TI The "Nursing Home Compare" Measure of Urinary/Fecal Incontinence: Cross-Sectional Variation, Stability over Time, and the Impact of Case Mix SO HEALTH SERVICES RESEARCH LA English DT Article DE Quality measure; Nursing Home Compare; incontinence; case mix; stability ID MINIMUM DATA SET; QUALITY REPORT CARDS; FECAL INCONTINENCE; RISK ADJUSTMENT; RESIDENTS; INDICATORS; RELIABILITY; MODEL AB Objectives To assess the impact of facility case mix on cross-sectional variations and short-term stability of the "Nursing Home Compare" incontinence quality measure (QM) and to determine whether multivariate risk adjustment can minimize such impacts. Study Design Retrospective analyses of the 2005 national minimum data set (MDS) that included approximately 600,000 long-term care residents in over 10,000 facilities in each quarterly sample. Mixed logistic regression was used to construct the risk-adjusted QM (nonshrinkage estimator). Facility-level ordinary least-squares models and adjusted R2 were used to estimate the impact of case mix on cross-sectional and short-term longitudinal variations of currently published and risk-adjusted QMs. Principal Findings At least 50 percent of the cross-sectional variation and 25 percent of the short-term longitudinal variation of the published QM are explained by facility case mix. In contrast, the cross-sectional and short-term longitudinal variations of the risk-adjusted QM are much less susceptible to case-mix variations (adjusted R2 < 0.10), even for facilities with more extreme or more unstable outcome. Conclusions Current "Nursing Home Compare" incontinence QM reflects considerable case-mix variations across facilities and over time, and therefore it may be biased. This issue can be largely addressed by multivariate risk adjustment using risk factors available in the MDS. C1 [Li, Yue] Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA 52242 USA. [Schnelle, John] Vanderbilt Univ, Vanderbilt Ctr Qual Aging, Nashville, TN USA. [Spector, William D.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Glance, Laurent G.] Univ Rochester, Sch Med & Dent, Dept Anesthesiol, Rochester, NY USA. [Mukamel, Dana B.] Univ Calif Irvine, Dept Med, Hlth Policy Res Inst, Irvine, CA 92717 USA. RP Li, Y (reprint author), Univ Iowa, Carver Coll Med, Div Gen Internal Med, SE610 GH,200 Hawkins Dr, Iowa City, IA 52242 USA. EM yue-li@uiowa.edu FU National Institute on Aging [AG027420] FX Joint Acknowledgment/Disclosure Statement: This study was funded by the National Institute on Aging under grant AG027420. An earlier version of this work was presented at the Academy Health Annual Research Meeting in June 2009 (Chicago, IL) and at the 137th APHA Annual Meeting in November 2009 (Philadelphia, PA). Disclosures: None. Disclaimers: None. NR 36 TC 5 Z9 5 U1 1 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 EI 1475-6773 J9 HEALTH SERV RES JI Health Serv. Res. PD FEB PY 2010 VL 45 IS 1 BP 79 EP 97 DI 10.1111/j.1475-6773.2009.01061.x PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 541YC UT WOS:000273456400006 PM 19878342 ER PT J AU Barton, M AF Barton, Mary CA US Preventive Serv Task Force TI Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement SO PEDIATRICS LA English DT Article DE children and adolescents; clinical practice; obesity; screening ID AGE AB DESCRIPTION: Update of the 2005 US Preventive Services Task Force (USPSTF) statement about screening for overweight in children and adolescents. METHODS: The USPSTF examined the evidence for the effectiveness of interventions that are primary care feasible or referable. It also examined the evidence for the magnitude of potential harms of treatment in children and adolescents. RECOMMENDATION. The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to intensive counseling and behavioral interventions to promote improvements in weight status (grade B recommendation). Pediatrics 2010; 125: 361-367 C1 [Barton, Mary] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Barton, M (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM mary.barton@ahrq.hhs.gov NR 19 TC 173 Z9 174 U1 1 U2 8 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 2010 VL 125 IS 2 BP 361 EP 367 DI 10.1542/peds.2009-2037 PG 7 WC Pediatrics SC Pediatrics GA 573VH UT WOS:000275942900022 ER PT J AU Al-Khatib, SM Calkins, H Eloff, BC Packer, DL Ellenbogen, KA Hammill, SC Natale, A Page, RL Prystowsky, E Jackman, WM Stevenson, WG Waldo, AL Wilber, D Kowey, P Yaross, MS Mark, DB Reiffel, J Finkle, JK Marinac-Dabic, D Pinnow, E Sager, P Sedrakyan, A Canos, D Gross, T Berliner, E Krucoff, MW AF Al-Khatib, Sana M. Calkins, Hugh Eloff, Benjamin C. Packer, Douglas L. Ellenbogen, Kenneth A. Hammill, Stephen C. Natale, Andrea Page, Richard L. Prystowsky, Eric Jackman, Warren M. Stevenson, William G. Waldo, Albert L. Wilber, David Kowey, Peter Yaross, Marcia S. Mark, Daniel B. Reiffel, James Finkle, John K. Marinac-Dabic, Danica Pinnow, Ellen Sager, Phillip Sedrakyan, Art Canos, Daniel Gross, Thomas Berliner, Elise Krucoff, Mitchell W. TI Planning the Safety of Atrial Fibrillation Ablation Registry Initiative (SAFARI) as a Collaborative Pan-Stakeholder Critical Path Registry Model: A Cardiac Safety Research Consortium "Incubator" Think Tank SO AMERICAN HEART JOURNAL LA English DT Article ID PULMONARY-VEIN ABLATION; RADIOFREQUENCY ABLATION; ANTIARRHYTHMIC-DRUGS; CATHETER ABLATION; RANDOMIZED-TRIAL; GUIDED ABLATION; CURE AB Atrial fibrillation (AF) is a major public health problem in the United States that is associated with increased mortality and morbidity. Of the therapeutic modalities available to treat AF, the use of percutaneous catheter ablation of AF is expanding rapidly. Randomized clinical trials examining the efficacy and safety of AF ablation are currently underway; however, such trials can only partially determine the safety and durability of the effect of the procedure in routine clinical practice, in more complex patients, and over a broader range of techniques and operator experience. These limitations of randomized trials of AF ablation, particularly with regard to safety issues, could be addressed using a synergistically structured national registry, which is the intention of the SAFARI. To facilitate discussions about objectives, challenges, and steps for such a registry, the Cardiac Safety Research Consortium and the Duke Clinical Research Institute, Durham, NC, in collaboration with the US Food and Drug Administration, the American College of Cardiology, and the Heart Rhythm Society, organized a Think Tank meeting of experts in the field. Other participants included the National Heart, Lung and Blood Institute, the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, the Society of Thoracic Surgeons, the AdvaMed AF working group, and additional industry representatives. The meeting took place on April 27 to 28, 2009, at the US Food and Drug Administration headquarters in Silver Spring, MD. This article summarizes the issues and directions presented and discussed at the meeting. (Am Heart J 2010; 159: 17-24. e1.) C1 [Al-Khatib, Sana M.; Mark, Daniel B.; Krucoff, Mitchell W.] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27715 USA. [Calkins, Hugh] Johns Hopkins Univ, Baltimore, MD USA. [Eloff, Benjamin C.; Marinac-Dabic, Danica; Pinnow, Ellen; Sedrakyan, Art; Canos, Daniel; Gross, Thomas] US FDA, Silver Spring, MD USA. [Packer, Douglas L.; Hammill, Stephen C.] Mayo Clin, Rochester, MN USA. [Ellenbogen, Kenneth A.] Virginia Commonwealth Univ, Med Coll Virginia, Richmond, VA 23298 USA. [Natale, Andrea] St Davids Med Ctr, Texas Cardiac Arrhythmia Inst, Austin, TX USA. [Page, Richard L.] Univ Washington, Seattle, WA 98195 USA. [Prystowsky, Eric] Care Grp, Indianapolis, IN USA. [Jackman, Warren M.] Univ Oklahoma, Hlth Sci Ctr, Oklahoma City, OK USA. [Stevenson, William G.] Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA. [Waldo, Albert L.] Case Western Reserve Univ, Cleveland, OH 44106 USA. [Wilber, David] Loyola Univ, Chicago, IL 60611 USA. [Kowey, Peter] Lankenau Inst Med Res, Diamond Bar, CA USA. Main Line Heart Ctr, Diamond Bar, CA USA. [Yaross, Marcia S.] Biosense Webster, Diamond Bar, CA USA. [Reiffel, James] Columbia Univ, New York, NY USA. [Finkle, John K.] GlaxoSmithKline Inc, Collegeville, PA USA. [Sager, Phillip] Gilead Sci Inc, Palo Alto, CA USA. [Berliner, Elise] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Al-Khatib, SM (reprint author), Duke Univ, Med Ctr, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA. EM alkha001@mc.duke.edu RI Page, Richard/L-5501-2014 OI Page, Richard/0000-0001-5603-1330 FU CSRC; DCRI; ACC; HRS FX This conference was funded by CSRC, DCRI, ACC, and HRS; registration fees and in- kind support from FDA and AdvaMed.; Views expressed in this article reflect the opinions of the authors only and not the official policy of the Food and Drug Administration, the Agency for Healthcare Research and Quality, the Department of Human Services, or the remaining authors' affiliated organizations. NR 17 TC 14 Z9 14 U1 0 U2 1 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0002-8703 J9 AM HEART J JI Am. Heart J. PD JAN PY 2010 VL 159 IS 1 BP 17 EP U34 PG 9 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 536NO UT WOS:000273051300003 PM 20102862 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Common Formats Allow Uniform Collection and Reporting of Patient Safety Data by Patient Safety Organizations 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, 540 Gaither Rd, Rockville, MD 20850 USA. EM Carolyn.Clancy@ahrq.hhs.gov NR 9 TC 7 Z9 7 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 JAN-FEB PY 2010 VL 25 IS 1 BP 73 EP 75 DI 10.1177/1062860609352438 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 538WC UT WOS:000273214000009 PM 20042765 ER PT S AU Berwick, DM Luo, E AF Berwick, Donald M. Luo, Eva BE Rouse, WB Cortese, DA TI Seeking care as a system SO ENGINEERING THE SYSTEM OF HEALTHCARE DELIVERY SE Studies in Health Technology and Informatics LA English DT Article; Book Chapter AB Kim, aged 3 years, lies asleep, waiting for a miracle. Outside her room, the nurses on the night shift pad softly through the half-lighted corridors, stopping to count breaths, take pulses, or check the intravenous pumps. In the morning, Kim will have her heart fixed. She will be medicated and wheeled into the operating suite. Machines will take on the functions of her body: breathing and circulating blood. The surgeons will place a small patch over a hole within her heart, closing off a shunt between her ventricles that would, if left open, slowly kill her. Kim will be fine if the decision to operate on her was correct; if the surgeon is competent; if that competent surgeon happens to be trained to deal with the particular anatomic wrinkle that is hidden inside Kim's heart; if the blood bank cross-matched her blood accurately and delivered it to the right place; if the blood gas analysis machine works properly and on time; if the suture does not snap; if the plastic tubing of the heart-lung machine does not suddenly spring loose; if the recovery room nurses know that she is allergic to penicillin; if the "oxygen" and "nitrogen" lines in the anesthesia machine have not been reversed by mistake; if the sterilizer temperature gauge is calibrated so that the instruments are in fact sterile; if the pharmacy does not mix up two labels; and if when the surgeon says urgently, "Clamp, right now,"there is a clamp on the tray. If all goes well, if ten thousand "ifs" go well, then Kim may sing her grandchildren to sleep some day. If not, she will be dead by noon tomorrow. If Kim were an astronaut, strapped into her seat at the top of some throbbing rocket, the crowd assembled would hold their breath in the morning Florida sun. "How can it possibly work?" they would whisper. "How many parts are there in that machine? A million? What if one fails? My toaster fails. Please let it all work right." The machine would bellow smoke, the gantry fall away, and slowly the monster would rise, Kim on top. If it worked, they would cheer. "A miracle," they would shout, in awe that the millions of tiny lines of effort, the millions of tiny lines of cause and effect, from job shops in Ohio and laboratories in Pasadena, criss-crossing through time and space, could converge so magnificently in a massive, gleaming rocket launched exactly right. Perfect. If it failed, they would cry. So would the rocket's makers, who had done their very best. No one wanted it to end this way. Poor Kim. What was the trouble? What went wrong? Why? The lines of cause will converge around Kim in the morning as she wheels toward the operating room. Thousands upon thousands of elements weaving a basket to hold her safely, all hope. No crowd holds its breath tonight; but wouldn't they if they knew? C1 [Berwick, Donald M.; Luo, Eva] IHI, Cambridge, MA USA. [Berwick, Donald M.] Harvard Univ, Sch Med, Pediat & Hlth Care Policy, Cambridge, MA 02138 USA. [Berwick, Donald M.] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Cambridge, MA 02138 USA. [Berwick, Donald M.] US Prevent Serv Task Force, Chapel Hill, NC USA. [Berwick, Donald M.] Agcy Healthcare Res & Qual, Natl Advisory Council, Sacramento, CA USA. [Berwick, Donald M.] IOMs Governing Council, Rome, Italy. [Luo, Eva] Univ Michigan, Sch Med, Ann Arbor, MI 48109 USA. [Luo, Eva] IHI Open Sch Hlth Profess Team, Cambridge, MA USA. RP Berwick, DM (reprint author), IHI, Cambridge, MA USA. EM dberwick@ini.org NR 0 TC 0 Z9 0 U1 0 U2 1 PU IOS PRESS PI AMSTERDAM PA NIEUWE HEMWEG 6B, 1013 BG AMSTERDAM, NETHERLANDS SN 0926-9630 BN 978-1-60750-533-4; 978-1-60750-532-7 J9 STUD HEALTH TECHNOL PY 2010 VL 153 BP 17 EP 21 DI 10.3233/978-1-60750-533-4-17 PG 5 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA BC2MQ UT WOS:000351085000003 PM 20543236 ER PT J AU Josephs, JS Fleishman, JA Korthuis, PT Moore, RD Gebo, KA AF Josephs, J. S. Fleishman, J. A. Korthuis, P. T. Moore, R. D. Gebo, K. A. CA HIV Res Network TI Emergency department utilization among HIV-infected patients in a multisite multistate study* SO HIV MEDICINE LA English DT Article DE emergency department; HIV; HIV research network; utilization ID ACTIVE ANTIRETROVIRAL THERAPY; HEALTH-SERVICES UTILIZATION; IMMUNODEFICIENCY-VIRUS-INFECTION; UNITED-STATES; MEDICAL-CARE; ACCESS; IMPACT; COST; INPATIENT; PEOPLE AB Objective The aim of this study was to examine Emergency Department (ED) utilization and clinical and sociodemographic correlates of ED use among HIV-infected patients. Methods During 2003, 951 patients participated in face-to-face interviews at 14 HIV clinics in the HIV Research Network. Respondents reported the number of ED visits in the preceding 6 months. Using logistic regression, we identified factors associated with visiting the ED in the last 6 months and admission to the hospital from the ED. Results Thirty-two per cent of respondents reported at least one ED visit in the last 6 months. In multivariate analysis, any ED use was associated with Medicaid insurance, high levels of pain (the third or fourth quartile), more than seven primary care visits in the last 6 months, current or former illicit drug use, social alcohol use and female gender. Of those who used ED services, 39% reported at least one admission to the hospital. Patients with pain in the highest quartile reported increased admission rates from the ED as did those who made six or seven primary care visits, or more than seven primary care visits vs. three or fewer. Conclusions The likelihood of visiting the ED has not diminished since the advent of highly active antiretroviral therapy (HAART). More ED visits are to treat illnesses not related to HIV or injuries than to treat direct sequelae of HIV infection. With the growing prevalence of people living with HIV infection, the numbers of HIV-infected patients visiting the ED may increase, and ED providers need to understand potential complications produced by HIV disease. C1 [Josephs, J. S.; Moore, R. D.; Gebo, K. A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA. [Fleishman, J. A.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Korthuis, P. T.] Oregon Hlth & Sci Univ, Dept Med, Portland, OR 97201 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 FU Agency for Healthcare Research and Quality [290-01-012]; National Institutes of Drug Abuse [K23-DA00523, R01 AG026250]; Johns Hopkins University; Agency for Healthcare Research and Quality, Rockville, MD; Health Resources and Services Administration, Rockville, MD; Substance Abuse and Mental Health Services Administration, Rockville, MD FX Agency for Healthcare Research and Quality, Rockville, MD (Fred Hellinger PhD, John Fleishman PhD, Irene Fraser PhD); Health Resources and Services Administration, Rockville, MD (Richard Conviser PhD, Alice Kroliczak PhD, Robert Mills PhD); dSubstance Abuse and Mental Health Services Administration, Rockville, MD (Joan Dilonardo PhD, Laura House PhD, Pat Roth). NR 39 TC 17 Z9 17 U1 0 U2 3 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1464-2662 J9 HIV MED JI HIV Med. PD JAN PY 2010 VL 11 IS 1 BP 74 EP 84 DI 10.1111/j.1468-1293.2009.00748.x PG 11 WC Infectious Diseases SC Infectious Diseases GA 530FE UT WOS:000272573600007 PM 19682102 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI The Promise and Future of Comparative Effectiveness Research SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID THERAPY C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 5 TC 2 Z9 2 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 JAN-MAR PY 2010 VL 25 IS 1 BP 1 EP 4 PG 4 WC Nursing SC Nursing GA 536CD UT WOS:000273018900001 PM 20010250 ER PT S AU Dixon, BE McGowan, JJ AF Dixon, Brian E. McGowan, Julie J. BE Safran, C Reti, S Marin, HF TI Enhancing a Taxonomy for Health Information Technology: An Exploratory Study of User Input Towards Folksonomy SO MEDINFO 2010, PTS I AND II SE Studies in Health Technology and Informatics LA English DT Proceedings Paper CT 13th World Congress on Medical and Health Informatics of International-Medical-Informatics-Association (Medinfo) CY SEP 12-15, 2010 CL Cape Town, SOUTH AFRICA SP Int Med Informat Assoc DE Classification; Information retrieval; Internet; Health informatics AB The U.S. Agency for Healthcare Research and Quality has created a public website to disseminate critical information regarding its health information technology initiative. The website is maintained by AHRQ's Natioanl Resource Center (NRC) for Health Information Technology. In the latest continuous quality improvement project, the NRC used the site's search logs to extract user-generated search phrases. The vocabulary with respect to language, grammar, and search precision. Results of the comparison demonstrate that search log data can be a cost-effective way to improve controlled vocabularies as well as information retrieval. User-entered search phrases were found to also share many similarities with folksonomy tags. C1 [Dixon, Brian E.; McGowan, Julie J.] Regenstrief Inst Hlth Care, Med Informat, Indianapolis, IN USA. [Dixon, Brian E.; McGowan, Julie J.] Agcy Healthcare Res & Qual, Natl Resource Ctr Hlth IT, Rockville, MD USA. [McGowan, Julie J.] Indiana Univ Sch Med, Dept Knowledge Informat & Translat, Indianapolis, IN 46202 USA. RP Dixon, BE (reprint author), Regenstrief Inst Inc, 410 West 10th St,Suite 2000, Indianapolis, IN 46202 USA. EM bdixon@regenstrief.org OI Dixon, Brian/0000-0002-1121-0607 FU U.S. Agency for Healthcare Research and Quality [290-04-0016] FX This paper is derived from work supported under a contract with the U.S. Agency for Healthcare Research and Quality (290-04-0016). The opinions expressed in this article are those of the authors and do not reflect the official position of AHRQ or the U.S. Department of Health and Human Services. NR 12 TC 0 Z9 1 U1 0 U2 0 PU IOS PRESS PI AMSTERDAM PA NIEUWE HEMWEG 6B, 1013 BG AMSTERDAM, NETHERLANDS SN 0926-9630 BN 978-1-60750-588-4 J9 STUD HEALTH TECHNOL PY 2010 VL 160 BP 1055 EP 1059 DI 10.3233/978-1-60750-588-4-1055 PG 5 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA BG8CS UT WOS:000392215900207 PM 20841845 ER PT S AU Encinosa, WE Bernard, D Dor, A AF Encinosa, William E. Bernard, Didem Dor, Avi BE Dor, A TI DOES PRESCRIPTION DRUG ADHERENCE REDUCE HOSPITALIZATIONS AND COSTS? THE CASE OF DIABETES SO PHARMACEUTICAL MARKETS AND INSURANCE WORLDWIDE SE Advances in Health Economics and Health Services Research LA English DT Article; Book Chapter ID PROPENSITY SCORE; PART-D; EFFICIENT ESTIMATION; MEDICARE PROGRAM; HEALTH; NONCOMPLIANCE; INSURANCE; BENEFITS; THERAPY; PRICES AB Purpose - To estimate the impact of diabetic drug adherence on hospitalizations, emergency room (ER) visits, and hospital costs. Methods - It is often difficult to measure the impact of drug adherence on hospitalizations since both adherence and hospitalizations may be correlated with unobservable patient severity. We control for such unobservables using propensity score methods and instrumental variables for adherence such as drug coinsurance levels and direct-to-consumer advertising. Findings - We find a significant bias due to unobservable severity in that patients with more severe health are more apt to comply with medications. Thus, the relationship between adherence and hospitalization will be under estimated if one does not control for unobservable severity. Over all, we find that increasing diabetic drug adherence from 50% to 100% reduces the hospitalization rate by 23.3% from 15% to 11.5%. ER visits reduce by 46.2% from 17.3% to 9.3%. Although such an increase in adherence increases diabetic drugs pending by $776 a year per diabetic, the cost savings for averted hospitalizations and ER visits are $886 per diabetic, a cost offset of $1.14 per $1.00 spent on diabetic drugs. Originality - Most of the drug cost-offset literature focuses only on the impact of cost-sharing and drug spending on cost-offsets, making it impossible to back-out the empirical impact of actual drug adherence on cost-offsets. In this chapter, we estimate the direct impact of adherence on hospitalizations and costs. C1 [Encinosa, William E.] Ctr Delivery Org & Markets, Rockville, MD USA. [Encinosa, William E.] Georgetown Univ, Washington, DC USA. [Bernard, Didem] Agcy Healthcare Res & Qual, Ctr Finance Access & Cost Trends, Rockville, MD USA. [Dor, Avi] George Washington Univ, Washington, DC USA. [Dor, Avi] NBER, New York, NY USA. RP Encinosa, WE (reprint author), Ctr Delivery Org & Markets, Rockville, MD USA. NR 42 TC 22 Z9 22 U1 0 U2 0 PU EMERALD GROUP PUBLISHING LTD PI BINGLEY PA HOWARD HOUSE, WAGON LANE, BINGLEY, W YORKSHIRE BD16 1WA, ENGLAND SN 0731-2199 BN 978-1-84950-716-5 J9 ADV HEALTH ECON HEAL PY 2010 VL 22 BP 151 EP 173 DI 10.1108/S0731-2199(2010)0000022010 PG 23 WC Economics; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA BYR63 UT WOS:000299897300008 PM 20575232 ER PT S AU Pylypchuk, Y AF Pylypchuk, Yuriy BE Dor, A TI ADVERSE SELECTION AND THE EFFECT OF HEALTH INSURANCE ON UTILIZATION OF PRESCRIBED MEDICINE AMONG PATIENTS WITH CHRONIC CONDITIONS SO PHARMACEUTICAL MARKETS AND INSURANCE WORLDWIDE SE Advances in Health Economics and Health Services Research LA English DT Article; Book Chapter ID QUALITY-OF-LIFE; PRESCRIPTION DRUGS; CHRONIC DISEASES; CARE; DEMAND; IMPACT; DETERMINANTS AB Purpose - To examine the effects of health insurance types on the use of prescribed medication that treat patients with hypertension, diabetes, and asthma. The study distinguishes between individuals with private health maintenance organization (HMO) plans and private non-HMO plans. The study also distinguishes between people with health insurance and drug coverage and people with health insurance and no drug coverage. Methods - Joint discrete factor models are estimated to control for endogeneity of each type of coverage. Findings - The main findings suggest that the effect of health insurance varies across patients with different conditions. The strongest and most significant effect is evident among patients with hypertension while the weakest and least significant is among patients with asthma. These findings suggest that patients with asymptomatic conditions are more likely to exhibit moral hazard than patients with conditions that impose immediate impairment. Additional results suggest that, relative to the uninsured and people with health insurance but no drug coverage, patients with drug coverage are more likely to initiate drug therapy and to consume more medications. Originality - The results of the study indicate that moral hazard of drug utilization is condition specific. The variation in "silence" of conditions' symptoms could be a key reason for difference in insurance effects among patients with hypertension, diabetes, and asthma. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Pylypchuk, Y (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 37 TC 0 Z9 0 U1 0 U2 2 PU EMERALD GROUP PUBLISHING LTD PI BINGLEY PA HOWARD HOUSE, WAGON LANE, BINGLEY, W YORKSHIRE BD16 1WA, ENGLAND SN 0731-2199 BN 978-1-84950-716-5 J9 ADV HEALTH ECON HEAL PY 2010 VL 22 BP 233 EP 272 DI 10.1108/S0731-2199(2010)0000022014 PG 40 WC Economics; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA BYR63 UT WOS:000299897300012 PM 20575236 ER PT J AU Hellinger, FJ Encinosa, WE AF Hellinger, Fred J. Encinosa, William E. TI The Cost and Incidence of Prescribing Errors Among Privately Insured HIV Patients SO PHARMACOECONOMICS LA English DT Article ID ACTIVE ANTIRETROVIRAL THERAPY; SOCIETY-USA PANEL; INFECTED PATIENTS; HOSPITALIZED-PATIENTS; UPDATED RECOMMENDATIONS; PROTEASE INHIBITORS; AIDS; CARE; EXPERIENCE; MORTALITY AB Background: With the rapid growth in the volume of HIV-related Studies that address drug interact ions, appropriate medication regimens. and when and how to alter drug regimens. it is challenging for physicians to stay Informed Physicians require knowledge about all drugs taken by HIV patients In order to assess accurately the benefits and risks of various drug combinations. Objective: To examine the cost and frequency of antiretroviral prescribing errors among a sample of privately insured patients with HIV disease. Methods: Data were obtained from the MarketScan(R) Commercial Claims and Encounter Database created by the Medstat Group Inc The MarketScan(R) database contains claims data for inpatient care, outpatient care, physician services and prescription drugs in benefit plans sponsored by >50 large employers in the US. This Study compared data from the 1999-2000 MarketScan(R) database with those from the 2005 MarketScan(R) database. The 2005 MarketScan(R) database includes 12226 HIV enrollees who received antiretroviral drugs This Study compared the claims experience of HIV patients who filled a prescription for a drug combination that is not recommended by the US Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents with the claims experience of patients who did not receive such a prescription. Results: In the 1999-2000 database the most common inappropriate drug combination involved the co-administration of a protease inhibitor (PI) and the lipid lowering, drug simvastatin, and 1% of patients experienced this type of error. In the 2005 database, only 0 4% of patients (46 of 12 226) experienced an inappropriate combination of simvastatin and a PI while 5 3% of patients (644 of 12226) received atazanavir and tenofovir without ritonavir (referred to herein as 'boosting errors') Patients who experienced a boosting error incurred hi-her annual costs than patients who took ritonavir along with tenofovir and atazanavir ($US20 927 vs $US16 704). Because atazanavir was approved by the US FDA in June 2003, medication errors involving atazanavir were not relevant in 1999 and 2000 Overall, it Was found that HIV patients were three times as likely to experience an inappropriate drug combination in 2005 than they were in either 1999 or 2000 (5 9% vs 1.9%). and that this increase is attributable to boosting errors In addition, the prevalence rate of HIV in the 2005 MarketScan(R) database was almost triple that in the 1999 MarketScan(R) database (0 14% vs 0 05%) Conclusion: This Study indicates that those who provide care to HIV patients must be vigilant in their efforts to provide patients with a drug therapy regimen that minimizes the chance of an adverse reaction and maximizes the potential to control viral replication C1 [Hellinger, Fred J.; Encinosa, William E.] 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. NR 47 TC 9 Z9 9 U1 3 U2 8 PU ADIS INT LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 1311, NEW ZEALAND SN 1170-7690 J9 PHARMACOECONOMICS JI Pharmacoeconomics PY 2010 VL 28 IS 1 BP 23 EP 34 PG 12 WC Economics; Health Care Sciences & Services; Health Policy & Services; Pharmacology & Pharmacy SC Business & Economics; Health Care Sciences & Services; Pharmacology & Pharmacy GA 559XH UT WOS:000274862600003 PM 20014874 ER PT J AU Genevro, JL Miller, TL AF Genevro, Janice L. Miller, Therese L. TI THE EMOTIONAL AND ECONOMIC COSTS OF BEREAVEMENT IN HEALTH CARE SETTINGS SO PSYCHOLOGICA BELGICA LA English DT Article ID OF-LIFE CARE; PALLIATIVE CARE; MORAL DISTRESS; END; GRIEF; MODEL; TEXTBOOKS; DEATH; INTERVENTIONS; EXPERIENCES AB Research to date on grief and bereavement in health care providers has focused on those experiences from the perspective of the individual. We propose, however, that the emotional costs of bereavement in the health care setting are also health care systems issues. This paper focuses on the emotional costs of grief and bereavement in health care providers, and on the economic costs of bereavement and bereavement care in health care settings. Evidence regarding the costs and cost-effectiveness of bereavement interventions is limited. We summarise existing relevant research and offer an overview of the types of costs and cost information that would optimally be collected in research on bereavement in health care settings. We also propose an analytic framework that could be used to systematically consider the larger picture of bereavement in health care settings, how available evidence fits into this picture, and what evidence is needed to improve care. This approach is derived from health services research. It is hoped that the proposed framework will prove useful in stimulating new research questions, and in guiding research that not only advances our understanding of the emotional and economic costs of bereavement but also improves bereavement care. C1 [Genevro, Janice L.] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Genevro, JL (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, John M Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20850 USA. EM Janice.Genevro@ahrq.hhs.gov NR 48 TC 3 Z9 3 U1 0 U2 1 PU BELGIAN PSYCHOL SOC PI LOUVAIN PA TIENSESTRAAT 102, 3000 LOUVAIN, BELGIUM SN 0033-2879 J9 PSYCHOL BELG JI Psychol. Belg. PY 2010 VL 50 IS 1-2 SI SI BP 69 EP 88 PG 20 WC Psychology, Multidisciplinary SC Psychology GA 648AC UT WOS:000281661300005 ER PT J CA US Preventive Serv Task Force TI Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; PRIMARY-CARE; QUALITY IMPROVEMENT; PHARMACOTHERAPY; PSYCHOTHERAPY; IMPACT AB Description: Update of the 2002 U. S. Preventive Services Task Force (USPSTF) recommendation statement on screening for depression in adults. Methods: The USPSTF examined evidence on the benefits and harms of screening primary care patients for depression, including direct evidence that depression screening programs improve health outcomes. The USPSTF did not reexamine evidence for those key questions that had strong, consistent evidence in the 2002 review, including questions about the accuracy of screening instruments in identifying depressed adult patients in primary care settings, and the efficacy of treatment of depressed adults with antidepressants or psychotherapy. New areas of evidence considered for this review (and not reviewed in 2002) include efficacy of treatment of depression in older adult patients, harms of screening for depression in primary care settings, and adverse events from treatment of depression in adults. Recommendations: The USPSTF recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. (Grade B recommendation) The USPSTF recommends against routinely screening adults for depression when staff-assisted depression care supports are not in place. There may be considerations that support screening for depression in an individual patient. (Grade C recommendation) C1 US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. FU Agency for Healthcare Research and Quality FX The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF. NR 23 TC 18 Z9 19 U1 0 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 DEC 1 PY 2009 VL 151 IS 11 BP 784 EP W256 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA 532EJ UT WOS:000272727900004 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Physician Leadership for High-Quality Care SO CHEST LA English DT Editorial Material ID REFORM C1 AHRQ, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), AHRQ, John M Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 5 TC 1 Z9 1 U1 1 U2 5 PU AMER COLL CHEST PHYSICIANS PI NORTHBROOK PA 3300 DUNDEE ROAD, NORTHBROOK, IL 60062-2348 USA SN 0012-3692 J9 CHEST JI Chest PD DEC PY 2009 VL 136 IS 6 BP 1452 EP 1454 DI 10.1378/chest.09-1396 PG 3 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA 532JE UT WOS:000272742900005 PM 19995761 ER PT J AU Mukamel, DB Ladd, H Weimer, DL Spector, WD Zinn, JS AF Mukamel, Dana B. Ladd, Heather Weimer, David L. Spector, William D. Zinn, Jacqueline S. TI Is There Evidence of Cream Skimming Among Nursing Homes Following the Publication of the Nursing Home Compare Report Card? SO GERONTOLOGIST LA English DT Article DE Nursing homes; Quality; Report cards; Cream skimming ID QUALITY REPORT CARDS; PERFORMANCE; INFORMATION; ADJUSTMENT; MDS AB Purpose: A national quality report card for nursing homes, Nursing Home Compare, has been published since 2002. It has been shown to have some, albeit limited, positive impact on quality of care. The objective of this study was to test empirically the hypothesis that nursing homes have responded to the publication of the report by adopting cream skimming admission policies. Design and Methods: The study included all non-Medicare newly admitted patients to all Medicare- and Medicaid-certified nursing homes nationally during the 2001-2005 period. Using the Minimum Data Set data, we calculated for each quarter several admission cohort characteristics: average number of activity of daily living limitations and percent of residents admitted with pain, with pressure ulcers, with urinary incontinence, with diabetes, and with memory limitations. We tested whether residents admitted in the postpublication period were less frail and sick compared with residents admitted in the prepublication period by estimating fixed facility effects longitudinal regression models. Analyses were stratified by nursing home ownership, occupancy, reported quality ranking, chain affiliation, and region. Results: Evidence for cream skimming was found with respect to pain and, to a lesser degree, with respect to memory limitation but not with respect to the 4 other admission cohort characteristics. Implications: Despite the theoretical expectation, empirical evidence suggests only a limited degree of cream skimming. Further studies are required to investigate this phenomenon with respect to other admission cohort characteristics and with respect to post-acute patients. C1 [Mukamel, Dana B.; Ladd, Heather] Univ Calif Irvine, Hlth Policy Res Inst, Irvine, CA 92697 USA. [Weimer, David L.] Univ Wisconsin, LaFollette Sch Publ Affairs, Madison, WI 53706 USA. [Spector, William D.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Zinn, Jacqueline S.] Temple Univ, Fox Sch Business & Management, Philadelphia, PA 19122 USA. RP Mukamel, DB (reprint author), Univ Calif Irvine, Hlth Policy Res Inst, 111 Acad,Suite 220, Irvine, CA 92697 USA. EM dmukamel@uci.edu FU NIA NIH HHS [R01 AG023177, R01 AG023177-05, AG023177] NR 23 TC 12 Z9 12 U1 0 U2 1 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD DEC PY 2009 VL 49 IS 6 BP 793 EP 802 DI 10.1093/geront/gnp062 PG 10 WC Gerontology SC Geriatrics & Gerontology GA 520BO UT WOS:000271815000008 PM 19491363 ER PT J AU Aranaz-Andres, JM Aibar-Remon, C Vitaller-Burillo, J Requena-Puche, J Terol-Garcia, E Kelley, E de Castro, MTGV AF Ma Aranaz-Andres, Jesus Aibar-Remon, C. Vitaller-Burillo, J. Requena-Puche, J. Terol-Garcia, E. Kelley, E. Gea-Velazquez de Castro, M. T. CA ENEAS Work TI Impact and preventability of adverse events in Spanish public hospitals: results of the Spanish National Study of Adverse Events (ENEAS) SO INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE LA English DT Article DE adverse events; medical errors; clinical safety; quality of care; patient safety ID HEALTH-CARE; MEDICAL ERRORS; PATIENT SAFETY; DEATHS AB To determine the impact and preventability of adverse events (AEs) associated with health care in Spanish hospitals. Retrospective cohort study. Twenty-four Spanish hospitals. Patients of any age with a clinical record indicating an inpatient stay of > 24 h and a discharge between 4 and 10 June 2005 (n = 5908). None. Percentage of AEs considered preventable. We were able to identify 525 patients suffering AEs associated directly with medical care, who accumulated 655 AEs with 43% of these AEs considered preventable. Overall, 45% (295 AEs) were considered minor, 39% (255 AEs) moderate and 16% (105 AEs) severe. There were no significant differences in AE severity by hospital size, but AEs associated with surgical services were more likely to be severe than those associated with medical services. Some 31.4% of AEs resulted in a longer stay and 23.4% led to hospital admission. AEs associated with medical care caused 6.1 additional days per patient. Of the patients, 66.3% required additional procedures and 69.9% required additional treatments. Incidence of death in patients with AEs was 4.4% (CI 95%: 2.8-6.5). Age over 65 was associated with a higher incidence of preventable AEs. The highest percentages of preventable AEs were related to diagnosis (84.2%), to nosocomial infections (56.6%) and to care (56%). In Spanish hospitals, AEs associated with health care cause distress, disability, death, lengthen hospital stay and cause increased consumption of health-care resources. A relatively high percentage of AEs in Spain may be preventable with improvements in medical care. C1 [Ma Aranaz-Andres, Jesus; Vitaller-Burillo, J.; Requena-Puche, J.; Gea-Velazquez de Castro, M. T.] Miguel Hernandez Univ Elche, Dept Publ Hlth Hist Sci & Gynaechol, Elche, Spain. [Aibar-Remon, C.] Univ Zaragoza, Teaching Hosp Lozano Blesa, Dept Prevent Med, E-50009 Zaragoza, Spain. [Aibar-Remon, C.] Univ Zaragoza, Dept Microbiol Prevent Med & Publ Hlth, E-50009 Zaragoza, Spain. [Kelley, E.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Aranaz-Andres, JM (reprint author), Miguel Hernandez Univ, Dept Publ Hlth, San Juan Campus,Carretera Alicante Valencia S-N, Alacant 03550, Spain. EM aranaz_jes@gva.es OI Aibar Remon, Carlos/0000-0001-9714-8105; Miralles-Bueno, Juan Jose/0000-0002-5965-0740 FU Miguel Hernandez University; Ministry of Health and Consumption FX The ENEAS study was conducted under the auspices of a collaboration agreement between the Miguel Hernandez University an the Ministry of Health and Consumption, and financed by the latter. NR 34 TC 34 Z9 35 U1 0 U2 4 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 2009 VL 21 IS 6 BP 408 EP 414 DI 10.1093/intqhc/mzp047 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 520CD UT WOS:000271816600004 PM 19841027 ER PT J AU Selden, TM AF Selden, Thomas M. TI The Impact of Increased Tax Subsidies on the Insurance Coverage of Self-Employed Families Evidence from the 1996-2004 Medical Expenditure Panel Survey SO JOURNAL OF HUMAN RESOURCES LA English DT Article ID HEALTH-INSURANCE; TAKE-UP; DEMAND; WORKERS; PREMIUMS; DECLINE; PRICE; BENEFITS; DECISION; MODELS AB The share of health insurance premiums that self-employed workers con deduct when computing federal income taxes rose from 30 percent in 1996 to 100 percent in 2003. Data front the 1996-2004 Medical Expenditure Panel Survey are used to show that the increased tax subsidy was associated with substantial increases in private coverage among self-employed workers and their spouses. Estimated effects oil public coverage and the coverage of children were smaller fit magnitude and less precisely estimated. Simulation results show that much of the post-1996 subsidy increase represented an inframarginal transfer to persons who would have had held private insurance anyway. Nevertheless, increased subsidization expanded private coverage by 1.1 to 1.7 million persons, at a cost per newly insured person less than $2,300 in all simulations-a cost below that found in simulations of more broadly based subsidies. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD 20850 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, 540 Gaither Rd, Rockville, MD 20850 USA. EM tselden@ahrq.gov NR 48 TC 10 Z9 10 U1 1 U2 15 PU UNIV WISCONSIN PRESS PI MADISON PA JOURNAL DIVISION, 1930 MONROE ST, 3RD FL, MADISON, WI 53711 USA SN 0022-166X J9 J HUM RESOUR JI J. Hum. Resour. PD WIN PY 2009 VL 44 IS 1 BP 115 EP 139 PG 25 WC Economics; Industrial Relations & Labor SC Business & Economics GA 401DM UT WOS:000262918900004 ER PT J AU Leape, L Berwick, D Clancy, C Conway, J Gluck, P Guest, J Lawrence, D Morath, J O'Leary, D O'Neill, P Pinakiewicz, D Isaac, T AF Leape, L. Berwick, D. Clancy, C. Conway, J. Gluck, P. Guest, J. Lawrence, D. Morath, J. O'Leary, D. O'Neill, P. Pinakiewicz, D. Isaac, T. CA Natl Patient Safety Fdn TI Transforming healthcare: a safety imperative SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID WRONG-SITE SURGERY; ADVERSE EVENTS; PATIENT SAFETY; PREVENTION; PATTERNS; LESSONS AB Ten years ago, the Institute of Medicine reported alarming data on the scope and impact of medical errors in the US and called for national efforts to address this problem. While efforts to improve patient safety have proliferated during the past decade, progress toward improvement has been frustratingly slow. Some of this lack of progress may be attributable to the persistence of a medical ethos, institutionalized in the hierarchical structure of academic medicine and healthcare organizations, that discourages teamwork and transparency and undermines the establishment of clear systems of accountability for safe care. The Lucian Leape Institute, established by the US National Patient Safety Foundation to provide vision and strategic direction for the patient safety work, has identified five concepts as fundamental to the endeavor of achieving meaningful improvement in healthcare system safety. These five concepts are transparency, care integration, patient/consumer engagement, restoration of joy and meaning in work, and medical education reform. This paper introduces the five concepts and illustrates the meaning and implications of each as a component of a vision for healthcare safety improvement. In future roundtable sessions, the Institute will further elaborate on the meaning of each concept, identify the challenges to implementation, and issue recommendations for policy makers, organizations, and healthcare professionals. C1 [Leape, L.; Berwick, D.] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Berwick, D.; Conway, J.] Inst Healthcare Improvement, Cambridge, MA USA. [Clancy, C.] Agcy Healthcare Res & Qual, Bethesda, MD USA. [Gluck, P.; Pinakiewicz, D.] Natl Patient Safety Fdn, Boston, MA USA. [Guest, J.] Consumers Union, Yonkers, NY USA. [Lawrence, D.] Kaiser Fdn Hlth Plan, Oakland, CA USA. [Morath, J.] Vanderbilt Univ, Med Ctr, Nashville, TN USA. [O'Neill, P.] ALCOA, Pittsburgh, PA 15219 USA. [Isaac, T.] Dana Farber Canc Inst, Boston, MA 02115 USA. RP Leape, L (reprint author), Harvard Univ, Sch Publ Hlth, 665 Huntington Ave, Boston, MA 02115 USA. EM leape@hsph.harvard.edu; dberwick@ihi.org; carolyn.clancy@ahrq.hhs.gov; jconway@ihi.org; astrogld2@aol.com; jguest@consumer.org; dmlawrencemd@gmail.com; julie.morath@childrensmn.org; do'leary@jointcommission.org; poneillpa@aol.com; dpinakiewicz@npsf.org; txi001@gmail.com NR 45 TC 179 Z9 181 U1 5 U2 43 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 2009 VL 18 IS 6 BP 424 EP 428 DI 10.1136/qshc.2009.036954 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 526VV UT WOS:000272324100005 PM 19955451 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, AJ Gregory, KD Grossman, D Isham, G LeFevre, ML Leipzig, RM Marion, LN Melnyk, B Moyer, VA Ockene, JK Sawaya, GF Schwartz, JS Wilt, T AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen J. Gregory, Kimberly D. Grossman, David Isham, George LeFevre, Michael L. Leipzig, Rosanne M. Marion, Lucy N. Melnyk, Bernadette Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Schwartz, J. Sanford Wilt, Timothy CA US Preventive Serv Task Force TI Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID CLIENT-DIRECTED INTERVENTIONS; MAMMOGRAPHY; WOMEN; PERFORMANCE; POPULATION; THERAPY AB Description: Update of the 2002 U. S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population. Methods: The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals. Recommendations: The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation) The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement) The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation) The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement) C1 [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [US Preventive Serv Task Force] Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen J.] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Hanover, NH 03756 USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Grossman, David] Grp Hlth Cooperat Puget Sound, Seattle, WA 98121 USA. [Isham, George] HealthPartners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Leipzig, Rosanne M.] Mt Sinai Sch Med, New York, NY USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Melnyk, Bernadette] Arizona State Univ, Coll Nursing & Hlth Innovat, Phoenix, AZ USA. [Moyer, Virginia A.] Baylor Coll Med, Houston, TX 77030 USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Schwartz, J. Sanford] Univ Penn, Sch Med, Philadelphia, PA 19104 USA. [Schwartz, J. Sanford] Univ Penn, Wharton Sch, Philadelphia, PA 19104 USA. [Wilt, Timothy] Univ Minnesota, Dept Med, Minneapolis, MN 55455 USA. [Wilt, Timothy] Minneapolis Vet Affairs Med Ctr, Minneapolis, MN USA. RP Calonge, N (reprint author), Colorado Dept Publ Hlth & Environm, Denver, CO USA. FU USPSTF FX The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF. NR 32 TC 770 Z9 788 U1 3 U2 41 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 17 PY 2009 VL 151 IS 10 BP 716 EP W236 PG 12 WC Medicine, General & Internal SC General & Internal Medicine GA 524LP UT WOS:000272145100005 ER PT J AU Bott, J AF Bott, J. TI Perspectives on current uses of the AHRQ quality indicators and future development SO DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT LA English DT Meeting Abstract DE quality; indicators; measurement C1 [Bott, J.] Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM john.bott@ahrq.hhs.gov NR 0 TC 0 Z9 0 U1 2 U2 2 PU GEORG THIEME VERLAG KG PI STUTTGART PA RUDIGERSTR 14, D-70469 STUTTGART, GERMANY SN 0012-0472 J9 DEUT MED WOCHENSCHR JI Dtsch. Med. Wochenschr. PD NOV 13 PY 2009 VL 134 BP S305 EP S305 DI 10.1055/s-0029-1242661 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 525UG UT WOS:000272241200003 ER PT J AU Tsertsvadze, A Fink, HA Yazdi, F MacDonald, R Bella, AJ Ansari, MT Garritty, C Soares-Weiser, K Daniel, R Sampson, M Fox, S Moher, D Wilt, TJ AF Tsertsvadze, Alexander Fink, Howard A. Yazdi, Fatemeh MacDonald, Roderick Bella, Anthony J. Ansari, Mohammed T. Garritty, Chantelle Soares-Weiser, Karla Daniel, Raymond Sampson, Margaret Fox, Steven Moher, David Wilt, Timothy J. TI Oral Phosphodiesterase-5 Inhibitors and Hormonal Treatments for Erectile Dysfunction: A Systematic Review and Meta-analysis SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID PLACEBO-CONTROLLED TRIAL; ISCHEMIC OPTIC NEUROPATHY; SILDENAFIL CITRATE VIAGRA((R)); SPARING RADICAL PROSTATECTOMY; RANDOMIZED CONTROLLED-TRIAL; ON-DEMAND TADALAFIL; BENIGN PROSTATIC HYPERPLASIA; EXTERNAL-BEAM RADIOTHERAPY; INCREASES PENILE RIGIDITY; CONTROLLED CLINICAL-TRIAL AB Background: Erectile dysfunction (ED) is a common male sexual disorder. The relative benefits and harms of pharmacologic therapies for ED, as well as the value of hormonal testing in men with ED, are uncertain. Purpose: To evaluate the efficacy and harms of oral phosphodiesterase-5 (PDE-5) inhibitors and hormonal treatments for ED and assess the effect of measuring serum hormone levels on treatment outcomes for ED. Data Sources: English-language studies from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, AMED, and SCOPUS through April 2009. Trial reference lists also were scanned. Study Selection: Randomized, controlled trials (RCTs) of oral PDE-5 inhibitors and hormonal treatment for ED, and observational studies reporting measurement of serum hormone levels, prevalence of hormonal abnormalities, or both in men with ED. Data Extraction: Two independent reviewers abstracted data on study, participant, and treatment characteristics; efficacy and harms outcomes; and prevalence of hormonal abnormalities. Data Synthesis: Data, primarily from short-term trials (<= 12 weeks), indicate that PDE-5 inhibitors were more effective than placebo in improving sexual intercourse success (69.0% vs. 35.0%). The proportion of men with improved erections was significantly greater among those treated with PDE-5 inhibitors (range, 67.0% to 89.0%) than with placebo (range, 27.0% to 35.0%). The PDE-5 inhibitors were associated with increased risk for any adverse events compared with placebo (for example, relative risk with sildenafil, 1.72 [95% CI, 1.53 to 1.93]). In 4 head-to-head RCTs comparing sildenafil, vardenafil, and tadalafil, improvement of ED and adverse events did not differ among treatments. Results from 15 RCTs evaluating hormonal treatment of ED were inconsistent on whether treatment improved outcomes. Evidence was insufficient regarding whether men with ED had a higher prevalence of hypogonadism than men without ED. Limitations: Many RCTs were of low methodological and reporting quality, particularly those involving hormonal treatments or directly comparing different PDE-5 inhibitors. Most RCTs provided only short-term efficacy and harms data. Conclusion: Oral PDE-5 inhibitors improved erectile functioning and had similar efficacy and safety profiles. Results on the efficacy of hormonal treatments and the value of hormone testing in men with ED were inconclusive. Primary Funding Source: Agency for Healthcare Research and Quality. C1 Univ Ottawa, Ottawa Hlth Res Inst, Ottawa, ON, Canada. Childrens Hosp Eastern Ontario, Res Inst, Ottawa, ON K1H 8L1, Canada. Minneapolis Vet Affairs Med Ctr, Ctr Chron Dis Outcomes Res, Geriatr Res Educ & Clin Ctr, Minneapolis, MN USA. Minneapolis Evidence Based Practice Ctr, Minneapolis, MN USA. Enhance Reviews, Kefar Sava, Israel. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Fink, HA (reprint author), Vet Affairs Med Ctr 11 G, 1 Vet Dr, Minneapolis, MN 55417 USA. EM howard.fink@va.gov RI Perez , Claudio Alejandro/F-8310-2010; Fink, Howard/F-3933-2012; OI Perez , Claudio Alejandro/0000-0001-9688-184X; Daniel, Raymond/0000-0002-1753-6683; Sampson, Margaret/0000-0003-2550-9893; Moher , David /0000-0003-2434-4206 FU Agency for Healthcare Research and Quality; Pfizer, Lilly, Bayer FX Agency for Healthcare Research and Quality.; Honoraria: A. J. Bella (Pfizer, Lilly, Bayer). NR 237 TC 72 Z9 74 U1 2 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 NOV 3 PY 2009 VL 151 IS 9 BP 650 EP W218 PG 22 WC Medicine, General & Internal SC General & Internal Medicine GA 514IM UT WOS:000271387700007 PM 19884626 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI The Canary's Warning: Why Infections Matter 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 11 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 NOV-DEC PY 2009 VL 24 IS 6 BP 462 EP 464 DI 10.1177/1062860609344818 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 516TV UT WOS:000271567100001 PM 19890139 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Ten Years After To Err Is Human SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material ID DISCHARGE C1 Agcy Healthcare Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 8 TC 20 Z9 20 U1 1 U2 6 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 2009 VL 24 IS 6 BP 525 EP 528 DI 10.1177/1062860609349728 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 516TV UT WOS:000271567100010 PM 19826077 ER PT J AU MacPherson, DW Gushulak, BD Baine, WB Bala, S Gubbins, PO Holtom, P Segarra-Newnham, M AF MacPherson, Douglas W. Gushulak, Brian D. Baine, William B. Bala, Shukal Gubbins, Paul O. Holtom, Paul Segarra-Newnham, Marisel TI Population Mobility, Globalization, and Antimicrobial Drug Resistance SO EMERGING INFECTIOUS DISEASES LA English DT Article ID PLASMODIUM-FALCIPARUM; CIPROFLOXACIN; SURVEILLANCE; TUBERCULOSIS; BACTERIA; WASTE; WATER AB Population mobility is a main factor in globalization of public health threats and risks, specifically distribution of antimicrobial drug-resistant organisms. Drug resistance is a major risk in healthcare settings and is emerging as a problem in community-acquired infections. Traditional health policy approaches have focused on diseases of global public health significance such as tuberculosis, yellow fever, and cholera; however, new diseases and resistant organisms challenge existing approaches. Clinical implications and health policy challenges associated with movement of persons across barriers permeable to products, pathogens, and toxins (e.g., geopolitical borders, patient care environments) are complex. Outcomes are complicated by high numbers of persons who move across disparate and diverse settings of disease threat and risk. Existing policies and processes lack design and capacity to prevent or mitigate adverse health outcomes. We propose an approach to global public health risk management that integrates population factors with effective and timely application of policies and processes. C1 [MacPherson, Douglas W.] Migrat Hlth Consultants Inc, Cheltenham, ON, Canada. [MacPherson, Douglas W.] McMaster Univ, Hamilton, ON, Canada. [Gushulak, Brian D.] Migrat Hlth Consultants Inc, Singapore, Singapore. [Baine, William B.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Bala, Shukal] US FDA, Rockville, MD 20857 USA. [Gubbins, Paul O.] Univ Arkansas Med Sci, Little Rock, AR 72205 USA. [Holtom, Paul] Univ So Calif, Keck Sch Med, Los Angeles, CA 90033 USA. [Segarra-Newnham, Marisel] Vet Affairs Med Ctr, W Palm Beach, FL USA. RP MacPherson, DW (reprint author), 14130 Creditview Rd, Cheltenham, ON L7C 1Y4, Canada. EM douglaswmacpherson@migrationhealth.com NR 40 TC 44 Z9 51 U1 1 U2 21 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1080-6040 J9 EMERG INFECT DIS JI Emerg. Infect. Dis PD NOV PY 2009 VL 15 IS 11 BP 1727 EP 1732 DI 10.3201/eid1511.090419 PG 6 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 518ML UT WOS:000271696600004 PM 19891858 ER PT J AU Kenney, GM Ruhter, J Selden, TM AF Kenney, Genevieve M. Ruhter, Joel Selden, Thomas M. TI Containing Costs And Improving Care For Children In Medicaid And CHIP SO HEALTH AFFAIRS LA English DT Article ID HEALTH-CARE; PRIVATE INSURANCE; ACCESS; CALIFORNIA; NEEDS AB The current health reform debate is greatly concerned with "bending the curve" of cost growth and containing costs, particularly in public programs. Our research demonstrates that spending in Medicaid and the Children's Health Insurance Program (CHIP) is highly concentrated, particularly among children with chronic health problems. Ten percent of enrollees (two-thirds of whom have a chronic condition) account for 72 percent of the spending; 30 percent of enrolled children receive little or no care. These results highlight the importance of cost containment strategies that reduce avoidable hospitalizations among children with chronic problems and policies that increase preventive care, particularly among African American children. [Health Aff (Millwood). 2009;28(6):w1025-36 (published online 17 September 2009; 10.1377/hlthaff.28.6.w1025)] C1 [Ruhter, Joel] Univ Michigan, Ann Arbor, MI 48109 USA. [Selden, Thomas M.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM jkenney@urban.org FU David and Lucile Packard Foundation; Agency for Healthcare Research and Quality FX This research was funded by the David and Lucile Packard Foundation and by the Agency for Healthcare Research and Quality. The views expressed in the paper are those of the authors, and no official endorsement by the David and Lucile Packard Foundation, the Urban Institute, the Agency for Healthcare Research and Quality, or the U. S. Department of Health and Human Services is intended or should be inferred. This paper greatly benefited from the insightful comments of Jessica Banthin, Joel Cohen, Stephen Zuckerman, Martha Herberlein, and Jocelyn Guyer and the invaluable assistance of Laurie Smith in the preparation of the manuscript. NR 31 TC 12 Z9 12 U1 0 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 NOV-DEC PY 2009 VL 28 IS 6 BP W1025 EP W1036 DI 10.1377/hlthaff.28.6.w1025 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 517NR UT WOS:000271622300048 PM 19762355 ER PT J AU MacNeil, A Holman, RC Yorita, KL Steiner, CA Parashar, UD Belay, ED AF MacNeil, Adam Holman, Robert C. Yorita, Krista L. Steiner, Claudia A. Parashar, Umesh D. Belay, Ermias D. TI Evaluation of seasonal patterns of Kawasaki Syndrome- and rotavirus-associated hospitalizations in California and New York, 2000-2005 SO BMC PEDIATRICS LA English DT Article ID UNITED-STATES; INFECTION; DISEASE AB Background: Kawasaki Syndrome (KS) is an uncommon childhood disease with unknown etiology. It has been suggested that rotavirus infection may play a causative role in the development of KS. Methods: To examine potential temporal associations between KS and rotavirus infection, seasonal patterns of KS- and rotavirus-associated hospitalizations among children in California and New York during 2000-2005 were compared. Results: Rotavirus hospital admissions were markedly winter seasonal, with very few summer hospitalizations. KS hospitalizations occurred year-round but also peaked slightly during winter and spring. Conclusion: The strong winter seasonal pattern of rotavirus clearly differed from the year-round pattern of KS hospitalizations. While the present study cannot completely rule out rotavirus as having a role in the development of KS, other agents must be involved in the etiology of KS. C1 [MacNeil, Adam; Holman, Robert C.; Yorita, Krista L.; Belay, Ermias D.] Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Zoonot Vector Borne & Enter Dis, US Dept HHS, Atlanta, GA 30333 USA. [Steiner, Claudia A.] US Dept HHS, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. [Parashar, Umesh D.] Ctr Dis Control & Prevent, Div Viral Dis, Natl Ctr Immunizat & Resp Dis, US Dept HHS, Atlanta, GA USA. RP MacNeil, A (reprint author), Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Zoonot Vector Borne & Enter Dis, US Dept HHS, Atlanta, GA 30333 USA. EM aho3@cdc.gov; rch1@cdc.gov; KYorita@cdc.gov; Claudia.Steiner@ahrq.hhs.gov; uap2@cdc.gov; ebb8@cdc.gov RI Belay, Ermias/A-8829-2013 FU California Office of Statewide Health Planning Development; New York State Department of Health; Healthcare Cost and Utilization Project; Centers for Disease Control and Prevention FX The authors thank the California Office of Statewide Health Planning & Development, and the New York State Department of Health for their support and participation in the Healthcare Cost and Utilization Project. Work was funded entirely by the Centers for Disease Control and Prevention. The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. NR 12 TC 8 Z9 9 U1 0 U2 1 PU BIOMED CENTRAL LTD PI LONDON PA 236 GRAYS INN RD, FLOOR 6, LONDON WC1X 8HL, ENGLAND SN 1471-2431 J9 BMC PEDIATR JI BMC Pediatr. PD OCT 16 PY 2009 VL 9 AR 65 DI 10.1186/1471-2431-9-65 PG 4 WC Pediatrics SC Pediatrics GA 513MG UT WOS:000271325800001 PM 19835612 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Gregory, KD Harris, R Isham, G 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. Gregory, Kimberly D. Harris, Russell Isham, George 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 Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment: US Preventive Services Task Force Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID BEAM COMPUTED-TOMOGRAPHY; C-REACTIVE PROTEIN; ARTERY CALCIUM SCORE; CARDIOVASCULAR-DISEASE; MYOCARDIAL-INFARCTION; ATHEROSCLEROSIS RISK; PRIMARY-CARE; EVENTS; PREDICTION; RATIONALE AB Description: New recommendation from the U.S. Preventive Services Task Force (USPSTF) on the use of nontraditional, or novel, risk factors in assessing the coronary heart disease (CHD) risk of asymptomatic persons. Methods: Systematic reviews were conducted of literature since 1996 on 9 proposed nontraditional markers of CHD risk: high-sensitivity C-reactive protein, ankle-brachial index, leukocyte count, fasting blood glucose, periodontal disease, carotid intima-media thickness, coronary artery calcification score on electron-beam computed tomography, homocysteine, and lipoprotein(a). The reviews followed a hierarchical approach aimed at determining which factors could practically and definitively reassign persons assessed as intermediate-risk according to their Framingham score to either a high-risk or low-risk strata, and thereby improve outcomes by means of aggressive risk-factor modification in those newly assigned to the high-risk stratum. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors studied to screen asymptomatic men and women with no history of CHD to prevent CHD events. (I statement). C1 [US Preventive Serv Task Force] US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Petitti, Diana B.] Arizona State Univ, Phoenix, AZ USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Harris, Russell] Univ N Carolina, Sch Med, Chapel Hill, NC USA. [Isham, George] HealthPartners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. [Marion, Lucy N.] Med Coll Georgia, Augusta, GA 30912 USA. [Moyer, Virginia A.] Baylor Coll Med, Houston, TX 77030 USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Siu, Albert L.] Mt Sinai Med Ctr, New York, NY 10029 USA. [Teutsch, Steven M.] Merck & Co Inc, West Point, PA USA. [Yawn, Barbara P.] Olmsted Med Ctr, Rochester, MN USA. NR 39 TC 88 Z9 92 U1 0 U2 3 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 OCT 6 PY 2009 VL 151 IS 7 BP 474 EP W160 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA 502OT UT WOS:000270470500005 ER PT J AU Casale, CR Clancy, CM AF Casale, Cecilia Rivera Clancy, Carolyn M. TI Commentary: Not About Us Without Us SO ACADEMIC MEDICINE LA English DT Editorial Material AB Disparities in health care are pervasive, but the patterns vary substantially across the nation. Solutions to eliminate health care disparities associated with patient race, ethnicity, income, education, geography, and other factors must be customized to address the specific circumstances of each community. The urgency of addressing disparities exceeds the available evidence to do so. In this context, community-based participatory research (CBPR) offers an appealing strategy to develop the requisite evidence while improving care. Using case studies from their experience, Moreno and colleagues convey a thoughtful, realistic account of the University of California, Los Angeles Family Medicine CBPR experience focused on addressing disparities in health and health care among racial/ethnic minority immigrant populations in a Los Angeles County community. This report highlights both the potential for community transformation and the challenges encountered by medical student researchers in the quest to establish meaningful partnerships that promote and value community members' contributions to the research areas under study, with the goal of improving health outcomes and reducing health care disparities. The authors of this commentary believe that the ongoing national debate addressing the need to reform the health care system in the United States and reduce health and health care disparities for underserved populations will bring increased focus on applying the tenets of CBPR. Sustaining relevant health care services research that engages community partners, researchers, and funders is a promising model of community engagement with potential for replication and sustainability. C1 [Casale, Cecilia Rivera; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Casale, CR (reprint author), 540 Gaither Rd, Rockville, MD 20850 USA. EM Cecilia.Casale@ahrq.hhs.gov NR 6 TC 0 Z9 0 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1040-2446 J9 ACAD MED JI Acad. Med. PD OCT PY 2009 VL 84 IS 10 BP 1333 EP 1335 DI 10.1097/ACM.0b013e3181b6afd0 PG 3 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA V15EU UT WOS:000207786100011 PM 19881415 ER PT J AU Aspinall, SL Banthin, JS Good, CB Miller, GE Cunningham, FE AF Aspinall, Sherrie L. Banthin, Jessica S. Good, Chester B. Miller, G. Edward Cunningham, Francesca E. TI VA Pharmacy Users: How They Differ From Other Veterans SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID MENTAL-HEALTH PROBLEMS; CARE; EXPENDITURES; MEDICARE; ACCESS; IRAQ AB Objective: To compare users and nonusers of Veterans Affairs (VA) pharmacy services by age group. Study Design: Cross-sectional. Methods: We used data on sociodemographics, health status, and medical conditions from the Medical Expenditure Panel Survey (MEPS) to compare users and nonusers of VA pharmacies for medications. Data were pooled for 2003-2005 to ensure adequate sample sizes. Student t tests were used to compare the means for each variable, and all analyses were adjusted for the complex sample design of the MEPS. Results: Among both nonelderly (18-64 years) and elderly (> 65 years) veterans, a higher proportion who used VA pharmacy services versus those who did not use VA pharmacy services (1) were black (nonelderly: 17.7% vs 7.4%, P < .001; elderly: 9.4% vs 4.7%, P < .001); (2) had no alternative insurance (nonelderly: 27.2% vs 4.8%, P < .001; elderly: 36.3% vs 19.9%, P < .001); (3) had lower incomes (nonelderly: 32.4% vs 11.5%, P < .001; elderly: 32.4% vs 25.4%, P = .01); (4) had less than a high school education (nonelderly: 13.0% vs 6.5%, P < .001; elderly: 27.5% vs 17.6%, P < .001); (5) were disabled; and (6) reported poorer health. A higher percentage of nonelderly users reported a mental health condition (31.6% vs 19.4%, P < .001). Conclusions: Veterans who use VA pharmacy services appear to be more ill than those who do not use VA pharmacy services. In addition, the VA appears to be a safety net for uninsured veterans who have mental health problems. (Am J Manag Care. 2009; 15(10): 701-708) C1 [Aspinall, Sherrie L.; Good, Chester B.] VA Pittsburgh Healthcare Syst, VA Ctr Hlth Equ Res & Promot, Pittsburgh, PA 15206 USA. [Aspinall, Sherrie L.; Good, Chester B.; Cunningham, Francesca E.] VA Ctr Medicat Safety, Hines, IL USA. [Aspinall, Sherrie L.; Good, Chester B.] Univ Pittsburgh, Sch Pharm, Pittsburgh, PA 15260 USA. [Good, Chester B.] Univ Pittsburgh, Sch Med, Pittsburgh, PA 15260 USA. [Banthin, Jessica S.; Miller, G. Edward] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Washington, DC USA. RP Aspinall, SL (reprint author), VA Pittsburgh Healthcare Syst, VA Ctr Hlth Equ Res & Promot, 7180 Highland Dr, Pittsburgh, PA 15206 USA. EM sherrie.aspinall@va.gov NR 13 TC 3 Z9 3 U1 1 U2 1 PU MANAGED CARE & HEALTHCARE COMMUNICATIONS LLC PI PLAINSBORO PA 666 PLAINSBORO RD, STE 300, PLAINSBORO, NJ 08536 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD OCT PY 2009 VL 15 IS 10 BP 701 EP 708 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 508YN UT WOS:000270975300004 PM 19845422 ER PT J AU Hellinger, FJ AF Hellinger, Fred J. TI The Effect of Certificate-of-Need Laws on Hospital Beds and Healthcare Expenditures: An Empirical Analysis SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID INVESTMENT; IMPACT; COSTS AB Objective: To estimate the effect of certificate-of- need legislation on hospital bed supply and healthcare expenditures. Study Design: This study uses state data on several variables, including healthcare expenditures, hospital bed supply, and the existence of a certificate-of-need program, from 4 periods (1985, 1990, 1995, and 2000). Methods: We estimate 2 multivariate regression equations. In the first equation, hospital bed supply is the dependent variable, and certificate of need is included as an independent variable. In the second equation, healthcare expenditures is the dependent variable, and hospital bed supply and certificate of need are included as independent variables. Results: Certificate-of-need laws have reduced the number of hospital beds by about 10% and have reduced healthcare expenditures by almost 2%. Certificate-of-need programs did not have a direct effect on healthcare expenditures. Conclusion: Certificate-of-need programs have limited the growth in the supply of hospital beds, and this has led to a slight reduction in the growth of healthcare expenditures. (Am J Manag Care. 2009; 15(10): 737-744) 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,Room 5319, Rockville, MD 20850 USA. EM fred.hellinger@ahrq.hhs.gov NR 31 TC 9 Z9 9 U1 1 U2 1 PU MANAGED CARE & HEALTHCARE COMMUNICATIONS LLC PI PLAINSBORO PA 666 PLAINSBORO RD, STE 300, PLAINSBORO, NJ 08536 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD OCT PY 2009 VL 15 IS 10 BP 737 EP 744 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 508YN UT WOS:000270975300007 PM 19845425 ER PT J AU Lau, DT Kirby, JB AF Lau, Denys T. Kirby, James B. TI LIVING ARRANGEMENT AND COLORECTAL CANCER SCREENING: UPDATED USPSTF GUIDELINES SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Letter C1 [Lau, Denys T.] Northwestern Univ, Feinberg Sch Med, Buehler Ctr Aging Hlth & Soc, Chicago, IL 60611 USA. [Lau, Denys T.] Northwestern Univ, Feinberg Sch Med, Div Gen Internal Med, Dept Med, Chicago, IL 60611 USA. [Kirby, James B.] Agcy Hlth Care Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Lau, DT (reprint author), Northwestern Univ, Feinberg Sch Med, Buehler Ctr Aging Hlth & Soc, 750 N Lake Shore Dr,Suite 601, Chicago, IL 60611 USA. EM D-Lau@northwestern.edu FU NIA NIH HHS [5K01 AG 027295-02, K01 AG027295-03, K01 AG027295] NR 3 TC 1 Z9 1 U1 0 U2 1 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 OCT PY 2009 VL 99 IS 10 BP 1733 EP 1734 DI 10.2105/AJPH.2009.172916 PG 2 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 507IS UT WOS:000270846500003 PM 19696371 ER PT J AU Baron, S McPhaul, K Phillips, S Gershon, R Lipscomb, J AF Baron, Sherry McPhaul, Kathleen Phillips, Sally Gershon, Robyn Lipscomb, Jane TI Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Editorial Material ID COMMUNITY-HEALTH; UNITED-STATES; SAFETY; PEER; RECOMMENDATIONS; EDUCATION; TRAINERS; SERVICES; AIDES AB The home health care sector is a critical element in a pandemic influenza emergency response. Roughly 85% of the 1.5 million workers delivering in-home care to 7.6 million clients are low-wage paraprofessionals, mostly women, and disproportionately members of racial and ethnic minorities. Home health care workers' ability and willingness to respond during a pandemic depends on appropriate communication, training, and adequate protections, including influenza vaccination and respiratory protection. Preparedness planning should also include support for child care and transportation and help home health care workers protect their income and access to health care. We summarize findings from a national stakeholder meeting, which highlighted the need to integrate home health care employers, workers, community advocates, and labor unions into the planning process. (Am J Public Health. 2009;99-S301-S307. doi:10.2105/AJPH.2008.157339) C1 [Baron, Sherry] Ctr Dis Control & Prevent, NIOSH, Cincinnati, OH USA. [McPhaul, Kathleen; Lipscomb, Jane] Univ Maryland, Sch Nursing, Work & Hlth Res Ctr, Baltimore, MD 21201 USA. [Phillips, Sally] Agcy Healthcare Res & Qual, Rockville, MD USA. [Gershon, Robyn] Columbia Univ, Mailman Sch Publ Hlth, New York, NY USA. RP Baron, S (reprint author), 4676 Columbia Pkwy,MS R-17, Cincinnati, OH 45226 USA. EM SBaron@cdc.gov NR 44 TC 6 Z9 7 U1 2 U2 4 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 OCT PY 2009 VL 99 BP S301 EP S307 DI 10.2105/AJPH.2008.157339 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 512BY UT WOS:000271218800015 PM 19461108 ER PT J AU Meyers, D AF Meyers, David TI Breastfeeding and Health Outcomes SO BREASTFEEDING MEDICINE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Ctr Primary Care, Rockville, MD 20850 USA. RP Meyers, D (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care, 540 Gaither Rd, Rockville, MD 20850 USA. EM david.meyers@ahrq.hhs.gov NR 0 TC 10 Z9 10 U1 0 U2 1 PU MARY ANN LIEBERT INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1556-8253 J9 BREASTFEED MED JI Breastfeed. Med. PD OCT PY 2009 VL 4 SU 1 BP S13 EP S15 DI 10.1089/bfm.2009.0066 PG 3 WC Obstetrics & Gynecology; Pediatrics SC Obstetrics & Gynecology; Pediatrics GA 585AW UT WOS:000276797700006 PM 19827918 ER PT J AU Byrd, KK Holman, RC Bruce, MG Hennessy, TW Wenger, JD Bruden, DL Haberling, DL Steiner, C Cheek, JE AF Byrd, Kathy K. Holman, Robert C. Bruce, Michael G. Hennessy, Thomas W. Wenger, Jay D. Bruden, Dana L. Haberling, Dana L. Steiner, Claudia Cheek, James E. TI Methicillin-Resistant Staphylococcus aureus-Associated Hospitalizations among the American Indian and Alaska Native Population SO CLINICAL INFECTIOUS DISEASES LA English DT Article ID INFECTIOUS-DISEASE HOSPITALIZATIONS; UNITED-STATES; BACTEREMIA AB Background. American Indians and Alaska Natives (AI/ANs) have had documented outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection but, to our knowledge, no studies have examined MRSA infection among this population nationally. We describe MRSA-associated hospitalizations among the similar to 1.6 million AI/ANs who receive care at Indian Health Service health care facilities nationwide. Methods. We used hospital discharge data from the Indian Health Service National Patient Information Reporting System to determine the rate of MRSA-associated hospitalizations among AI/ANs who used Indian Health Service health care in 1996-2005 and in the comparison periods 1996-1998 and 2003-2005. Hospitalization rates among AI/ANs were examined by year, age group, sex, and region. MRSA-associated diagnoses were also examined. Rate comparisons were performed using Poisson regression analysis. Comparison of rates to those of the general United States population was made for 2003-2005 by means of the Nationwide Inpatient Sample. Results. Between comparison periods, the rate of MRSA-associated hospitalization increased from 4.6 to 50.6 hospitalizations per 100,000 AI/ANs (P<.01), with increases in both sexes, all age groups, and all regions. By 2005, MRSA was the causative organism for the majority (52%) of all S. aureus-associated hospitalizations. The most common associated diagnosis was skin and soft-tissue infection, which accounted for 59% of MRSA-associated diagnoses. In 2003-2005, the age-adjusted rate among AI/ANs was 58.8 hospitalizations per 100,000 persons, compared with 84.7 hospitalizations per 100,000 persons in the general US population. Conclusions. MRSA-associated hospitalizations have increased significantly among AI/ANs served by Indian Health Service health care facilities. Clinicians should have a high index of suspicion for MRSA infection in AI/ANs, especially in those with a diagnosis of skin and soft-tissue infection. C1 [Byrd, Kathy K.] Ctr Dis Control & Prevent, Epidem Intelligence Serv, Div Appl Publ Hlth Training, Epidemiol Program Off,CDC,USDHHS, Atlanta, GA USA. [Holman, Robert C.; Haberling, Dana L.] Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Zoonot Vector Borne & Enter Dis, CDC,USDHHS, Atlanta, GA USA. [Bruce, Michael G.; Hennessy, Thomas W.; Wenger, Jay D.; Bruden, Dana L.] CDC, Div Emerging Infect & Surveillance Syst, Natl Ctr Preparedness Detect & Control Infect Dis, USDHHS, Anchorage, AK USA. [Steiner, Claudia] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Healthcare Cost & Utilizat Project, Rockville, MD USA. Indian Hlth Serv, Div Epidemiol & Prevent, Off Publ Hlth Support, USDHHS, Albuquerque, NM USA. RP Byrd, KK (reprint author), 1600 Clifton Rd NE,Mailstop G-37, Atlanta, GA 30333 USA. EM gdn8@cdc.gov NR 23 TC 14 Z9 14 U1 0 U2 0 PU UNIV CHICAGO PRESS PI CHICAGO PA 1427 E 60TH ST, CHICAGO, IL 60637-2954 USA SN 1058-4838 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD OCT PY 2009 VL 49 IS 7 BP 1009 EP 1015 DI 10.1086/605560 PG 7 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 492PX UT WOS:000269672300004 PM 19725783 ER PT J AU Christensen, KLY Holman, RC Steiner, CA Sejvar, JJ Stoll, BJ Schonberger, LB AF Christensen, Krista L. Yorita Holman, Robert C. Steiner, Claudia A. Sejvar, James J. Stoll, Barbara J. Schonberger, Lawrence B. TI Infectious Disease Hospitalizations in the United States SO CLINICAL INFECTIOUS DISEASES LA English DT Article ID STAPHYLOCOCCUS-AUREUS INFECTIONS; OLDER-ADULTS; US CHILDREN; TRENDS; MORTALITY; POPULATION; OUTBREAK; INFANTS AB Background. Infectious diseases (IDs) cause widespread morbidity and mortality. We describe the epidemiology of ID hospitalizations in the United States with use of a nationally representative database. Methods. First-listed ID hospitalizations in the United States were analyzed using the Nationwide Inpatient Sample for 1998-2006. Hospitalization rates were calculated overall for IDs and for specific ID groups. Results. An estimated 40,085,978 (standard error, 255,418) hospitalizations with a first-listed ID occurred during 1998-2006, for an age-adjusted hospitalization rate of 154.4 (95% confidence interval, 153.3-155.5) hospitalizations per 10,000 persons. The rate increased slightly over the study period (152.5 [95% confidence interval, 149.6-155.4] in 1998 vs 162.2 [95% confidence interval, 158.7-165.5] in 2006); an increase was seen for both sexes, for older patients, and for Hispanic patients. Among those aged 5-39 years, female patients had a significantly higher hospitalization rate than did male patients; male patients had higher rates among the youngest children and adults aged >= 40 years. Approximately 4.5 million hospital days and $865 billion in hospital charges were associated with primary ID hospitalizations over the study period. Lower respiratory tract infections were the most commonly listed ID (34.4%), followed by kidney, urinary tract, and bladder infections; cellulitis; and abdominal and rectal infections. Conclusions. The ID hospitalization rate increased during 1998-2006, reflecting an increase in ID hospitalizations among adults aged >= 30 years, particularly older adults. Differences in trends and patterns of ID hospitalizations were noted by sex, age group, and race. Lower respiratory tract infections accounted for the largest proportion of ID hospitalizations. Future efforts should focus on preventive measures and improving early interventions for IDs. C1 [Christensen, Krista L. Yorita; Holman, Robert C.; Sejvar, James J.; Schonberger, Lawrence B.] Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Zoonot Vector Borne & Enter Dis, US Dept Hlth & Human Serv, Atlanta, GA 30333 USA. [Stoll, Barbara J.] Emory Sch Med, Dept Pediat, Atlanta, GA USA. [Steiner, Claudia A.] US Dept Hlth & Human Serv, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Christensen, KLY (reprint author), Ctr Dis Control & Prevent, Div Viral & Rickettsial Dis, Natl Ctr Zoonot Vector Borne & Enter Dis, US Dept Hlth & Human Serv, MS A-39, Atlanta, GA 30333 USA. EM KYorita@cdc.gov NR 32 TC 59 Z9 60 U1 0 U2 3 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1058-4838 EI 1537-6591 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD OCT PY 2009 VL 49 IS 7 BP 1025 EP 1035 DI 10.1086/605562 PG 11 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 492PX UT WOS:000269672300007 PM 19708796 ER PT J AU Berdahl, TA Stone, RAT AF Berdahl, Terceira A. Stone, Rosalie A. Torres TI Examining Latino Differences in Mental Healthcare Use: The Roles of Acculturation and Attitudes Towards Healthcare SO COMMUNITY MENTAL HEALTH JOURNAL LA English DT Article DE Racial-ethnic disparities; Latinos; Acculturation; Attitudes; Healthcare Use; Help-seeking ID HELP-SEEKING; SERVICE USE; LANGUAGE; ACCESS; BARRIERS; ILLNESS; GENDER AB Latinos are less likely to use mental health services compared to non-Latino whites, but little research has examined the relative contribution of acculturation and attitudes towards healthcare. In the current study, we analyze data from a nationally representative sample of Mexicans, Cubans, Puerto Ricans and non-Latino whites from the 2002-2003 Medical Expenditure Panel Survey (n = 30,234). Findings show different utilization patterns in use of specialty, non-specialty, and any type of mental healthcare across the three Latino subgroups. The predictive efficacy of acculturation variables on ethnic group differences varies by subgroup. Self-reliant attitudes towards healthcare are associated with lower use, but these attitudes do not explain the ethnic gaps in use. C1 [Berdahl, Terceira A.] AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [Stone, Rosalie A. Torres] Univ Massachusetts, Sch Med, Dept Psychiat, Ctr Mental Hlth Serv Res, Worcester, MA 01655 USA. RP Berdahl, TA (reprint author), AHRQ, Ctr Financing Access & Cost Trends, 540 Gaither Rd,Suite 5000, Rockville, MD 20850 USA. EM terceira.berdahl@ahrq.hhs.gov; terceirab@yahoo.com NR 29 TC 20 Z9 20 U1 0 U2 7 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0010-3853 J9 COMMUNITY MENT HLT J JI Community Ment. Health J. PD OCT PY 2009 VL 45 IS 5 BP 393 EP 403 DI 10.1007/s10597-009-9231-6 PG 11 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA 501LU UT WOS:000270384200009 PM 19690955 ER PT J AU Billinger, ME Olivier, KN Viboud, C de Oca, RM Steiner, C Holland, SM Prevots, DR AF Billinger, Megan E. Olivier, Kenneth N. Viboud, Cecile de Oca, Ruben Montes Steiner, Claudia Holland, Steven M. Prevots, D. Rebecca TI Nontuberculous Mycobacteria-associated Lung Disease in Hospitalized Persons, United States, 1998-2005 SO EMERGING INFECTIOUS DISEASES LA English DT Article ID AVIUM COMPLEX; PULMONARY-DISEASE; ENVIRONMENTAL MYCOBACTERIA; CYSTIC-FIBROSIS; INFECTION; INTRACELLULARE; EPIDEMIOLOGY; PREVALENCE; SPECIMENS; DIAGNOSIS AB The prevalence and trends of pulmonary nontuberculous mycobacteria (NTM)-associated hospitalizations in the United States were estimated using national hospital discharge data. Records were extracted for all persons with a pulmonary NTM International Classification of Diseases code (031.0) hospitalized in the 11 states with continuous data available from 1998 through 2005. Prevalence was calculated using US census data. Pulmonary NTM hospitalizations (031.0) increased significantly with age among both sexes: relative prevalence for persons 70-79 years of age compared with those 40-49 years of age was 15/100,000 for women (9.4 vs. 0.6) and 9/100,000 for men (7.6 vs. 0.83). Annual prevalence increased significantly among men and women in Florida (3.2%/year and 6.5%/year, respectively) and among women in New York (4.6%/year) with no significant changes in California. The prevalence of pulmonary NTM-associated hospitalizations is increasing in selected geographic areas of the United States. C1 [Prevots, D. Rebecca] NIAID, NIH, Bethesda, MD 20892 USA. [Billinger, Megan E.] George Washington Univ, Washington, DC USA. [Steiner, Claudia] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Prevots, DR (reprint author), NIAID, NIH, 8 West Dr,MSC 2665, Bethesda, MD 20892 USA. EM rprevots@niaid.nih.gov FU Division of Intramural Research, National Institute of Allergy and Infectious Diseases FX This work was supported by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases. NR 37 TC 66 Z9 74 U1 0 U2 5 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1080-6040 J9 EMERG INFECT DIS JI Emerg. Infect. Dis PD OCT PY 2009 VL 15 IS 10 BP 1562 EP 1569 DI 10.3201/eid1510.090196 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 503ZD UT WOS:000270580600003 PM 19861046 ER PT J AU Khoury, MJ Rich, EC Randhawa, G Teutsch, SM Niederhuber, J AF Khoury, Muin J. Rich, Eugene C. Randhawa, Gurvaneet Teutsch, Steven M. Niederhuber, John TI Comparative effectiveness research and genomic medicine: An evolving partnership for 21st century medicine SO GENETICS IN MEDICINE LA English DT Editorial Material DE genomics; medicine; comparative effectiveness; evidence-based medicine ID EGAPP WORKING GROUP; PERSONALIZED MEDICINE; WARFARIN; POLICY; RECOMMENDATIONS; ANTICOAGULATION; PREDICTION; GENETICS; CANCER; HEALTH AB The American Recovery and Reinvestment Act has provided resources for comparative effectiveness research that will lead to evidence-based decisions about health and health care choices. Some have voiced concerns that evidence-based comparative effectiveness research principles are only relevant to "average" patients and not as much to individuals with unique combinations of genes, exposures and disease outcomes, intrinsic to genomic medicine. In this commentary, we argue that comparative effectiveness research and genomic medicine not only can and should coexist but also they will increasingly benefit front each other. The promise and success of genomic medicine will depend on rigorous comparative effectiveness research to compare outcomes for genome-based applications in practice to traditional non-genome-based approaches. In addition, the success of comparative effectiveness research will depend on developing new methods and clinical research infrastructures to integrate genome-based personalized perspectives into point of care decisions by patients and providers. There is a need to heal the apparent schism between genomic medicine and comparative effectiveness research to enhance knowledge-driven practice of medicine in the 21st century. Genet Aled 2009:11(10):707-711. C1 [Khoury, Muin J.] Ctr Dis Control & Prevent, Off Publ Hlth Genom, Atlanta, GA 30333 USA. [Khoury, Muin J.; Niederhuber, John] NCI, Bethesda, MD 20892 USA. [Rich, Eugene C.] Assoc Amer Med Coll, Washington, DC USA. [Randhawa, Gurvaneet] Agcy Healthcare Res & Qual, Rockville, MD USA. [Teutsch, Steven M.] Los Angeles Cty Dept Publ Hlth, Los Angeles, CA USA. RP Khoury, MJ (reprint author), Ctr Dis Control & Prevent, Off Publ Hlth Genom, 1600 Clifton Rd, Atlanta, GA 30333 USA. EM mkhoury@cdc.gov NR 40 TC 29 Z9 31 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1098-3600 J9 GENET MED JI Genet. Med. PD OCT PY 2009 VL 11 IS 10 BP 707 EP 711 DI 10.1097/GIM.0b013e3181b99b90 PG 5 WC Genetics & Heredity SC Genetics & Heredity GA 515EK UT WOS:000271449800003 PM 19752739 ER PT J AU Williams, C Moore, T Spector, W Limcangco, R AF Williams, C. Moore, T. Spector, W. Limcangco, R. TI A NURSING HOME QUALITY MEASURE FOR SERIOUS FALL-RELATED INJURIES SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Williams, C.; Moore, T.] ABT Associates Inc, Durham, NC USA. [Spector, W.; Limcangco, R.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2009 VL 49 SU 2 BP 73 EP 74 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 519UI UT WOS:000271793900347 ER PT J AU Sharkey, S Dichter, E Hudak, S Spector, W Horn, SD AF Sharkey, S. Dichter, E. Hudak, S. Spector, W. Horn, S. D. TI A PRACTICAL APPROACH TO REDUCING PRESSURE ULCERS IN NURSING FACILITIES: NY STATE'S EXPERIENCE IMPLEMENTING ON-TIME QI SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Sharkey, S.; Hudak, S.] Hlth Management Strategies, Austin, TX USA. [Spector, W.] Agcy Hlth Care Res & Qual, Rockville, MD USA. [Horn, S. D.] Inst Clin Outcomes Res, Salt Lake City, UT USA. [Dichter, E.] NY State Dept Hlth, Albany, NY USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2009 VL 49 SU 2 BP 290 EP 290 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 519UK UT WOS:000271794100400 ER PT J AU Troyer, J McAuley, WJ McCutcheon, M AF Troyer, J. McAuley, W. J. McCutcheon, M. TI COST-EFFECTIVENESS OF MEDICAL NUTRITION THERAPY AND MEALS FOR SENIORS WITH CARDIOVASCULAR DISEASE SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Troyer, J.] Univ N Carolina, Charlotte, NC 28223 USA. [McAuley, W. J.; McCutcheon, M.] George Mason Univ, Fairfax, VA 22030 USA. [McAuley, W. J.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2009 VL 49 SU 2 BP 402 EP 402 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 519UK UT WOS:000271794100954 ER PT J AU Spector, W Mukamel, DB Limcangco, R AF Spector, W. Mukamel, D. B. Limcangco, R. TI THE COST OF INCREASING THE PROPORTION OF POST-ACUTE CCARE PATIENTS IN NURSING HOMES SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Spector, W.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Mukamel, D. B.] Univ Calif Irvine, Irvine, CA USA. [Limcangco, R.] Social & Sci Syst Inc, Silver Spring, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2009 VL 49 BP 428 EP 428 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 519UL UT WOS:000271794200104 ER PT J AU McDonald, K Karon, S Lee, S Geppert, J Cubbins, LA Potter, D AF McDonald, K. Karon, S. Lee, S. Geppert, J. Cubbins, L. A. Potter, D. TI USING THE MEDICAID ANALYTIC EXTRACT (MAX) TO IDENTIFY THE HCBS (ASSISTED LIVING) WAIVER POPULATION SO GERONTOLOGIST LA English DT Meeting Abstract C1 [McDonald, K.] Stanford Univ, Ctr Hlth Policy, Ctr Primary Care & Outcomes Res, Stanford, CA 94305 USA. [Karon, S.] Univ Wisconsin, Madison, WI USA. [Lee, S.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Geppert, J.] Battelle Mem Inst, Arlington, VA USA. [Cubbins, L. A.] Battelle Mem Inst, Seattle, WA USA. [Potter, D.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2009 VL 49 BP 429 EP 429 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 519UL UT WOS:000271794200110 ER PT J AU Potter, D AF Potter, D. TI UPDATE: ESTIMATES ON THE LONG-TERM CARE POPULATION SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Potter, D.] AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2009 VL 49 BP 429 EP 429 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 519UL UT WOS:000271794200109 ER PT J AU Potter, D AF Potter, D. TI IS IT A HEALTH CARE FACILITY, A HOUSING UNIT OR A GROUP QUARTERS SETTING? IMPLICATIONS AND POSSIBLE DATA SOURCES SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Potter, D.] AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2009 VL 49 BP 429 EP 429 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 519UL UT WOS:000271794200108 ER PT J AU Zuvekas, SH Olin, GL AF Zuvekas, Samuel H. Olin, Gary L. TI Validating Household Reports of Health Care Use in the Medical Expenditure Panel Survey SO HEALTH SERVICES RESEARCH LA English DT Article DE Self-reported utilization; concordance; validity ID SELF-REPORT; PHYSICIAN UTILIZATION; PROVIDER RECORDS; SERVICES; CONCORDANCE; INFORMATION; ACCURACY AB Background The Medical Expenditure Panel Survey (MEPS) is a widely used nationally representative survey of health care use and expenditures. Numerous studies raise concerns that use is underreported in household surveys. Objective To assess the quality of household reports in the MEPS and the impact of misreporting on descriptive and behavioral analyses. Research Design Participants in MEPS with Medicare coverage during 2001-2003 were matched to their Medicare enrollment and claims data (4,045 person-year observations). Household reports of Medicare-covered services for the matched sample were validated against Medicare claims. Standard models of the determinants of health care utilization were estimated with both MEPS and claims-based utilization measures. Measures In-person interviews with household informants obtained data on hospital inpatient, emergency department (ED), and office-based visits. Comparable measures were created from the claims. Results In the validation sample, households accurately reported inpatient stays (agreement rate=0.96, kappa=0.89) and number of nights (Lin's concordance statistic=0.88). Households underreported ED visits by one-third (Lin's concordance statistic=0.51) and office visits by 19 percent (Lin's concordance statistic=0.67). Conclusions Household respondents in the validation sample accurately report inpatient hospitalizations but underreport ED and office visits. Behavioral analyses are largely unaffected because underreporting cuts across all sociodemographic groups. C1 [Zuvekas, Samuel H.] AHRQ, CFACT, Rockville, MD 20850 USA. RP Zuvekas, SH (reprint author), AHRQ, CFACT, 540 Gaither Rd, Rockville, MD 20850 USA. EM samuel.zuvekas@ahrq.hhs.gov NR 29 TC 40 Z9 40 U1 0 U2 9 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 2009 VL 44 IS 5 BP 1679 EP 1700 DI 10.1111/j.1475-6773.2009.00995.x PG 22 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 490IO UT WOS:000269494600014 PM 19619249 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Healthcare Quality and Disparities Attacking Problems at Their Root SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. NR 5 TC 2 Z9 2 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 OCT-DEC PY 2009 VL 24 IS 4 BP 269 EP 272 PG 4 WC Nursing SC Nursing GA 497GX UT WOS:000270047500001 PM 19755876 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, AJ Gregory, KD Harris, R Isham, GJ LeFevre, ML Leipzig, RM Loveland-Cherry, C Marion, LN Melnyk, B Moyer, VA Ockene, JK Sawaya, GF Yawn, BP AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen J. Gregory, Kimberly D. Harris, Russell Isham, George J. LeFevre, Michael L. Leipzig, Rosanne M. Loveland-Cherry, Carol Marion, Lucy N. Melnyk, Bernadette Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Yawn, Barbara P. CA US Preventive Services Task Force TI Screening of Infants for Hyperbilirubinemia to Prevent Chronic Bilirubin Encephalopathy: US Preventive Services Task Force Recommendation Statement SO PEDIATRICS LA English DT Article DE encephalopathy; hyperbilirubinemia; infants; prevention; screening ID NEWBORNS; MANAGEMENT; RISK AB DESCRIPTION: Recommendation on screening newborn infants, based on a recent supplemental review of a 2003 Agency for Healthcare Research and Quality evidence report on the effectiveness of various screening strategies for preventing the development of chronic bilirubin encephalopathy, performed at the request of the US Preventive Services Task Force (USPSTF). This topic has not been previously considered by the USPSTF. METHODS: The USPSTF reviewed experimental and observational studies that included comparison groups. For harms associated with phototherapy, case reports or case series were also included. CONCLUSION: The evidence is insufficient to assess the balance of benefits and harms of screening for hyperbilirubinemia to prevent chronic bilirubin encephalopathy (I statement). Pediatrics 2009; 124: 1172-1177 C1 [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Melnyk, Bernadette] Arizona State Univ, Coll Nursing & Hlth Innovat, Phoenix, AZ USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen J.] Dartmouth Med Sch, Lebanon, NH USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Harris, Russell] Univ N Carolina, Sch Med, Chapel Hill, NC USA. [Isham, George J.] HealthPartners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Leipzig, Rosanne M.] Mt Sinai Sch Med, New York, NY USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Med, Ann Arbor, MI USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Moyer, Virginia A.] Baylor Coll Med, Houston, TX 77030 USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Yawn, Barbara P.] Olmsted Med Ctr, Rochester, MN USA. RP Calonge, N (reprint author), Care of Barton M, Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. NR 12 TC 23 Z9 25 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 OCT PY 2009 VL 124 IS 4 BP 1172 EP 1177 DI 10.1542/peds.2009-0128 PG 6 WC Pediatrics SC Pediatrics GA 500CI UT WOS:000270274300020 ER PT J AU Teschemaker, AR Lawrence, W AF Teschemaker, A. R. Lawrence, W. TI COST-EFFECTIVENESS OF GENEOTYPE-GUIDED DOSING OF SHORT-TERM USE OF WARFARIN AMONG DVT/PE PATIENTS SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Teschemaker, A. R.] Howard Univ, Washington, DC 20059 USA. [Lawrence, W.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD OCT PY 2009 VL 12 IS 7 BP A332 EP A332 DI 10.1016/S1098-3015(10)74632-5 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 495GH UT WOS:000269878100557 ER PT J AU Barton, MB Elmore, JG AF Barton, Mary B. Elmore, Joann G. TI Pointing the Way to Informed Medical Decision Making: Test Characteristics of Clinical Breast Examination SO JOURNAL OF THE NATIONAL CANCER INSTITUTE LA English DT Editorial Material ID UNITED-STATES; MAMMOGRAPHY; CANCER; DETECT C1 [Elmore, Joann G.] Univ Washington, Sch Med, Dept Med, Seattle, WA 98104 USA. [Barton, Mary B.] Ctr Primary Care Prevent & Clin Partnerships, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Elmore, JG (reprint author), Univ Washington, Sch Med, Dept Med, 325 9th Ave,Box 359780, Seattle, WA 98104 USA. EM jelmore@u.washington.edu FU NCI NIH HHS [K05 CA 104699, K05 CA104699] NR 20 TC 1 Z9 1 U1 0 U2 3 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 16 PY 2009 VL 101 IS 18 BP 1223 EP 1224 DI 10.1093/jnci/djp279 PG 2 WC Oncology SC Oncology GA 496YD UT WOS:000270015400001 PM 19720968 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI New Patient Safety Culture Survey Helps Medical Offices Assess Awareness 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 5 TC 0 Z9 0 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 SEP-OCT PY 2009 VL 24 IS 5 BP 441 EP 443 DI 10.1177/1062860609343055 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 493VH UT WOS:000269765900008 PM 19666740 ER PT J AU Petitti, DB Teutsch, SM Barton, MB Sawaya, GF Ockene, JK DeWitt, T AF Petitti, Diana B. Teutsch, Steven M. Barton, Mary B. Sawaya, George F. Ockene, Judith K. DeWitt, Thomas TI Comparing the USPSTF and GRADE Approaches to Recommendations RESPONSE SO ANNALS OF INTERNAL MEDICINE LA English DT Letter ID SERVICES TASK-FORCE; QUALITY; STRENGTH; UPDATE; SYSTEMS C1 [Petitti, Diana B.] Arizona State Univ, Phoenix, AZ 85041 USA. [Teutsch, Steven M.] Los Angeles Cty Dept Publ Hlth, Los Angeles, CA 90012 USA. [Barton, Mary B.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA 01655 USA. [DeWitt, Thomas] Univ Cincinnati, Coll Med, Cincinnati, OH 45229 USA. RP Petitti, DB (reprint author), Arizona State Univ, Phoenix, AZ 85041 USA. NR 12 TC 1 Z9 1 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 SEP 1 PY 2009 VL 151 IS 5 BP 363 EP 364 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 492KB UT WOS:000269653100014 ER PT J AU Finkelstein, EA Trogdon, JG Cohen, JW Dietz, W AF Finkelstein, Eric A. Trogdon, Justin G. Cohen, Joel W. Dietz, William TI Annual Medical Spending Attributable To Obesity: Payer- And Service-Specific Estimates SO HEALTH AFFAIRS LA English DT Article AB In 1998 the medical costs of obesity were estimated to be as high as $ 78.5 billion, with roughly half financed by Medicare and Medicaid. This analysis presents updated estimates of the costs of obesity for the United States across payers (Medicare, Medicaid, and private insurers), in separate categories for inpatient, non-inpatient, and prescription drug spending. We found that the increased prevalence of obesity is responsible for almost $ 40 billion of increased medical spending through 2006, including $ 7 billion in Medicare prescription drug costs. We estimate that the medical costs of obesity could have risen to $ 147 billion per year by 2008. [Health Affairs 28, no. 5 (2009): w822-w831 (published online 27 July 2009; 10.1377/hlthaff.28.5.w822)] C1 [Finkelstein, Eric A.; Trogdon, Justin G.] RTI Int, Publ Hlth Econ Program, Res Triangle Pk, NC USA. [Cohen, Joel W.] Agcy Healthcare Res & Qual, Div Social & Econ Res, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Dietz, William] Ctr Dis Control & Prevent, Div Nutr & Phys Act, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA. RP Finkelstein, EA (reprint author), RTI Int, Publ Hlth Econ Program, Res Triangle Pk, NC USA. EM finkelse@rti.org FU CDC Foundation FX Eric Finkelstein and Justin Trogdon received external support for this work through a contract with the CDC Foundation. The authors thank Charles Feagan for his research assistance. NR 9 TC 848 Z9 860 U1 13 U2 95 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 2009 VL 28 IS 5 BP W822 EP W831 DI 10.1377/hlthaff.28.5.w822 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 492HP UT WOS:000269646100058 PM 19635784 ER PT J AU Poon, EG Cusack, CM McGowan, JJ AF Poon, Eric G. Cusack, Caitlin M. McGowan, Julie J. TI Evaluating Healthcare Information Technology Outside of Academia: Observations from the National Resource Center for Healthcare Information Technology at the Agency for Healthcare Research and Quality SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article AB The National Resource Center for Health Information Technology (NRC) was formed in the fall of 2004 as part of the Agency for Healthcare Research and Quality (AHRQ) health IT portfolio to support its grantees. One of the core functions of the NRC was to assist grantees in their evaluation efforts of Health IT. This manuscript highlights some common challenges experienced by health IT project teams at nonacademic institutions, including inappropriately scoped and resourced evaluation efforts, inappropriate choice of metrics, inadequate planning for data collection and analysis, and lack of consideration of qualitative methodologies. Many of these challenges can be avoided or overcome. The strategies adopted by various AHRQ grantees and the lessons learned from their projects should become part of the toolset for current and future implementers of health IT as the nation moves rapidly towards its widespread adoption. C1 [Poon, Eric G.] Brigham & Womens Hosp, Dept Med, Div Gen Med & Primary Care, Boston, MA 02120 USA. [Poon, Eric G.] Harvard Univ, Sch Med, Boston, MA USA. [Cusack, Caitlin M.] Univ Chicago, Natl Opin Res Ctr, Off Bethesda, Bethesda, MD USA. [McGowan, Julie J.] Indiana Univ, Sch Med, Indianapolis, IN USA. [McGowan, Julie J.] Regenstrief Inst Inc, Indianapolis, IN USA. [Cusack, Caitlin M.; McGowan, Julie J.] Agcy Healthcare Res & Qual, Natl Resource Ctr Healthcare Informat Technol, Rockville, MD USA. RP Poon, EG (reprint author), Brigham & Womens Hosp, Dept Med, Div Gen Med & Primary Care, 3-F 1620 Tremont St, Boston, MA 02120 USA. EM epoon@partners.org FU PHS HHS [290-04-0016] NR 16 TC 3 Z9 3 U1 3 U2 5 PU HANLEY & BELFUS-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 1067-5027 J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD SEP-OCT PY 2009 VL 16 IS 5 BP 631 EP 636 DI 10.1197/jamia.M3033 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 493RL UT WOS:000269755500004 PM 19567800 ER PT J AU Kumar, V Encinosa, W AF Kumar, Virender Encinosa, William TI Effects of Antidepressant Treatment on Antiretroviral Regimen Adherence Among Depressed HIV-Infected Patients SO PSYCHIATRIC QUARTERLY LA English DT Article DE Medication adherence; HIV drugs; Antidepressants ID NATIONAL PROBABILITY SAMPLES; LOW-PREVALENCE DISEASES; MEDICATION ADHERENCE; SERVICES UTILIZATION; INHIBITOR THERAPY; DRUG-USERS; OUTCOMES; ADULTS; PERSPECTIVES; METAANALYSIS AB This study examined whether the relationship between HAART medication adherence and antidepressant treatment varied with HAART regimen complexity. The analysis included 1,192 respondents to the HIV Cost and Service Utilization Study (HCSUS) who were taking HAART. Self-reported past-week HAART adherence, antidepressant use, current mental health status, and an aggregate measure of regimen complexity were used in the analysis. Regression models with interactions between antidepressant treatment of mental health problems, poor emotional well-being or depressive symptoms, and medication complexity were estimated to assess differential associations with adherence. Irrespective of antidepressant treatment, poor mental health status was negatively associated with HAART medication adherence. However, only untreated higher depressive symptoms were strongly associated with maladherence to HAART medication (OR = 0.72 at P < 0.05). Medication complexity was strongly associated with maladherence to HAART medication (OR = 0.96 with P < 0.05) in the model including emotional well-being; and weakly associated with maladherence (OR = 0.97 and P < 0.07) in the model including depressive and/or anxiety symptoms. However, as HAART medication complexity increased, adherence was higher among individuals with poorer mental health but using antidepressants compared to those with better mental health (OR = 1.09 with P < 0.05 in the model including emotional well-being; OR = 1.09 and P < 0.05 in the model including depressive and/or anxiety symptoms), and compared to those with poorer mental health but not using antidepressants (OR = 1.09, P = 0.08 in the model including emotional well-being, and OR = 1.12, P < 0.05 in model including depressive and/or anxiety symptoms). In conclusion, while individuals with poorer mental health generally have poor HAART adherence, their adherence improved with the use of antidepressants as the HAART complexity increased. C1 [Encinosa, William] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Kumar, Virender] WESTAT Corp, Rockville, MD 20850 USA. RP Encinosa, W (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM William.Encinosa@ahrq.hhs.gov NR 28 TC 21 Z9 22 U1 1 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0033-2720 J9 PSYCHIAT QUART JI Psychiatr. Q. PD SEP PY 2009 VL 80 IS 3 BP 131 EP 141 DI 10.1007/s11126-009-9100-z PG 11 WC Psychiatry SC Psychiatry GA 483YJ UT WOS:000269009100001 PM 19387832 ER PT J AU Pezzin, LE Pollak, RA Schone, BS AF Pezzin, Liliana E. Pollak, Robert A. Schone, Barbara S. TI Long-term care of the disabled elderly: do children increase caregiving by spouses? SO REVIEW OF ECONOMICS OF THE HOUSEHOLD LA English DT Article DE Intergenerational transfers; Families; Long-term care; Disability ID ADULT CHILDREN; PARENTS; TRANSFERS AB Do adult children affect the care elderly parents provide each other? We develop two models in which the anticipated behavior of adult children provides incentives for nondisabled elderly parents to increase care for their disabled spouses. The "demonstration effect'' postulates that adult children learn from a parent's example that family caregiving is appropriate behavior. The "punishment effect'' postulates that adult children may punish parents who fail to provide spousal care by not providing future care for the nondisabled spouse if and when necessary. Thus, joint children act as a commitment mechanism, increasing the probability that elderly parents will provide care for their disabled spouses. We argue that stepchildren provide weaker incentives for spousal care because the attachment of a stepchild to a stepparent is likely to be weaker than the attachment of children to parents in a traditional nuclear family. Using data from the HRS, we find evidence consistent with the hypothesis that joint children provide stronger incentives than stepchildren for nondisabled elderly parents to provide care for their disabled spouse. C1 [Pollak, Robert A.] Washington Univ, Dept Econ, St Louis, MO 63130 USA. [Pollak, Robert A.] Washington Univ, Olin Business Sch, St Louis, MO 63130 USA. [Pezzin, Liliana E.] Med Coll Wisconsin, Milwaukee, WI 53226 USA. [Schone, Barbara S.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Schone, Barbara S.] Georgetown Univ, Washington, DC USA. RP Pollak, RA (reprint author), Washington Univ, Dept Econ, St Louis, MO 63130 USA. EM lpezzin@mcw.edu; pollak@wustl.edu; bschone@ahrq.gov FU NIA NIH HHS [R01 AG024049-02, R01 AG024049, R01 AG024049-01, R01 AG024049-03] NR 19 TC 12 Z9 12 U1 5 U2 13 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1569-5239 J9 REV ECON HOUSEHOLD JI Rev. Econ. Househ. PD SEP PY 2009 VL 7 IS 3 BP 323 EP 339 DI 10.1007/s11150-009-9057-6 PG 17 WC Economics SC Business & Economics GA 666BI UT WOS:000283082500006 PM 20473357 ER PT J AU Weaver, F Stearns, SC Norton, EC Spector, W AF Weaver, France Stearns, Sally C. Norton, Edward C. Spector, William TI PROXIMITY TO DEATH AND PARTICIPATION IN THE LONG-TERM CARE MARKET SO HEALTH ECONOMICS LA English DT Article DE proximity to death; long-term care; informal care ID NURSING-HOME POPULATION; INFORMAL CARE; MEDICARE EXPENDITURES; PROBIT MODELS; ELDERLY PARENTS; HEALTH; LONGEVITY; TIME; LIFE; AGE AB The extent to which increasing longevity increases per capita demand for long-term care depends oil the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities Of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care - i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70 + from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-residence with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal Support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect oil institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, Such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care. Copyright (C) 2008 John Wiley & Sons, Ltd. C1 [Weaver, France] Swiss Hlth Observ, CH-2010 Neuchatel, Switzerland. [Stearns, Sally C.] Univ N Carolina, Dept Hlth Policy & Management, Chapel Hill, NC USA. [Norton, Edward C.] Univ Michigan, Dept Hlth Policy & Management, Ann Arbor, MI 48109 USA. [Norton, Edward C.] Univ Michigan, Dept Econ, Ann Arbor, MI 48109 USA. [Spector, William] Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Weaver, F (reprint author), Swiss Hlth Observ, Espace Europe 10, CH-2010 Neuchatel, Switzerland. EM france.weaver@bfs.admin.ch RI Norton, Edward/B-2211-2009 OI Norton, Edward/0000-0003-4555-0631 FU Swiss Science Foundation [PBSK1-106659]; University of North Carolina at Chapel Hill [NIA P30 AG024376] FX Our thanks go to Frank Sloan, Willard Manning, Peter Kemper and Peggy Dilworth-Anderson for helpful comments during the course of this study. We also want to thank the participants at the inaugural ASHE conference in Madison and the Health Service Research Colloquium at The Pennsylvania State University, in particular John Moran and Pamela Farley Short. This research was funded by the Swiss Science Foundation, grant number PBSK1-106659. Additional support was provided by the Demography and Economics of Aging Research Group at The University of North Carolina at Chapel Hill, grant number NIA P30 AG024376. NR 46 TC 23 Z9 24 U1 0 U2 10 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1057-9230 EI 1099-1050 J9 HEALTH ECON JI Health Econ. PD AUG PY 2009 VL 18 IS 8 BP 867 EP 883 DI 10.1002/hec.1409 PG 17 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 474SZ UT WOS:000268305600002 PM 18770873 ER PT J AU Weidmer-Ocampo, B Johansson, P Dalpoas, D Wharton, D Darby, C Hays, RD AF Weidmer-Ocampo, Beverly Johansson, Patrick Dalpoas, Debbie Wharton, David Darby, Charles Hays, Ron D. TI Adapting CAHPS (R) for an American Indian Population SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Article DE CAHPS American Indian Survey; American Indian Health; community-based participatory research; American Indians ID HEALTH-CARE; HOSPITAL SURVEY; NATIVES AB Objective. Develop a culturally appropriate, reliable, and valid survey that can be used by the Choctaw Nation Health Services (CNHS) to compare patients' health care experiences across CNHS clinics, and to support quality improvement efforts. Methods. We worked with CNHS staff to adapt the CAHPS Clinician and Group Survey for this purpose. We conducted cognitive interviews and a field-test to evaluate the survey. Results. Cognitive testing yielded a survey that covered issues relevant to CNHS patients. Field testing yielded 696 surveys, (58% response rate). Analyses provided support for internal consistency of multi-item scales. Correlations among scales indicate the scales were related to one another but not redundant. Discussion. The CAHPS American Indian Survey is useful for assessing perceptions of care at the clinic level and across different clinics. The close partnership with CNHS helped yield a survey that is scientifically sound, reflects how services are organized and delivered locally, and meets CNHS information needs. C1 [Weidmer-Ocampo, Beverly] RAND Corp, Santa Monica, CA 90407 USA. [Johansson, Patrick] George Washington Univ, Sch Publ Hlth & Hlth Sci, Washington, DC 20052 USA. [Dalpoas, Debbie; Wharton, David] Choctaw Nation Hlth Care Ctr, Talihina, OK USA. [Darby, Charles] Agcy Healthcare Res & Qual, Rockville, MD USA. [Hays, Ron D.] Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res, Los Angeles, CA 90024 USA. RP Weidmer-Ocampo, B (reprint author), RAND Corp, 1776 Main St,POB 2138, Santa Monica, CA 90407 USA. RI Hays, Ronald/D-5629-2013 FU AHRQ HHS [U18 HS016980, U18 HS09204] NR 35 TC 3 Z9 3 U1 1 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 AUG PY 2009 VL 20 IS 3 BP 695 EP 712 PG 18 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 473JT UT WOS:000268203000009 PM 19648698 ER PT J AU Trontell, AE Hornbrook, M Crystal, S AF Trontell, Anne E. Hornbrook, Mark Crystal, Stephen TI Annual Roundtable Discussion: Centers for Education and Research on Therapeutics SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Trontell, Anne E.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Hornbrook, Mark] Kaiser Permanente NW, Ctr Hlth Res, Portland, OR USA. [Crystal, Stephen] Rutgers State Univ, Ctr Pharmacotherapy Chron Dis Management & Outcom, New Brunswick, NJ 08903 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 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 AUG PY 2009 VL 18 BP S124 EP S125 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 483YQ UT WOS:000269009900284 ER PT J AU Conway, PH Clancy, C AF Conway, Patrick H. Clancy, Carolyn TI Comparative-Effectiveness Research - Implications of the Federal Coordinating Council's Report SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID HEALTH-CARE C1 [Conway, Patrick H.; Clancy, Carolyn] Dept Hlth & Human Serv, Washington, DC USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA. [Clancy, Carolyn] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Conway, PH (reprint author), Dept Hlth & Human Serv, Washington, DC USA. NR 4 TC 104 Z9 108 U1 1 U2 1 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 JUL 23 PY 2009 VL 361 IS 4 BP 328 EP 330 DI 10.1056/NEJMp0905631 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 473DC UT WOS:000268184500002 PM 19567829 ER PT J AU Pitzer, VE Viboud, C Simonsen, L Steiner, C Panozzo, CA Alonso, WJ Miller, MA Glass, RI Glasser, JW Parashar, UD Grenfell, BT AF Pitzer, Virginia E. Viboud, Cecile Simonsen, Lone Steiner, Claudia Panozzo, Catherine A. Alonso, Wladimir J. Miller, Mark A. Glass, Roger I. Glasser, John W. Parashar, Umesh D. Grenfell, Bryan T. TI Demographic Variability, Vaccination, and the Spatiotemporal Dynamics of Rotavirus Epidemics SO SCIENCE LA English DT Article ID UNITED-STATES; SPATIAL HIERARCHIES; TRAVELING-WAVES; SEASONALITY; DIARRHEA; EFFICACY; MEASLES; SAFETY; GASTROENTERITIS; PROTECTION AB Historically, annual rotavirus activity in the United States has started in the southwest in late fall and ended in the northeast 3 months later; this trend has diminished in recent years. Traveling waves of infection or local environmental drivers cannot account for these patterns. A transmission model calibrated against epidemiological data shows that spatiotemporal variation in birth rate can explain the timing of rotavirus epidemics. The recent large-scale introduction of rotavirus vaccination provides a natural experiment to further test the impact of susceptible recruitment on disease dynamics. The model predicts a pattern of reduced and lagged epidemics postvaccination, closely matching the observed dynamics. Armed with this validated model, we explore the relative importance of direct and indirect protection, a key issue in determining the worldwide benefits of vaccination. C1 [Pitzer, Virginia E.; Grenfell, Bryan T.] Penn State Univ, Ctr Infect Dis Dynam, State Coll, PA 16801 USA. [Pitzer, Virginia E.; Viboud, Cecile; Alonso, Wladimir J.; Miller, Mark A.; Glass, Roger I.; Grenfell, Bryan T.] NIH, Fogarty Int Ctr, Bethesda, MD 20892 USA. [Simonsen, Lone] George Washington Univ, Sch Publ Hlth & Hlth Serv, Washington, DC 20052 USA. [Steiner, Claudia] US Dept HHS, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Panozzo, Catherine A.; Glasser, John W.; Parashar, Umesh D.] Ctr Dis Control & Prevent, Epidemiol Branch, Div Viral Dis, Natl Ctr Immunizat & Resp Dis, Atlanta, GA 30333 USA. [Grenfell, Bryan T.] Princeton Univ, Dept Ecol & Evolutionary Biol, Princeton, NJ 08544 USA. [Grenfell, Bryan T.] Princeton Univ, Woodrow Wilson Sch, Princeton, NJ 08544 USA. RP Pitzer, VE (reprint author), Penn State Univ, Ctr Infect Dis Dynam, State Coll, PA 16801 USA. EM vep2@psu.edu OI Pitzer, Virginia/0000-0003-1015-2289; Simonsen, Lone/0000-0003-1535-8526 FU NIH [R01 GM083983-01]; Bill and Melinda Gates Foundation; RAPIDD program of the Science and Technology Directorate; U.S. Department of Homeland Security FX V.E.P and B.G. were supported by NIH (grant R01 GM083983-01) and the Bill and Melinda Gates Foundation. V.E.P, B.G., and L.S. were also supported by the RAPIDD program of the Science and Technology Directorate, U.S. Department of Homeland Security, and the Fogarty International Center, NIH. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC). NR 30 TC 106 Z9 107 U1 2 U2 18 PU AMER ASSOC ADVANCEMENT SCIENCE PI WASHINGTON PA 1200 NEW YORK AVE, NW, WASHINGTON, DC 20005 USA SN 0036-8075 J9 SCIENCE JI Science PD JUL 17 PY 2009 VL 325 IS 5938 BP 290 EP 294 DI 10.1126/science.1172330 PG 5 WC Multidisciplinary Sciences SC Science & Technology - Other Topics GA 471DZ UT WOS:000268036600037 PM 19608910 ER PT J AU Lin, KW AF Lin, Kenneth W. TI New USPSTF Resources and Tools Can Help Put Prevention into Your Practice SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID SERVICES TASK-FORCE; CARE C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, Rockville, MD USA. RP Lin, KW (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnership, Rockville, MD USA. EM kenneth.lin@ahrq.hhs.gov NR 8 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 2009 VL 80 IS 2 BP 132 EP + PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 474EI UT WOS:000268264900003 PM 19621853 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, AJ Gregory, KD Grossman, D Isham, G LeFevre, ML Leipzig, RM Marion, LN Melnyk, B Moyer, VA Ockene, JK Sawaya, GF Schwartz, JS Wilt, T AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen J. Gregory, Kimberly D. Grossman, David Isham, George LeFevre, Michael L. Leipzig, Rosanne M. Marion, Lucy N. Melnyk, Bernadette Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Schwartz, J. Sanford Wilt, Timothy CA US Preventive Serv Task Force TI Screening for Impaired Visual Acuity in Older Adults: US Preventive Services Task Force Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID INTRAOCULAR-LENS IMPLANTATION; RANDOMIZED-TRIAL; UNITED-STATES; CATARACT-EXTRACTION; PREVALENCE; PEOPLE; VISION; FALLS AB Description: Update of the 1996 U. S. Preventive Services Task Force (USPSTF) recommendation statement on screening for visual impairment. Methods: The USPSTF reviewed evidence published since its last review on screening adults 65 years or older in the primary care setting for visual acuity impairment associated with uncorrected refractive errors, cataracts, and age-related macular degeneration. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for visual acuity for the improvement of outcomes in older adults. (I statement). C1 [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Petitti, Diana B.] Arizona State Univ, Phoenix, AZ USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen J.] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Hanover, NH 03756 USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Grossman, David] Grp Hlth Cooperat Puget Sound, Seattle, WA 98121 USA. [Isham, George] Hlth Partners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Leipzig, Rosanne M.] Mt Sinai Sch Med, New York, NY USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Melnyk, Bernadette] Arizona State Univ, Coll Nursing & Hlth Innovat, Phoenix, AZ USA. [Moyer, Virginia A.] Univ Texas Hlth Sci Ctr, Houston, TX USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Schwartz, J. Sanford] Univ Penn, Sch Med, Philadelphia, PA 19104 USA. [Schwartz, J. Sanford] Univ Penn, Wharton Sch, Philadelphia, PA 19104 USA. [Wilt, Timothy] Minneapolis Vet Affairs Med Ctr, Minneapolis, MN USA. [Wilt, Timothy] Univ Minnesota, Dept Med, Denver, CO USA. [US Preventive Serv Task Force] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Calonge, N (reprint author), Colorado Dept Publ Hlth & Environm, Denver, CO USA. FU Agency for Healthcare Research and Quality FX The USPSTF is an independent, voluntary body. The U. S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF. NR 27 TC 9 Z9 10 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 JUL 7 PY 2009 VL 151 IS 1 BP 37 EP U56 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 470BF UT WOS:000267946100005 ER PT J AU Lin, KW Slawson, DC AF Lin, Kenneth W. Slawson, David C. TI Identifying and Using Good Practice Guidelines SO AMERICAN FAMILY PHYSICIAN LA English DT Article ID CLINICAL-PRACTICE GUIDELINES; SERVICES TASK-FORCE; MEDICAL LITERATURE; USERS GUIDES; RECOMMENDATIONS; DISEASE AB Performance measurement and payment are increasingly linked to goals established by practice guidelines. The best guidelines are based on systematic reviews and patient-oriented evidence, use an evidence-rating system such as the Strength of Recommendation Taxonomy, and are prospectively validated. The guidelines also should have a transparent development process, identify potential conflicts of interest, and offer flexibility in various clinical situations. (Am Fam Physician. 2009;80(1):67-69. Copyright (C) 2009 American Academy of Family Physicians.) C1 [Lin, Kenneth W.] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. [Slawson, David C.] Univ Virginia, Sch Med, Dept Family Med, Charlottesville, VA 22908 USA. [Slawson, David C.] Univ Virginia, Sch Med, Fac Dev Fellowship Program, Charlottesville, VA 22908 USA. RP Lin, KW (reprint author), 540 Gaither Rd,Suite 6107, Rockville, MD 20850 USA. EM Kenneth.Lin@ahrq.hhs.gov NR 12 TC 5 Z9 5 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 1 PY 2009 VL 80 IS 1 BP 67 EP 69 PG 3 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 467WJ UT WOS:000267773500008 PM 19621847 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Reengineering Hospital Discharge: A Protocol to Improve Patient Safety, Reduce Costs, and Boost Patient Satisfaction 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 0 TC 19 Z9 19 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 JUL-AUG PY 2009 VL 24 IS 4 BP 344 EP 346 DI 10.1177/1062860609338131 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 469SG UT WOS:000267920000008 PM 19502567 ER PT J AU Lau, DT Kirby, JB AF Lau, Denys T. Kirby, James B. TI The Relationship Between Living Arrangement and Preventive Care Use Among Community-Dwelling Elderly Persons SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID MANAGED CARE; RECOMMENDATION STATEMENT; HEALTH EXAMINATIONS; SERVICES; AMERICANS; BEHAVIOR; WOMEN AB Objectives. We sought to examine the relationship between living arrangements and obtaining preventive care among the elderly population. Methods. We obtained data on 13038 community-dwelling elderly persons from the 2002 to 2005 Medical Expenditure Panel Survey and used multivariate logistic regression models to estimate the likelihood of preventive care use among elderly persons in 4 living arrangements: living alone (38%), living with one's spouse only (52%), living with one's spouse and with one's adult off spring (5%), and living with one's adult offspring only (5%). Preventive care services included influenza vaccination, physical and dental checkup, and screenings for hypertension, cholesterol, and colorectal cancer. Results. After we controlled for age, gender, race, education, income, health insurance, comorbidities, self-reported health, physical function status, and residence location, we found that elderly persons living with a spouse only were more likely than were those living alone to obtain all preventive care services, except for hypertension screening. However, those living with their adult offspring were not more likely to obtain recommended preventive care compared with those living alone. These results did not change when the employment status and functional status of adult offspring were considered. Conclusions. Interventions to improve preventive care use should target not only those elderly persons who live alone but also those living with adult offspring. (Am J Public Health. 2009;99:1315-1321. doi:10.2105/AJPH.2008.151142) C1 [Lau, Denys T.] Northwestern Univ, Feinberg Sch Med, Buehler Ctr Aging Hlth & Soc, Chicago, IL 60611 USA. [Lau, Denys T.] Northwestern Univ, Feinberg Sch Med, Dept Med, Div Gen Internal Med, Chicago, IL 60611 USA. [Kirby, James B.] Agcy Hlth Care Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Lau, DT (reprint author), Northwestern Univ, Feinberg Sch Med, Buehler Ctr Aging Hlth & Soc, 750 N Lake Share Dr,Suite 601, Chicago, IL 60611 USA. EM D-Lau@northwestern.edu FU National Institute on Aging [5K01AG02729502] FX No sources of funding were used to assist in the preparation of this study. During part of this study, D. T. Lau was supported by a K-01 career development award from the National Institute on Aging (5K01AG02729502). NR 23 TC 18 Z9 18 U1 1 U2 10 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 JUL PY 2009 VL 99 IS 7 BP 1315 EP 1321 DI 10.2105/AJPH.2008.151142 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 463CL UT WOS:000267406100031 PM 19443817 ER PT J AU Talati, R Reinhart, KM White, CM Phung, OJ Sedrakyan, A Kluger, J Coleman, CI AF Talati, Ripple Reinhart, Kurt M. White, C. Michael Phung, Olivia J. Sedrakyan, Art Kluger, Jeffrey Coleman, Craig I. TI Outcomes of Perioperative beta-Blockade in Patients Undergoing Noncardiac Surgery: A Meta-Analysis SO ANNALS OF PHARMACOTHERAPY LA English DT Article DE beta-blocker; ischemia; meta-analysis; noncardiac surgery ID RANDOMIZED CONTROLLED-TRIAL; MYOCARDIAL-INFARCTION; MULTICENTER TRIAL; VASCULAR-SURGERY; CLINICAL-TRIALS; RISK PATIENTS; QUALITY; BLOCKERS; BISOPROLOL; METOPROLOL AB BACKGROUND: Several studies have evaluated the impact on myocardial infarction (MI), stroke, and overall mortality of perioperative beta-blocker use in patients undergoing noncardiac surgery (NCS). However, most studies did not have adequate sample size and statistical power and were therefore under-powered to adequately evaluate these endpoints. OBJECTIVE: To conduct a meta-analysis to determine the balance of benefits and harms associated with perioperative beta-blocker use in NCS. METHODS: A systematic literature search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from January 1960 through February 2009. Manual reference search was performed to identify additional relevant trials. Randomized, double-blinded, placebo-controlled trials comparing the use of beta-blockers with placebo; using beta-blockers perioperatively in beta-blocker-naive patients undergoing NCS; and evaluating endpoints of MI, stroke, or all-cause mortality were included. RESULTS: Six trials (N = 10,183) met our inclusion criteria. Perioperative beta-blocker use was associated with a significant reduction in patients' odds of developing MI (OR 0.74, 95% CI 0.61 to 0.89) but a significant increase in odds of developing stroke (OR 1.98, 95% CI 1.23 to 3.20) and also a nonsignificant increase in mortality (OR 1.21, 95% CI 0.98 to 1.49) versus placebo. Control-rate meta-regression determined that patients with highest baseline odds of stroke had decreased relative odds of having a stroke with a beta-blocker versus placebo (beta coefficient -0.97;95% credible interval -1.04 to -0.90). CONCLUSIONS: When perioperative beta-blockers are used in NCS patients, there is a trade-off between reduction in MI and increase in stroke, with a troubling trend toward an increase in mortality. Patients with lower baseline odds of developing stroke appear to be at greater risk of beta-blocker-induced stroke. C1 [Coleman, Craig I.] Hartford Hosp, Pharmacoecon & Outcomes Studies Grp, Hartford, CT 06102 USA. [Coleman, Craig I.] Univ Connecticut, Sch Pharm, Storrs, CT 06269 USA. [White, C. Michael] Univ Connecticut, Hartford Hosp, Evidence Based Practice Ctr, Storrs, CT 06269 USA. [Sedrakyan, Art] Dept Hlth & Human Serv, Agcy Hlth Care Res & Qual, Ctr Outcomes & Evidence, Washington, DC USA. [Kluger, Jeffrey] Univ Connecticut, Hartford Hosp, Sch Med, Storrs, CT 06269 USA. RP Coleman, CI (reprint author), Hartford Hosp, Pharmacoecon & Outcomes Studies Grp, 80 Seymour St, Hartford, CT 06102 USA. EM ccolema@harthosp.org NR 27 TC 14 Z9 15 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 2009 VL 43 IS 7-8 BP 1181 EP 1188 DI 10.1345/aph.1L706 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 477IM UT WOS:000268512700003 PM 19531697 ER PT J AU Khoury, MJ Feero, WG Reyes, M Citrin, T Freedman, A Leonard, D Burke, W Coates, R Croyle, RT Edwards, K Kardia, S McBride, C Manolio, T Randhawa, G Rasooly, R Pierre, JS Terry, S AF Khoury, Muin J. Feero, W. Gregory Reyes, Michele Citrin, Toby Freedman, Andrew Leonard, Debra Burke, Wylie Coates, Ralph Croyle, Robert T. Edwards, Karen Kardia, Sharon McBride, Colleen Manolio, Teri Randhawa, Gurvaneet Rasooly, Rebekah Pierre, Jeannette St. Terry, Sharon CA GAPPNet Planning Grp TI The Genomic Applications in Practice and Prevention Network SO GENETICS IN MEDICINE LA English DT Review DE decision support; genomics; information; medicine; network; public health ID EGAPP WORKING GROUP; OVARIAN-CANCER; UNITED-STATES; HEALTH-CARE; PROPHYLACTIC SURGERY; BREAST; RECOMMENDATIONS; WOMEN; SUSCEPTIBILITY; MORBIDITY AB The authors describe the rationale and initial development of a new collaborative initiative, the Genomic Applications in Practice and Prevention Network. The network convened by the Centers for Disease Control and Prevention and the National Institutes of Health includes multiple stakeholders from academia, government, health care, public health, industry and consumers. The premise of Genomic Applications in Practice and Prevention Network is that there is an unaddressed chasm between gene discoveries and demonstration of their clinical validity and utility. This chasm is due to the lack of readily accessible information about the utility of most genomic applications and the lack of necessary knowledge by consumers and providers to implement what is known. The mission of Genomic Applications in Practice and Prevention Network is to accelerate and streamline the effective integration of validated genomic knowledge into the practice of medicine and public health, by empowering and sponsoring research, evaluating research findings, and disseminating high quality information on candidate genomic applications in practice and prevention. Genomic Applications in Practice and Prevention Network will develop a process that links ongoing collection of information on candidate genomic applications to four crucial domains: (1) knowledge synthesis and dissemination for new and existing technologies, and the identification of knowledge gaps, (2) a robust evidence-based recommendation development process, (3) translation research to evaluate validity, utility and impact in the real world and how to disseminate and implement recommended genomic applications, and (4) programs to enhance practice, education, and surveillance. Genet Med 2009:11(7):488-494. C1 [Khoury, Muin J.; Reyes, Michele; Coates, Ralph; Pierre, Jeannette St.] Ctr Dis Control & Prevent, Off Publ Hlth Genom, Atlanta, GA 30333 USA. [Feero, W. Gregory; Kardia, Sharon; McBride, Colleen; Manolio, Teri] Natl Human Genome Res Inst, NIH, Bethesda, MD USA. [Citrin, Toby; Croyle, Robert T.] Univ Michigan, Ctr Community & Publ Hlth Genom, Ann Arbor, MI 48109 USA. [Freedman, Andrew] NCI, Div Canc Control & Populat Sci, NIH, Bethesda, MD 20892 USA. [Leonard, Debra] Cornell Univ, Dept Pathol & Lab Med, New York, NY 10021 USA. [Burke, Wylie] Univ Washington, Ctr Genom & Healthcare Equal, Seattle, WA 98195 USA. [Edwards, Karen] Univ Washington, Ctr Genom & Publ Hlth, Seattle, WA 98195 USA. [Randhawa, Gurvaneet] Agcy Healthcare Res Qual, Rockville, MD USA. [Rasooly, Rebekah] NIDDK, NIH, Bethesda, MD USA. [Terry, Sharon] Genet Alliance, Washington, DC USA. RP Khoury, MJ (reprint author), Ctr Dis Control & Prevent, Off Publ Hlth Genom, Atlanta, GA 30333 USA. EM mkhoury@cdc.gov OI Rasooly, Rebekah/0000-0002-6357-5528 NR 31 TC 37 Z9 39 U1 1 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1098-3600 J9 GENET MED JI Genet. Med. PD JUL PY 2009 VL 11 IS 7 BP 488 EP 494 DI 10.1097/GIM.0b013e3181a551cc PG 7 WC Genetics & Heredity SC Genetics & Heredity GA 472WA UT WOS:000268162200002 PM 19471162 ER PT J AU Hudson, JL AF Hudson, Julie L. TI Families With Mixed Eligibility For Public Coverage: Navigating Medicaid, CHIP, And Uninsurance SO HEALTH AFFAIRS LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Health-Economists (ASHE) CY JUN, 2008 CL Durham, NC SP Amer Soc Hlth Econ AB In the midst of health care reform, eligible but uninsured children remain a cause for concern. Children in the same family often have differing eligibility status for public coverage. Mixed eligibility is associated with higher uninsurance rates, even when all children in a family are eligible. Medicaid policies play an important role in creating mixed-eligibility families via age-related eligibility thresholds and limited benefits for immigrants; states running separate Children's Health Insurance Program ( CHIP) programs have higher uninsurance rates among eligible children. Recent policies to simplify enrollment have not lowered uninsurance among these children. States may improve take-up rates by focusing on eligible children in mixed-eligibility families. [ Health Affairs 28, no. 4 ( 2009): w697-w709 (published online 23 June 2009; 10.1377/hlthaff.28.4.w697)] C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD USA. RP Hudson, JL (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD USA. EM jhudson@ahrq.gov NR 10 TC 13 Z9 13 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 JUL-AUG PY 2009 VL 28 IS 4 BP W697 EP W709 DI 10.1377/hlthaff.28.4.w697 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 469YY UT WOS:000267939100065 PM 19549628 ER PT J AU Selden, TM Kenney, GM Pantell, MS Ruhter, J AF Selden, Thomas M. Kenney, Genevieve M. Pantell, Matthew S. Ruhter, Joel TI Cost Sharing In Medicaid And CHIP: How Does It Affect Out-Of-Pocket Spending? SO HEALTH AFFAIRS LA English DT Article; Proceedings Paper CT Annual Research Meeting of the Academy-Health CY JUN 09-10, 2008 CL Washington, DC SP Acad Hlth ID HEALTH-CARE; BURDENS AB Rapidly rising spending has prompted debate about increasing cost sharing in Medicaid and the Children's Health Insurance Program ( CHIP). In this paper we assess the role of cost sharing in Medicaid and the CHIP and its potential financial burden on low-income families with children. We find that many families would face high health spending burdens even with minimal cost sharing for their publicly insured children. Adding even modest cost sharing for such children could greatly increase high financial burdens. Our results also suggest that implementing income-based caps on family spending can help address the burden of high spending for low-income families. [ Health Affairs 28, no. 4 ( 2009): w607-w619 (published online 2 June 2009; 10.1377/hlthaff.28.4.w607)] C1 [Selden, Thomas M.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Pantell, Matthew S.] Univ Calif Berkeley, Joint Med Program, Berkeley, CA 94720 USA. [Pantell, Matthew S.] UC San Francisco, San Francisco, CA USA. [Ruhter, Joel] Urban Inst, Ctr Hlth Policy, Washington, DC 20037 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM tselden@ahrq.gov NR 18 TC 13 Z9 13 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 2009 VL 28 IS 4 BP W607 EP W619 DI 10.1377/hlthaff.28.4.w607 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 469YY UT WOS:000267939100056 PM 19491137 ER PT J AU Pylypchuk, Y Hudson, J AF Pylypchuk, Yuriy Hudson, Julie TI IMMIGRANTS AND THE USE OF PREVENTIVE CARE IN THE UNITED STATES SO HEALTH ECONOMICS LA English DT Article DE immigrants; preventive care; switching regressions ID HEALTH-CARE; INSURANCE-COVERAGE; SERVICE USE; PANEL-DATA; COST; BENEFIT; DEMAND; ASSIMILATION; NETWORKS; LANGUAGE AB Using data from the Medical Expenditure Panel Survey, we compare immigrants' use of preventive care with that of natives. We employ a multinomial switching regression framework that accounts for non-random selection into continuous private insurance, temporary private insurance, public insurance, and no insurance. Our results indicate that among the populations with Continuous private coverage and without covet-age (uninsured), immigrants, especially non-citizens, are less likely to use preventive care than natives. We find that the longer immigrants stay in the US the more their use of care approximates to that of natives. However, for most types of care, immigrants' use Of care never fully converges to that of natives. Among the publicly insured Population, immigrants' use of care is similar to natives, but non-citizen immigrants are significantly less likely to use preventive measures. We find that the ability to speak English does not have I significant effect on the use of preventive care among publicly insured persons. Published in 2008 by John Wiley & Sons, Ltd. C1 [Pylypchuk, Yuriy] Social & Sci Syst, Rockville, MD 20850 USA. [Hudson, Julie] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Pylypchuk, Y (reprint author), Social & Sci Syst, 540 Gaither Rd, Rockville, MD 20850 USA. EM ypylypch@ahrq.gov NR 54 TC 13 Z9 13 U1 1 U2 5 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 2009 VL 18 IS 7 BP 783 EP 806 DI 10.1002/hec.1401 PG 24 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 467MX UT WOS:000267744100003 PM 18726922 ER PT J AU Hughes, RG Clancy, CM AF Hughes, Ronda G. Clancy, Carolyn M. TI Complexity, Bullying, and Stress Analyzing and Mitigating a Challenging Work Environment for Nurses SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 [Hughes, Ronda G.; Clancy, Carolyn M.] 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 11 TC 6 Z9 7 U1 0 U2 6 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 2009 VL 24 IS 3 BP 180 EP 183 PG 4 WC Nursing SC Nursing GA 464KQ UT WOS:000267504200002 PM 19525756 ER PT J AU Cohen, JW Cohen, SB Banthin, JS AF Cohen, Joel W. Cohen, Steven B. Banthin, Jessica S. TI The Medical Expenditure Panel Survey A National Information Resource to Support Healthcare Cost Research and Inform Policy and Practice SO MEDICAL CARE LA English DT Article DE healthcare costs; national surveys; economic analysis ID PRESCRIPTION DRUGS; MEPS AB Background: The Medical Expenditure Panel Survey (MEPS) collects detailed information regarding the use and payment for health care services from a nationally representative sample of Americans. The survey is designed to provide analysts with the data they need to support policy-relevant research on health care expenses, utilization, insurance coverage, and access in the United States and to provide policymakers with the results and data they need to make informed decisions. Objectives: This article summarizes the capacity of this broad-based and publicly available information resource to support research efforts directed towards achieving a better understanding of the dynamics of American healthcare and to better characterize its current state. Methods: The MEPS comprises a nationally representative sample of the civilian noninstitutionalized population in the United States, and collects comprehensive data on individuals and their health care experiences over a span of 2 years. Household survey data are collected by means of computer-assisted personal interviews, and those data are supplemented by information collected directly from the medical providers used by survey participants. Insurance data are collected both from households and through a separate state and nationally representative survey of business establishments, which collects information on health insurance provided by United States employers. Results: The MEPS has been used extensively in scientific publications and published reports, as well as by the Federal and state governments to examine the delivery and financing of healthcare in the United States. Conclusions: The analytical findings generated by the MEPS are key inputs to facilitate the development, implementation, and evaluation of policies and practices addressing health care in the United States and its related costs. Recent efforts to reconcile MEPS and the National Health Expenditure Accounts have the potential to provide an even more accurate and powerful data toot for research and policy analysis. C1 [Cohen, Joel W.] Agcy Healthcare Res & Qual, Div Social & Econ Res, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Banthin, Jessica S.] Agcy Healthcare Res & Qual, Div Modeling & Simulat, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Cohen, JW (reprint author), Agcy Healthcare Res & Qual, Div Social & Econ Res, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD USA. EM joel.cohen@ahrq.hhs.gov NR 35 TC 90 Z9 90 U1 2 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 2009 VL 47 IS 7 BP S44 EP S50 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 463WA UT WOS:000267462500008 PM 19536015 ER PT J AU Lipscomb, J Barnett, PG Brown, ML Lawrence, W Yabroff, KR AF Lipscomb, Joseph Barnett, Paul G. Brown, Martin L. Lawrence, William Yabroff, K. Robin TI Advancing the Science of Health Care Costing SO MEDICAL CARE LA English DT Article ID UNITED-STATES; CANCER CARE; PROJECTIONS; ILLNESS; TIME C1 [Lipscomb, Joseph] Emory Univ, Dept Hlth Policy & Management, Rollins Sch Publ Hlth Emory, Atlanta, GA 30322 USA. [Barnett, Paul G.] Hlth Econ Resource Ctr, Dept Vet Affairs, Palo Alto, CA USA. [Brown, Martin L.; Yabroff, K. Robin] Appl Res Progam, Hlth Serv & Econ Branch, Rockville, MD USA. [Brown, Martin L.; Yabroff, K. Robin] Natl Canc Inst, Div Canc Control & Populat Sci, Rockville, MD USA. [Lawrence, William] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Gaithersburg, MD USA. RP Lipscomb, J (reprint author), Emory Univ, Dept Hlth Policy & Management, Rollins Sch Publ Hlth Emory, 1518 Clifton Rd NE, Atlanta, GA 30322 USA. EM jlipsco@sph.emory.edu NR 32 TC 10 Z9 11 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 JUL PY 2009 VL 47 IS 7 BP S120 EP S126 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 463WA UT WOS:000267462500020 PM 19536003 ER PT J AU Lipscomb, J Yabroff, KR Brown, ML Lawrence, W Barnett, PG AF Lipscomb, Joseph Yabroff, K. Robin Brown, Martin L. Lawrence, William Barnett, Paul G. TI Health Care Costing: Data, Methods, Current Applications INTRODUCTION SO MEDICAL CARE LA English DT Editorial Material C1 [Lipscomb, Joseph] Emory Univ, Dept Hlth Policy & Management, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. [Yabroff, K. Robin; Brown, Martin L.] Natl Canc Inst, Div Canc Control & Populat Sci, Appl Res Program, Rockville, MD USA. [Lawrence, William] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Gaithersburg, MD USA. [Barnett, Paul G.] Hlth Econ Res Ctr, Dept Vet Affairs, Palo Alto, CA USA. RP Lipscomb, J (reprint author), Emory Univ, Dept Hlth Policy & Management, Rollins Sch Publ Hlth, 1518 Clifton Rd NE, Atlanta, GA 30322 USA. EM jlipsco@sph.emory.edu NR 24 TC 31 Z9 31 U1 0 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 JUL PY 2009 VL 47 IS 7 BP S1 EP S6 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 463WA UT WOS:000267462500001 PM 19536004 ER PT J AU Lund, JL Yabroff, KR Ibuka, Y Russell, LB Barnett, PG Lipscomb, J Lawrence, WF Brown, ML AF Lund, Jennifer L. Yabroff, K. Robin Ibuka, Yoko Russell, Louise B. Barnett, Paul G. Lipscomb, Joseph Lawrence, William F. Brown, Martin L. TI Inventory of Data Sources for Estimating Health Care Costs in the United States SO MEDICAL CARE LA English DT Article DE health care costs; data sources; administrative data; linked data; survey; health economics ID OF-ILLNESS; MEDICARE AB Objective: To develop an inventory of data sources for estimating health care costs in the United States and provide information to aid researchers in identifying appropriate data sources for their specific research questions. Methods: We identified data sources for estimating health care costs using 3 approaches: (1) a review of the 18 articles included in this Supplement, (2) an evaluation of websites of federal government agencies, non profit foundations, and related societies that support health care research or provide health care services, and (3) a systematic review of the recently published literature. Descriptive information was abstracted from each data source, including sponsor, website, lowest level of data aggregation, type of data source, population included, cross-sectional or longitudinal data capture, Source of diagnosis information, and cost of obtaining the data source. Details about the cost elements available in each data Source were also abstracted. Results: We identified 88 data sources that can be used to estimate health care costs in the United States. Most data Sources were sponsored by government agencies, national or nationally representative, and cross-sectional. About 40% were surveys, followed by administrative or linked administrative data, fee or cost schedules, discharges, and other types of data. Diagnosis information was available in most data sources through procedure or diagnosis codes, self-report, registry, or chart review. Cost elements included inpatient hospitalizations (42.0%), physician and other outpatient services (45.5%), Outpatient pharmacy or laboratory (28.4%), out-of-pocket (22.7%), patient time and other direct nonmedical costs (35.2%), and wages (13.6%). About half were freely available for downloading or available for a nominal fee, and the cost of obtaining the remaining data sources varied by the scope of the project. Conclusions: Available data sources vary in population included, type of data source, scope, and accessibility, and have different strengths and weaknesses for specific research questions. C1 [Yabroff, K. Robin] NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. [Lund, Jennifer L.] Univ N Carolina, Dept Epidemiol, Gillings Sch Global Publ Hlth, Chapel Hill, NC USA. [Ibuka, Yoko; Russell, Louise B.] Rutgers State Univ, Inst Hlth, New Brunswick, NJ USA. [Ibuka, Yoko] Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, New Haven, CT 06510 USA. [Barnett, Paul G.] Hlth Econ Resource Ctr, Dept Vet Affairs, Palo Alto, CA USA. [Lipscomb, Joseph] Emory Univ, Dept Hlth Policy & Management, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. [Lawrence, William F.] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Gaithersburg, 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 RI Lund, Jennifer/G-9420-2012 FU NIDDK NIH HHS [T32 DK007634, T32 DK007634-09] NR 27 TC 10 Z9 10 U1 1 U2 8 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 2009 VL 47 IS 7 BP S127 EP S142 PG 16 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 463WA UT WOS:000267462500021 PM 19536009 ER PT J AU Yabroff, KR Warren, JL Banthin, J Schrag, D Mariotto, A Lawrence, W Meekins, A Topor, M Brown, ML AF Yabroff, K. Robin Warren, Joan L. Banthin, Jessica Schrag, Deborah Mariotto, Angela Lawrence, William Meekins, Angela Topor, Marie Brown, Martin L. TI Comparison of Approaches for Estimating Prevalence Costs of Care for Cancer Patients What Is the Impact of Data Source? SO MEDICAL CARE LA English DT Article DE health care costs; health services research; cost and cost analysis; colorectal neoplasms; Medicare; SEER program; MEPS ID SEER-MEDICARE DATA; UNITED-STATES; LIFE AB Background: National prevalence costs of medical care can be key inputs in health policy decisions. Cost estimates vary across data sources, patient populations, and methods, however, the objective of this study was to compare 3 approaches for estimating the prevalence costs of colorectal cancer (CRC) care using different data sources, but similar patient populations and methods. Methods: We identified prevalent CRC patients aged 65 and older from: (1) linked Surveillance Epidemiology and End Results (SEER) registry-Medicare data, (2) Medicare claims only, and (3) the Medical Expenditure Panel Survey (MEPS). Controls were matched by sex, age-group, and geographic location. Mean per person total and net costs, measured as the difference between patients and controls, were compared for each approach during a similar observation period. The SEER-Medicare approach was our reference, and we evaluated the impact of patient selection criteria with sensitivity analyses. Aggregate prevalence estimates were also compared. Results: We found considerable variability across the different approaches to estimating prevalence costs of CRC. Mean net annual per person estimates in the SEER-Medicare reference were $5341 (95% CI: $5243, $5439), compared with $8736 (95% CI: $8203, $9269) for the Medicare claims only and $11,614 (95% CI: $7566, $15,663) for the MEPS. Aggregate national estimates of net prevalence costs of CRC in 2004 ranged from $4524 million, using the SEER-Medicare approach, to $9629 million, using the MEPS approach. Estimates varied by data source based on the payors included and identification of prevalent CRC patients. Conclusions: CRC prevalence cost estimates vary substantially depending on the data sources. Our findings have implications for estimating prevalence costs for other cancers and other diseases without registry systems that can be used to identify newly diagnosed individuals as well as those diagnosed less recently. C1 [Yabroff, K. Robin; Warren, Joan L.; Mariotto, Angela; Brown, Martin L.] NCI, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. [Banthin, Jessica; Lawrence, William] Agcy Healthcare Res & Qual, Rockville, MD USA. [Schrag, Deborah] Massachusetts Gen Hosp, Ctr Canc, Boston, MA USA. [Schrag, Deborah] Harvard Univ, Sch Med, Boston, MA USA. [Meekins, Angela; Topor, Marie] Informat Management Serv Inc, Rockville, MD USA. RP Yabroff, KR (reprint author), Appl Res Program, Hlth Serv & Econ Branch, Execut Plaza N,Room 4005,6130 Execut Blvd,MSC 734, Bethesda, MD 20892 USA. EM yabroffr@mail.nih.gov FU Intramural NIH HHS [Z99 CA999999] NR 20 TC 35 Z9 36 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 JUL PY 2009 VL 47 IS 7 BP S64 EP S69 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 463WA UT WOS:000267462500011 PM 19536016 ER PT J AU Tekin, E Mocan, N Liang, L AF Tekin, Erdal Mocan, Naci Liang, Lan TI Do Adolescents with Emotional or Behavioral Problems Respond to Cigarette Prices? SO SOUTHERN ECONOMIC JOURNAL LA English DT Article ID RATIONAL ADDICTION; CONTROL POLICIES; TOBACCO CONTROL; DISCOUNT RATES; YOUNG-ADULTS; SMOKING; DEPRESSION; ILLNESS; COCAINE; HEALTH AB Adolescents with mental health problems have much higher rates of smoking than those without such problems. Although a large body of evidence suggests that higher cigarette prices reduce smoking prevalence and the quantity smoked, little is known about the interaction between mental health or behavioral problems and tobacco consumption in the general population or among adolescents. Using a national representative sample of adolescents from the National Longitudinal Study of Adolescent Health and employing validated psychiatric measures of emotional distress and behavioral problems, we estimate the price elasticity of cigarette demand for adolescents who have behavioral or emotional problems. The results indicate that these adolescents are at least as responsive to cigarette prices as adolescents with no emotional or behavioral problems. C1 [Tekin, Erdal] Georgia State Univ, Andrew Young Sch Policy Studies, NBER, Atlanta, GA 30302 USA. [Mocan, Naci] Louisiana State Univ, Dept Econ, Baton Rouge, LA 70803 USA. [Liang, Lan] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Tekin, E (reprint author), Georgia State Univ, Andrew Young Sch Policy Studies, NBER, POB 3992, Atlanta, GA 30302 USA. EM tekin@gsu.edu; mocan@lsu.edu; lliang@ahrq.gov NR 45 TC 4 Z9 4 U1 1 U2 6 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0038-4038 EI 2325-8012 J9 SOUTH ECON J JI South. Econ. J. PD JUL PY 2009 VL 76 IS 1 BP 67 EP 85 DI 10.4284/sej.2009.76.1.67 PG 19 WC Economics SC Business & Economics GA 475OV UT WOS:000268370300005 ER PT J AU Dhruva, SS Phurrough, SE Salive, ME Redberg, RF AF Dhruva, Sanket S. Phurrough, Steve E. Salive, Marcel E. Redberg, Rita F. TI CMS's Landmark Decision on CT Colonography - Examining the Relevant Data SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Dhruva, Sanket S.; Redberg, Rita F.] Univ Calif San Francisco, Sch Med, San Francisco, CA 94143 USA. [Phurrough, Steve E.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Salive, Marcel E.] CMS, Div Med & Surg Sci, Baltimore, MD USA. RP Dhruva, SS (reprint author), Univ Calif San Francisco, Sch Med, San Francisco, CA 94143 USA. NR 6 TC 44 Z9 44 U1 0 U2 0 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JUN 25 PY 2009 VL 360 IS 26 BP 2699 EP 2701 DI 10.1056/NEJMp0904408 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 461RC UT WOS:000267286600003 PM 19474419 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, AJ Gregory, KD Grossman, D Isham, G LeFevre, ML Leipzig, RM Marion, LN Melnyk, B Moyer, VA Ockene, JK Sawaya, GF Schwartz, JS Wilt, T AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen J. Gregory, Kimberly D. Grossman, David Isham, George LeFevre, Michael L. Leipzig, Rosanne M. Marion, Lucy N. Melnyk, Bernadette Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Schwartz, J. Sanford Wilt, Timothy CA US Preventive Serv Task Force TI Screening for Hepatitis B Virus Infection in Pregnancy: US Preventive Services Task Force Reaffirmation Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB Description: Reaffirmation of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for hepatitis B virus hepatitis B virus infection in pregnancy. Methods: The USPSTF performed a brief literature update, including a search for new and substantial evidence on the benefits and harms of screening pregnant women for hepatitis B virus infection. Finding: The net benefit of screening continues to be well established. Recommendation: Screen for hepatitis B virus infection in pregnant women at their first prenatal visit. (Grade A recommendation.) C1 [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. [Melnyk, Bernadette] Arizona State Univ, Coll Nursing & Healthcare Innovat, Phoenix, AZ USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen J.] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Hanover, NH 03756 USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Grossman, David] Grp Hlth Cooperat Puget Sound, Seattle, WA USA. [Isham, George] Hlth Partners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Leipzig, Rosanne M.] Mt Sinai Sch Med, New York, NY USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Moyer, Virginia A.] Baylor Coll Med, Houston, TX 77030 USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Schwartz, J. Sanford] Univ Penn, Sch Med, Philadelphia, PA 19104 USA. [Schwartz, J. Sanford] Univ Penn, Wharton Sch, Philadelphia, PA 19104 USA. [Wilt, Timothy] Univ Minnesota, Dept Med, Minneapolis, MN 55455 USA. [Wilt, Timothy] Minneapolis Veteran Affairs Med Ctr, Minneapolis, MN USA. RP Calonge, N (reprint author), Colorado Dept Publ Hlth & Environm, Denver, CO USA. FU USPSTF FX The USPSTF is an independent, voluntary body. The U. S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF. NR 7 TC 17 Z9 18 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 JUN 16 PY 2009 VL 150 IS 12 BP 869 EP U70 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 460CX UT WOS:000267164800006 ER PT J AU Lin, K Vickery, J AF Lin, Kenneth Vickery, John TI Screening for Hepatitis B Virus Infection in Pregnant Women: Evidence for the US Preventive Services Task Force Reaffirmation Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID IMMUNIZATION AB Background: Screening for hepatitis B virus (HBV) infection in pregnant women to identify newborns who will require prophylaxis against perinatal infection is a well-established, evidence-based standard of current medical practice. In 2004, the U.S. Preventive Services Task Force (USPSTF) recommended universal screening of pregnant women for HBV infection at the first prenatal visit. Purpose: To search for large, high-quality studies related to hepatitis B screening in pregnancy that have been published since the 2004 USPSTF recommendation. Data Sources: English-language studies indexed in PubMed and the Cochrane Database of Systematic Reviews and published between 1 January 2001 and 5 March 2008. Study Selection: For benefits of screening and newborn prophylaxis, we included systematic reviews; meta-analyses; and randomized, controlled trials. For harms of screening, we included systematic reviews; meta-analyses; randomized, controlled trials; cohort studies; case-control studies; and case series of large, multisite databases. Abstracts and full articles were independently reviewed for inclusion by both reviewers. Data Extraction: Data on the benefits of screening, including benefits of hepatitis B immune globulin and hepatitis B vaccine prophylaxis of newborns of hepatitis B surface antigen-positive mothers, were extracted by 1 reviewer. Data Synthesis: No new studies met inclusion criteria. A 2006 systematic review of randomized, controlled trials found that newborn prophylaxis reduced perinatal transmission of HBV infection; all relevant trials were published in 1996 or earlier. Limitation: The focused search strategy, which was restricted to English-language articles, may have missed some smaller studies or new research published in languages other than English. Conclusion: No new evidence was found on the benefits or harms of screening for HBV infection in pregnant women. Previously published randomized trials support the 2004 USPSTF recommendation for screening. C1 [Lin, Kenneth] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Lin, K (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM Kenneth.Lin@ahrq.hhs.gov NR 10 TC 15 Z9 17 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 16 PY 2009 VL 150 IS 12 BP 874 EP 876 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 460CX UT WOS:000267164800007 PM 19528566 ER PT J AU Matzo, M Wilkinson, A Lynn, J Gatto, M Phillips, S AF Matzo, Marianne Wilkinson, Anne Lynn, Joanne Gatto, Maria Phillips, Sally TI PALLIATIVE CARE CONSIDERATIONS IN MASS CASUALTY EVENTS WITH SCARCE RESOURCES SO BIOSECURITY AND BIOTERRORISM-BIODEFENSE STRATEGY PRACTICE AND SCIENCE LA English DT Article ID CRITICALLY-ILL; DEFINITIVE CARE; JANUARY 26-27; TASK-FORCE; DISASTER; TRIAGE; CHICAGO; SURGE; REDUCTION; INCIDENTS AB Catastrophic mass casualty events, such as pandemic flu outbreaks or large-scale terrorism-related events, could yield thousands of victims whose needs would overwhelm local and regional healthcare systems, personnel, and resources. Such conditions will require deploying scarce resources in a manner that is different from the more common single-event disaster. This article introduces the topic of palliative care during a mass casualty event and reviews the major findings for a federally funded planning guide that examined palliative care issues associated with providing medical care under circumstances where resources are scarce. We focus on the role of palliative care in the support of individuals not expected to survive and offer recommendations of specific actions for a coordinated disaster response plan. Semistructured telephone discussions with disaster management experts and a group meeting of experts identified issues, roles, responsibilities, procedures, and resources that offer the benefits of integrating palliative care into disaster planning and response. The investigations identified 5 domains of concern, along with guidance: (1) the role of palliative care in a mass casualty event with resulting scarce resources; (2) the triage and ensuing treatment decisions for those "likely to die"; (3) the critical palliative care services to provide, along with the personnel and settings; (4) the pragmatic plans needed for ensuring training, supplies, and organizational or jurisdictional arrangements; and (5) unusual issues affecting palliative care under mass casualty event scenarios. Palliative care minimizes the suffering of those who die, ensures comfort, addresses their needs, and may also free up resources to optimize survival of others. Planning to provide palliative care during mass casualty events should be part of the current state and local disaster planning/training guidelines, protocols, and activities. C1 [Matzo, Marianne] Univ Oklahoma, Coll Nursing, Sooner Palliat Care Inst, Oklahoma City, OK 73117 USA. [Matzo, Marianne] Univ Oklahoma, Dept Geriatr Med, Oklahoma City, OK 73117 USA. [Wilkinson, Anne] Edith Cowan Univ, Sch Nursing, Perth, WA, Australia. [Lynn, Joanne] Govt Dist Columbia, Dept Hlth, Community Hlth Adm, Washington, DC USA. [Gatto, Maria] Bon Secours Hlth Syst, Marriottsville, MD USA. [Phillips, Sally] Agcy Healthcare Res & Qual, Publ Hlth Emergency Preparedness Res Program, Rockville, MD USA. RP Matzo, M (reprint author), Univ Oklahoma, Coll Nursing, Sooner Palliat Care Inst, 1100 N Stonewall Ave, Oklahoma City, OK 73117 USA. EM Marianne-Matzo@ouhsc.edu NR 49 TC 11 Z9 11 U1 0 U2 6 PU MARY ANN LIEBERT INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1538-7135 J9 BIOSECUR BIOTERROR JI Biosecur. Bioterror. PD JUN PY 2009 VL 7 IS 2 BP 199 EP 210 DI 10.1089/bsp.2009.0017 PG 12 WC Public, Environmental & Occupational Health; International Relations SC Public, Environmental & Occupational Health; International Relations GA 475DC UT WOS:000268337100014 PM 19635004 ER PT J AU Selden, TM AF Selden, Thomas M. TI The Within-Year Concentration of Medical Care: Implications for Family Out-of-Pocket Expenditure Burdens SO HEALTH SERVICES RESEARCH LA English DT Article DE Medical utilization; expenditures; burdens ID HEALTH-CARE; ADULTS AB To examine the within-year concentration of family health care and the resulting exposure of families to short periods of high expenditure burdens. Household data from the pooled 2003 and 2004 Medical Expenditure Panel Survey (MEPS) yielding nationally representative estimates for the nonelderly civilian noninstitutionalized population. The paper examines the within-year concentration of family medical care use and the frequency with which family out-of-pocket expenditures exceeded 20 percent of family income, computed at the annual, quarterly, and monthly levels. On average among families with medical care, 49 percent of all (charge-weighted) care occurred in a single month, and 63 percent occurred in a single quarter). Nationally, 27 percent of the study population experienced at least 1 month in which out-of-pocket expenditures exceeded 20 percent of income. Monthly 20 percent burden rates were highest among the poor, at 43 percent, and were close to or above 30 percent for all but the highest income group (families above four times the federal poverty line). Within-year spikes in health care utilization can create financial pressures missed by conventional annual burden analyses. Within-year health-related financial pressures may be especially acute among lower-income families due to low asset holdings. C1 Agcy Healthcare Res & Qual, Div Modeling & Simulat, Dept Hlth & Human Serv, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Div Modeling & Simulat, Dept Hlth & Human Serv, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM tselden@ahrq.gov FU U.S. Department of Health and Human Services FX Disclaimer: None. NR 17 TC 6 Z9 6 U1 2 U2 4 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 2009 VL 44 IS 3 BP 1029 EP 1051 DI 10.1111/j.1475-6773.2009.00963.x PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 446HB UT WOS:000266111600015 PM 19674431 ER PT J AU Trinite, T Loveland-Cherry, C Marion, L AF Trinite, Tricia Loveland-Cherry, Carol Marion, Lucy TI The US Preventive Services Task Force: An evidence-based prevention resource for nurse practitioners SO JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS LA English DT Article DE Advanced practice nurse (APN); primary care; prevention; clinical practice guidelines; evidence-based practice ID RECOMMENDATION STATEMENT; PRIMARY-CARE; INTERVENTIONS; HEALTH; UPDATE AB To describe the work of the U.S. Preventive Services Task Force and to encourage nurse practitioners (NPs) to use its evidence-based recommendations for clinical preventive services. Evidence reports, recommendation statements, and journal articles published under the auspices of the U.S. Preventive Services Task Force since its establishment in 1984. A core competency for NPs working in primary care is knowledge about and provision of appropriate preventive services for their patients. The U.S. Preventive Services Task Force, an independent panel of experts in prevention and primary care, is an important resource for NPs. NPs can use Task Force recommendations to guide their screening, counseling, and preventive medication decisions. They can also educate patients about the missed prevention opportunities related to underuse of effective services and the potential harms of overuse of inappropriate preventive services. C1 [Trinite, Tricia] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. [Marion, Lucy] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. RP Trinite, T (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM tricia.trinite@ahrq.hhs.gov NR 18 TC 1 Z9 1 U1 0 U2 2 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1041-2972 J9 J AM ACAD NURSE PRAC JI J. Am. Acad. Nurse Pract. PD JUN PY 2009 VL 21 IS 6 BP 301 EP 306 DI 10.1111/j.1745-7599.2009.00410.x PG 6 WC Health Care Sciences & Services; Nursing SC Health Care Sciences & Services; Nursing GA 453UF UT WOS:000266637700001 PM 19527308 ER PT J AU Sedrakyan, A AF Sedrakyan, Art TI CABG versus PCl for multivessel coronary artery disease SO LANCET LA English DT Letter C1 US Dept HHS, Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Sedrakyan, A (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. EM Art.Sedrakyan@fda.hhs.gov NR 2 TC 0 Z9 0 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0140-6736 J9 LANCET JI Lancet PD JUN-JUL PY 2009 VL 373 IS 9682 BP 2199 EP 2200 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 463PQ UT WOS:000267444500028 PM 19560600 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, A Gregory, KD Grossman, D Isham, G LeFevre, ML Leipzig, R Marion, LN Melnyk, B Moyer, VA Ockene, JK Sawaya, GF Schwartz, JS Wilt, T AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen Gregory, Kimberly D. Grossman, David Isham, George LeFevre, Michael L. Leipzig, Rosanne Marion, Lucy N. Melnyk, Bernadette Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Schwartz, J. Sanford Wilt, Timothy CA US Preventive Serv Task Force TI Screening for Syphilis Infection in Pregnancy: US Preventive Services Task Force Reaffirmation Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB Description: Update of the 2004 U. S. Preventive Services Task Force statement about screening for syphilis in pregnancy. Methods: The U. S. Preventive Services Task Force did a targeted literature search for evidence on the benefits of screening, the harms of screening, and the harms of treatment of syphilis with penicillin during pregnancy. Recommendation: Screen all pregnant women for syphilis infection. (Grade A recommendation.) C1 [Calonge, Ned; US Preventive Serv Task Force] US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. [Calonge, Ned] Colorado Dept Publ Hlth, Denver, CO USA. [Melnyk, Bernadette] Arizona State Univ, Coll Nursing & Healthcare Innovat, Phoenix, AZ USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen] Dartmouth Med Sch, Lebanon, NH USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Dept Obstet & Gynecol, Los Angeles, CA 90048 USA. [Grossman, David] Grp Hlth Cooperat Puget Sound, Seattle, WA 98121 USA. [Isham, George] Hlth Partners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Leipzig, Rosanne] Mt Sinai Sch Med, New York, NY USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Moyer, Virginia A.] Baylor Coll Med, Houston, TX 77030 USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Schwartz, J. Sanford] Univ Penn, Wharton Sch, Philadelphia, PA 19104 USA. [Schwartz, J. Sanford] Univ Penn, Sch Med, Philadelphia, PA 19104 USA. [Wilt, Timothy] Minneapolis Vet Affairs Med Ctr Chron Dis Outcome, Minneapolis, MN USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 5 TC 12 Z9 13 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 MAY 19 PY 2009 VL 150 IS 10 BP 705 EP U7 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 448TQ UT WOS:000266285300006 ER PT J AU Wolff, T Shelton, E Sessions, C Miller, T AF Wolff, Tracy Shelton, Erica Sessions, Cecili Miller, Therese TI Screening for Syphilis Infection in Pregnant Women: Evidence for the US Preventive Services Task Force Reaffirmation Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB Background: In 2004, the U. S. Preventive Services Task Force strongly recommended that clinicians screen all pregnant women for syphilis infection. Purpose: To update the evidence on screening pregnant women for syphilis infection. Data Sources: MEDLINE searches from 1 January 2003 through 31 July 2008, recent systematic reviews, reference lists of retrieved articles, and expert suggestions. Study Selection: English-language studies were selected to answer the following 2 questions: Does screening for syphilis in pregnancy reduce the prevalence of congenital syphilis in neonates? Are there harms of screening for syphilis or harms of treatment with penicillin in pregnancy to women or neonates? Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; and ecologic studies were selected for the potential benefits question. Randomized, controlled trials; meta-analyses; systematic reviews; cohort studies; case-control studies; and large case series were selected for the potential harms question. Data Extraction: Information on the study design, selection criteria, demographic characteristics, and clinical outcomes was extracted from each study. Data Synthesis: One study on benefits evaluated the effect before and after the implementation of a universal syphilis screening program for pregnant women and found reductions in rates of congenital syphilis. Two studies on screening accuracy for syphilis reported false-positive rates of less than 1%. One study that used a large insurance claims database reported an incidence of anaphylaxis after oral penicillin of 0.1 per 10 000 dispensings. In a study from Hungary, oral penicillin in pregnancy was not associated with orofacial clefts. Limitations: This was a targeted literature search and could have missed small studies on the benefits and harms of screening for syphilis in pregnancy. We did not review evidence on interventions to improve rates of prenatal screening. Conclusion: New evidence from a study of universal screening supports previous evidence on the effectiveness of screening for syphilis in pregnancy to prevent congenital syphilis. Harms include testing and follow-up for false-positive test results and adverse effects from penicillin treatment. C1 [Wolff, Tracy; Shelton, Erica; Sessions, Cecili; Miller, Therese] US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Wolff, T (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. NR 15 TC 22 Z9 23 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 MAY 19 PY 2009 VL 150 IS 10 BP 710 EP U8 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 448TQ UT WOS:000266285300007 PM 19451578 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, AJ Gregory, KD Grossman, D Isham, G LeFevre, ML Leipzig, RM Marion, LN Melnyk, B Moyer, VA Ockene, JK Sawaya, GF Schwartz, JS Wilt, T AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen J. Gregory, Kimberly D. Grossman, David Isham, George LeFevre, Michael L. Leipzig, Rosanne M. Marion, Lucy N. Melnyk, Bernadette Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Schwartz, J. Sanford Wilt, Timothy CA US Preventive Serv Task Force TI Folic Acid for the Prevention of Neural Tube Defects: US Preventive Services Task Force Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID UNITED-STATES; MANAGEMENT ISSUES; CHILDBEARING AGE; DIETARY-FOLATE; WOMEN; SUPPLEMENTATION; FORTIFICATION; HEALTH; EPILEPSY AB Description: In 1996, the U. S. Preventive Services Task Force (USPSTF) recommended that all women planning or capable of pregnancy take a multivitamin supplement containing folic acid for the prevention of neural tube defects. This recommendation is an update of the 1996 USPSTF recommendation. Methods: The USPSTF reviewed the evidence on folic acid supplementation in women of childbearing age published since the 1996 USPSTF recommendation. The USPSTF did not review the evidence on folic acid food fortification, counseling to increase dietary intake, or screening for neural tube defects. Recommendation: The USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mu g) of folic acid. (Grade A recommendation). C1 [Calonge, Ned] US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. [Calonge, Ned] USPSTF, Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Petitti, Diana B.] Arizona State Univ, USPSTF, Phoenix, AZ USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen J.] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Hanover, NH 03756 USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Grossman, David] Grp Hlth Cooperat Puget Sound, Seattle, WA USA. [Isham, George] HealthPartners Inc, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Leipzig, Rosanne M.] Mt Sinai Sch Med, New York, NY USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Melnyk, Bernadette] Arizona State Univ, Coll Nursing & Healthcare Innovat, Phoenix, AZ USA. [Moyer, Virginia A.] Baylor Coll Med, Houston, TX 77030 USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Schwartz, J. Sanford] Univ Penn, Sch Med, Philadelphia, PA 19104 USA. [Schwartz, J. Sanford] Univ Penn, Wharton Sch, Philadelphia, PA 19104 USA. [Wilt, Timothy] Minneapolis Vet Affairs Med Ctr, Minneapolis, MN USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. FU USPSTF FX The USPSTF is an independent, voluntary body. The U. S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF. NR 22 TC 90 Z9 101 U1 0 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 MAY 5 PY 2009 VL 150 IS 9 BP 626 EP U10 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 443IQ UT WOS:000265903800007 ER PT J AU Wolff, T Witkop, CT Miller, T Syed, SB AF Wolff, Tracy Witkop, Catherine Takacs Miller, Therese Syed, Shamsuzzoha B. TI Folic Acid Supplementation for the Prevention of Neural Tube Defects: An Update of the Evidence for the US Preventive Services Task Force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID DIETARY-FOLATE; ACID/MULTIVITAMIN SUPPLEMENTATION; MULTIPLE BIRTHS; VITAMIN USE; RISK; PREGNANCY; FORTIFICATION; COHORT AB Background: Neural tube defects (NTDs) are among the most common birth defects in the United States. In 1996, the U. S. Preventive Services Task Force (USPSTF) recommended that all women planning a pregnancy or capable of conception take a supplement containing folic acid to reduce the risk for NTDs. Purpose: To search for new evidence published since 1996 on the benefits and harms of folic acid supplementation for women of childbearing age to prevent neural tube defects in offspring, to inform an updated USPSTF recommendation. Data Sources: MEDLINE and Cochrane Central Register of Controlled Trials searches from January 1995 through December 2008, recent systematic reviews, reference lists of retrieved articles, and expert suggestions. Study Selection: English-language randomized, controlled trials; cohort studies; case-control studies; systematic reviews; and meta-analyses were selected if they provided information on the benefits and harms of folic acid supplementation in women of childbearing age to reduce NTDs in offspring. Data Extraction: All studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria. Data Synthesis: Four observational studies reported benefit of reduction of risk for NTDs associated with folic acid-containing supplements. Differences in study type and methods prevent the calculation of a summary of the reduction in risk. The one included study on harms reported that the association of twinning with folic acid intake disappeared after adjustment for in vitro fertilization and underreporting of folic acid intake. Limitations: The evidence on dose was limited. No evidence was found on the potential harm of masking vitamin B-12 deficiency in women of childbearing age. The search focused on the association of NTDs with supplementation only and therefore does not provide a comprehensive review of the effects of folic acid on all possible outcomes or of the effects of dietary intake of folic acid. Conclusion: New observational evidence supports previous evidence from a randomized, controlled trial that folic acid-containing supplements reduce the risk for NTD-affected pregnancies. The association of folic acid use with twin gestation may be confounded by fertility interventions. C1 [Wolff, Tracy; Witkop, Catherine Takacs; Miller, Therese; Syed, Shamsuzzoha B.] US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Wolff, T (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 30 TC 85 Z9 91 U1 2 U2 19 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAY 5 PY 2009 VL 150 IS 9 BP 632 EP U14 PG 12 WC Medicine, General & Internal SC General & Internal Medicine GA 443IQ UT WOS:000265903800008 PM 19414843 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI More Work Is Needed to Protect Medical Residents From Fatigue and Potential Errors, IOM Report Finds 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 8 TC 2 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 MAY-JUN PY 2009 VL 24 IS 3 BP 259 EP 261 DI 10.1177/1062860609334614 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 448VO UT WOS:000266290300011 PM 19461069 ER PT J AU Zuvekas, SH Meyerhoefer, CD AF Zuvekas, Samuel H. Meyerhoefer, Chad D. TI State Variations In The Out-Of-Pocket Spending Burden For Outpatient Mental Health Treatment SO HEALTH AFFAIRS LA English DT Article ID SERVICES; PARITY; 2ND-GENERATION; SCHIZOPHRENIA; INSURANCE; DEMAND; TRIAL; DRUGS; CARE AB We examine the potential of mental health/substance abuse (MH/SA) parity laws to reduce the out-of-pocket spending burden for outpatient treatment at the state level by exploring cross-state variations and their causes, as well as the provisions of MH/SA parity laws. We find modest (yet important) variation in out-of-pocket burden across states overall, but-because prescription medications account for two-thirds of out-of-pocket spending and are generally beyond the scope of recently enacted federal parity laws-evidence suggests that those laws will do little to reduce the observed burden or its variation. Other policy measures, designed to expand and improve health insurance coverage or reduce racial/ethnic disparities, could have a more profound impact. [Health Affairs 28, no. 3 (2009): 713-722; 10.1377/hlthaff.28.3.713] C1 [Zuvekas, Samuel H.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Meyerhoefer, Chad D.] Lehigh Univ, Dept Econ, Bethlehem, PA 18015 USA. RP Zuvekas, SH (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM samuel.zuvekas@ahrq.hhs.gov NR 19 TC 6 Z9 6 U1 2 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 MAY-JUN PY 2009 VL 28 IS 3 BP 713 EP 722 DI 10.1377/hlthaff.28.3.713 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 441OV UT WOS:000265779400012 PM 19414879 ER PT J AU Donohue, JM Huskamp, HA Zuvekas, SH AF Donohue, Julie M. Huskamp, Haiden A. Zuvekas, Samuel H. TI Dual Eligibles With Mental Disorders And Medicare Part D: How Are They Faring? SO HEALTH AFFAIRS LA English DT Article ID PRESCRIPTION DRUG BENEFIT; RISK ADJUSTMENT; ACCESS; SCHIZOPHRENIA; SENIORS AB In 2006, six million beneficiaries who were eligible for both Medicare and Medicaid switched from Medicaid to Medicare Part D for coverage of their prescription drugs. This change led to an expanded role for Medicare in financing psychotropic medications for dual eligibles. A reduction in the number of plans serving these beneficiaries and an increase in utilization restrictions for some psychotropics since 2006 raise concerns about access to medications for dual eligibles with mental disorders and point to potential problems with adverse selection. To improve access for this population, Medicare might consider changes to its enrollment and risk-sharing systems. [Health Affairs 28, no. 3 (2009): 746-759; 10.1377/hlthaff.28.3.746] C1 [Donohue, Julie M.] Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA 15260 USA. [Huskamp, Haiden A.] Harvard Univ, Sch Med, Boston, MA USA. [Zuvekas, Samuel H.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Donohue, JM (reprint author), Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA 15260 USA. EM jdonohue@pitt.edu OI Donohue, Julie/0000-0003-2418-6017 FU National Center for Research Resources; National Institutes of Health (NIH); NIH Roadmap for Medical Research [KL2-RR024154-01]; Robert Wood Johnson Foundation FX The authors are grateful for financial support from the National Center for Research Resources, a component of the National Institutes of Health (NIH); the NIH Roadmap for Medical Research (Grant no. KL2-RR024154-01 to Julie Donohue); and a Robert Wood Johnson Foundation Investigator Award in Health Policy Research (to Haiden Huskamp). The authors thank Richard Frank, Rachel Garfield, Steven Hill, and Marie Stagnitti for helpful comments on previous drafts of this paper. The paper represents the views of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services is intended or should be inferred. NR 31 TC 25 Z9 25 U1 1 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 MAY-JUN PY 2009 VL 28 IS 3 BP 746 EP 759 DI 10.1377/hlthaff.28.3.746 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 441OV UT WOS:000265779400016 PM 19414883 ER PT J AU Bernard, DM Banthin, JS Encinosa, WE AF Bernard, Didem M. Banthin, Jessica S. Encinosa, William E. TI Wealth, Income, And The Affordability Of Health Insurance SO HEALTH AFFAIRS LA English DT Article ID SAVINGS; CARE AB There have been debates over how many uninsured people can afford insurance but refuse to purchase it. Examining the difference in asset holdings between the privately insured and the uninsured, we found that the difference in purchasing power is not fully revealed by income comparisons. Median income among the privately insured is 2.9 times that of the uninsured, but median wealth among those with private insurance is 23.2 times that of the uninsured. Our results suggest that assets are an important determinant of effective affordability, undermining the notion that many people are uninsured by choice. [Health Affairs 28, no. 3 (2009): 887-896; 10.1377/hlthaff.28.3.887] C1 [Bernard, Didem M.; Banthin, Jessica S.; Encinosa, William E.] AHRQ, Rockville, MD USA. RP Bernard, DM (reprint author), AHRQ, Rockville, MD USA. EM didem.bernard@ahrq.hhs.gov NR 18 TC 15 Z9 15 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 MAY-JUN PY 2009 VL 28 IS 3 BP 887 EP 896 DI 10.1377/hlthaff.28.3.887 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 441OV UT WOS:000265779400035 PM 19414902 ER PT J AU Ebrahim, SH Anderson, JE Correa-de-Araujo, R Posner, SF Atrash, HK AF Ebrahim, Shahul H. Anderson, John E. Correa-de-Araujo, Rosaly Posner, Samuel F. Atrash, Hani K. TI Overcoming social and health inequalities among US women of reproductive age-Challenges to the nation's health in the 21st century SO HEALTH POLICY LA English DT Article DE United States; Macrosocial determinants; Women; Pregnancy; Children ID UNITED-STATES AB Objective: To frame the discussion of the nation's health within the context of maternal and child health. Methods: We used national data or estimates to assess the burden of 46 determinants. Results: During 2002-2004, U.S. women of reproductive age experienced significant challenges from macrosocial determinants, to health care access, and to their individual health preservation. Two-thirds of women do not consume recommended levels of fruits and vegetables. Overall, 29% experienced income poverty, 16.3% were uninsured. About one in four women of reproductive age lived with poor social capital. Compared with white women of reproductive age, non-white women reported higher levels of dissatisfaction with the health care system and race-related discrimination. Among all U.S. women, chronic diseases contributed to the top nine leading causes of disability adjusted life years. About one-third of women had no prophylactic dental visits in the past year, or consumed alcohol at harmful levels and smoked tobacco. One in three women who had a child born recently did not breast feed their babies. Demographics of women who are at increased risk for the above indicators predominate among the socioeconomically disadvantaged. Conclusions: At least three-fourths of the U.S. women of reproductive age were at risk for poor health of their own and their offspring. Social intermediation and health policy changes are needed to increase the benefits of available health and social sector interventions to women and thereby to their offspring. Published by Elsevier Ireland Ltd C1 [Ebrahim, Shahul H.; Anderson, John E.; Posner, Samuel F.; Atrash, Hani K.] Ctr Dis Control & Prevent, Atlanta, GA USA. [Correa-de-Araujo, Rosaly] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Ebrahim, SH (reprint author), CDC, Mail Stop E-64,1600 Clifton Road, Atlanta, GA 30333 USA. EM sebrahim@cdc.gov OI Posner, Samuel/0000-0003-1574-585X NR 29 TC 12 Z9 13 U1 2 U2 7 PU ELSEVIER IRELAND LTD PI CLARE PA ELSEVIER HOUSE, BROOKVALE PLAZA, EAST PARK SHANNON, CO, CLARE, 00000, IRELAND SN 0168-8510 J9 HEALTH POLICY JI Health Policy PD MAY PY 2009 VL 90 IS 2-3 BP 196 EP 205 DI 10.1016/j.healthpol.2008.09.011 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 444RL UT WOS:000265998000011 PM 19027188 ER PT J AU Owens, MD Beckles, GLA Ho, KK Gorrell, P Brady, J Kaftarian, SJ AF Owens, Michelle D. Beckles, Gloria L. A. Ho, Karen K. Gorrell, Paul Brady, Jeff Kaftarian, Shakeh J. TI Underuse of Recommended Preventive Care Services among Women with Diabetes Across the Life Stages SO JOURNAL OF WOMENS HEALTH LA English DT Meeting Abstract C1 [Owens, Michelle D.; Beckles, Gloria L. A.] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Diabet Translat, Atlanta, GA USA. [Ho, Karen K.; Gorrell, Paul; Brady, Jeff; Kaftarian, Shakeh J.] Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 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 MAY PY 2009 VL 18 IS 5 MA 35 BP 755 EP 755 PG 1 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 446DP UT WOS:000266100900054 ER PT J AU Encinosa, WE Bernard, DM Du, DY Steiner, CA AF Encinosa, William E. Bernard, Dideni M. Du, Dongyi Steiner, Claudia A. TI Recent Improvements in Bariatric Surgery Outcomes SO MEDICAL CARE LA English DT Article DE bariatric surgery; obesity; postoperative complications; claims data ID METAANALYSIS AB Objective: Bariatric surgery is one of the fastest growing hospital procedures, but with a 40% complication rate in 2001. Between 2001 and 2005 bariatric Surgeries grew by 113%. Our objective is to examine how 6-month complications improved between 2001 and 2006, using a nationwide, population-based sample. Data/Design: We examined insurance claims in 2001-2002 and 2005-2006 for 9582 bariatric surgeries, at 652 hospitals, among a population of 16 million nonelderly people. Outcomes and costs were risk-adjusted using multivariate regression methods with hospital fixed effects. Principal Findings: Between 2001 and 2006, while older and sicker patients underwent the surgery, the 180-day risk-adjusted complication rate declined 21% from 41.7% to 32.8%. Most of die improvement was in the initial hospital stay, where the risk-adjusted inpatient complication rate declined 37%, from 23.6% to 14.8%. Risk-adjusted rates of readmissions with complications declined 31%, from 9.8% to 6.8%. Risk-adjusted hospital days declined from 6 to 3.7 days, and risk-adjusted and inflation-adjusted payments declined 6%. Improvements in complication rates and readmission rates were associated with a within-hospital 30% increase in hospital volume. Volume had no impact on costs. The use of laparoscopy, which increased from 9% to 71%, reduced costs by 12%, while gastric banding decreased costs by 20%. Laparoscopy had no impact on readmissions, but the increase in banding Without bypass reduced readmissions. Conclusions: Improvements in bariatric outcomes and costs were due to a mix of within-hospital Volume increases, a move to a laparoscopic technique, and an increase in banding without bypass. C1 [Encinosa, William E.; Steiner, Claudia A.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. [Bernard, Dideni M.] AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD USA. [Du, Dongyi] Univ Maryland, Sch Pharm, Baltimore, MD 21201 USA. RP Encinosa, WE (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. EM wencinos@ahrq.gov FU Agency for Healthcare Research and Quality; U.S. Department of Health and Human Services FX Supported by the Agency for Healthcare Research and Quality. NR 9 TC 75 Z9 77 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 MAY PY 2009 VL 47 IS 5 BP 531 EP 535 PG 5 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 438NY UT WOS:000265563500005 PM 19318997 ER PT J AU Friedman, B Encinosa, W Jiang, HJ Mutter, R AF Friedman, Bernard Encinosa, William Jiang, H. Joanna Mutter, Ryan TI Do Patient Safety Events Increase Readmissions? SO MEDICAL CARE LA English DT Article DE patient safety; hospital readmissions ID MEDICAL ERRORS; CARE; QUALITY AB Objective: Adverse safety events in the hospital could impose extra costs not only due to longer stays and corrective treatments, but also due to deaths and readmissions. The effects of safety events on readmissions have rarely been analyzed. Large, all-payer and all-diagnosis databases permit new tests. This study will simultaneously test the effects of safety events on risks of deaths and readmission. Study Design: The population is a selection of almost 1.5 million adult surgery patients initially treated in 1088 short stay hospitals. These are patients at risk for at least 1 of 9 types of patient safety event, as specified in software in the public domain from the Agency for Healthcare Research and Quality. The main data sources are 7 statewide databases of hospitalizations in 2004, maintained by Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. We control for many factors affecting readmission or death, particularly the severity of illness, chronic comorbidities, age, and payer group. Separate models are used for each type of safety event and a composite model is used for any safety event. Principal Findings: Among the patients at risk for any of the patient safety events, 2.6% had at least one safety event. The 3-month readmission rate was about 17% for those with no safety event, but about 25% when a safety event was recorded. The corresponding rates for readmission within 1 month were 11% and 16%. The in-hospital death rate was 1.3% with no safety event, but 9.2% with a safety event. After risk adjustment, the relative risk of readmission within 3 months was about 1.20 (P < 0.01), ranging from 1.14 to 1.56 for specific types of events. The risk-adjusted result for readmission within 1 month associated with lit least one safety event was 1.17 (P < 0.01). However, the models for specific safety events gave a significantly high risk of readmission within 1 month for only 2 of the more common types of safety events. Conclusions: Hospital readmissions are one way that safety events can have costly consequences. More attention is warranted to assess the full extra cost of safety events, the factors influencing the rate of safety events, and strategies for health plans to improve incentives for safety. C1 [Friedman, Bernard; Encinosa, William; Jiang, H. Joanna; Mutter, Ryan] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Friedman, B (reprint author), 540 Gaither Rd, Rockville, MD 20850 USA. EM bernard.friedman@ahrq.hhs.gov FU California Office of Statewide Health Planning and Development; Florida Agency for Health Care Administration; Hospital Industry Data Institute (MO); New York State Department of Health; Tennessee Hospital Association; Utah Department of Health; Virginia Health Information FX The authors thank Andrew Mosso of Social and Scient fic Systems Inc., for programming assistance; the Editor, Dr. Deborah Freund, and reviewers for this Journal; and the following data source agencies: California Office of Statewide Health Planning and Development, Florida Agency for Health Care Administration, Hospital Industry Data Institute (MO), New York State Department of Health, Tennessee Hospital Association, Utah Department of Health, and Virginia Health Information. NR 21 TC 25 Z9 25 U1 2 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 2009 VL 47 IS 5 BP 583 EP 590 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 438NY UT WOS:000265563500012 PM 19318996 ER PT J AU Wong, H Levit, K AF Wong, H. Levit, K. TI PILOT PROJECT: INTEGRATING ADMINISTRATIVE AND FINANCIAL DATABASES TO ESTIMATE PRICE OF HOSPITALIZATIONS SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Wong, H.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Levit, K.] Thomson Reuters Agcy Healthcare Res & Qual, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2009 VL 12 IS 3 BP A6 EP A6 DI 10.1016/S1098-3015(10)73090-4 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 433WO UT WOS:000265236700022 ER PT J CA US Preventive Serv Task Force TI Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women: U. S. Preventive Services Task Force Reaffirmation Recommendation Statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB Description: Reaffirmation of the 2003 U. S. Preventive Services Task Force (USPSTF) recommendation on counseling to prevent tobacco use. Methods: The USPSTF reviewed new evidence in the U. S. Public Health Service's 2008 clinical practice guideline and determined that the net benefits of tobacco cessation interventions in adults and pregnant women remain well established. Recommendations: Ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. (Grade A recommendation) Ask all pregnant women about tobacco use and provide augmented, pregnancy-tailored counseling for those who smoke. (Grade A recommendation) C1 [US Preventive Serv Task Force] US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. FU USPSTF FX The USPSTF is an independent, voluntary body. The U. S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF. NR 7 TC 12 Z9 13 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 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD APR 21 PY 2009 VL 150 IS 8 BP 551 EP W99 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 437AD UT WOS:000265457000005 ER PT J AU Farley, DO Battles, JB AF Farley, Donna O. Battles, James B. TI Evaluation of the AHRQ Patient Safety Initiative: Framework and Approach SO HEALTH SERVICES RESEARCH LA English DT Article DE Program evaluation; evaluation design and research; quality care-patient safety (measurement) ID FORMATIVE EVALUATION AB Describe the evaluation performed of the patient safety initiative operated by the Agency for Healthcare Research and Quality (AHRQ). When patient safety became a national priority in 2000, Congress charged and funded AHRQ to improve health care safety. Over the next 6 years, AHRQ funded more than 300 research projects and other activities, addressing diverse patient safety issues and practices. AHRQ contracted with RAND in 2002 to perform a 4-year evaluation of the initiative, which was completed in 2006. This formative evaluation used the CIPP program evaluation model, which emphasizes multiple stakeholders' interests (e.g., patients, providers, funded researchers). We monitored the progress of the patient safety initiative and provided AHRQ annual feedback that assessed each year's activities, identifying issues and offering suggestions for actions by AHRQ. Given the size and complexity of the initiative, the evaluation needed to examine key individual components and synthesize results across them, and it also had to be responsive to changes in the initiative over time. We used a conceptual framework to bring together the disparate pieces to synthesize overall findings. The remaining articles in this issue describe selected results from this evaluation. C1 [Farley, Donna O.] RAND Corp, Pittsburgh, PA 15213 USA. [Battles, James B.] Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Farley, DO (reprint author), RAND Corp, 4570 5th Ave,Suite 600, Pittsburgh, PA 15213 USA. EM farley@rand.org FU AHRQ [290-02-0010]; U.S. Department of Health and Human Services FX Disclosures: None. NR 24 TC 5 Z9 5 U1 0 U2 9 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2009 VL 44 IS 2 BP 628 EP 645 DI 10.1111/j.1475-6773.2008.00931.x PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 418QW UT WOS:000264164500002 PM 21456107 ER PT J AU Steiner, CA Barrett, M Jiang, J Friedman, B Merrill, C AF Steiner, C. A. Barrett, M. Jiang, J. Friedman, B. Merrill, C. TI A MORE COMPLETE PICTURE OF READMISSIONS FOR POTENTIALLY PREVENTABLE CONDITIONS - THE IMPACT OF INCLUDING VISITS TO THE ED SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 32nd Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 13-16, 2009 CL Miami, FL SP Soc Gen Internal Med C1 [Steiner, C. A.; Jiang, J.; Friedman, B.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Barrett, M.] Thomson Reuters, San Diego, CA USA. [Merrill, C.] Thomson Reuters, Clifton, VA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2009 VL 24 SU 1 BP 5 EP 5 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 435ZI UT WOS:000265382000012 ER PT J AU Kelly, CY Clancy, CM AF Kelly, Carmen Y. Clancy, Carolyn M. TI Importance of Recommendations for Gestational Weight Gain SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 [Kelly, Carmen Y.; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Kelly, CY (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM carmen.kelly@abrq.hhs.gov NR 4 TC 0 Z9 0 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 2009 VL 24 IS 2 BP 96 EP 99 PG 4 WC Nursing SC Nursing GA 422AI UT WOS:000264399000002 PM 19287245 ER PT J AU Durant, NH Bartman, B Person, SD Collins, F Austin, SB AF Durant, Nefertiti H. Bartman, Barbara Person, Sharina D. Collins, Felicia Austin, S. Bryn TI Patient provider communication about the health effects of obesity SO PATIENT EDUCATION AND COUNSELING LA English DT Article DE Obesity; Race/ethnicity; Patient provider communication ID FACTOR SURVEILLANCE SYSTEM; LOSE WEIGHT; PATIENTS PERCEPTIONS; RACIAL-DIFFERENCES; PRIMARY-CARE; PHYSICIAN; OVERWEIGHT; MANAGEMENT; SMOKING; RISK AB Objective: We assessed the influence of race/ethnicity and provider Communication oil overweight and obese patients' perceptions of the damage weight causes to their health. Methods: The-study included 1071 overweight and obese patients who completed the 2002 Community Health Center (CHC) User survey. We used logistic regression analyses to examine determinants of patients' perceptions of the impact of their weight oil their health. Models were adjusted for covariates and weighting was used to account for the sampling design. Results: Forty-one percent of respondents were overweight and 59% were obese. Non-Hispanic Blacks and Hispanics were half as likely as non-Hispanic Whites to believe weight was damaging to their health while controlling for covariates. Overweight/obese CHC patients who were told they were overweight by healthcare providers were almost nine times more likely to perceive that weight was damaging to their health compared to those not told. Conclusions: We observed large racial/ethnic disparities in the perception that overweight is unhealthful but provider communication may be a powerful tool for helping patients understand that overweight is damaging to health. Practice implications: Given obesity is a national epidemic, further attention to the role of patient provider communication in illness is essential with important implications for both health professional training and health care provision. (C) 2008 Elsevier Ireland Ltd. All rights reserved. C1 [Durant, Nefertiti H.] Univ Alabama, Dept Med, Div Gen Pediat & Adolescent Med, Birmingham, AL 35233 USA. [Bartman, Barbara; Collins, Felicia] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. [Austin, S. Bryn] Childrens Hosp, Div Adolescent & Young Adult Med, Boston, MA 02115 USA. [Austin, S. Bryn] Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Cambridge, MA 02138 USA. RP Durant, NH (reprint author), Univ Alabama, Dept Med, Div Gen Pediat & Adolescent Med, MTC 201,1600 7th Ave S, Birmingham, AL 35233 USA. EM ndurant@peds.uab.edu RI Sriwisit, Sukhumaphorn/G-1405-2011 FU Leadership in Education for Adolescent Health project; Maternal and Child Health Bureau [6171-MC00009-15-01]; Commonwealth Fund/Harvard University Fellowship in Minority Health Policy; National Research Service Award [T32 HP10018] FX This work was supported by the Leadership in Education for Adolescent Health project, the Maternal and Child Health Bureau (HRSA Grant 6171-MC00009-15-01), the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy and National Research Service Award Grant T32 HP10018. We also acknowledge Dr. Alison Field for their insights on the analyses. NR 34 TC 14 Z9 14 U1 1 U2 8 PU ELSEVIER IRELAND LTD PI CLARE PA ELSEVIER HOUSE, BROOKVALE PLAZA, EAST PARK SHANNON, CO, CLARE, 00000, IRELAND SN 0738-3991 J9 PATIENT EDUC COUNS JI Patient Educ. Couns. PD APR PY 2009 VL 75 IS 1 BP 53 EP 57 DI 10.1016/j.pec.2008.09.021 PG 5 WC Public, Environmental & Occupational Health; Social Sciences, Interdisciplinary SC Public, Environmental & Occupational Health; Social Sciences - Other Topics GA 426WC UT WOS:000264738000007 PM 19038523 ER PT J AU Barton, MB Petitti, DB DeWitt, TG Dietrich, A Gordis, L Gregory, KD Harris, R Isham, G LeFevre, ML Leipzig, R Loveland-Cherry, C Marion, LN Moyer, VA Ockene, JK Sawaya, GF Yawn, BP AF Barton, Mary B. Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen Gordis, Leon Gregory, Kimberly D. Harris, Russell Isham, George LeFevre, Michael L. Leipzig, Rosanne Loveland-Cherry, Carol Marion, Lucy N. Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Yawn, Barbara P. CA US Preventive Serv Task Force TI Screening and Treatment for Major Depressive Disorder in Children and Adolescents: US Preventive Services Task Force Recommendation Statement SO PEDIATRICS LA English DT Article DE screening; treatment; depression; child and adolescent AB DESCRIPTION. This is an update of the 2002 US Preventive Services Task Force recommendation on screening for child and adolescent major depressive disorder. METHODS. The US Preventive Services Task Force weighed the benefits and harms of screening and treatment for major depressive disorder in children and adolescents, incorporating new evidence addressing gaps in the 2002 recommendation statement. Evidence examined included the benefits and harms of screening, the accuracy of primary care-feasible screening tests, and the benefits and risks of treating depression by using psychotherapy and/or medications in patients aged 7 to 18 years. RECOMMENDATIONS. Screen adolescents (12-18 years of age) for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up (B recommendation). Evidence is insufficient to warrant a recommendation to screen children (7-11 years of age) for major depressive disorder (I statement). Pediatrics 2009; 123: 1223-1228 C1 [US Preventive Serv Task Force] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Petitti, Diana B.] Arizona State Univ, Phoenix, AZ USA. [DeWitt, Thomas G.] Childrens Hosp Med Ctr, Cincinnati, OH USA. [Dietrich, Allen] Dartmouth Med Sch, Lebanon, NH USA. [Gordis, Leon] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Harris, Russell] Univ N Carolina, Sch Med, Chapel Hill, NC USA. [Isham, George] HealthPartners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Leipzig, Rosanne] Mt Sinai Sch Med, New York, NY USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Moyer, Virginia A.] Baylor Coll Med, Houston, TX 77030 USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Yawn, Barbara P.] Olmsted Med Ctr, Rochester, MN USA. RP Barton, MB (reprint author), Ctr Primary Care Prevent & Clin Practice, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM mary.barton@ahrq.hhs.gov NR 6 TC 91 Z9 91 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 EI 1098-4275 J9 PEDIATRICS JI Pediatrics PD APR PY 2009 VL 123 IS 4 BP 1223 EP 1228 DI 10.1542/peds.2008-2381 PG 6 WC Pediatrics SC Pediatrics GA 425UO UT WOS:000264663100019 ER PT J AU Wolff, T Miller, T Ko, S AF Wolff, Tracy Miller, Therese Ko, Stephen TI Aspirin for the Primary Prevention of Cardiovascular Events: An Update of the Evidence for the US Preventive Services Task Force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID LOW-DOSE ASPIRIN; RANDOMIZED-TRIAL; HEART-DISEASE; VITAMIN-E; RISK; STROKE; WOMEN; MEN AB Background: Coronary heart disease and cerebrovascular disease are leading causes of death in the United States. In 2002, the U. S. Preventive Services Task Force (USPSTF) strongly recommended that clinicians discuss aspirin with adults who are at increased risk for coronary heart disease. Purpose: To determine the benefits and harms of taking aspirin for the primary prevention of myocardial infarctions, strokes, and death. Data Sources: MEDLINE and Cochrane Library (search dates, 1 January 2001 to 28 August 2008), recent systematic reviews, reference lists of retrieved articles, and suggestions from experts. Study Selection: English-language randomized, controlled trials (RCTs); case-control studies; meta-analyses; and systematic reviews of aspirin versus control for the primary prevention of cardiovascular disease (CVD) were selected to answer the following questions: Does aspirin decrease coronary heart events, strokes, death from coronary heart events or stroke, or all-cause mortality in adults without known CVD? Does aspirin increase gastrointestinal bleeding or hemorrhagic strokes? Data Extraction: All studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria. Data Synthesis: New evidence from 1 good-quality RCT, 1 good-quality meta-analysis, and 2 fair-quality subanalyses of RCTs demonstrates that aspirin use reduces the number of CVD events in patients without known CVD. Men in these studies experienced fewer myocardial infarctions and women experienced fewer ischemic strokes. Aspirin does not seem to affect CVD mortality or all-cause mortality in either men or women. The use of aspirin for primary prevention increases the risk for major bleeding events, primarily gastrointestinal bleeding events, in both men and women. Men have an increased risk for hemorrhagic strokes with aspirin use. A new RCT and meta-analysis suggest that the risk for hemorrhagic strokes in women is not statistically significantly increased. Limitations: New evidence on aspirin for the primary prevention of CVD is limited. The dose of aspirin used in the RCTs varied, which prevented the estimation of the most appropriate dose for primary prevention. Several of the RCTs were conducted within populations of health professionals, which potentially limits generalizability. Conclusion: Aspirin reduces the risk for myocardial infarction in men and strokes in women. Aspirin use increases the risk for serious bleeding events. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. New York Presbyterian Hosp Cornell, New York, NY USA. RP Wolff, T (reprint author), Agcy Hlth Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. NR 15 TC 132 Z9 144 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 MAR 17 PY 2009 VL 150 IS 6 BP 405 EP W72 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 423AJ UT WOS:000264468500006 PM 19293073 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI CMS's Hospital-Acquired Condition Lists Link Hospital Payment, 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 13 TC 10 Z9 10 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 2009 VL 24 IS 2 BP 166 EP 168 DI 10.1177/1062860608331241 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 423KJ UT WOS:000264494900009 PM 19228892 ER PT J AU Grossman, JM Zayas-Caban, T Kemper, N AF Grossman, Joy M. Zayas-Caban, Teresa Kemper, Nicole TI Information Gap: Can Health Insurer Personal Health Records Meet Patients' And Physicians' Needs? SO HEALTH AFFAIRS LA English DT Article AB Personal health records (PHRs), centralized places for people to electronically store and organize their health information, can benefit both patients and doctors. This qualitative study of health insurers' PHRs for enrollees reveals potential benefits and challenges. Insurers' ability to put claims-based data into the PHR offers an advantage. However, consumers are concerned about sharing personal health information with insurers and about Internet security. Physicians question (1) the validity of claims data in making treatment decisions and (2) whether accessing these PHRs is worth the disruptions to their workflow. This paper offers possible solutions that may lead to more widespread adoption of insurer PHRs. [Health Affairs 28, no. 2 (2009): 377-389; 10.1377/hlthaff.28.2.377] C1 [Grossman, Joy M.] Ctr Studying Hlth Syst Change HSC, Washington, DC USA. [Zayas-Caban, Teresa] AHRQ, Rockville, MD USA. RP Grossman, JM (reprint author), Ctr Studying Hlth Syst Change HSC, Washington, DC USA. EM jgrossman@hschange.org FU Robert Wood Johnson Foundation FX Funding for data collection and for Joy Grossman's and Nicole Kemper's time was provided by the Robert Wood Johnson Foundation. The authors thank Michael Painter, Jon White, Rebecca Roper, and Debra Draper for valuable input on earlier drafts. The authors of this paper are entirely responsible for its content. Statements in the paper should not be construed as endorsement by the Agency for Healthcare Research and Quality or theU. S. Department of Health and Human Services. NR 15 TC 10 Z9 11 U1 2 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 2009 VL 28 IS 2 BP 377 EP 389 DI 10.1377/hlthaff.28.2.377 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 422RJ UT WOS:000264445100009 PM 19275993 ER PT J AU Clancy, CM Anderson, KM White, PJ AF Clancy, Carolyn M. Anderson, Kristine Martin White, P. Jon TI Investing In Health Information Infrastructure: Can It Help Achieve Health Reform? SO HEALTH AFFAIRS LA English DT Article AB Health care reform has reemerged as a policy imperative. Congressional discussions regarding sizable federal investments in health information technology (IT) infrastructure have revitalized the vision of health IT as a critical component of accelerating improvements in the quality and value of health care for all Americans. Policymakers will be challenged to link investments in the health information infrastructure to the objectives of health care reform. The purpose of this paper is to articulate some near- and long-term steps that increase the likelihood of achieving high-value health care with the aid of health IT. [Health Affairs 28, no. 2 (2009): 478-482; 10.1377/hlthaff.28.2.478] C1 [Clancy, Carolyn M.; White, P. Jon] AHRQ, Rockville, MD USA. [Anderson, Kristine Martin] Booz Allen Hamilton, Rockville, MD USA. RP Clancy, CM (reprint author), AHRQ, Rockville, MD USA. EM Carolyn.Clancy@ahrq.hhs.gov NR 6 TC 11 Z9 12 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 2009 VL 28 IS 2 BP 478 EP 482 DI 10.1377/hlthaff.28.2.478 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 422RJ UT WOS:000264445100023 PM 19276007 ER PT J AU Zuvekas, SH Olin, GL AF Zuvekas, Samuel H. Olin, Gary L. TI Accuracy of Medicare Expenditures in the Medical Expenditure Panel Survey SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID CARE; MODELS; SERVICES AB This paper examines underreporting and underrepresentation of high expenditure cases in the Medical Expenditure Panel Survey (MEPS) and their implications for analyses. Our data come from a sample of Medicare beneficiaries in the MEPS who were matched to their Medicare claims and enrollment files, with supplemental data from the Medicare Current Beneficiary Survey (MCBS). Underreporting of expenditures affected all groups of Medicare beneficiaries in the matched sample, but uniformly so that behavioral analyses were largely unaffected. Straightforward adjustments to the MEPS expenditure estimates could align them with aggregate sources, such as the National Health Expenditure Accounts, while preserving underlying relationships between expenditures and key correlates. C1 [Zuvekas, Samuel H.] 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 Samuel.zuvekas@ahrq.hhs.gov NR 25 TC 19 Z9 19 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 SPR PY 2009 VL 46 IS 1 BP 92 EP 108 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 448JB UT WOS:000266257800008 PM 19489486 ER PT J AU Kreider, B Hill, SC AF Kreider, Brent Hill, Steven C. TI Partially Identifying Treatment Effects with an Application to Covering the Uninsured SO JOURNAL OF HUMAN RESOURCES LA English DT Article ID HEALTH-INSURANCE COVERAGE; SELF-RATED HEALTH; PRIVATE INSURANCE; CARE UTILIZATION; MEDICAID; IDENTIFICATION; MORTALITY; PHYSICIAN; SERVICES; MASSACHUSETTS AB We extend the nonparametric literature on partially identified probability, distributions and use our analytical results to provide sharp bounds oil the impact of universal health insurance on provider visits and medical expenditures. Our approach accounts for uncertainty about the reliability of self-reported insurance status as well as uncertainty created by unknown counterfactuals. We construct health insurance validation data using detailed information from the Medical Expenditure Panel Survey. Imposing relatively weak nonparametric assumptions, we estimate that under universal coverage monthly per capita provider visits and expenditures would rise by less than 8 percent and 16 percent, respectively, across the nonelderly population. C1 [Hill, Steven C.] AHRQ, CFACT, Rockville, MD 20850 USA. [Kreider, Brent] Iowa State Univ, Ames, IA 50011 USA. RP Hill, SC (reprint author), AHRQ, CFACT, 540 Gaither Rd, Rockville, MD 20850 USA. EM shill@ahrq.gov NR 65 TC 17 Z9 17 U1 1 U2 7 PU UNIV WISCONSIN PRESS PI MADISON PA JOURNAL DIVISION, 1930 MONROE ST, 3RD FL, MADISON, WI 53711 USA SN 0022-166X J9 J HUM RESOUR JI J. Hum. Resour. PD SPR PY 2009 VL 44 IS 2 BP 409 EP 449 PG 41 WC Economics; Industrial Relations & Labor SC Business & Economics GA 436VO UT WOS:000265444400006 ER PT J AU Bernard, D Sivrioglu, Y Encinosa, W AF Bernard, Didem Sivrioglu, Yusuf Encinosa, William TI Health Care Expenditure Burdens among People with Anxiety Disorders SO JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS LA English DT Meeting Abstract C1 [Bernard, Didem; Sivrioglu, Yusuf; Encinosa, William] Agcy Healthcare Res & Qual, CDOM, Rockville, MD 20850 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU INT CTR 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 2009 VL 12 BP S5 EP S5 PG 1 WC Health Policy & Services; Psychiatry SC Health Care Sciences & Services; Psychiatry GA 431UJ UT WOS:000265089300011 ER PT J AU Kelly, CY Clancy, CM AF Kelly, Carmen Y. Clancy, Carolyn M. TI Pharmacists emerge as key stakeholders in quality, patient safety efforts SO JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION LA English DT Editorial Material C1 [Kelly, Carmen Y.; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Kelly, CY (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. EM carmen.kelly@ahrq.hhs.gov; carolyn.clancy@ahrq.hhs.gov NR 9 TC 3 Z9 3 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 MAR-APR PY 2009 VL 49 IS 2 BP 146 EP + DI 10.1331/JAPhA.2009.08171 PG 2 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 453LO UT WOS:000266612200004 PM 19289338 ER PT J AU Zhan, CL Elixhauser, A Richards, CL Wang, Y Baine, WB Pineau, M Verzier, N Kliman, R Hunt, D AF Zhan, Chunliu Elixhauser, Anne Richards, Chesley L., Jr. Wang, Yun Baine, William B. Pineau, Michael Verzier, Nancy Kliman, Rebecca Hunt, David TI Identification of Hospital-Acquired Catheter-Associated Urinary Tract Infections From Medicare Claims Sensitivity and Positive Predictive Value SO MEDICAL CARE LA English DT Article DE administrative data; positive predictive value; urinary catheter; urinary tract infections ID NOSOCOMIAL INFECTIONS; ADMINISTRATIVE DATA; UNITED-STATES; SURVEILLANCE; CARE; COMPLICATIONS AB Background and Objective: Hospital-acquired catheter-associated urinary tract infection (CAUTI) is one of the first 6 conditions Medicare is targeting to reduce payment associated with hospital-acquired conditions under Congressional mandate. This study was to determine the positive predictive value (PPV) and sensitivity in identifying patients in Medicare claims who had urinary catheterization and who had hospital-acquired CAUTIs. Research Design: CAUTIs identified by ICD-9-CM codes in Medicare claims were compared with those revealed by medical record abstraction in random samples of Medicare discharges in 2005 to 2006. Hospital discharge abstracts (2005) from the states of New York and California were used to estimate the potential impact of a present-on-admission (POA) indicator on PPV. Results: ICD-9-CM procedure codes for urinary catheterization appeared in only 1.4% of Medicare claims for patients who had urinary catheters. As a proxy, claims with major Surgery had a PPV of 75% and sensitivity of 48%, and claims with any surgical procedure had a PPV of 53% and sensitivity of 79% in identifying urinary catheterization. The PPV and sensitivity for identifying hospital-acquired CAUTIs varied, with the PPV at 30% and sensitivity at 65% in claims with major Surgery. About 80% of the secondary diagnosis codes indicating UTIs were flagged as POA, suggesting that the addition of POA indicators in Medicare claims Would increase PPV up to 86% and sensitivity up to 79% in identifying hospital-acquired CAUTIs. Conclusions: The validity in identifying urinary catheter use and CAUTIs from Medicare claims is limited, but will be increased substantially upon addition of a POA indicator. C1 [Zhan, Chunliu] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [Richards, Chesley L., Jr.] Ctr Dis Control & Prevent, Atlanta, GA USA. [Wang, Yun; Pineau, Michael; Verzier, Nancy] Qualidigm, Middletown, CT USA. [Kliman, Rebecca] Ctr Medicare, Baltimore, MD USA. [Kliman, Rebecca] Medicaid Serv, Baltimore, MD USA. [Hunt, David] Off Natl Coordinator Hlth Informat Technol, Washington, DC USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM czhan@ahrq.hhs.gov NR 23 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 2009 VL 47 IS 3 BP 364 EP 369 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 412VT UT WOS:000263753000014 PM 19194330 ER PT J AU Willy, M Kelly, JP Nourjah, P Kaufman, DW Budnitz, DS Staffa, J AF Willy, Mary Kelly, Judith P. Nourjah, Parivash Kaufman, David W. Budnitz, Daniel S. Staffa, Judy TI Emergency department visits attributed to selected analgesics, United States, 2004-2005 SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Article DE analgesics; emergency department; adverse events ID ADVERSE DRUG EVENTS; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; US ADULT-POPULATION; NATIONAL SURVEILLANCE; ACETAMINOPHEN TOXICITY; NONPRESCRIPTION; PRESCRIPTION; CHILDREN AB Purpose To estimate the rate of emergency department (ED) visits attributed to selected analgesic-containing medications. Methods We used a nationally representative public health surveillance system to provide estimates of adverse events identified in EDs, and a national telephone survey to provide estimates of selected analgesic-containing medication usage in the US population, 2004-2005. Analysis was restricted to products containing acetaminophen, aspirin, ibuprofen, or naproxen. Types of adverse events and outcomes were compared. Estimated numbers and rates of ED visits were calculated by analgesic groupings and patient age groups. Results The estimated overall rate of ED visits attributed to analgesic-containing medications was 1.6 visits/100 000 users per week. The very old and very young had the highest rates; there were minimal differences in rates by patient gender. Acetaminophen was the attributed drug with the most estimated ED visits and generally had the highest rates of ED visits. The highest estimated rate for a specific product group was among subjects 18-64 years of age taking narcotic-acetaminophen products (8.9 ED visits /100 000 users per week). Overall, 12% of patients presenting to EDs with analgesic-attributed events were hospitalized. Conclusions Rates of ED visits due to analgesics vary depending on the age of the patient and the product; most do not result in hospitalization. Although the rate of emergency visits is relatively low, because of the wide use of the analgesics, public health impact is considerable. Copyright (C) 2008 John Wiley & Sons, Ltd. C1 [Willy, Mary; Staffa, Judy] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Kelly, Judith P.; Kaufman, David W.] Boston Univ, Slone Epidemiol Ctr, Boston, MA 02215 USA. [Nourjah, Parivash] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Budnitz, Daniel S.] Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Atlanta, GA USA. RP Willy, M (reprint author), 10903 New Hampshire Ave,Room 2488, Silver Spring, MD 20993 USA. EM mary.willy@fda.hhs.gov FU Slone Epidemiology Center funds; FDA FX The authors greatly appreciate the contributions to the Slone Survey of Theresa Anderson, study coordinator; Marie Berarducci and Marilyn Wasti, study supervisors; Gene Sun, information systems; and the interviewing staff. Slone Survey data collection was supported by internal Slone Epidemiology Center funds; the present analysis was supported by the FDA. The authors thank Kelly Weidenbach, M.P.H., and Victor Johnson of CDC and Cathy Irish, B.S., and Joel Friedman, B.A. of the U.S. Consumer Product Safety Commission for assistance with data collection and database management in NEISS-CADES. NR 23 TC 6 Z9 6 U1 3 U2 6 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 2009 VL 18 IS 3 BP 188 EP 195 DI 10.1002/pds.1691 PG 8 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 421PR UT WOS:000264371300002 PM 19116955 ER PT J AU Conway, PH Clancy, C AF Conway, Patrick H. Clancy, Carolyn TI Transformation of Health Care at the Front Line SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID QUALITY; PERFORMANCE C1 [Conway, Patrick H.; Clancy, Carolyn] US Dept HHS, Washington, DC 20201 USA. [Conway, Patrick H.; Clancy, Carolyn] Agcy Healthcare Res & Qual, Rockville, MD USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Ctr Hlth Care Qual, Cincinnati, OH USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Div Hlth Policy & Clin Effectiveness, Cincinnati, OH USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Div Gen Pediat, Cincinnati, OH USA. RP Conway, PH (reprint author), US Dept HHS, Humphrey Bldg,200 Independence Ave,Room 447D-3, Washington, DC 20201 USA. EM patrick.conway@hhs.gov NR 16 TC 52 Z9 52 U1 0 U2 3 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 FEB 18 PY 2009 VL 301 IS 7 BP 763 EP 765 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 407MX UT WOS:000263370100019 PM 19224753 ER PT J AU Meyers, DS Clancy, CM AF Meyers, David S. Clancy, Carolyn M. TI Primary Care: Too Important to Fail SO ANNALS OF INTERNAL MEDICINE LA English DT Editorial Material C1 [Meyers, David S.; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Meyers, DS (reprint author), Agcy Healthcare Res & Qual, John M Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20850 USA. EM david.meyers@ahrq.hhs.gov NR 7 TC 15 Z9 15 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 FEB 17 PY 2009 VL 150 IS 4 BP 272 EP U68 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 410FI UT WOS:000263562500007 PM 19221380 ER PT J AU Wolff, T Tai, E Miller, T AF Wolff, Tracy Tai, Eric Miller, Therese TI Screening for Skin Cancer: An Update of the Evidence for the U. S. Preventive Services Task Force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID CUTANEOUS MELANOMA; SELF-EXAMINATION; HISTOPATHOLOGIC DIAGNOSIS; THINNER MELANOMAS; ACCURACY; LESIONS; DERMATOLOGISTS; POPULATION; PHYSICIANS AB Background: Skin cancer is the most commonly diagnosed cancer in the United States. The majority of skin cancer is nonmelanoma cancer, either basal cell cancer or squamous cell cancer. The incidence of both melanoma and nonmelanoma skin cancer has been increasing over the past 3 decades. In 2001, the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against routine screening for skin cancer by using whole-body skin examination for early detection of skin cancer. Purpose: To update the evidence of benefits and harms of screening for skin cancer in the general population. Data Sources: MEDLINE and Cochrane Library searches from 1 June 1999 to 9 August 2005 for English-language articles; recent systematic reviews; reference lists of retrieved articles; and expert suggestions. Study Selection: English-language studies were selected to answer the following key question: Does screening in asymptomatic persons with whole-body examination by a primary care clinician or by self-examination reduce morbidity and mortality from skin cancer? Randomized, controlled trials and case-control studies of screening for skin cancer were selected. One author selected English-language studies to answer the following contextual questions: Can screening with whole-body examination by primary care clinicians or by self-examination accurately detect skin cancer? Does screening with whole-body examination or by self-examination detect melanomas at an earlier stage (thinner lesions)? Data Extraction: All studies for the key question were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria. Data Synthesis: No new evidence from controlled studies was found that addressed the benefit of screening for skin cancer with a whole-body examination by a physician. One article of fair quality, which reanalyzed data from a 1996 study identified for the 2001 report for the USPSTF, provides limited but insufficient evidence on the benefit of skin self-examination in the reduction of morbidity and mortality from melanoma. Limitations: Direct evidence linking skin cancer screening to improved health outcomes is lacking. Information is limited on the accuracy of screening by physicians or patients using real patients and lesions. Conclusion: The limited evidence prevents accurate estimation of the benefits of screening for skin cancer in the general primary care population. C1 [Wolff, Tracy; Tai, Eric; Miller, Therese] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Wolff, T (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. NR 26 TC 87 Z9 88 U1 0 U2 3 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 FEB 3 PY 2009 VL 150 IS 3 BP 194 EP + PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 402RA UT WOS:000263029600006 PM 19189909 ER PT J AU Petitti, DB Teutsch, SM Barton, MB Sawaya, GF Ockene, JK DeWitt, T AF Petitti, Diana B. Teutsch, Steven M. Barton, Mary B. Sawaya, George F. Ockene, Judith K. DeWitt, Thomas CA US Preventive Serv Task Force TI Update on the Methods of the US Preventive Services Task Force: Insufficient Evidence SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID DECISION-MAKING; RECOMMENDATION STATEMENT; STRENGTH; QUALITY; SYSTEMS AB The U.S. Preventive Services Task Force (USPSTF) seeks to provide reliable and accurate evidence-based recommendations to primary care clinicians. However, clinicians indicate frustration with the lack of guidance provided by the USPSTF when the evidence is insufficient to make a recommendation. This article describes a new USPSTF plan to commission its Evidence-based Practice Centers to collect information in 4 domains pertinent to clinical decisions about prevention and to report this information routinely. The 4 domains are potential preventable burden, potential harm of the intervention, costs (both monetary and opportunity), and current practice. The process and rationale used to select these domains are presented, along with examples of how clinicians might use the information to guide clinical decision making when evidence is insufficient. C1 [Petitti, Diana B.] Arizona State Univ, Dept Biomed Informat, Phoenix, AZ 85041 USA. Merck & Co Inc, West Point, PA USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. Univ Massachusetts, Sch Med, Worcester, MA USA. Univ Calif San Francisco, San Francisco, CA 94143 USA. Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp, Med Ctr, Cincinnati, OH USA. RP Petitti, DB (reprint author), Arizona State Univ, Dept Biomed Informat, Phoenix, AZ 85041 USA. NR 30 TC 48 Z9 48 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 FEB 3 PY 2009 VL 150 IS 3 BP 199 EP + PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 402RA UT WOS:000263029600007 PM 19189910 ER PT J AU Calonge, N Petitti, DB Lin, KW AF Calonge, Ned Petitti, Diana B. Lin, Kenneth W. TI Are Age-Based Criteria the Best Way to Determine Eligibility for Prostate Cancer Screening? RESPONSE SO ANNALS OF INTERNAL MEDICINE LA English DT Letter ID RADICAL PROSTATECTOMY C1 [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO 80246 USA. [Petitti, Diana B.] Univ So Calif, Keck Sch Med, Los Angeles, CA 90089 USA. [Lin, Kenneth W.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Calonge, N (reprint author), Colorado Dept Publ Hlth & Environm, Denver, CO 80246 USA. NR 4 TC 0 Z9 0 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 FEB 3 PY 2009 VL 150 IS 3 BP 221 EP 222 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 402RA UT WOS:000263029600016 ER PT J AU Li, Y Cai, XY Glance, LG Spector, WD Mukamel, DB AF Li, Yue Cai, Xueya Glance, Laurent G. Spector, William D. Mukamel, Dana B. TI National Release of the Nursing Home Quality Report Cards: Implications of Statistical Methodology for Risk Adjustment SO HEALTH SERVICES RESEARCH LA English DT Article DE Nursing home; quality report cards; activities of daily living; risk adjustment; MDS ID MINIMUM DATA SET; RESIDENT ASSESSMENT INSTRUMENT; LONG-TERM-CARE; OUTCOME MEASURES; CABG SURGERY; OF-CARE; SELECTION; MODELS; RELIABILITY; PERFORMANCE AB To determine how alternative statistical risk-adjustment methods may affect the quality measures (QMs) in nursing home (NH) report cards. Secondary data from the national Minimum Data Set files of 2004 and 2005 that include 605,433 long-term residents in 9,336 facilities. We estimated risk-adjusted QMs of decline in activities of daily living (ADL) functioning using classical, fixed-effects, and random-effects logistic models. Risk-adjusted QMs were compared with each other, and with the published QM (unadjusted) in identifying high- and low-quality facilities by either the rankings or 95 percent confidence intervals of QMs. Risk-adjusted QMs showed better overall agreement (or convergent validity) with each other than did the unadjusted versus each adjusted QM; the disagreement rate between unadjusted and adjusted QM can be as high as 48 percent. The risk-adjusted QM derived from the random-effects shrinkage estimator deviated nonrandomly from other risk-adjusted estimates in identifying the best 10 percent facilities using rankings. The extensively risk-adjusted QMs of ADL decline, even when estimated by alternative statistical methods, show higher convergent validity and provide more robust NH comparisons than the unadjusted QM. Outcome rankings based on ADL decline tend to show lower convergent validity when estimated by the shrinkage estimator rather than other statistical methods. C1 [Li, Yue] Univ Calif Irvine, Dept Med, Irvine, CA 92697 USA. [Cai, Xueya] Indiana Univ Purdue Univ, Indiana Univ Sch Med, Div Biostat, Indianapolis, IN 46202 USA. [Glance, Laurent G.] Univ Rochester, Sch Med & Dent, Dept Anesthesiol, Rochester, NY USA. [Spector, William D.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Mukamel, Dana B.] Univ Calif Irvine, Ctr Hlth Policy Res, Irvine, CA 92697 USA. RP Li, Y (reprint author), Univ Calif Irvine, Dept Med, Irvine, CA 92697 USA. EM ylill@uci.edu FU National Institute on Aging [AG029608, AG020644] FX This study was funded by the National Institute on Aging under grants AG029608 (to Y.L.) and AG020644 (to D.B.M.). The views presented in this manuscript are those of the authors and may not reflect those of the National Institute on Aging. NR 53 TC 12 Z9 12 U1 3 U2 8 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD FEB PY 2009 VL 44 IS 1 BP 79 EP 102 DI 10.1111/j.1475-6773.2008.00910.x PG 24 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 394TM UT WOS:000262470800007 PM 19146565 ER PT J AU Le Cook, B McGuire, TG Zuvekas, SH AF Le Cook, Benjamin McGuire, Thomas G. Zuvekas, Samuel H. TI Measuring Trends in Racial/Ethnic Health Care Disparities SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE racial disparities; medical expenditure; trends; statistical adjustment for health status ID RACIAL-DIFFERENCES; MEDICAL PROCEDURES; DIAGNOSTIC-TESTS; SERVICES; ACCESS; RESOURCES; INSURANCE; QUALITY AB Monitoring disparities over time is complicated by the varying disparity definitions applied in the literature. This study used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to compare trends in disparities by three definitions of racial/ethnic disparities and to assess the influence of changes in socioeconomic status (SES) among racial/ethnic minorities on disparity trends. This study prefers the Institute of Medicine's (IOM) definition, which adjusts for health status but allows for mediation of racial/ethnic disparities through SES factors. Black-White disparities in having an office-based or outpatient visit and medical expenditure were roughly constant and Hispanic-White disparities increased for office-based or outpatient visits and for medical expenditure between 1996-1997 and 2004-2005. Estimates based on the independent effect of race/ethnicity were the most conservative accounting of disparities and disparity trends, underlining the importance of the role of SES mediation in the study of trends in disparities. C1 [Le Cook, Benjamin] Harvard Univ, Sch Med, Somerville, MA USA. [McGuire, Thomas G.] Harvard Univ, Sch Med, Boston, MA USA. [Zuvekas, Samuel H.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Le Cook, B (reprint author), Harvard Univ, Sch Med, Somerville, MA USA. FU National Institute of Mental Health [P50 MHO 73469, R03 MH82312]; National Center for Minority Health and Disparities [P60 MD002261] FX This research was supported by grants P50 MHO 73469 and R03 MH82312 from the National Institute of Mental Health and P60 MD002261 from the National Center for Minority Health and Disparities. The views expressed in this article are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the US Department of Health and Human Services is intended or should be inferred. NR 45 TC 28 Z9 28 U1 0 U2 4 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 FEB PY 2009 VL 66 IS 1 BP 23 EP 48 DI 10.1177/1077558708323607 PG 26 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 390CR UT WOS:000262142400002 PM 18796581 ER PT J AU Selim, A Rogers, W Fleishman, J Qian, S Fincke, B Rothendler, J Kazis, L AF Selim, Alfredo J. Rogers, William Fleishman, John A. Qian, Shirley X. Fincke, Benjamin G. Rothendler, James A. Kazis, Lewis E. TI Updated US population standard for the Veterans RAND 12-item Health Survey (VR-12) SO QUALITY OF LIFE RESEARCH LA English DT Article DE Health-related quality of life; Veterans RAND 12-item Health Survey; Veterans; Standard-based scoring ID QUALITY-OF-LIFE; MEDICAL OUTCOMES; SF-36; SF-12; VALIDITY AB The purpose of this project was to develop an updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). We used a well-defined and nationally representative sample of the U.S. population from 52,425 responses to the Medical Expenditure Panel Survey (MEPS) collected between 2000 and 2002. We applied modified regression estimates to update the non-proprietary 1990 scoring algorithms. We applied the updated standard to the Medicare Health Outcomes Survey (HOS) to compute the VR-12 physical (PCS((MEPS standard))) and mental (MCS((MEPS standard))) component summaries based on the MEPS. We compared these scores to PCS and MCS based on the 1990 U.S. population standard. Using the updated U.S. population standard, the average VR-12 PCS((MEPS standard)) and MCS((MEPS standard)) scores in the Medicare HOS were 39.82 (standard deviation [SD] = 12.2) and 50.08 (SD = 11.4), respectively. For the same Medicare HOS, the average PCS and MCS scores based on the 1990 standard were 1.40 points higher and 0.99 points lower in comparison to VR-12 PCS and MCS, respectively. Changes in the U.S. population between 1990 and today make the old standard obsolete for the VR-12, so the updated standard developed here is widely available to serve as such a contemporary standard for future applications for health-related quality of life (HRQoL) assessments. C1 [Selim, Alfredo J.; Rogers, William; Qian, Shirley X.; Fincke, Benjamin G.; Rothendler, James A.; Kazis, Lewis E.] VA Med Ctr, Ctr Hlth Qual Outcomes & Econ Res, Hlth Serv Res & Dev Ctr Excellence, Bedford, MA USA. [Selim, Alfredo J.; Fleishman, John A.; Rothendler, James A.; Kazis, Lewis E.] Boston Univ, Sch Publ Hlth, CAPP, Dept Hlth Policy & Management, Boston, MA 02118 USA. [Selim, Alfredo J.] Boston VA Hlth Care Syst, Sect Emergency Serv, W Roxbury, MA USA. [Selim, Alfredo J.; Fincke, Benjamin G.] Boston Univ, Sch Med, Boston, MA 02118 USA. [Rogers, William] Tufts Univ New England Med Ctr, Hlth Inst, Boston, MA 02111 USA. [Fleishman, John A.] Agcy Healthcare Res & Qual, CFACT, Rockville, MD USA. RP Selim, A (reprint author), VA Med Ctr, Ctr Hlth Qual Outcomes & Econ Res, Hlth Serv Res & Dev Ctr Excellence, Bedford, MA USA. EM Selim.Alfredo_J@Boston.Med.VA.gov; lek@bu.edu OI Kazis, Lewis/0000-0003-1800-5849 FU Centers for Medicare & Medicaid Services (CMS); National Committee for Quality Assurance (NCQA) [500-00-0055]; NCQA; Office of Quality and Performance (OQP); Department of Veterans Affairs; Center for Health Quality, Outcomes and Economic Research (CHQOER); Boston University School of Public Health FX The research in this article was supported by the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) under contract numbers 500-00-0055 with the NCQA, Office of Quality and Performance (OQP) of the Department of Veterans Affairs, The Center for Health Quality, Outcomes and Economic Research (CHQOER), Department of Veterans Affairs, and Boston University School of Public Health. NR 37 TC 67 Z9 68 U1 1 U2 9 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0962-9343 J9 QUAL LIFE RES JI Qual. Life Res. PD FEB PY 2009 VL 18 IS 1 BP 43 EP 52 DI 10.1007/s11136-008-9418-2 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 402PM UT WOS:000263025600006 PM 19051059 ER PT J AU Battles, JB Stevens, DP AF Battles, James B. Stevens, David P. TI Adverse event reporting systems and safer healthcare SO QUALITY & SAFETY IN HEALTH CARE LA English DT Editorial Material C1 [Battles, James B.; Stevens, David P.] CQuIPS, AHRQ, Rockville, MD 20850 USA. RP Battles, JB (reprint author), CQuIPS, AHRQ, 540 Gaither Rd, Rockville, MD 20850 USA. EM james.battles@ahrq.hhs.gov NR 11 TC 12 Z9 12 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 FEB PY 2009 VL 18 IS 1 BP 2 EP 2 DI 10.1136/qshc.2008.031997 PG 1 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 404UJ UT WOS:000263178200001 PM 19204123 ER PT J AU Wolff, T AF Wolff, Tracy TI Screening for Carotid Artery Stenosis SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Wolff, T (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, Ctr Primary Care Prevent & Clin Partnerships, 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 JAN 15 PY 2009 VL 79 IS 2 BP 95 EP 96 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 396UL UT WOS:000262616600006 PM 19178060 ER PT J AU Chander, G Himelhoch, S Fleishman, JA Hellinger, J Gaist, P Moore, RD Gebo, KA AF Chander, Geetanjali Himelhoch, Seth Fleishman, John A. Hellinger, James Gaist, Paul Moore, Richard D. Gebo, Kelly A. TI HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use SO AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV LA English DT Article DE HIV; mental health; illicit drug use; viral suppression ID ACTIVE ANTIRETROVIRAL THERAPY; SUBSTANCE USE DISORDERS; VIROLOGICAL RESPONSE; ABUSE; ADHERENCE; SCHIZOPHRENIA; DEPRESSION; ASSOCIATION; COMORBIDITY; MANAGEMENT AB Mental illness (MI) and illicit drug use (DU) frequently co-occur. We sought to determine the individual and combined effects of MI and DU on highly active antiretroviral therapy (HAART) receipt and HIV-RNA suppression among individuals engaged in HIV care. Using 2004 data from the HIV Research Network (HIVRN), we performed a cross-sectional study of HIV-infected patients followed at seven primary care sites. Outcomes of interest were HAART receipt and virological suppression, defined as an HIV-RNA 400 copies/ml. Independent variables of interest were: (1) MI/DU; (2) DU only; (3) MI only; and (4) Neither. We used chi-squared analysis for comparison of categorical variables, and logistic regression to adjust for age, race, sex, frequency of outpatient visits, years in clinical care, CD4 nadir, and study site. During 2004, 10,284 individuals in the HIVRN were either on HAART or HAART eligible defined as a CD4 cell count 350. Nearly half had neither MI nor DU (41%), 22% MI only, 15% DU only, and 22% both MI and DU. In multivariate analysis, co-occurring MI/DU was associated with the lowest odds of HAART receipt (Adjusted Odds Ratio: 0.63 (95% CI: (0.55-0.72]), followed by those with DU only (0.75(0.63-0.87)), compared to those with neither. Among those on HAART, concurrent MI/DU (0.66 (0.58-0.75)), DU only (0.77 (0.67-0.88)), were also associated with a decreased odds of HIV-RNA suppression compared to those with neither. MI only was not associated with a statistically significant decrease in HAART receipt (0.93(0.81-1.07)) or viral suppression (0.93 (0.82-1.05)) compared to those with neither. Post-estimation testing revealed a significant difference between those with MI/DU and DU only, and MI/DU and MI only. Co-occurring MI and DU is associated with lower HAART receipt and viral suppression compared to individuals with either MI or DU or neither. Integrating HIV, substance abuse, and mental healthcare may improve outcomes in this population. C1 [Chander, Geetanjali; Moore, Richard D.; Gebo, Kelly A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Himelhoch, Seth] Univ Maryland, Sch Med, Dept Psychiat, Baltimore, MD 21201 USA. [Fleishman, John A.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Hellinger, James] Community Med Alliance, Boston, MA USA. [Gaist, Paul] NIH, Bethesda, MD 20892 USA. [Hellinger, James] Tufts Univ New England Med Ctr, Boston, MA USA. RP Chander, G (reprint author), Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. EM GChande1@jhmi.edu FU NIAAA NIH HHS [K23 AA 015313, K23 AA015313, K23 AA015313-05]; NIAID NIH HHS [U01 AI069918]; NIDA NIH HHS [K23-DA 019820, K23 DA000523, K23 DA019820, K23-DA 00523, K24 DA 00432, K24 DA000432] NR 32 TC 20 Z9 20 U1 2 U2 6 PU ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD PI ABINGDON PA 4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXFORDSHIRE, ENGLAND SN 0954-0121 EI 1360-0451 J9 AIDS CARE JI Aids Care-Psychol. Socio-Med. Asp. Aids-Hiv PY 2009 VL 21 IS 5 BP 655 EP 663 AR PII 911200181 DI 10.1080/09540120802459762 PG 9 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 445WB UT WOS:000266081100015 PM 19444675 ER PT J AU Unruh, L Russo, CA Jiang, HJ Stocks, C AF Unruh, Lynn Russo, C. Allison Jiang, H. Joanna Stocks, Carol BE Savage, GT Fottler, MD TI MEASURING UP: ARE NURSE STAFFING MEASURES ADEQUATE FOR HEALTH SERVICES RESEARCH? SO BIENNIAL REVIEW OF HEALTH CARE MANAGEMENT: MESO PERSPECTIVE SE Advances in Health Care Management LA English DT Article; Book Chapter ID ADVERSE EVENTS; PENNSYLVANIA HOSPITALS; CARE; QUALITY; PATIENT; MORTALITY; REDUCTIONS; ISSUES; COSTS AB Background - Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is growing as to whether current nurse staffing measures adequately meet the needs of health services researchers. Objective - This study assesses whether the measures, sampling frameworks, and data sources meet the needs of health services research in areas such as staffing assessment; patient, nurse, and financial outcomes; and prediction of staffing. Methods - We performed a systematic review of articles from 1990 through 2007, which use hospital nurse staffing measures in original research, or which address the validity, reliability, and availability of the measures. Taxonomies of measures, sampling frameworks, and sources were developed. Articles were analyzed to assess what measures, sampling strategies, and sources of data were used and to ascertain whether the measures, samples, and sources meet the needs of researchers. Results - The review identified 107 articles that use hospital nurse staffing measures for original research. Multiple types of measures, some of which are used more often than others and some of which are more valid than others, exist in each of the following categories: staffing counts, staffing/patient load ratios, and skill mix. Sampling frameworks range from hospital units to all hospitals nationally, with all hospitals in a state being the most common. Data sources range from small-scale surveys to national databases. The American Hospital Association Annual Survey is the most frequently used data source, but there are limitations with its nurse staffing measures. Arguably, the multiplicity of measures and differences in sampling and data sources are due, in part, to data availability. The limitations noted by other researchers and by this review indicate that staffing measures need improvements in conceptualization, content, scope, and availability. Discussion - Recommendations are made for improvements to research and administrative practice and to data. C1 [Unruh, Lynn] Univ Cent Florida, Dept Hlth Profess, Coll Hlth Serv Adm Hlth & Publ Affairs, Orlando, FL 32816 USA. [Jiang, H. Joanna; Stocks, Carol] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Russo, C. Allison] Thomson Reuters, Washington, DC USA. RP Unruh, L (reprint author), Univ Cent Florida, Dept Hlth Profess, Coll Hlth Serv Adm Hlth & Publ Affairs, Orlando, FL 32816 USA. OI Stocks, Carol/0000-0003-3440-3193 NR 32 TC 2 Z9 2 U1 0 U2 0 PU EMERALD GROUP PUBLISHING LIMITED PI BINGLEY PA HOWARD HOUSE, WAGON LANE, BINGLEY, W YORKSHIRE BD16 1WA, ENGLAND BN 978-1-84855-672-0 J9 ADV HEALTH CARE MANA PY 2009 VL 8 BP 115 EP 154 DI 10.1108/S1474-8231(2009)0000008009 PG 40 WC Health Policy & Services SC Health Care Sciences & Services GA BLS25 UT WOS:000270924000006 ER PT J AU Coleman, K Austin, BT Brach, C Wagner, EH AF Coleman, Katie Austin, Brian T. Brach, Cindy Wagner, Edward H. TI Evidence On The Chronic Care Model In The New Millennium SO HEALTH AFFAIRS LA English DT Article ID COMMUNITY-HEALTH CENTERS; IMPROVING DIABETES CARE; CHRONIC ILLNESS CARE; QUALITY IMPROVEMENT; DISEASE MANAGEMENT; GLYCEMIC CONTROL; SYSTEMS; RISK; COLLABORATIVES; INTERVENTIONS AB Developed more than a decade ago, the Chronic Care Model (CCM)is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States and around the world. We examine the evidence of the CCM's effectiveness by reviewing articles published since 2000 that used one of five key CCM papers as a reference. Accumulated evidence appears to support the CCM as an integrated framework to guide practice redesign. Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes. [Health Affairs 28, no. 1 (2009): 75-85; 10.1377/hlthaff.28.1.75] C1 [Coleman, Katie] Grp Hlth Ctr Hlth Studies, MacColl Inst Healthcare Innovat, Seattle, WA USA. [Brach, Cindy] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Coleman, K (reprint author), Grp Hlth Ctr Hlth Studies, MacColl Inst Healthcare Innovat, Seattle, WA USA. EM coleman.cf@ghc.org FU Robert Wood Johnson Foundation [053022, 58194]; Agency for Healthcare Research and Quality (AHRQ) FX This work was funded by the Robert Wood Johnson Foundation Improving Chronic Illness Care: Transitional Support for Field Building Grant no. 053022 and Improving Chronic Illness Care: Scientific Support Grant no. 58194. This work was also supported in part by a task order from the Agency for Healthcare Research and Quality (AHRQ) titled "Integrating Chronic Care and Business Strategies in the Safety Net." The views expressed in this paper are those of the authors and do not necessarily reflect the official position of AHRQ or the U. S. Department of Health and Human Services. The authors thank the Robert Wood Johnson Foundation and their colleagues at the MacColl Institute for Healthcare Innovation, Group Health Center for Health Studies, for their ongoing support of this work. NR 40 TC 483 Z9 493 U1 5 U2 57 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 2009 VL 28 IS 1 BP 75 EP 85 DI 10.1377/hlthaff.28.1.75 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 390WM UT WOS:000262194400011 PM 19124857 ER PT B AU Henderson, MJ AF Henderson, Melford J. BE Hofmann, BR TI SYNTHESIS OF "STATISTICAL INNOVATIONS FOR COST-EFFECTIVENESS ANALYSIS" TRANSLATING RESEARCH INTO POLICY AND PRACTICE (TRIPP) SO HEALTH CARE COSTS: CAUSES, EFFECTS AND CONTROL SE Health Care Issues Costs and Access LA English DT Article; Book Chapter ID IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR; SAMPLE-SIZE CALCULATIONS; CONFIDENCE-INTERVALS; EFFECTIVENESS RATIOS; HEART-DISEASE; HEALTH-CARE; MEDICAL PROGNOSIS; CLINICAL-TRIALS; MARKOV-MODELS; POWER AB Rapid increases in health care costs continue to be of significance to public, federal and state agencies, as well as private industry. Publicly funded insurance programs such as Medicare and Medicaid are continually challenged with difficult decisions in allocating health care dollars. Private industries are similarly challenged in providing adequate health care benefits to their employees. The need to contain health care costs forces us to consider which interventions produce the greatest value. Cost-effectiveness analysis (CEA) offers a structured approach for determining economic evaluations of health care programs. It can be used for optimizing health benefits from a specified health care budget, or in finding the lowest cost strategy for a specific health benefit. CEA has also been promoted as a useful tool in the effort to prioritize expenditures on health care programs. By quantifying the trade-offs between resources that need to be deployed and health benefits that accrue from use of alternative interventions, CEA offers guidance in decision-making by structuring comparisons between these interventions. The Agency for Healthcare Research and Quality has funded investigator-initiated research projects for promoting developments related to Translating Research into Policy and Practice. This article summarizes the work led by Joseph Gardiner and colleagues. The goals of this research were to develop new statistical methods that fill methodological gaps, and resolve inconsistencies in CEA. Adopting a framework in which both costs and benefits are stochastic in nature, the research team describes summary measures used in CEA, such as the cost-effectiveness ratio as functions of parameters in an underlying stochastic model. In estimation of these summary measures, the inherent variability in the estimates can be quantified. Markov models provide a probabilistic description of the evolution of events in patients through different health states. In this longitudinal framework, Gardiner et al. use stochastic models that reflect the experience of patients in sustained and changing states of health. Costs are incurred in random amounts at random points in time during the course of an intervention. By compiling these expenditure streams at the individual level into costs per unit time of sojourn in a health state, and in transition between health states, Gardiner et al. estimate the net present value of all expenditures. Health outcome measures such as life expectancy and quality-adjusted life years can also be estimated. In summary, several aspects and complexities in the analyses of health care costs and outcomes are incorporated into these models. The team's work is continuing. Their methods promise useful applications in CEA. C1 Agcy Healthcare Res & Qual, Div Socioecon Res, CFACT, Program Official, Rockville, MD 20850 USA. RP Henderson, MJ (reprint author), Agcy Healthcare Res & Qual, Div Socioecon Res, CFACT, Program Official, 540 Gaither Rd, Rockville, MD 20850 USA. EM Melford.Henderson@ahrq.hhs.gov NR 74 TC 0 Z9 0 U1 0 U2 3 PU NOVA SCIENCE PUBLISHERS, INC PI HAUPPAUGE PA 400 OSER AVE, STE 1600, HAUPPAUGE, NY 11788-3635 USA BN 978-1-60456-976-6 J9 HEALTH CARE ISS COST PY 2009 BP 121 EP 151 PG 31 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA BLV03 UT WOS:000271119500010 ER PT J AU Harrison, MI Kimani, J AF Harrison, Michael I. Kimani, James TI Building capacity for a transformation initiative: System redesign at Denver Health SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article DE delivery systems; improvement; organizational change; redesign; transformation ID RADICAL ORGANIZATIONAL-CHANGE; CARE; LESSONS; FIRM AB Background: This article examines the development of transformation initiatives-deliberate attempts to achieve systemic changes and rapid performance improvements. Accounts of transformation initiatives often reveal little about past organizational and contextual conditions that contributed to success. instead, these accounts concentrate on change barriers. Purpose: We seek to restore balance to this field by examining how antecedent system capacities contributed to a successful transformation initiative. Methodology: This article presents a case study of the first 2 years of a system redesign initiative at an integrated safety-net health system and provides a historical analysis of developments during the decade preceding the redesign. Findings: Beginning in the mid-1990s, Denver Health benefited from strong municipal support for its development and expansion. Gradually, it developed its financial and human resources, organizational structure, change strategy, change-management capabilities, information technology, and physical plant. These antecedent capacities all contributed to the implementation of the 2004 system redesign and helped Denver Health overcome several constraints. Implications: Transformation initiatives may build on existing features and resources, even as they overcome or depart from others. The Denver Health case study helps researchers identify positive antecedents to transformation initiatives, assess the success of such initiatives in terms of implementation progress and outcomes, and recognize complementary contributions of incremental and episodic changes. The study alerts practitioners to the importance of assuring that change efforts rest on solid organizational foundations. C1 [Harrison, Michael I.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Kimani, James] Impaq Int, Columbia, MD USA. RP Harrison, MI (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. EM Michael.Harrison@ahrq.hhs.gov NR 47 TC 18 Z9 18 U1 0 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0361-6274 EI 1550-5030 J9 HEALTH CARE MANAGE R JI Health Care Manage. Rev. PD JAN-MAR PY 2009 VL 34 IS 1 BP 42 EP 53 PG 12 WC Health Policy & Services SC Health Care Sciences & Services GA 389LW UT WOS:000262095200005 PM 19104263 ER PT J AU Jiang, HJ Lockee, C Bass, K Fraser, I AF Jiang, H. Joanna Lockee, Carlin Bass, Karma Fraser, Irene TI Board Oversight of Quality: Any Differences in Process of Care and Mortality? SO JOURNAL OF HEALTHCARE MANAGEMENT LA English DT Article ID PAY-FOR-PERFORMANCE; IMPROVEMENT; LEADERSHIP AB In response to legal and accreditation mandates as well as pressures from purchasers and consumers for quality improvement, hospital governing boards seek to improve their oversight of quality of care by adopting various practices. Based on a previous survey of hospital presidents/chief executive officers, this study examines differences in hospital quality performance associated with the adoption of particular practices in board oversight of quality. Quality was measured by performance in process of care and risk-adjusted mortality, using the Hospital Compare data from the Centers for Medicare & Medicaid Services and the Healthcare Cost and Utilization Project inpatient databases of the Agency for Healthcare Research and Quality. Board practices found to be associated with better performance in both process of care and mortality include (1) having a board quality committee; (2) establishing strategic goals for quality improvement; (3) being involved in setting the quality agenda for the hospital; (4) including a specific item on quality in board meetings; (5) using a dashboard with national benchmarks that includes indicators for clinical quality, patient safety, and patient satisfaction; and (6) linking senior executives' performance evaluation to quality and patient safety indicators. Involvement of physician leadership in the board quality committee further enhanced the hospital's quality performance. Taken together, these findings seem to support the will-execution-constancy Of Purpose framework on improving the effectiveness of hospital boards in overseeing quality. Future study should examine how specific board practices influence the culture and operations of the hospital that lead to better quality of care. C1 [Jiang, H. Joanna; Fraser, Irene] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Lockee, Carlin; Bass, Karma] Governance Inst, San Diego, CA USA. RP Jiang, HJ (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. EM joanna.jiang@ahrq.hhs.gov NR 16 TC 30 Z9 30 U1 3 U2 9 PU AMER COLL HEALTHCARE EXEC HEALTH ADMINISTRATION PRESS PI CHICAGO PA ONE NORTH FRANKLIN ST SUITE 1700, CHICAGO, IL 60606 USA SN 1096-9012 J9 J HEALTHC MANAG JI J. Healthc. Manag. PD JAN-FEB PY 2009 VL 54 IS 1 BP 15 EP 29 PG 15 WC Health Policy & Services SC Health Care Sciences & Services GA 397WE UT WOS:000262692100005 PM 19227851 ER PT J AU Hughes, RG Clancy, CM AF Hughes, Ronda G. Clancy, Carolyn M. TI Nurses' Role in Patient Safety SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 [Hughes, Ronda G.; Clancy, Carolyn M.] 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 6 TC 9 Z9 9 U1 0 U2 2 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 JAN-MAR PY 2009 VL 24 IS 1 BP 1 EP 4 PG 4 WC Nursing SC Nursing GA 391UW UT WOS:000262260700001 PM 19092471 ER PT J AU Cohen, SB Yu, WW AF Cohen, Steven B. Yu, William W. TI The Utility of Prediction Models to Oversample the Long-Term Uninsured SO MEDICAL CARE LA English DT Article DE long-term uninsured; oversampling; MEPS ID COVERAGE; CARE AB Objectives: To evaluate the performance of prediction models in identifying the long-term uninsured and their utility for oversampling purposes in national health care surveys. Data and Methods: Nationally representative data from the Medical Expenditure Panel Survey (MEPS) were used to examine national estimates of nonelderly adults without health insurance coverage for 2 consecutive years and to identify the factors that distinguished them from the short-term uninsured and those who are continually insured. The MEPS data were also used in the development of the prediction models to identify individuals most likely to experience long-term spells without coverage in the future. The prediction models were developed using data from the MEPS panel covering 2004-2005 and evaluated with all independent MEPS panel. Results: Study findings revealed these prediction models to be markedly effective statistical tools in facilitating an efficient oversample of individuals likely to be uninsured for long periods of duration in the future. Use of these models for oversampling purposes, to support a 50% increase in sample yield over a self-weighting design, permits the selection of the target sample of individuals who are continuously uninsured for 2 consecutive years in the most cost-efficient manner. This methodology allows for ail overall sample size specification for nonelderly adults that is at least 25% lower than a design without access to the predictor variables from a screening interview or without application of oversampling techniques. Conclusions: This examination of the performance of probabilistic models, to both identify and facilitate an oversample of the long-term uninsured, demonstrates the viability of these model-based sampling methodologies for adoption in national health care surveys. C1 [Cohen, Steven B.; Yu, William W.] 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, Rockville, MD 20850 USA. EM scohen@ahrq.gov NR 22 TC 2 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 JAN PY 2009 VL 47 IS 1 BP 80 EP 87 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 390TL UT WOS:000262186500012 PM 19106735 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 Modifying ICD-9-CM Coding of Secondary Diagnoses to Improve Risk-Adjustment of Inpatient Mortality Rates SO MEDICAL DECISION MAKING LA English DT Article DE risk adjustment; hospital mortality; quality of health care; data collection; data sources; International Classification of Diseases; medical records ID ACUTE MYOCARDIAL-INFARCTION; HOSPITAL MORTALITY; VETERANS-AFFAIRS; HEART-FAILURE; SURGERY; MODEL; ENHANCEMENT; QUALITY; CARE AB Objective. To assess the effect on risk-adjustment of inpatient mortality rates of progressively enhancing administrative claims data with clinical data that are increasingly expensive to obtain. Data Sources. Claims and abstracted clinical data on patients hospitalized for 5 medical conditions and 3 surgical procedures at 188 Pennsylvania hospitals from July 2000 through June 2003. Methods. Risk-adjustment models for inpatient mortality were derived using claims data with secondary diagnoses limited to conditions unlikely to be hospital-acquired complications. Models were enhanced with one or more of 1) secondary diagnoses inferred from clinical data to have been present-on-admission (POA), 2) secondary diagnoses not coded on claims but documented in medical records as POA, 3) numerical laboratory results from the first hospital day, and 4) all available clinical data from the first hospital day. Alternative models were compared using c-statistics, the magnitude of errors in prediction for individual cases, and the percentage of hospitals with aggregate errors in prediction exceeding specified thresholds. Results. More complete coding of a few under-reported secondary diagnoses and adding numerical laboratory results to claims data substantially improved predictions of inpatient mortality. Little improvement resulted from increasing the maximum number of available secondary diagnoses or adding additional clinical data. Conclusions. Increasing the completeness and consistency of reporting a few secondary diagnosis codes for findings POA and merging claims data with numerical laboratory values improved risk adjustment of inpatient mortality rates. Expensive abstraction of additional clinical information from medical records resulted in little further improvement. C1 [Pine, Michael; Fry, Donald E.; Jones, Barbara; Meimban, Roger] Michael Pine & Associates Inc, Chicago, IL USA. [Jordan, Harmon S.; Hoaglin, David C.; Warner, David; Gonzales, Junius] ABT Associates Inc, Cambridge, MA 02138 USA. [Jordan, Harmon S.] Tufts Univ, Sch Med, Boston, MA 02111 USA. [Elixhauser, Anne] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Pine, M (reprint author), 1210 Chicago Ave Ste 503, Evanston, IL 60202 USA. EM michaelorjoan@yahoo.com NR 32 TC 11 Z9 12 U1 0 U2 2 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 JAN-FEB PY 2009 VL 29 IS 1 BP 69 EP 81 DI 10.1177/0272989X08323297 PG 13 WC Health Care Sciences & Services; Medical Informatics SC Health Care Sciences & Services; Medical Informatics GA 421KD UT WOS:000264356900007 PM 18812585 ER PT J AU Conway, PH White, PJ Clancy, C AF Conway, Patrick H. White, P. Jonathan Clancy, Carolyn TI The Public Role in Promoting Child Health Information Technology SO PEDIATRICS LA English DT Article DE health information technology; pediatric data standards; electronic health record; public policy ID IMMUNIZATION; SYSTEMS; RECORD; CARE AB The public sector plays an important role in promoting child health information technology. Public sector support is essential in 5 main aspects of child health information technology, namely, data standards, pediatric functions in health information systems, privacy policies, research and implementation funding, and incentives for technology adoption. Some innovations in health information technology for adult populations can be transferred to or adapted for children, but there also are unique needs in the pediatric population. Development of health information technology that addresses children's needs and effective adoption of that technology are critical for US children to receive care of the highest possible quality in the future. Pediatrics 2009; 123: S125-S127 C1 [Conway, Patrick H.; White, P. Jonathan; Clancy, Carolyn] Agcy Healthcare Res & Qual, Rockville, MD USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Ctr Hlth Care Qual, Div Hlth Policy & Clin Effectiveness, Cincinnati, OH USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Div Gen Pediat, Cincinnati, OH USA. RP Conway, PH (reprint author), 200 Independence Ave,Humphrey Bldg 447 D-3, Washington, DC 20201 USA. EM patrick.conway@hhs.gov NR 15 TC 2 Z9 2 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 JAN PY 2009 VL 123 BP S125 EP S127 DI 10.1542/peds.2008-1755O PG 3 WC Pediatrics SC Pediatrics GA 413XK UT WOS:000263825800014 PM 19088229 ER PT B AU Jiang, HJ Lockee, C Fraser, I AF Jiang, H. Joanna Lockee, Carlin Fraser, Irene BE Gao, J Cheng, Y Li, JH Fu, XL TI HOW HOSPITAL GOVERNING BOARDS ENHANCE QUALITY OVERSIGHT: AN APPLICATION OF THE AGENCY THEORY PERSPECTIVE SO PROCEEDINGS OF ACADEMY OF INNOVATION AND ENTREPRENEURSHIP 2009 LA English DT Proceedings Paper CT 2nd Annual Conference of the Academy-of-Innovation-and-Entrepreneurship CY JUL 16-18, 2009 CL Tsinghua Univ, Sch Econ & Management, Beijing, PEOPLES R CHINA SP Acad Innovat & Entrepreneurship, Tsinghua Univ, Res Ctr Technol Innovat, Tsinghua Univ, Natl Entrepreneurship Res Ctr, Tsinghua Univ, Innovat & Entrepreneurship Dept, Univ Oxford, Saniaya Lall Programme Technol Dev HO Tsinghua Univ, Sch Econ & Management DE Hospital governance; Quality of care; Agency theory ID PHYSICIAN; PERFORMANCE; CARE AB Community hospitals in the U.S. are almost all governed by a governing board which is legally accountable for the quality of care provided. This study employs the agency theory to examine governance practices in enhancing oversight for quality of care. Data on governance practices are based on a survey conducted in 2007 and data on hospital quality are drawn from two large federal databases. The study sample includes 445 hospitals. Consistent with the agency theory, some practices are outcome-based that focus on measuring and reporting of the hospital's quality performance, while other practices are behavior-based that mainly deal with actions and processes important to the provision of quality care. Better quality performance is significantly associated with adoption of six practices as well as the existence of a board quality committee. C1 [Jiang, H. Joanna; Fraser, Irene] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. EM joanna.jiang@ahrq.hhs.gov; clockee@governanceinstitute.com; Irene.fraser@ahrq.hhs.gov NR 19 TC 0 Z9 0 U1 0 U2 1 PU CHINA WATERPOWER PRESS-CWPP PI BEIJING PA 6 SANLIHELU, FUXINGMENWAI, BEIJING, 100044, PEOPLES R CHINA BN 978-7-5084-6533-3 PY 2009 BP 278 EP 285 PG 8 WC Business; Economics SC Business & Economics GA BNO72 UT WOS:000275143800034 ER PT J AU Wideroff, L Phillips, KA Randhawa, G Ambs, A Armstrong, K Bennett, CL Brown, ML Donaldson, MS Follen, M Goldie, SJ Hiatt, RA Khoury, MJ Lewis, G McLeod, HL Piper, M Powell, I Schrag, D Schulman, KA Scott, J AF Wideroff, Louise Phillips, Kathryn A. Randhawa, Gurvaneet Ambs, Anita Armstrong, Katrina Bennett, Charles L. Brown, Martin L. Donaldson, Molla S. Follen, Michele Goldie, Sue J. Hiatt, Robert A. Khoury, Muin J. Lewis, Graham McLeod, Howard L. Piper, Margaret Powell, Isaac Schrag, Deborah Schulman, Kevin A. Scott, Joan TI A Health Services Research Agenda for Cellular, Molecular and Genomic Technologies in Cancer Care SO PUBLIC HEALTH GENOMICS LA English DT Review DE Genomics; Health services research; Emerging technologies; Translational research ID COST-EFFECTIVENESS ANALYSIS; METASTATIC BREAST-CANCER; REPORTS RADAR PROJECT; ADVERSE DRUG EVENTS; CLINICAL-PRACTICE; RACIAL-DIFFERENCES; CERVICAL-CANCER; PUBLIC-HEALTH; PROPHYLACTIC VACCINES; PROSTATE-CANCER AB Background: In recent decades, extensive resources have been invested to develop cellular, molecular and genomic technologies with clinical applications that span the continuum of cancer care. Methods: In December 2006, the National Cancer Institute sponsored the first workshop to uniquely examine the state of health services research on cancer-related cellular, molecular and genomic technologies and identify challenges and priorities for expanding the evidence base on their effectiveness in routine care. Results: This article summarizes the workshop outcomes, which included development of a comprehensive research agenda that incorporates health and safety endpoints, utilization patterns, patient and provider preferences, quality of care and access, disparities, economics and decision modeling, trends in cancer outcomes, and health-related quality of life among target populations. Conclusions: Ultimately, the successful adoption of useful technologies will depend on understanding and influencing the patient, provider, health care system and societal factors that contribute to their uptake and effectiveness in 'real-world' settings. Copyright (C) 2009 S. Karger AG, Basel C1 [Wideroff, Louise; Ambs, Anita; Brown, Martin L.] NCI, Bethesda, MD 20892 USA. [Phillips, Kathryn A.; Hiatt, Robert A.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Randhawa, Gurvaneet] Agcy Healthcare Res & Qual, Rockville, MD USA. [Armstrong, Katrina] Univ Penn, Philadelphia, PA 19104 USA. [Bennett, Charles L.] Northwestern Univ, Evanston, IL USA. [Donaldson, Molla S.] George Washington Univ, Washington, DC USA. [Follen, Michele] Univ Texas Houston, MD Anderson Canc Ctr, Houston, TX 77030 USA. [Goldie, Sue J.] Harvard Univ, Boston, MA 02115 USA. [Schrag, Deborah] Dana Farber Canc Inst, Boston, MA 02115 USA. [Khoury, Muin J.] Ctr Dis Control & Prevent, Atlanta, GA USA. [McLeod, Howard L.] Univ N Carolina, Chapel Hill, NC USA. [Piper, Margaret] Blue Cross Blue Shield Assoc Technol Evaluat Ctr, Chicago, IL USA. [Powell, Isaac] Wayne State Univ, Detroit, MI USA. [Schulman, Kevin A.] Duke Univ, Durham, NC USA. [Scott, Joan] Johns Hopkins Univ, Baltimore, MD USA. [Lewis, Graham] Univ York, Heslington, England. RP Wideroff, L (reprint author), Natl Inst Drug Abuse, Epidemiol Res Branch, Div Epidemiol Serv & Prevent Res, 6001 Executive Blvd,Suite 5153 MSC 9589, Bethesda, MD 20892 USA. EM Wideroff@nih.gov RI Hernandez, Jessica/G-6527-2011; OI Piper, Margaret/0000-0002-6231-9653 FU NCI [263-MQ-610769, 263-MQ-612315, 263-MQ-612317, 263MQ-700870, 263-MQ-701381, 263-MQ612321, 263-MQ-611969, 263-MQ-612316, 263-MQ-612323, 263-MQ-611964, 263MQ-612324, 263-MQ-611967]; [HHSN261200700005C] FX The study was funded by the NCI (263-MQ-610769 to K. A. P.; 263-MQ-612315 to K. A.; 263-MQ-612317 to C. L. B.; 263MQ-700870 to M. S. D.; 263-MQ-701381 to M. F.; 263-MQ612321 to S. J. G.; 263-MQ-611969 to R. A. H.; 263-MQ-612316 to H. L. M.; 263-MQ-612323 to I. P.; 263-MQ-611964 to D. S.; 263MQ-612324 to K. A. S.; 263-MQ-611967 to the University of York; HHSN261200700005C to Scientific Consulting Group for organizational and editorial assistance). NR 83 TC 12 Z9 12 U1 2 U2 2 PU KARGER PI BASEL PA ALLSCHWILERSTRASSE 10, CH-4009 BASEL, SWITZERLAND SN 1662-4246 J9 PUBLIC HEALTH GENOMI JI Pub. Health Genomics PY 2009 VL 12 IS 4 BP 233 EP 244 DI 10.1159/000203779 PG 12 WC Genetics & Heredity; Public, Environmental & Occupational Health SC Genetics & Heredity; Public, Environmental & Occupational Health GA 432LX UT WOS:000265136600004 PM 19367091 ER PT S AU Kirby, JB Bollen, KA AF Kirby, James B. Bollen, Kenneth A. BE Xie, Y TI USING INSTRUMENTAL VARIABLE TESTS TO EVALUATE MODEL SPECIFICATION IN LATENT VARIABLE STRUCTURAL EQUATION MODELS SO SOCIOLOGICAL METHODOLOGY 2009, VOL 39 SE Sociological Methodology LA English DT Article; Book Chapter ID LEAST-SQUARES 2SLS; ESTIMATOR AB Structural equation modeling (SEM) with latent variables is a powerful tool for social and behavioral scientists, combining many of the strengths of psychometrics and econometrics into a single framework. The most common estimator for SEM is the full information maximum likelihood (ML) estimator, but there is continuing interest in limited information estimators because of their distributional robustness and their greater resistance to structural specification errors. However, the literature discussing model fit for limited information estimators for latent variable models is sparse compared with that for full-information estimators. We address this shortcoming by providing several specification tests based on the 2SLS estimator for latent variable structural equation models developed by Bollen (1996). We explain how these tests can be used not only to identify a misspecified model but to help diagnose the source of misspecification within a model. We present and discuss results from a Monte Carlo experiment designed to evaluate the finite sample properties of these tests. Our findings suggest that the 2SLS tests successfully identify most misspecified models, even those with modest misspecification, and that they provide researchers with information that can help diagnose the source of misspecification. C1 [Kirby, James B.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Bollen, Kenneth A.] Univ N Carolina, Chapel Hill, NC USA. RP Kirby, JB (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM jkirby@ahrq.gov FU NIDA NIH HHS [R01 DA013148, R01 DA013148-01] NR 29 TC 13 Z9 13 U1 2 U2 9 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN STREET, MALDEN 02148, MA USA SN 0081-1750 BN 978-1-4443-3293-3 J9 SOCIOL METHODOL JI Sociol. Methodol. PY 2009 VL 39 BP 327 EP 355 PG 29 WC Social Sciences, Interdisciplinary; Sociology SC Social Sciences - Other Topics; Sociology GA BLQ81 UT WOS:000270819200010 PM 20419054 ER PT J AU Schunemann, HJ Oxman, AD Brozek, J Glasziou, P Bossuyt, P Chang, S Muti, P Jaeschke, R Guyatt, GH AF Schuenemann, Holger J. Oxman, Andrew D. Brozek, Jan Glasziou, Paul Bossuyt, Patrick Chang, Stephanie Muti, Paola Jaeschke, Roman Guyatt, Gordon H. TI GRADE: assessing the quality of evidence for diagnostic recommendations SO ANNALS OF INTERNAL MEDICINE LA English DT Editorial Material ID SUSPECTED ACUTE UROLITHIASIS; HELICAL COMPUTED-TOMOGRAPHY; HUNTINGTONS-DISEASE; INTRAVENOUS PYELOGRAPHY; CONSEQUENCES C1 [Schuenemann, Holger J.; Jaeschke, Roman; Guyatt, Gordon H.] McMaster Univ, Hamilton, ON, Canada. [Oxman, Andrew D.] Norwegian Knowledge Ctr Hlth Serv, Oslo, Norway. [Brozek, Jan; Muti, Paola] Italian Natl Canc Inst Regina Elena, Rome, Italy. [Glasziou, Paul] Univ Oxford, Oxford, England. [Bossuyt, Patrick] Univ Amsterdam, Amsterdam, Netherlands. [Chang, Stephanie] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Schunemann, HJ (reprint author), McMaster Univ, Hamilton, ON, Canada. RI Bossuyt, Patrick/B-4557-2016 OI Bossuyt, Patrick/0000-0003-4427-0128 NR 11 TC 17 Z9 17 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 16 PY 2008 VL 149 IS 12 AR JC6-2 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 384VI UT WOS:000261771900018 PM 19071869 ER PT J AU Berdahl, TA AF Berdahl, Terceira A. TI Racial/Ethnic and Gender Differences in Individual Workplace Injury Risk Trajectories: 1988-1998 SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID AFRICAN-AMERICAN; WORK; RACE; HEALTH; PREVALENCE; GROWTH; CAREER; WHITE AB Objectives. I examined workplace injury risk over time and across racial/ethnic and gender groups to observe patterns of change and to understand how occupational characteristics and job mobility influence these changes. Methods. I used hierarchical generalized linear models to estimate individual workplace injury and illness risk overtime ("trajectories") for a cohort of American workers who participated in the National Longitudinal Survey of Youth (1988-1998). Results. Significant temporal variation in injury risk was observed across racial/ethnic and gender groups. At baseline,White men had a high risk of injury relative to the other groups and experienced the greatest decline over time. Latino men demonstrated a pattern of lower injury risk across time compared with White men. Among both Latinos; and non-Latino Whites, women had lower odds of injury than did men. Non-Latino Black women's injury risk was similar to Black men's and greater than that for both Latino and non-Latino White women. Occupational characteristics and job mobility partly explained these differences. Conclusions. Disparities between racial/ethnic and gender groups were dynamic and changed over time. Workplace injury risk was associated with job dimensions such as work schedule, union representation, health insurance, job hours, occupational racial segregation, and occupational environmental hazards. (Am J Public Health. 2008;98:2258-2263. doi:10.2105/AJPH.2006.103135) C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Berdahl, TA (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM terceira.berdahl@ahrq.hhs.gov FU Bureau of Labor Statistics; Center for Human Resource Research at the Ohio State University; Dictionary of Occupational Titles is supported through the Inter-University Consortium for Political and Social Research at the University of Michigan FX The National Longitudinal Survey of Youth is supported by the Bureau of Labor Statistics and the Center for Human Resource Research at the Ohio State University. The integrated public rise microdata for the 1990 US Census is supported by the Minnesota Population Center at the University of Minnesota Occupational data from the Dictionary of Occupational Titles is supported through the Inter-University Consortium for Political and Social Research at the University of Michigan (original data front principal investigators Paula England, PhD, and Barbara Kilbourne, PhD). NR 26 TC 17 Z9 17 U1 1 U2 4 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 DEC PY 2008 VL 98 IS 12 BP 2258 EP 2263 DI 10.2105/AJPH.2006.103135 PG 6 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 378GP UT WOS:000261309500030 PM 18235072 ER PT J AU Mutter, RL Rosko, MD Wong, HS AF Mutter, Ryan L. Rosko, Michael D. Wong, Herbert S. TI Measuring Hospital Inefficiency: The Effects of Controlling for Quality and Patient Burden of Illness SO HEALTH SERVICES RESEARCH LA English DT Article DE Hospital efficiency; stochastic frontier analysis; hospital quality; patient safety ID COST INEFFICIENCY; MORTALITY-RATES; EFFICIENCY; CARE; MEMBERSHIP; IMPACT AB To assess the impact of employing a variety of controls for hospital quality and patient burden of illness on the mean estimated inefficiency and relative ranking of hospitals generated by stochastic frontier analysis (SFA). This study included urban U.S. hospitals in 20 states operating in 2001. We took hospital data for 1,290 hospitals from the American Hospital Association Annual Survey and the Medicare Cost Reports. We employed a variety of controls for hospital quality and patient burden of illness. Among the variables we used were a subset of the quality indicators generated from the application of the Patient Safety Indicator and Inpatient Quality Indicator modules of the Agency for Healthcare Research and Quality, Quality Indicator software to the Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases. Measures of a component of patient burden of illness came from the application of the Comorbidity Software to HCUP data. We used SFA to estimate hospital cost-inefficiency. We tested key assumptions of the SFA model with likelihood ratio tests. The measures produced by the Comorbidity Software appear to account for variations in patient burden of illness that had previously been masquerading as inefficiency. Outcome measures of quality can provide useful insight into a hospital's operations but may have little impact on estimated inefficiency once controls for structural quality and patient burden of illness have been employed. Choices about controlling for quality and patient burden of illness can have a nontrivial impact on mean estimated hospital inefficiency and the relative ranking of hospitals generated by SFA. C1 [Mutter, Ryan L.; Wong, Herbert S.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [Rosko, Michael D.] Widener Univ, Sch Business Adm, Grad Program Hlth & Med Servi Adm, Chester, PA 19013 USA. RP Mutter, RL (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. EM rmutter@ahrq.gov NR 38 TC 12 Z9 12 U1 1 U2 7 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 2008 VL 43 IS 6 BP 1992 EP 2013 DI 10.1111/j.1475-6773.2008.00892.x PG 22 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 372BZ UT WOS:000260877700006 PM 18783458 ER PT J AU Encinosa, WE Hellinger, FJ AF Encinosa, William E. Hellinger, Fred J. TI The Impact of Medical Errors on Ninety-Day Costs and Outcomes: An Examination of Surgical Patients SO HEALTH SERVICES RESEARCH LA English DT Article DE Medical errors; patient safety; expenditures ID ADVERSE EVENTS; CLAIMS DATA; INJURIES; COLORADO; UTAH; QUALITY; SAFETY; CARE AB To estimate the effect of medical errors on medical expenditures, death, readmissions, and outpatient care within 90 days after surgery. 2001-2002 MarketScan insurance claims for 5.6 million enrollees. The Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) were used to identify 14 PSIs among 161,004 surgeries. We used propensity score matching and multivariate regression analyses to predict expenditures and outcomes attributable to the 14 PSIs. Excess 90-day expenditures likely attributable to PSIs ranged from $646 for technical problems (accidental laceration, pneumothorax, etc.) to $28,218 for acute respiratory failure, with up to 20 percent of these costs incurred postdischarge. With a third of all 90-day deaths occurring postdischarge, the excess death rate associated with PSIs ranged from 0 to 7 percent. The excess 90-day readmission rate associated with PSIs ranged from 0 to 8 percent. Overall, 11 percent of all deaths, 2 percent of readmissions, and 2 percent of expenditures were likely due to these 14 PSIs. The effects of medical errors continue long after the patient leaves the hospital. Medical error studies that focus only on the inpatient stay can underestimate the impact of patient safety events by up to 20-30 percent. C1 [Encinosa, William E.; Hellinger, Fred J.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Encinosa, WE (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM william.encinosa@ahrq.hhs.gov FU AHRQ FX This research was funded by the AHRQ. This is a publication produced within the federal government (AHRQ, Department of Health and Human Services). All authors are employed by AHRQ, which has an internal peer review process for employees. Prior to submitting a manuscript for publication, the draft first undergoes an internal referee review and then must be approved for submission to HSR. NR 24 TC 43 Z9 43 U1 3 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 2008 VL 43 IS 6 BP 2067 EP 2085 DI 10.1111/j.1475-6773.2008.00882.x PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 372BZ UT WOS:000260877700010 PM 18662169 ER PT J AU Friedman, B Jiang, HJ Elixhauser, A AF Friedman, Bernard Jiang, H. Joanna Elixhauser, Anne TI Costly Hospital Readmissions and Complex Chronic Illness SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID CARE; METAANALYSIS; QUALITY AB People with multiple chronic conditions account for a large and disproportionate share of total health care costs. One aspect of the high cost for such patients is a relatively high number of hospital admissions per year. This study aims to clarify how the rate of hospital readmissions and hospital cost per person in a year depend on a patient's number of different chronic conditions ("complexity"), severity of illness, principal diagnosis at discharge, payer group, and other variables. We use a database of all hospital discharges for adults in six states. The number of different chronic conditions has a smoothly increasing effect on readmissions and cost per year, and there are notable differences by payer group. We offer illustrations of the potential savings from reducing total inpatient cost and readmissions in narrowly targeted populations with the most complex problems. The study's methods and descriptive data potentially could be useful for health plans and their sponsors (employers, government) when they design strategies to address the high cost of complex chronic illness. C1 [Friedman, Bernard; Jiang, H. Joanna; Elixhauser, Anne] AHRQ, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. RP Friedman, B (reprint author), AHRQ, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM Bernard.friedman@ahrq.hhs.gov NR 24 TC 27 Z9 27 U1 2 U2 5 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 2008 VL 45 IS 4 BP 408 EP 421 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 403JY UT WOS:000263080100006 PM 19209836 ER PT J AU Korthuis, PT Saha, S Fleishman, JA McGrath, MM Josephs, JS Moore, RD Gebo, KA Hellinger, J Beach, MC AF Korthuis, P. Todd Saha, Somnath Fleishman, John A. McGrath, Moriah McSharry Josephs, Joshua S. Moore, Richard D. Gebo, Kelly A. Hellinger, James Beach, Mary Catherine CA HIV Res Network TI Impact of Patient Race on Patient Experiences of Access and Communication in HIV Care SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE physician-patient relations; communication; HIV/AIDS treatment; health services accessibility; blacks; HIV Research Network ID HEALTH-CARE; RACIAL DISPARITIES; INFECTED ADULTS; UNITED-STATES; ANTIRETROVIRAL THERAPY; SERVICES UTILIZATION; ETHNIC-DIFFERENCES; QUALITY; CONCORDANCE; MULTISTATE AB BACKGROUND: Patient-centered care-including the domains of access and communication-is an important determinant of positive clinical outcomes. OBJECTIVE: To explore associations between race and HIV-infected patients' experiences of access and communication. DESIGN: This was a cross-sectional survey. PARTICIPANTS: Nine hundred and fifteen HIV-infected adults receiving care at 14 U.S. HIV clinics. MEASUREMENTS: Dependent variables included patients' reports of travel time to their HIV care site and waiting time to see their HIV provider (access) and ratings of their HIV providers on always listening, explaining, showing respect, and spending enough time with them (communication). We used multivariate logistic regression to estimate associations between patient race and dependent variables, and random effects models to estimate site-level contributions. RESULTS: Patients traveled a median 30 minutes (range 1 - 180) and waited a median 20 minutes (range 0 - 210) to see their provider. On average, blacks and Hispanics reported longer travel and wait times compared with whites. Adjusting for HIV care site attenuated this association. HIV care sites that provide services to a greater proportion of blacks and Hispanics may be more difficult to access for all patients. The majority of patients rated provider communication favorably. Compared to whites, blacks reported more positive experiences with provider communication. CONCLUSIONS: We observed racial disparities in patients' experience of access to care but not in patient - provider communication. Disparities were explained by poor access at minority-serving clinics. Efforts to make care more patient-centered for minority HIV-infected patients should focus more on improving access to HIV care in minority communities than on improving cross-cultural patient - provider interactions. C1 [Korthuis, P. Todd; Saha, Somnath; McGrath, Moriah McSharry] Oregon Hlth & Sci Univ, Dept Med, Portland, OR 97239 USA. [Saha, Somnath] Portland VA Med Ctr, Gen Internal Med Sect, Portland, OR USA. [Fleishman, John A.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Josephs, Joshua S.; Moore, Richard D.; Gebo, Kelly A.; Beach, Mary Catherine] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Hellinger, James] Community Med Alliance, Boston, MA USA. RP Korthuis, PT (reprint author), Oregon Hlth & Sci Univ, Dept Med, 3181 SW Sam Jackson Pk Rd,Mail Code L-475, Portland, OR 97239 USA. EM korthuis@ohsu.edu FU Agency for Healthcare Research and Quality, Rockville, Maryland; Health Resources and Services Administration, Rockville, Maryland FX Agency for Healthcare Research and Quality, Rockville, Maryland (Fred Hellinger, Ph. D., John Fleishman, Ph. D., Irene Fraser, Ph. D.); Health Resources and Services Administration, Rockville, Maryland (Alice Kroliczak, Ph. D., Robert Mills, Ph. D.) NR 38 TC 11 Z9 11 U1 2 U2 8 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD DEC PY 2008 VL 23 IS 12 BP 2046 EP 2052 DI 10.1007/s11606-008-0788-5 PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 379VJ UT WOS:000261424000017 PM 18830770 ER PT J AU McAuley, WJ Spector, W Van Nostrand, J AF McAuley, William J. Spector, William Van Nostrand, Joan TI Home health care agency staffing patterns before and after the Balanced Budget Act of 1997, by rural and urban location SO JOURNAL OF RURAL HEALTH LA English DT Article ID SERVICE USE AB Context: The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. Purpose: We examine the staffing characteristics of stable Medicare-certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Methods: Data were drawn from Medicare Provider of Service files and the Area Resource File. The unit of analysis was the 3,126 counties in the United States, grouped into 5 categories: metropolitan, nonmetropolitan adjacent, and 3 nonmetropolitan nonadjacent groups identified by largest town size. Only relatively stable HHAs were included. We generated summary HHA staff statistics for each county group and year. Findings: All staff categories, other than therapists, declined from 1997 to 2002 across the metropolitan and nonmetropolitan county groupings. There were substantial population-adjusted decreases in stable HHA-based home health aides in all counties, including remote counties. Conclusions: The limited presence of stable HHA staff in certain nonmetropolitan county types has been exacerbated since implementation of the BBA, especially in the most rural counties. The loss of aides in more rural counties may limit the availability of home-based long-term care in these locations, where the need for long-term care is considerable. Future research should examine the degree to which the presence of HHA staff influences actual access and whether other paid and unpaid sources of care substitute for Medicare home health care in counties with limited supplies of HHA staff. C1 [McAuley, William J.] George Mason Univ, Ctr Social Sci Res, Dept Commun, Fairfax, VA 22030 USA. [Spector, William] Agcy Healthcare Res & Qual, Rockville, MD USA. [Van Nostrand, Joan] US Hlth Resources & Serv Adm, Off Rural Hlth Policy, Rockville, MD 20857 USA. RP McAuley, WJ (reprint author), George Mason Univ, Ctr Social Sci Res, Dept Commun, 9201 Chain Bridge Rd,Suite B100-MSN 1H5, Fairfax, VA 22030 USA. EM wmcauley@gmu.edu NR 30 TC 6 Z9 6 U1 0 U2 1 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 WIN PY 2008 VL 24 IS 1 BP 12 EP 23 DI 10.1111/j.1748-0361.2008.00132.x PG 12 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 258WF UT WOS:000252899800002 PM 18257866 ER PT J AU Rubenstein, LV Hempel, S Farmer, MM Asch, SM Yano, EM Dougherty, D Shekelle, PW AF Rubenstein, L. V. Hempel, S. Farmer, M. M. Asch, S. M. Yano, E. M. Dougherty, D. Shekelle, P. W. TI Finding order in heterogeneity: types of quality-improvement intervention publications SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID PATIENT-OUTCOMES-RESEARCH; RANDOMIZED CLINICAL-TRIALS; HEALTH-CARE; ORGANIZATIONAL-CHANGE; TRANSLATING RESEARCH; SYSTEMATIC REVIEWS; ASTHMA-CARE; DESIGN; IMPLEMENTATION; POLICY AB Background: Stakeholders in quality improvement agree on the need for augmenting and synthesising the scientific literature supporting it. The diversity of perspectives, approaches, and contexts critical to advancing quality improvement science, however, creates challenges. The paper explores the heterogeneity in clinical quality improvement intervention (QII) publications. Methods: A preliminary classification framework was developed for QII articles, aiming for categories homogeneous enough to support coherent scientific discussion on QII reporting standards and facilitate systematic review. QII experts were asked to identify articles important to QII science. The framework was tested and revised by applying it to the article set. The final framework screened articles into (1) empirical literature on development and testing of QIIs; (2) QII stories, theories, and frameworks; (3) QII literature syntheses and meta-analyses; or (4) development and testing of QII-related tools. To achieve homogeneity, category (1) required division into (1a) development of QIIs; 1(b) history, documentation, or description of QIIs; or (1c) success, effectiveness or impact of QIIs. Results: By discussing unique issues and established standards relevant to each category, QII stakeholders can advance QII practice and science, including the scope and conduct of systematic literature reviews. C1 [Rubenstein, L. V.; Farmer, M. M.; Asch, S. M.; Yano, E. M.; Shekelle, P. W.] Vet Affairs Greater Los Angeles Healthcare Syst S, North Hills, CA 91343 USA. [Rubenstein, L. V.; Hempel, S.; Asch, S. M.; Shekelle, P. W.] RAND Corp, Santa Monica, CA USA. [Rubenstein, L. V.; Yano, E. M.] Univ Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90024 USA. [Rubenstein, L. V.; Asch, S. M.; Shekelle, P. W.] Univ Calif Los Angeles, Dept Med, Los Angeles, CA 90024 USA. [Dougherty, D.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Rubenstein, LV (reprint author), Vet Affairs Greater Los Angeles Healthcare Syst S, 16111 Plummer St 152, North Hills, CA 91343 USA. EM lisa_rubenstein@rand.org FU Agency for Healthcare Research and Quality (AHRQ) [HHSP233200400717P]; Centers for Disease Control and Prevention FX Agency for Healthcare Research and Quality (AHRQ) under a contract to LVR ( contract no HHSP233200400717P) funded by an Interagency Agreement between AHRQ and the Centers for Disease Control and Prevention. NR 98 TC 31 Z9 31 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 DEC PY 2008 VL 17 IS 6 BP 403 EP 408 DI 10.1136/qshc.2008.028423 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 380YK UT WOS:000261501800004 PM 19064654 ER PT J AU Farley, DO Haviland, A Champagne, S Jain, AK Battles, JB Munier, WB Loeb, JM AF Farley, D. O. Haviland, A. Champagne, S. Jain, A. K. Battles, J. B. Munier, W. B. Loeb, J. M. TI Adverse-event-reporting practices by US hospitals: results of a national survey SO QUALITY & SAFETY IN HEALTH CARE LA English DT Article ID IMPROVE PATIENT SAFETY; MEDICAL ERRORS; INTENSIVE-CARE; SYSTEM; LESSONS AB Context: Little is known about hospitals' adverse-event-reporting systems, or how they use reported data to improve practices. This information is needed to assess effects of national patient-safety initiatives, including implementation of the Patient Safety and Quality Improvement Act of 2005 (PSQIA). This survey generated baseline information on the characteristics of hospital adverse-event-reporting systems and processes, for use in assessing progress in improvements to reporting. Methods: The Adverse Event Reporting Survey, developed by Westat, was administered in September 2005 through January 2006, using a mixed-mode (mail/telephone) survey with a stratified random sample of 2050 non-federal US hospitals. Risk managers were the respondents. An 81% response rate was obtained, for a sample of 1652 completed surveys. Results: Virtually all hospitals reported they have centralised adverse-event-reporting systems, although characteristics varied. Scores on four performance indexes suggest that only 32% of hospitals have established environments that support reporting, only 13% have broad staff involvement in reporting adverse events, and 20-21% fully distribute and consider summary reports on identified events. Because survey responses are self-reported by risk managers, these may be optimistic assessments of hospital performance. Conclusions: Survey findings document the current status of hospital adverse-event-reporting systems and point to needed improvements in reporting processes. PSQIA liability protections for hospitals reporting data to patient-safety organisations should also help stimulate improvements in hospitals' internal reporting processes. Other mechanisms that encourage hospitals to strengthen their reporting systems, for example, strong patient-safety programmes, also would be useful. C1 [Farley, D. O.; Haviland, A.] RAND Corp, Pittsburgh, PA 15213 USA. [Champagne, S.; Loeb, J. M.] Joint Commiss, Oak Brook Terrace, IL USA. [Jain, A. K.] RAND Corp, Arlington, VA USA. [Battles, J. B.; Munier, W. B.] AHRQ, Rockville, MD USA. RP Farley, DO (reprint author), RAND Corp, 4570 5th Ave,Suite 600, Pittsburgh, PA 15213 USA. EM donna_farley@rand.org FU Agency for Healthcare Research and Quality; US Department of Health and Human Services FX We thank the risk managers at the hospitals in our sample for their willing participation in the survey. We also thank the staff at RAND Survey Research Group (SRG) and the University of Illinois Survey Research Laboratory (SRL) for administering the survey data-collection efforts, under the leadership of C Pham at RAND SRG, and J Ronco and R Hazen at SRL. The contributions of P Goldschmidt during preparation for survey administration are appreciated. This study was conducted with support from the Agency for Healthcare Research and Quality, US Department of Health and Human Services. NR 34 TC 36 Z9 38 U1 1 U2 5 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 2008 VL 17 IS 6 BP 416 EP 423 DI 10.1136/qshc.2007.024638 PG 8 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 380YK UT WOS:000261501800006 PM 19064656 ER PT J AU Brousseau, D Panepinto, JA Owens, P Steiner, C AF Brousseau, David Panepinto, Julie A. Owens, Pamela Steiner, Claudia TI Acute Care Visits in Sickle Cell Disease: a Population-Based Multi-State Study SO BLOOD LA English DT Meeting Abstract CT 50th Annual Meeting of the American-Society-of-Hematology CY DEC 06-09, 2008 CL San Francisco, CA SP Amer Soc Hematol C1 [Brousseau, David; Panepinto, Julie A.] Med Coll Wisconsin, Childrens Hosp Wisconsin, Childrens Res Inst, Milwaukee, WI 53226 USA. [Owens, Pamela; Steiner, Claudia] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 3 PU AMER SOC HEMATOLOGY PI WASHINGTON PA 1900 M STREET. NW SUITE 200, WASHINGTON, DC 20036 USA SN 0006-4971 J9 BLOOD JI Blood PD NOV 16 PY 2008 VL 112 IS 11 BP 68 EP 68 PG 1 WC Hematology SC Hematology GA 389OP UT WOS:000262104700166 ER PT J AU Merrill, CT Miller, JL Steiner, C AF Merrill, Chaya T. Miller, Jeffery L. Steiner, Claudia TI Analysis of Increased Blood Transfusions in US Hospitals, 1997-2006. SO BLOOD LA English DT Meeting Abstract CT 50th Annual Meeting of the American-Society-of-Hematology CY DEC 06-09, 2008 CL San Francisco, CA SP Amer Soc Hematol C1 [Merrill, Chaya T.] Thomson Reuters Agcy Healthcare Res & Qual, Hlth Serv Res, Washington, DC USA. [Miller, Jeffery L.] NIDDK, Mol Med Branch, NIH, Bethesda, MD USA. [Steiner, Claudia] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER SOC HEMATOLOGY PI WASHINGTON PA 1900 M STREET. NW SUITE 200, WASHINGTON, DC 20036 USA SN 0006-4971 J9 BLOOD JI Blood PD NOV 16 PY 2008 VL 112 IS 11 BP 471 EP 471 PG 1 WC Hematology SC Hematology GA 389OP UT WOS:000262104701524 ER PT J AU Korthuis, PT Zephyrin, LC Fleishman, JA Saha, S Josephs, JS McGrath, MM Hellinger, J Gebo, KA AF Korthuis, P. Todd Zephyrin, Laurie C. Fleishman, John A. Saha, Somnath Josephs, Joshua S. McGrath, Moriah M. Hellinger, James Gebo, Kelly A. CA HIV Res Network TI Health-Related Quality of Life in HIV-Infected Patients: The Role of Substance Use SO AIDS PATIENT CARE AND STDS LA English DT Article ID MULTICENTER AIDS COHORT; UNITED-STATES; SERVICES UTILIZATION; PSYCHIATRIC-DISORDERS; ANTIRETROVIRAL THERAPY; ABUSE TREATMENT; MENTAL-HEALTH; OPIATE USERS; DRUG-USE; ADULTS AB HIV infection and substance use disorders are chronic diseases with complex contributions to health-related quality of life (HRQOL). We conducted a cross-sectional survey of 951 HIV-infected adults receiving care at 14 HIV Research Network sites in 2003 to estimate associations between HRQOL and specific substance use among HIV-infected patients. HRQOL was assessed by multi-item measures of physical and role functioning, general health, pain, energy, positive affect, anxiety, and depression. Mental and physical summary scales were developed by factor analysis. We used linear regression to estimate adjusted associations between HRQOL and current illicit use of marijuana, analgesics, heroin, amphetamines, cocaine, sedatives, inhalants, hazardous/binge alcohol, and drug use severity. Current illicit drug use was reported by 37% of subjects. Mental HRQOL was reduced for current users [adjusted beta coefficient -9.66, 95% confidence interval [(CI]) -13.4, -5.94] but not former users compared with never users. Amphetamines and sedatives were associated with large decreases in mental (amphetamines: beta = -22.8 [95% CI -33.5, -12.0], sedatives: beta = -18.6 [95% CI -26.2, -11.0]), and physical HRQOL (amphetamines: beta = -11.5 [95% CI -22.6, -0.43], sedatives: beta = -13.2 [95% CI -21.0, -5.36]). All illicit drugs were associated with decreased mental HRQOL: marijuana (beta = -7.72 [95% CI -12.0, -3.48]), non-prescription analgesics (beta = -13.4 [95% CI -20.8, -6.07]), cocaine (beta = -10.5 [95% CI -16.4, -4.67]), and inhalants (beta = -14.0 [95% CI -24.1, -3.83]). Facilitating sobriety for patients with attention to specific illicit drugs represents an important avenue for elevating HRQOL in patients living with HIV. C1 [Korthuis, P. Todd; Saha, Somnath; McGrath, Moriah M.] Oregon Hlth & Sci Univ, Dept Med, Portland, OR 97239 USA. [Zephyrin, Laurie C.] Columbia Univ, Dept Obstet & Gynecol, New York, NY USA. [Fleishman, John A.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Saha, Somnath] Portland VA Med Ctr, Gen Internal Med Sect, Portland, OR USA. [Josephs, Joshua S.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Hellinger, James] Community Med Alliance, Boston, MA USA. RP Korthuis, PT (reprint author), Oregon Hlth & Sci Univ, Dept Med, 3181 SW Sam Jackson Pk Rd,Mail Code L-475, Portland, OR 97239 USA. EM korthuis@ohsu.edu FU Agency for Healthcare Research and Quality [290-01-0012]; National Institutes of Aging [R01 AG026250, K23 AA015313, K23-DA00523, K-23-DA019820]; Department of Veterans Affairs Health Services Research & Development Service; Robert Wood Johnson Foundation; Johns Hopkins Clinician Scientist FX Participating Sites: Alameda County Medical Center, Oakland, California (Silver Sisneros, D. O.); Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Richard Rutstein, M. D.); Community Health Network, Rochester, New York (Roberto Corales, D. O.); Community Medical Alliance, Boston, Massachusetts (James Hellinger, M. D.); Drexel University, Philadelphia, Pennsylvania (Peter Sklar, M. D.); Henry Ford Hospital Detroit, Michigan (Norman Markowitz, M. D.); Johns Hopkins University, Baltimore, Maryland (Kelly Gebo, M. D., Richard Moore, M. D); Montefiore Medical Group, Bronx, New York (Robert Beil, M. D.); Montefiore Medical Center, Bronx, New York (Lawrence Hanau, M. D.); Nemechek Health Renewal, Kansas City, Missouri (Patrick Nemechek, D. O.); Oregon Health and Science University, Portland, Oregon (P. Todd Korthuis, M. D.); Parkland Health and Hospital System, Dallas, Texas (Philip Keiser, M. D.); St. Jude's Children's Hospital and University of Tennessee, Memphis, Tennessee (Aditya Gaur, M. D.); St. Luke's Roosevelt Hospital Center, New York, New York (Victoria Sharp, M. D.); Tampa General Health Care, Tampa, Florida (Charurut Somboonwit, M. D., Jeffrey Nadler, M. D.); University of California, San Diego, La Jolla, California (Stephen Spector, M. D.); University of California, San Diego, California (W. Christopher Mathews, M. D.); Wayne State University, Detroit, Michigan (Lawrence Crane, M. D.).; Sponsoring Agencies: Agency for Healthcare Research and Quality, Rockville, Maryland (Fred Hellinger, Ph. D., John Fleishman, Ph. D., Irene Fraser, Ph. D.); Health Resources and Services Administration, Rockville, Maryland (Alice Kroliczak, Ph. D., Robert Mills, Ph. D., Richard Conviser, Ph. D.); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Laura House, Ph. D., Joan Dilonardo, Ph. D.); Office of AIDS Research, NIH, Bethesda, Maryland (Paul Gaist, Ph. D, M. P. H.).; Supported by the Agency for Healthcare Research and Quality (290-01-0012) and the National Institutes of Aging (R01 AG026250) Alcohol (K23 AA015313) and Drug Abuse (K23-DA00523 and K-23-DA019820). Dr. Saha is supported by an Advanced Research Career Development Award from the Department of Veterans Affairs Health Services Research & Development Service, and a Generalist Physician Faculty Scholar Award from The Robert Wood Johnson Foundation. Dr. Gebo also received support from a Johns Hopkins Clinician Scientist Award.; The views expressed in this paper are those of the authors. No official endorsement by DHHS, the National Institutes of Health, the Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation, or the Department of Veterans Affairs is intended or should be inferred. NR 48 TC 35 Z9 36 U1 1 U2 6 PU MARY ANN LIEBERT, INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1087-2914 EI 1557-7449 J9 AIDS PATIENT CARE ST JI Aids Patient Care STDS PD NOV PY 2008 VL 22 IS 11 BP 859 EP 867 DI 10.1089/apc.2008.0005 PG 9 WC Public, Environmental & Occupational Health; Infectious Diseases SC Public, Environmental & Occupational Health; Infectious Diseases GA 378SM UT WOS:000261344200004 PM 19025480 ER PT J AU Brady, J Ho, K Clancy, CM AF Brady, Jeffrey Ho, Karen Clancy, Carolyn M. TI Commentary State Snapshots-A Picture of Unacceptable Variation: Are We Destined to Live With "Geography Is Destiny"? SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 [Brady, Jeffrey; Ho, Karen; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Brady, J (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 14 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 NOV-DEC PY 2008 VL 23 IS 6 BP 492 EP 495 DI 10.1177/1062860608325192 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 374JB UT WOS:000261038500010 PM 19001105 ER PT J AU de Cordova, PB Collins, S Peppard, L Currie, LM Hughes, R Walsh, M Stone, PW AF de Cordova, Pamela B. Collins, Sarah Peppard, Lora Currie, Leanne M. Hughes, Ronda Walsh, Mary Stone, Patricia W. TI Implementing evidence-based nursing with student nurses and clinicians: Uniting the strengths SO APPLIED NURSING RESEARCH LA English DT Article AB Implementing evidence-based practice (EBP) is challenging for both clinicians and Students. Facilitating collaboration among Students and clinicians can improve the process of both teaching EBP in the academic setting and utilizing EBP in the clinical setting. A unique and successful EBP program is described, and other schools are encouraged to emulate this model. (C) 2008 Elsevier Inc. All rights reserved. C1 [de Cordova, Pamela B.; Collins, Sarah; Peppard, Lora; Currie, Leanne M.; Stone, Patricia W.] Columbia Univ, Sch Nursing, New York, NY 10032 USA. [Hughes, Ronda] Agcy Healthcare Res & Qual, Rockville, MD 20144 USA. [Walsh, Mary] Beth Israel Deaconess Med Ctr, New York, NY 10009 USA. RP Stone, PW (reprint author), Columbia Univ, Sch Nursing, New York, NY 10032 USA. EM ps2024@columbia.edu NR 7 TC 6 Z9 6 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 NOV PY 2008 VL 21 IS 4 BP 242 EP 245 DI 10.1016/j.apnr.2008.06.008 PG 4 WC Nursing SC Nursing GA 377RF UT WOS:000261267600012 PM 18995169 ER PT J AU Shih, C Berliner, E AF Shih, Chuck Berliner, Elise TI Diffusion Of New Technology And Payment Policies: Coronary Stents SO HEALTH AFFAIRS LA English DT Article ID ARTERY STENTS; ANGIOPLASTY; RESTENOSIS; OUTCOMES AB Medicare payment is often cited as a major driver of medical technology diffusion. Stakeholders claimed that beneficiaries would be denied access to stents because Medicare payment did not initially cover the cost of stents. Nevertheless, stents diffused rapidly, including to untested indications. Outcomes with stents improved over time, primarily because of a fundamental property of technology diffusion termed "reinvention," in which new technology is modified by users. The traditional system of regulatory approval and reimbursement does not account for this dynamic process. There has been no incentive for systematic collection of data to determine which modifications are most beneficial. [Health Affairs 27, no. 6 (2008): 1566-1576; 10.1377/hlthaff.27.6.1566] C1 [Shih, Chuck] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD 21218 USA. [Berliner, Elise] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Technol Assessment Program, Rockville, MD USA. RP Shih, C (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD 21218 USA. EM elise.berliner@ahrq.hhs.gov NR 32 TC 8 Z9 8 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 NOV-DEC PY 2008 VL 27 IS 6 BP 1566 EP 1576 DI 10.1377/hlthaff.27.6.1566 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 370NQ UT WOS:000260769300014 PM 18997213 ER PT J AU Liang, L Huang, JD AF Liang, Lan Huang, Jidong TI GO OUT OR STAY IN? THE EFFECTS OF ZERO TOLERANCE LAWS ON ALCOHOL USE AND DRINKING AND DRIVING PATTERNS AMONG COLLEGE STUDENTS SO HEALTH ECONOMICS LA English DT Article DE drinking and driving; college students; zero tolerance laws ID YOUNG DRIVERS; POLICIES; STATES; LIMITS; RISK AB Zero tolerance laws make it illegal per se for anyone under age 21 to drive with any measurable amount of blood alcohol. Although a link has been established between zero tolerance laws and lower motor vehicle fatalities, research has not produced strong evidence oil how zero tolerance laws influence individual alcohol use and drinking and driving behaviors. Using a unique data set and a difference-in-difference-in-difference-type research design, we are able to analyze a number of pathways through which zero tolerance laws can work among all important underage population, college students. We find that zero tolerance laws reduce drinking and driving among college students. Further analysis of our detailed alcohol use measures Suggests that zero tolerance laws are particularly effective at reducing the probability of driving after drinking for those who reported drinking away from home. Published in 2008 by John Wiley & Sons, Ltd. C1 [Liang, Lan] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Liang, Lan] Natl Bur Econ Res, Cambridge, MA 02138 USA. RP Liang, L (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM lliang@ahrq.gov FU Robert Wood Johnson Foundation [046227]; Wood Johnson Foundation FX This paper was initially written when the authors were at the University of Illinois at Chicago. This research is supported in part by a grant from Robert Wood Johnson Foundation Substance Use Policy Research Program to the University of Illinois at Chicago (grant #046227). We wish to thank Henry Wechsler for providing the data from the Harvard School of Public Health College Alcohol Study, funded by the Robert Wood Johnson Foundation. Kritchaya Pattanachak and Zhenxiang Zhao provided research assistance. The views in this paper are our own. No official endorsement by the Agency for Healthcare Research and Quality or the Department of Health and Human Services is intended or should be inferred. NR 19 TC 9 Z9 9 U1 3 U2 8 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 NOV PY 2008 VL 17 IS 11 BP 1261 EP 1275 DI 10.1002/hec.1321 PG 15 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 372JB UT WOS:000260896800003 PM 18219708 ER PT J AU Owens, MD Beckles, GLA Kar-Yee, K Gorrell, P Brady, J Kaftarian, JS AF Owens, Michelle D. Beckles, Gloria L. A. Kar-Yee, Karen Gorrell, Paul Brady, Jeffrey Kaftarian, Jackie Shakeh TI Women with Diagnosed Diabetes across the Life Stages: Underuse of Recommended Preventive Care Services SO JOURNAL OF WOMENS HEALTH LA English DT Article ID QUALITY-OF-CARE; CARDIOVASCULAR-DISEASE; MANAGED CARE; HEALTH-CARE; ETHNIC-DIFFERENCES; GENDER-DIFFERENCES; DISPARITIES; RISK; METAANALYSIS; MELLITUS AB Diabetes is a common and costly disease. In 2007, an estimated 24 million people in the United States had diabetes, with almost half of these being women. Diabetes increases the risk of morbidity and mortality from several conditions, including cardiovascular disease, several types of cancers, influenza and pneumococcal infection, and kidney, eye, and periodontal diseases. The aim of this study was to examine the quality of care that women with diabetes receive and to assess how receipt of some clinical preventive services and screening for common conditions associated with diabetes vary according to socioeconomic factors. Our findings indicate that use of diabetes-specific preventive care among women is low, with the youngest women (<= 45 years) and those with low educational levels being the least likely to receive the recommended services. Women with diabetes were less likely than women without diabetes to receive a Pap smear, with the oldest women (<= 65 years) being the most vulnerable. Women with diabetes who were poor and nonwhite were less likely than more affluent and white women to receive a pneumococcal vaccination. This study's findings suggest that having a chronic disease may serve as a barrier to the receipt of recommended preventive care among women. Effective interventions should be designed to meet the needs of the most vulnerable women with diabetes, in particular, those who are at the extremes of the life cycle, are poor, and have low levels of education. Programs should use a life stage approach to address the unique needs of women with diabetes. C1 [Owens, Michelle D.] Ctr Dis Control & Prevent, Div Diabet Translat, Atlanta, GA 30341 USA. [Kar-Yee, Karen; Brady, Jeffrey; Kaftarian, Jackie Shakeh] Agcy Healthcare Res & Qual, Rockville, MD USA. [Gorrell, Paul] Social & Sci Syst, Silver Spring, MD USA. RP Owens, MD (reprint author), Ctr Dis Control & Prevent, Div Diabet Translat, 4770 Buford Highway,NE Mailstop K-10, Atlanta, GA 30341 USA. EM MOwens1@cdc.gov NR 39 TC 18 Z9 18 U1 0 U2 2 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 NOV PY 2008 VL 17 IS 9 BP 1415 EP 1423 DI 10.1089/jwh.2008.1125 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 378OF UT WOS:000261331400001 PM 18954234 ER PT J AU Pezzin, LE Pollak, RA Schone, BS AF Pezzin, Liliana E. Pollak, Robert A. Schone, Barbara Steinberg TI Parental Marital Disruption, Family Type, and Transfers to Disabled Elderly Parents SO JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES LA English DT Article DE Divorce; Remarriage; Family type; Intergenerational transfers; Living arrangements ID INTER-VIVOS TRANSFERS; INTERGENERATIONAL TRANSFERS; DIVORCE; CHILDREN; MARRIAGE; CONSEQUENCES; REMARRIAGE; ALTRUISM; OUTCOMES; CONTACT AB Objectives. The objective of this study, was to investigate file effect of parental marital stains. marital history, and family type on intergenerational living arrangements and adult children's time and cash transfers to their unpartnered disabled elderly parents. Methods. We used data from the Asset and Health Dynamics Among the Oldest Old survey to estimate the joint probabilities that in adult child provides little and/or cash transfers to a parent and to analyze a five-level categorical variable capturing parent-child living arrangements. Results. The estimates suggest significant detrimental effects of parental divorce and step relationship on little transfers and oil the probability of coresidence with the index child. Family type, as captured by the composition of the index child's sibling, network according, to kill relationship to file parent. also affected transfers, and living arrangement choices of adult children. Discussion. The findings that transfers from adult children to their unpartnered disabled elderly parents, depend on parental marital status and kill relationship suggest that changing. family patterns are altering the traditional role of the family as a support network. These findings raise concerns about he care likely to be available to future cohorts of elderly persons who will have experienced substantially higher rated of divorce, remarriage. and step parenthood than the cohort considered in this study. C1 [Pezzin, Liliana E.] Med Coll Wisconsin, Dept Med, Med & Hlth Policy Inst, Milwaukee, WI 53226 USA. [Pollak, Robert A.] Washington Univ, Dept Econ, St Louis, MO 63130 USA. [Schone, Barbara Steinberg] Georgetown Univ, Washington, DC USA. [Schone, Barbara Steinberg] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Pezzin, LE (reprint author), Med Coll Wisconsin, Dept Med, Med & Hlth Policy Inst, Milwaukee, WI 53226 USA. EM lpezzin@mcw.edu FU Schone, All authors Contributed to the drafting of the manuscript. [1 R01 AG24049, R01 AG025475] FX All authors contributed to the conceptualization of the paper. Data construction and data analysis were performed by L E. Pezzin and B. S. Schone, All authors Contributed to the drafting of the manuscript. NR 63 TC 16 Z9 16 U1 0 U2 9 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 NOV PY 2008 VL 63 IS 6 BP S349 EP S358 PG 10 WC Geriatrics & Gerontology; Gerontology; Psychology; Psychology, Multidisciplinary SC Geriatrics & Gerontology; Psychology GA 389MN UT WOS:000262097400011 PM 19092044 ER PT J AU Berdahl, TA McQuillan, J AF Berdahl, Terceira A. McQuillan, Julia TI Occupational Racial Composition and Nonfatal Work Injuries SO SOCIAL PROBLEMS LA English DT Article ID AFRICAN-AMERICAN; LINEAR-MODELS; UNITED-STATES; LABOR-MARKET; WAGE LEVELS; RACE; HEALTH; INEQUALITY; GENDER; RISK AB Is there an association between occupational racial composition and nonfatal workplace injuries? Guided by several labor market theories (queuing, social closure, devaluation, poor market position, and human capital), we use occupational data from the U. S. Census and Dictionary of Occupational Titles combined with individual data from the National Longitudinal Survey of Youth to answer this question. Hierarchical generalized linear models of individuals within occupations show that there is an association between occupational racial composition and workplace injuries, but this association is only statistically significant for white men in the model controlling for relevant occupational and individual level characteristics. A 10 percent increase in the occupation percent black is associated with a 28 percent increase in injury risk. Contrary to expectations, white men have the highest adjusted odds of injury; white women and black men have significantly lower odds of injury than white men. Additionally, occupation-level environmental hazards and individual-level education, hours worked per week, jobs with insurance benefits, working in the South, and specific industries are associated with differential injury risk. These findings are consistent with labor market theories that suggest social closure, market position, and individual skills contribute to differential labor market outcomes. We demonstrate that sociological theories of labor market inequality are useful for understanding workplace injury risk, and that workplace injuries should be studied as an outcome of social inequality. Keywords: occupational racial composition, work injury, health, labor markets, and social inequality. C1 [Berdahl, Terceira A.] Agcy Hlth Care Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [McQuillan, Julia] Univ Nebraska, 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.gov NR 50 TC 7 Z9 7 U1 3 U2 7 PU UNIV CALIFORNIA PRESS PI BERKELEY PA C/O JOURNALS DIVISION, 2000 CENTER ST, STE 303, BERKELEY, CA 94704-1223 USA SN 0037-7791 J9 SOC PROBL JI Soc. Probl. PD NOV PY 2008 VL 55 IS 4 BP 549 EP 572 DI 10.1525/sp.2008.55.4.549 PG 24 WC Sociology SC Sociology GA 364NA UT WOS:000260341200005 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, AJ Gordis, L Gregory, KD Harris, R Isham, G Leipzig, R LeFevre, ML Loveland-Cherry, C Marion, LN Moyer, VA Ockene, JK Sawaya, GF Yawn, BP AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen J. Gordis, Leon Gregory, Kimberly D. Harris, Russell Isham, George Leipzig, Rosanne LeFevre, Michael L. Loveland-Cherry, Carol Marion, Lucy N. Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Yawn, Barbara P. CA US Preventive Serv Task Force TI Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; RISK AB Description: New U. S. Preventive Services Task Force (USPSTF) recommendations about behavioral counseling of adolescents and adults to prevent sexually transmitted infections (STIs). Methods: The USPSTF reviewed the evidence on the benefits and harms of counseling. The review included studies evaluating behavioral counseling interventions conducted in primary settings, those judged feasible in primary care, and those to which patients might be referred from primary care. Recommendations: The USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. ( B recommendation) Current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs. (I statement). C1 [Calonge, Ned] USPSTF, Colorado Dept Publ Hlth & Environm, Denver, CO USA. USPSTF, Agcy Healthcare Res & Qual, Rockville, MD USA. [Petitti, Diana B.] Univ So Calif, USPSTF, Keck Sch Med, Sierra Madre, CA USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen J.] Dartmouth Med Sch, Hanover, NH USA. [Gordis, Leon] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Harris, Russell] Univ N Carolina, Sch Med, Chapel Hill, NC USA. [Isham, George] HealthPartners Inc, Minneapolis, MN USA. [Leipzig, Rosanne] Mt Sinai Sch Med, New York, NY USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. [Marion, Lucy N.] Med Coll Georgia, Augusta, GA 30912 USA. [Moyer, Virginia A.] Univ Texas Hlth Sci Ctr, Houston, TX USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Yawn, Barbara P.] Olmsted Med Ctr, Rochester, MN USA. RP Calonge, N (reprint author), USPSTF, Colorado Dept Publ Hlth & Environm, Denver, CO USA. FU USPSTF; Agency for Healthcare Research and Quality FX The USPSTF is an independent, voluntary body. The U. S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF. NR 11 TC 26 Z9 28 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 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD OCT 7 PY 2008 VL 149 IS 7 BP 491 EP W95 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 359QY UT WOS:000260004400006 ER PT J AU Calonge, N Petitti, DB Lin, K AF Calonge, Ned Petitti, Diana B. Lin, Kenneth TI Will recommendations against spirometry make chronic obstructive pulmonary disease harder to treat? Response SO ANNALS OF INTERNAL MEDICINE LA English DT Letter C1 [Calonge, Ned; Petitti, Diana B.; Lin, Kenneth] Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Calonge, N (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 5 TC 0 Z9 0 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 OCT 7 PY 2008 VL 149 IS 7 BP 513 EP 513 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 359QY UT WOS:000260004400010 ER PT J AU Spector, W AF Spector, W. TI PREVENTION OF PRESSURE ULCERS: BRINGING QUALITY IMPROVEMENT TO SCALE SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Spector, W.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 159 EP 159 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810600553 ER PT J AU Potter, D Williams, C AF Potter, D. Williams, C. TI QUALITY MEASURES FOR MEDICAID HCBS POPULATIONS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Potter, D.; Williams, C.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 216 EP 216 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810600750 ER PT J AU Potter, D AF Potter, D. TI STANDARDIZED MEASURES FOR COMMUNITY-BASED LONG-TERM CARE POPULATIONS: RECENT FEDERAL EFFORTS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Potter, D.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 216 EP 216 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810600749 ER PT J AU Potter, D Spector, W Redfoot, D AF Potter, D. Spector, W. Redfoot, D. TI DEVELOPING STANDARDIZED MEASURES FOR ASSISTED LIVING: THE ASSISTED LIVING DISCLOSURE COLLABORATIVE (ALDC) SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Potter, D.; Spector, W.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Redfoot, D.] AARP Publ Policy Inst, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 217 EP 217 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810600754 ER PT J AU Sangl, J Frentzel, E Cosenza, C Brown, J Buchanan, J Levine, R Teichman, L AF Sangl, J. Frentzel, E. Cosenza, C. Brown, J. Buchanan, J. Levine, R. Teichman, L. TI DEVELOPMENT OF THE CAHPS (R) HOME HEALTH CARE SURVEY SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Sangl, J.] AHRQ, Rockville, MD USA. [Frentzel, E.; Levine, R.] Amer Inst Res, Chapel Hill, NC USA. [Cosenza, C.] Univ Massachusetts, Boston, MA 02125 USA. [Brown, J.] RAND Corp, Santa Monica, CA USA. [Buchanan, J.] Harvard Univ, Sch Med, Boston, MA USA. [Teichman, L.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 217 EP 217 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810600753 ER PT J AU Spector, W AF Spector, W. TI ON-TIME PRESSURE ULCER PREVENTION: RECENT DEVELOPMENTS AND LESSONS LEARNED SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Spector, W.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 381 EP 381 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810601365 ER PT J AU Spector, W AF Spector, W. TI ON-TIME PRESSURE ULCER PREVENTION AND HEALING: NEW TOOLS AND NEW PARTNERSHIPS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Spector, W.] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 381 EP 381 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810601364 ER PT J AU Sangl, J Keller, S Frentzel, E Cosenza, C Brown, J Buchanan, J Sekscenski, E Ginsberg, C AF Sangl, J. Keller, S. Frentzel, E. Cosenza, C. Brown, J. Buchanan, J. Sekscenski, E. Ginsberg, C. TI DEVELOPMENT OF NURSING HOME CAHPS (R) SURVEY FOR FAMILY MEMBERS AS A MEASURE OF QUALITY SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Sangl, J.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Keller, S.; Frentzel, E.] Amer Inst Res, Chapel Hill, NC USA. [Cosenza, C.] Survey Res Ctr, Boston, MA USA. [Brown, J.] RAND Corp, Santa Monica, CA USA. [Buchanan, J.] Harvard Univ, Sch Med, Boston, MA USA. [Sekscenski, E.] Ctr Medicare, Baltimore, MD USA. [Sekscenski, E.] Ctr Medicaid Serv, Baltimore, MD USA. [Ginsberg, C.] WESTAT Corp, Rockville, MD 20850 USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 594 EP 594 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810602320 ER PT J AU Fraser, I Encinosa, W Glied, S AF Fraser, Irene Encinosa, William Glied, Sherry TI Improving efficiency and value in health care: Introduction SO HEALTH SERVICES RESEARCH LA English DT Editorial Material C1 [Fraser, Irene; Encinosa, William] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. [Glied, Sherry] Columbia Univ, Mailman Sch Publ Hlth, Dept Hlth Policy & Management, New York, NY USA. RP Fraser, I (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM Irene.fraser@ahrq.hhs.gov NR 8 TC 6 Z9 6 U1 0 U2 1 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 OCT PY 2008 VL 43 IS 5 BP 1781 EP 1786 DI 10.1111/j.1475-6773.2008.00904.x PN 2 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 350HW UT WOS:000259344300001 PM 18811736 ER PT J AU Valdmanis, VG Rosko, MD Mutter, RL AF Valdmanis, Vivian G. Rosko, Michael D. Mutter, Ryan L. TI Hospital quality, efficiency, and input slack differentials SO HEALTH SERVICES RESEARCH LA English DT Article DE hospital efficiency; data envelopment analysis; congestion; patient safety; nurse-sensitive outcomes ID PATIENT OUTCOMES; COST INEFFICIENCY; OF-CARE; MORTALITY AB Objective. To use an advance in data envelopment analysis (DEA) called congestion analysis to assess the trade-offs between quality and efficiency in U.S. hospitals. Study Setting. Urban U.S. hospitals in 34 states operating in 2004. Study Design and Data Collection. Input and output data from 1,377 urban hospitals were taken from the American Hospital Association Annual Survey and the Medicare Cost Reports. Nurse-sensitive measures of quality came from the application of the Patient Safety Indicator (PSI) module of the Agency for Healthcare Research and Quality (AHRQ) Quality Indicator software to State Inpatient Databases (SID) provided by the Healthcare Cost and Utilization Project (HCUP). Data Analysis. In the first step of the study, hospitals' relative output-based efficiency was determined in order to obtain a measure of congestion (i.e., the productivity loss due to the occurrence of patient safety events). The outputs were adjusted to account for this productivity loss, and a second DEA was performed to obtain input slack values. Differences in slack values between unadjusted and adjusted outputs were used to measure either relative inefficiency or a need for quality improvement. Principal Findings. Overall, the hospitals in our sample could increase the total amount of outputs produced by an average of 26 percent by eliminating inefficiency. About 3 percent of this inefficiency can be attributed to congestion. Analysis of subsamples showed that teaching hospitals experienced no congestion loss. We found that quality of care could be improved by increasing the number of labor inputs in low-quality hospitals, whereas high-quality hospitals tended to have slack on personnel. Conclusions. Results suggest that reallocation of resources could increase the relative quality among hospitals in our sample. Further, higher quality in some dimensions of care need not be achieved as a result of higher costs or through reduced access to health care. C1 [Mutter, Ryan L.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. [Valdmanis, Vivian G.] Univ Sci, Dept Hlth Policy & Publ Hlth, Philadelphia, PA USA. [Rosko, Michael D.] Widener Univ, Sch Business Adm, Grad Program Hlth & Med Serv Adm, Chester, PA 19013 USA. RP Mutter, RL (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, 540 Gaither Rd, Rockville, MD 20850 USA. EM rmutter@ahrq.gov OI Rosko, Michael/0000-0003-1699-6204 NR 34 TC 26 Z9 26 U1 3 U2 27 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 OCT PY 2008 VL 43 IS 5 BP 1830 EP 1848 DI 10.1111/j.1475-6773.2008.00893.x PN 2 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 350HW UT WOS:000259344300004 PM 18783457 ER PT J AU Korthuis, PT Josephs, JS Fleishman, JA Hellinger, J Himelhoch, S Chander, G Morse, EB Gebo, KA AF Korthuis, Philip Todd Josephs, Joshua S. Fleishman, John A. Hellinger, James Himelhoch, Seth Chander, Geetanjali Morse, Elizabeth B. Gebo, Kelly A. CA HIV Res Network TI Substance abuse treatment in human immunodeficiency virus: The role of patient-provider discussions SO JOURNAL OF SUBSTANCE ABUSE TREATMENT LA English DT Article DE HIV; communication; health services accessibility; African Americans; substance-related disorders; transportation ID ACTIVE ANTIRETROVIRAL THERAPY; INJECTION-DRUG USERS; PRIMARY-HEALTH-CARE; HIV-INFECTED ADULTS; BRIEF PHYSICIAN ADVICE; OUT-OF-TREATMENT; UNITED-STATES; SERVICES UTILIZATION; METHADONE-MAINTENANCE; ALCOHOL-PROBLEMS AB Substance abuse treatment is associated with decreases in human immunodeficiency virus (HIV) risk behavior and can improve HIV outcomes. The purpose of this study was to examine factors associated with substance abuse treatment utilization, including patient-provider discussions of substance use issues. We surveyed 951 HIV-infected adults receiving care at 14 HIV Research Network primary care sites regarding drug and alcohol use, substance abuse treatment, and provider discussions of substance use issues. Although 71% reported Substance use, only 24% reported receiving substance abuse treatment and less than half reported discussing substance use issues with their HIV providers. In adjusted logistic regression models, receipt of substance abuse treatment was associated with patient-provider discussions. Patient-provider discussions of substance use issues were associated with current drug use, hazardous or binge drinking, and Black race or ethnicity, though substance use was comparable between Blacks and Whites. These data suggest potential opportunities for improving engagement in substance abuse treatment services. (C) 2008 Elsevier Inc. All rights reserved. C1 [Korthuis, Philip Todd; Morse, Elizabeth B.] Oregon Hlth & Sci Univ, Dept Med, Portland, OR 97239 USA. [Josephs, Joshua S.; Chander, Geetanjali; Gebo, Kelly A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Fleishman, John A.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Hellinger, James] Community Med Alliance, Boston, MA 02210 USA. [Himelhoch, Seth] Univ Maryland, Sch Med, Dept Psychiat, Baltimore, MD 21201 USA. RP Josephs, JS (reprint author), Oregon Hlth & Sci Univ, Dept Med, 3181 SW Sam Jackson Pk Rd,Mail Code L-475, Portland, OR 97239 USA. EM korthuis@ohsu.edu FU NIA NIH HHS [R01 AG026250]; NIAAA NIH HHS [R01 AA016893, K23 AA015313]; NIDA NIH HHS [K23 DA000523, K23 DA019809, K23 DA019809-01A2, K23 DA019820, K23-DA00523, K23-DA019809, K23-DA019820, K24 DA000432, K24 DA000432-09, R01 DA011602, R01 DA011602-10]; PHS HHS [290-01-0012] NR 78 TC 18 Z9 19 U1 5 U2 7 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0740-5472 J9 J SUBST ABUSE TREAT JI J. Subst. Abus. Treat. PD OCT PY 2008 VL 35 IS 3 BP 294 EP 303 DI 10.1016/j.jsat.2007.11.005 PG 10 WC Psychology, Clinical; Substance Abuse SC Psychology; Substance Abuse GA 353TO UT WOS:000259591300008 PM 18329222 ER PT J AU Basu, J Mobley, LR AF Basu, Jayasree Mobley, Lee R. TI Trends in racial disparities among the elderly for selected procedures SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE racial disparities; CABG; PTCA; hip/joint replacement; referral-sensitive procedures; elderly ID ACUTE MYOCARDIAL-INFARCTION; HEALTH-CARE UTILIZATION; NEW-YORK-STATE; MANAGED CARE; OLDER-ADULTS; CARDIAC REVASCULARIZATION; CARDIOVASCULAR PROCEDURES; RESIDENTIAL SEGREGATION; SOCIOECONOMIC-STATUS; UNITED-STATES AB The authors examine trends over 1997-2001 in racial or ethnic disparities in the utilization of three costly, referral-sensitive procedures among the elderly-coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), and hip/joint replacement. Using a multivariate framework, they undertake a simultaneous examination of the relationships between patient, local area context, and health systems on these admission types after comparing them to a control group. This period spans the implementation of the Balanced Budget Act and a major Department of Health and Human Services initiative to reduce disparities in cardiovascular and other diseases. Findings suggest increasing disparities for African Americans relative to Whites in their lower utilization of CABG and PTCA over time, and increasing disparities in the utilization of hip/joint replacement among other races' relative to Whites. The authors find that racial or ethnic disparities in use of referral-sensitive procedures did not narrow over 1997-2001. C1 [Basu, Jayasree] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Mobley, Lee R.] RTI Int, Res Triangle Pk, NC USA. RP Basu, J (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Jayasree.basu@ahrq.hhs.gov FU Agency for Healthcare Research and Quality (AHRQ); RTI International; Office of Minority Health, Washington, DC FX This research is funded wholly by the authors' employers, the Agency for Healthcare Research and Quality (AHRQ) and RTI International. The views expressed in this article are those of the authors. No official endorsement by any agency of the federal government is intended or should be inferred. The authors would like to thank Roxanne Andrews, PhD, of AHRQ for carefully reviewing the draft, and Doug Kamerow, MD, for providing information regarding the diffusion of cardiac technology. The authors would also like to thank Kaytura Felix-Aaron, MD, and Karen Bagley for their help in an earlier draft of the article. The authors acknowledge the state data organizations that participate in the HCUP State Inpatient Databases: New York State Department of Health; Pennsylvania Health Care Cost Containment Council. An earlier version of the article was presented at the National Leadership Summit on Eliminating Racial & Ethnic Disparities in Health, sponsored by Office of Minority Health, Washington, DC, in January 2006 and at AcademyHealth annual research meeting, 2007. NR 64 TC 11 Z9 12 U1 4 U2 8 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 EI 1552-6801 J9 MED CARE RES REV JI Med. Care Res. Rev. PD OCT PY 2008 VL 65 IS 5 BP 617 EP 637 DI 10.1177/1077558708318284 PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 348EL UT WOS:000259193700006 PM 18490701 ER PT J AU Wang, YF Beydoun, MA Liang, L Caballero, B Kumanyika, SK AF Wang, Youfa Beydoun, May A. Liang, Lan Caballero, Benjamin Kumanyika, Shiriki K. TI Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic SO OBESITY LA English DT Article ID BODY-MASS INDEX; UNITED-STATES; SOCIOECONOMIC-STATUS; EXPERT COMMITTEE; RECOMMENDATIONS; ASSOCIATION; ADOLESCENTS; PREVENTION; GUIDELINES; CHILDREN AB We projected future prevalence and BMI distribution based on national survey data (National Health and Nutrition Examination Study) collected between 1970s and 2004. Future obesity-related health-care costs for adults were estimated using projected prevalence, Census population projections, and published national estimates of per capita excess health-care costs of obesity/overweight. The objective was to illustrate potential burden of obesity prevalence and health-care costs of obesity and overweight in the United States that would occur if current trends continue. Overweight and obesity prevalence have increased steadily among all US population groups, but with notable differences between groups in annual increase rates. The increase (percentage points) in obesity and overweight in adults was faster than in children (0.77 vs. 0.46-0.49), and in women than in men (0.91 vs. 0.65). If these trends continue, by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. By 2048, all American adults would become overweight or obese, while black women will reach that state by 2034. In children, the prevalence of overweight (BMI >= 95th percentile, 30%) will nearly double by 2030. Total health-care costs attributable to obesity/overweight would double every decade to 860.7-956.9 billion US dollars by 2030, accounting for 16-18% of total US health-care costs. We continue to move away from the Healthy People 2010 objectives. Timely, dramatic, and effective development and implementation of corrective programs/policies are needed to avoid the otherwise inevitable health and societal consequences implied by our projections. C1 [Wang, Youfa; Beydoun, May A.; Caballero, Benjamin] Johns Hopkins Bloomberg Sch Publ Hlth, Ctr Human Nutr, Dept Int Hlth, Baltimore, MD USA. [Liang, Lan] Agcy Healthcare Res & Qual, Ctr Financing, Rockville, MD USA. [Kumanyika, Shiriki K.] Univ Penn, Sch Med, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA. RP Wang, YF (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Ctr Human Nutr, Dept Int Hlth, Baltimore, MD USA. EM ywang@jhsph.edu FU US Department of Agriculture [2044-05322]; National Institutes of Health [NIDDK R01 DK63383, NICHD 1R03HD056073] FX The study was supported in part by the US Department of Agriculture (2044-05322) and the National Institutes of Health (NIDDK R01 DK63383 and NICHD 1R03HD056073). We thank Dr Zhang for his assistance by providing some of the data used in our analysis. Y.W. contributed to conceptualization, statistical analysis, literature review, interpretation of results, and write-up of the manuscript. M. A. B. and L. L. contributed to data management and statistical analysis, interpretation of results, and write-up part of the manuscript. B. C contributed to interpretation of results and revision of the manuscript. S. K. K assisted in data analysis, interpretation of results, and revision of the manuscript. NR 39 TC 581 Z9 597 U1 5 U2 59 PU NATURE PUBLISHING GROUP PI NEW YORK PA 75 VARICK STREET, 9TH FLOOR, NEW YORK, NY 10013-1917 USA SN 1930-7381 J9 OBESITY JI Obesity PD OCT PY 2008 VL 16 IS 10 BP 2323 EP 2330 DI 10.1038/oby.2008.351 PG 8 WC Endocrinology & Metabolism; Nutrition & Dietetics SC Endocrinology & Metabolism; Nutrition & Dietetics GA 354OR UT WOS:000259649400020 PM 18719634 ER PT J AU Brady, J Ho, K Clancy, CM AF Brady, Jeffrey Ho, Karen Clancy, Carolyn M. TI The quality and disparities reports: Why is progress so slow? SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 [Brady, Jeffrey] Natl Healthcare Qual Report, Rockville, MD USA. [Ho, Karen] Natl Healthcare Dispar, Rockville, MD USA. [Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Brady, J (reprint author), Natl Healthcare Qual Report, Rockville, MD USA. NR 5 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 SEP-OCT PY 2008 VL 23 IS 5 BP 396 EP 398 DI 10.1177/1062860608321925 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 352OM UT WOS:000259506600010 PM 18820145 ER PT J AU Selden, TM Sing, M AF Selden, Thomas M. Sing, Merrile TI The Distribution Of Public Spending For Health Care In The United States, 2002 SO HEALTH AFFAIRS LA English DT Article; Proceedings Paper CT 6th World Congress of the International-Health-Economics-Association CY JUL, 2007 CL Copenhagen, DENMARK SP Int Hlth Econ Assoc ID MEDICARE; BENEFITS; INSURANCE AB U.S. health care spending is projected to approach $2.4 trillion in 2008; a large share will be paid by government outlays and tax subsidies. Other countries routinely conduct incidence analyses of public health care spending, yet we know of no recent and comprehensive incidence studies for the United States. We examined data for 2002 from the Medical Expenditure Panel Survey aligned to the National Health Expenditure Accounts and augmented with simulated tax subsidies. The public sector accounted for 56.1 percent of health spending within the civilian noninstitutionalized population. Our analysis highlights this sector's role in financing the care of seniors and people in poor health. [Health Affairs 27, no. 5 (2008): w349-w359 (published online 29 July 2008; 10.1377/hlthaff.27.5.w349)] C1 [Selden, Thomas M.; Sing, Merrile] AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Selden, TM (reprint author), AHRQ, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM tselden@ahrq.gov NR 31 TC 10 Z9 10 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 SEP-OCT PY 2008 VL 27 IS 5 BP W349 EP W359 DI 10.1377/hlthaff.27.5.w349 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 357QR UT WOS:000259861700048 PM 18664527 ER PT J AU Mutter, RL Wong, HS Goldfarb, MG AF Mutter, Ryan L. Wong, Herbert S. Goldfarb, Marsha G. TI The Effects of Hospital Competition on Inpatient Quality of Care SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID MORTALITY AB Existing empirical studies have produced inconclusive, and sometimes contradictory, findings on the effects of hospital competition on inpatient quality of care. These inconsistencies may be due to the use of different methodologies, hospital competition measures, and hospital quality measures. This paper applies the Quality Indicator software from the Agency for Healthcare Research and Quality to the 1997 Healthcare Cost and Utilization Project State Inpatient Databases to create three versions (i.e., observed, risk-adjusted, and "smoothed") of 38 distinct measures of inpatient quality. The relationship between 12 different hospital competition measures and these quality measures are assessed, using ordinary least squares, two-step efficient generalized method of moments, and negative binomial regression techniques. We find that across estimation strategies, hospital competition has an impact on a number of hospital quality measures. However,. the effect is not unidirectional some indicators show improvements in hospital quality with greater levels of competition, some show decreases in hospital quality, and others are unaffected. We provide hypotheses based on emerging areas of research that could explain these findings, but inconsistencies remain. C1 [Mutter, Ryan L.; Wong, Herbert S.] AHRQ, CDOM, Rockville, MD 20850 USA. [Goldfarb, Marsha G.] Univ Maryland, Dept Econ, Baltimore, MD 21201 USA. RP Mutter, RL (reprint author), AHRQ, CDOM, 540 Gaither Rd, Rockville, MD 20850 USA. EM Ryan.Mutter@ahrq.hhs.gov NR 32 TC 18 Z9 18 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 2008 VL 45 IS 3 BP 263 EP 279 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 374MS UT WOS:000261048300004 PM 19069009 ER PT J AU Selden, TM AF Selden, Thomas M. TI The effect of tax subsidies on high health care expenditure burdens in the United States SO INTERNATIONAL JOURNAL OF HEALTH CARE FINANCE & ECONOMICS LA English DT Article DE burdens; tax subsidies; equity ID OF-POCKET EXPENSES; METHODOLOGICAL BIASES; ADULTS AB Previous analyses of families with high health care expenditure burdens have ignored the potentially mitigating effects of tax subsidies. This analysis uses data from the Medical Expenditure Panel Survey (MEPS) to fill this gap. A range of health expenditure burden measures are computed, with and without tax subsidies, showing the impact that tax subsidies have on both the prevalence and magnitude of high health care spending burdens among the nonelderly. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, Rockville, MD 20850 USA. RP Selden, TM (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat, 540 Gaither Rd, Rockville, MD 20850 USA. EM tselden@ahrq.gov NR 27 TC 7 Z9 7 U1 0 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1389-6563 J9 INT J HEALTH CARE FI JI Int. J. Health Care Financ. Econ. PD SEP PY 2008 VL 8 IS 3 BP 209 EP 223 DI 10.1007/s10754-008-9043-1 PG 15 WC Business, Finance; Economics; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 354AO UT WOS:000259611500005 PM 18587643 ER PT J AU Zuvekas, SH Fleishman, JA AF Zuvekas, Samuel H. Fleishman, John A. TI Self-rated mental health and racial/ethnic disparities in mental health service use SO MEDICAL CARE LA English DT Article DE mental health service use; self-rated mental health; racial-ethnic disparities ID NATIONAL COMORBIDITY SURVEY; UNITED-STATES; OUTPATIENT SERVICES; PERCEIVED NEED; DISORDERS; SUBPOPULATIONS; POPULATION; PREVALENCE; ONTARIO; ILLNESS AB Background: Studies of health service use for emotional problems show that the majority of those with disorders do not seek professional help. In addition, mental health service use is lower among members of minority communities, compared with non-Hispanic whites. Objective: To examine the role of self-reported mental health as an indicator of awareness of mental conditions and as an influence in the process of seeking mental health care. Research Design: We conducted cross-sectional analyses of nationally representative data from the Medical Expenditure Panel Survey (MEPS) for 2000-2004. Measures: In-person interviews obtained data on self-rated mental health (SRMH), ambulatory mental health visits, and purchase of prescription medications to treat mental conditions. Respondents completed the SF-12 health status survey; analyses included the SF-12 mental component summary (MCS) as a measure of emotional symptoms. Analyses included only those who provided self-reports of MCS and SRMH. Results: SRMH was related to any ambulatory visit and any medication purchase for mental health treatment, controlling for MCS, and other sociodemographic and clinical variables. The association between SRMH and service use was weaker for black and Hispanic respondents than for whites. In addition, the magnitude of the association between SRMH and MCS was weaker for black and Hispanic respondents than for whites. Conclusions: Racial/ethnic differences in service use may arise in part from different propensities to interpret emotional symptoms as reflecting one's mental health and then to seek professional intervention for emotional problems. SRMH may be useful as an indicator of the extent to which people acknowledge the existence of emotional problems. C1 [Zuvekas, Samuel H.; Fleishman, John A.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 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 FU Agency for Healthcare Research and Quality, Rockville, MD FX Supported by the Agency for Healthcare Research and Quality, Rockville, MD. NR 23 TC 60 Z9 60 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 SEP PY 2008 VL 46 IS 9 BP 915 EP 923 DI 10.1097/MLR.0b013e31817919e5 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 344RQ UT WOS:000258945400005 PM 18725845 ER PT J AU Klabunde, CN Lanier, D Meissner, HI Breslau, ES Brown, ML AF Klabunde, Carrie N. Lanier, David Meissner, Helen I. Breslau, Erica S. Brown, Martin L. TI Improving colorectal cancer screening through research in primary care settings - Introduction SO MEDICAL CARE LA English DT Editorial Material ID PREVENTIVE SERVICES; UNITED-STATES; GUIDELINES; FUTURE; RATIONALE; DELIVERY; MEDICINE C1 [Klabunde, Carrie N.; Brown, Martin L.] NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. [Lanier, David] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. [Meissner, Helen I.] NIH, Off Behav & Social Sci Res, Bethesda, MD 20892 USA. [Breslau, Erica S.] NCI, Div Canc Control & Populat Sci, Behav Res Program, Appl Canc Screening Res Branch, Bethesda, MD 20892 USA. RP Klabunde, CN (reprint author), NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, Execut Plaza N Room 4005,6130 Execut Blvd, Bethesda, MD 20892 USA. EM klabundc@mail.nih.gov NR 50 TC 11 Z9 11 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 SEP PY 2008 VL 46 IS 9 SU 1 BP S1 EP S4 DI 10.1097/MLR.0b013e3181805e2a PG 4 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 344RR UT WOS:000258945500001 PM 18725819 ER PT J AU Lanier, D AF Lanier, David TI Practice-based research networks - Laboratories for improving colorectal cancer screening in primary care practice SO MEDICAL CARE LA English DT Editorial Material ID FAMILY-PRACTICE; PATIENT; HEALTH; SETTINGS; DELIVERY C1 Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Patnerships, Rockville, MD 20850 USA. RP Lanier, D (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Patnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM david.lanier@ahrq.hhs.gov NR 33 TC 10 Z9 10 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 2008 VL 46 IS 9 SU 1 BP S147 EP S152 DI 10.1097/MLR.0b013e31817f0d00 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 344RR UT WOS:000258945500021 PM 18725827 ER PT J CA US Preventive Serv Task Force TI Screening for prostate cancer: US preventive services task force recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID ANTIGEN; MEN AB Description: Update of the 2002 U. S. Preventive Services Task Force (USPSTF) recommendation statement about screening for prostate cancer. Methods: The USPSTF evaluated randomized, controlled trials of the benefits of prostate cancer screening; cohort and cross-sectional studies of the psychological harms of false-positive prostate-specific antigen test results; and evidence on the natural history of prostate-specific antigen-detected prostate cancer to address previously identified gaps in the evidence from the 2002 USPSTF recommendation. Recommendations: Current evidence is insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years (I statement). Do not screen for prostate cancer in men age 75 years or older (Grade D recommendation). C1 [US Preventive Serv Task Force] Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. NR 22 TC 0 Z9 0 U1 0 U2 3 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 5 PY 2008 VL 149 IS 3 BP 185 EP 191 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 336CW UT WOS:000258342900005 ER PT J AU Lin, K Lipsitz, R Miller, T Janakiraman, S AF Lin, Kenneth Lipsitz, Robert Miller, Therese Janakiraman, Supriya TI Benefits and harms of prostate-specific antigen screening for prostate cancer: An evidence update for the US preventive services task force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; DIGITAL RECTAL EXAMINATION; ACTIVE SURVEILLANCE; UNITED-STATES; FOLLOW-UP; MORTALITY; MANAGEMENT; OUTCOMES; HISTORY; BIOPSY AB Background: Prostate cancer is the most common nonskin cancer in men in the United States, and prostate cancer screening has increased in recent years. In 2002, the U. S. Preventive Services Task Force concluded that evidence was insufficient to recommend for or against screening for prostate cancer with prostate-specific antigen (PSA) testing. Purpose: To examine new evidence on benefits and harms of screening asymptomatic men for prostate cancer with PSA. Data Sources: English-language articles identified in PubMed and the Cochrane Library (search dates, January 2002 to July 2007), reference lists of retrieved articles, and expert suggestions. Study Selection: Randomized, controlled trials and meta-analyses of PSA screening and cross-sectional and cohort studies of screening harms and of the natural history of screening-detected cancer were selected to answer the following questions: Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? What are the magnitude and nature of harms associated with prostate cancer screening, other than overtreatment? What is the natural history of PSA-detected, nonpalpable, localized prostate cancer? Data Extraction: Studies were reviewed, abstracted, and rated for quality by using predefined U. S. Preventive Services Task Force criteria. Data Synthesis: No good-quality randomized, controlled trials of screening for prostate cancer have been completed. In 1 cross-sectional and 2 prospective cohort studies of fair to good quality, false-positive PSA screening results caused psychological adverse effects for up to 1 year after the test. The natural history of PSA-detected prostate cancer is poorly understood. Limitations: Few eligible studies were identified. Long-term adverse effects of false-positive PSA screening test results are unknown. Conclusion: Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain. C1 [Lin, Kenneth; Lipsitz, Robert; Miller, Therese; Janakiraman, Supriya] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Lin, K (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM kenneth.lin@ahrq.hhs.gov NR 40 TC 139 Z9 144 U1 3 U2 17 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 5 PY 2008 VL 149 IS 3 BP 192 EP 199 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 336CW UT WOS:000258342900006 PM 18678846 ER PT J AU Mukamel, DB Weimer, DL Spector, WD Ladd, H Zinn, JS AF Mukamel, Dana B. Weimer, David L. Spector, William D. Ladd, Heather Zinn, Jacqueline S. TI Publication of quality report cards and trends in reported quality measures in nursing homes SO HEALTH SERVICES RESEARCH LA English DT Article DE quality report cards; Nursing Home Compare; long-term care; MDS ID MEDICARE MANAGED CARE; PERFORMANCE REPORTS; RISK-ADJUSTMENT; MARKET SHARE; IMPROVEMENT; SURGERY; IMPACT; INFORMATION; MORTALITY; OUTCOMES AB Objective. To examine associations between nursing homes' quality and publication of the Nursing Home Compare quality report card. Data Sources/Study Settings. Primary and secondary data for 2001-2003: 701 survey responses of a random sample of nursing homes; the Minimum Data Set (MDS) with information about all residents in these facilities, and the Nursing Home Compare published quality measure (QM) scores. Study Design. Survey responses provided information on 20 specific actions taken by nursing homes in response to publication of the report card. MDS data were used to calculate five QMs for each quarter, covering a period before and following publication of the report. Statistical regression techniques were used to determine if trends in these QMs have changed following publication of the report card in relation to actions undertaken by nursing homes. Principal Findings. Two of the five QMs show improvement following publication. Several specific actions were associated with these improvements. Conclusions. Publication of the Nursing Home Compare report card was associated with improvement in some but not all reported dimensions of quality. This suggests that report cards may motivate providers to improve quality, but it also raises questions as to why it was not effective across the board. C1 [Mukamel, Dana B.; Ladd, Heather] Univ Calif Irvine, Ctr Hlth Policy Res, Acad 111, Irvine, CA 92697 USA. [Weimer, David L.] Univ Wisconsin, LaFollette Sch Publ Affairs, Madison, WI USA. [Spector, William D.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Zinn, Jacqueline S.] Temple Univ, Philadelphia, PA 19122 USA. RP Mukamel, DB (reprint author), Univ Calif Irvine, Ctr Hlth Policy Res, Acad 111, Suite 220, Irvine, CA 92697 USA. FU NIA NIH HHS [AG023177, R01 AG023177, R01 AG023177-05] NR 35 TC 73 Z9 73 U1 0 U2 6 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 2008 VL 43 IS 4 BP 1244 EP 1262 DI 10.1111/j.1475-6773.2007.00829.x PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 327VG UT WOS:000257756000008 PM 18248401 ER PT J AU Gray, DT Hollingworth, W Onwudiwe, N Jarvik, JG AF Gray, Darryl T. Hollingworth, William Onwudiwe, Nneka Jarvik, Jeffrey G. TI Costs and state-specific rates of thoracic and lumbar vertebroplasty, 2001-2005 SO SPINE LA English DT Article; Proceedings Paper CT 5th Annual Meeting of Health Technology Assessment International CY JUL 06-09, 2008 CL Montreal, CANADA DE vertebroplasty; thoracic; lumbar; costs; rates; Medicare; health service research ID LOW-BACK-PAIN; PERCUTANEOUS VERTEBROPLASTY; VERTEBRAL FRACTURES; ACCURACY; CATARACT; SURGERY; CLAIMS AB Study Design. Sequential cross-sectional analysis. Objective. To document vertebroplasty rates and costs. Summary of Background Data. Little is known about interstate variation in rates or about nation-wide costs associated with the growing use of percutaneous vertebroplasty. Methods. Using specific CPT-4 billing codes, we reviewed aggregate Medicare Part B fee-for-service claims data (cross-stratified by physician specialty and treatment setting) on thoracolumbar vertebroplasties performed from 2001-2005. Vertebroplasty rates for individual states were expressed per 100,000 Part B fee-for-service enrollees. Nation-wide facility and physician charges (combining expected contributions from all sources) allowed by Medicare for vertebroplasties and associated imaging guidance procedures were applied to observed vertebroplasty volumes. These charges (reflecting direct medical costs from an all-payer perspective) were expressed in 2005 dollars using the Producer Price Index. Results. Vertebroplasty rates for individual states rose but varied considerably, ranging from 0.0 to 515.6/100,000 Medicare Part B fee-for-service enrollees in 2001 (median state rate = 35.4), and from 9.8 to 849.5 in 2005 (median state rate = 75.0). On average, 1.3 vertebral levels were treated per procedure, varying by treatment site and physician specialty. Fluoroscopic rather than computed tomography guidance was used in 98.7% of cases. Total nation-wide inflation-adjusted charges rose from $76.0 million for 14,142 cases performed in 2001 to $152.3 million for 29,090 cases in 2005. While vertebroplasty was predominantly an outpatient procedure, inpatient cases generated most of the charges. Increasing volumes and costs were associated with cases performed in ambulatory surgery centers and physicians' offices. Conclusion. Nation-wide vertebroplasty volumes and inflation-adjusted charges doubled from 2001 to 2005 in this Medicare population. Procedure rates varied considerablyby state. Almost all cases involved fluoroscopic guidance; procedures treating multiple vertebral levels were not uncommon. Procedures performed in free-standing facilities are of growing importance. Given the issues surrounding appropriate vertebroplasty use, future practice patterns and outcomes should be closely tracked. C1 [Gray, Darryl T.; Onwudiwe, Nneka] Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. [Hollingworth, William] Univ Bristol, Dept Social Med, Bristol, Avon, England. [Onwudiwe, Nneka] Univ Maryland, Sch Pharm, Pharmaceut Hlth Services Res, Baltimore, MD 21201 USA. [Jarvik, Jeffrey G.] Univ Washington, Dept Radiol, Seattle, WA 98195 USA. [Jarvik, Jeffrey G.] Univ Washington, Dept Neurosurg, Seattle, WA 98195 USA. [Jarvik, Jeffrey G.] Univ Washington, Dept Hlth Serv, 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 [5R01AR049373-04, P60 AR048093, P60 AR48093, R01 AR049373] NR 42 TC 21 Z9 22 U1 0 U2 2 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 2008 VL 33 IS 17 BP 1905 EP 1912 PG 8 WC Clinical Neurology; Orthopedics SC Neurosciences & Neurology; Orthopedics GA 333NK UT WOS:000258159000014 PM 18622357 ER PT J AU Meyers, D Turner-Maffei, C AF Meyers, David Turner-Maffei, Cindy TI Improved breastfeeding success through the Baby-Friendly Hospital Initiative SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID PROMOTION; TRIAL; RATES C1 [Meyers, David] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. [Turner-Maffei, Cindy] Bady Friendly USA, E Sandwich, MA USA. RP Meyers, D (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. NR 10 TC 0 Z9 0 U1 1 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 JUL 15 PY 2008 VL 78 IS 2 BP 180 EP + PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 329CI UT WOS:000257844100004 PM 18697501 ER PT J AU Owens, PL Zodet, MW Berdahl, T Dougherty, D McCormick, MC Simpson, LA AF Owens, Pamela L. Zodet, Marc W. Berdahl, Terceira Dougherty, Denise McCormick, Marie C. Simpson, Lisa A. TI Annual report on health care for children and youth in the United States: Focus on injury-related emergency department utilization and expenditures SO AMBULATORY PEDIATRICS LA English DT Article DE emergency department care; expenditures; injury; utilization ID SEVERITY SCORE; TRAUMA CENTERS; BELT LAWS; ACCESS; QUALITY; VISITS; INSURANCE; PATTERNS; COVERAGE AB Objective.-To examine state differences in children's utilization of injury-related emergency department (ED) care across 14 states, benchmarking aggregate state estimates against national expenditure estimates for outpatient injury-related ED care. Methods.-A retrospective analysis was performed using the 2003 State Emergency Department Databases and State Inpatient Databases from the Healthcare Cost and Utilization Project and data from the Medical Expenditure Panel Survey. Pediatric ED visits with any injury International Classification of Diseases Ninth Version Clinical Modification (ICD-9-CM) diagnosis code were selected. The Barell Injury Diagnosis Matrix, ICD-MAP-90 software, and the Trauma Information Exchange Program data were used to classify injuries, produce injury severity scores, and examine utilization in trauma centers. Aggregate and state-specific descriptive analyses compared differences in patient and injury characteristics and admission status by age, severity of injury, and expected payer. Results.-Over 1.5 million or nearly one-third of ED visits were for pediatric injuries in the 14 states studied. Nationally, 5.4% of children had an injury-related ED visit, and approximately $2.3 billion was spent on outpatient injury-related ED visits in 2003. The pattern of injury-related ED visit care varied considerably by state. For example, injury-related ED visit rates ranged from 63.3 to 164.4 per 1000 children. Infants, adolescents, children from very low income communities, and children from nonmetropolitan and nonmicropolitan areas were more likely to have an injury-related ED visit than their peers. Although patient characteristics were fairly consistent across states, admission rates and expected source of payment for injury-related ED visits varied considerably by state. Hospital admission rates ranged from 1.5% to 4.4% of injury-related ED visits and expected payer estimates ranged from 37.1 % to 71.0% of visits billed to private insurance, 17.9% to 47.0% billed to Medicaid, and 2.1% to 10.4% billed as uninsured. Conclusions.-This study suggests that injuries account for a significant portion of pediatric ED visits. There is substantial variation in ED use and hospital admissions for injured children across states and payers. This variation suggests that there are several opportunities for improvement in emergency care for children. To better understand the underlying reason for the variation, multivariate and hypothesis-driven research should focus on the nature and outcomes of injury-related ED care in the context of small area practice patterns and state programs, policies, and care system characteristics. C1 [Owens, Pamela L.; Zodet, Marc W.; Berdahl, Terceira; Dougherty, Denise] Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [McCormick, Marie C.] Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA. [Simpson, Lisa A.] Cincinnati Childrens Hosp, Dept Pediat, Cincinnati, OH USA. RP Owens, PL (reprint author), Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM Pamela.Owens@ahrq.hhs.gov NR 64 TC 24 Z9 25 U1 2 U2 5 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 JUL-AUG PY 2008 VL 8 IS 4 BP 219 EP 240 DI 10.1016/j.ambp.2008.03.032 PG 22 WC Pediatrics SC Pediatrics GA 329UL UT WOS:000257896000003 PM 18644545 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI New patient safety organizations lower roadblocks to medical error reporting 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 3 Z9 3 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 JUL-AUG PY 2008 VL 23 IS 4 BP 318 EP 321 DI 10.1177/1062860608319673 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 328OB UT WOS:000257806600010 PM 18658105 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, A Gregory, KD Harris, R Isham, G LeFevre, ML Leipzig, R Loveland-Cherry, C Marion, LN Melnyk, B Moyer, VA Ockene, JK Sawaya, GF Yawn, BP AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen Gregory, Kimberly D. Harris, Russell Isham, George LeFevre, Michael L. Leipzig, Rosanne Loveland-Cherry, Carol Marion, Lucy N. Melnyk, Bernadette Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Yawn, Barbara P. CA US Preventive Serv Task Force TI Screening for asymptomatic bacteriuria in adults: US preventive services task force reaffirmation recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB Description: Reaffirmation of the 2004 U. S. Preventive Services Task Force recommendation statement about screening for asymptomatic bacteriuria in adults. Methods: The U. S. Preventive Services Task Force did a targeted literature search for evidence on the benefits and harms of screening for asymptomatic bacteriuria in pregnant women, nonpregnant women, and men. Recommendations: Screen for asymptomatic bacteriuria with urine culture in pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, if later. (Grade A recommendation.) Do not screen for asymptomatic bacteriuria in men and nonpregnant women. (Grade D recommendation.). C1 [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [US Preventive Serv Task Force] US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. [Petitti, Diana B.] Univ So Calif, Keck Sch Med, Sierra Madre, CA USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen] Dartmouth Med Sch, Lebanon, NH USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Harris, Russell] Univ N Carolina, Sch Med, Chapel Hill, NC USA. [Isham, George] HealthPartners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Leipzig, Rosanne] Mt Sinai Sch Med, New York, NY USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Melnyk, Bernadette] Arizona State Coll Nursing & Healthcare Innovat, Phoenix, AZ USA. [Moyer, Virginia A.] Univ Texas Houston, Hlth Sci Ctr, Houston, TX USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Yawn, Barbara P.] Olmsted Med Ctr, Rochester, MI USA. RP Calonge, N (reprint author), Colorado Dept Publ Hlth & Environm, Denver, CO USA. NR 8 TC 25 Z9 27 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 JUL 1 PY 2008 VL 149 IS 1 BP 43 EP + PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 323EZ UT WOS:000257428200006 ER PT J AU Lin, K Fajardo, K AF Lin, Kenneth Fajardo, Kevin TI Screening for asymptomatic bacteriuria in adults: Evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID WOMEN AB Background: Asymptomatic bacteriuria is common, and screening for this condition in pregnant women is a well-established, evidence-based standard of current medical practice. Screening other groups of adults has not been shown to improve outcomes. Purpose: To review new and substantial evidence on screening for asymptomatic bacteriuria, to support the work of the U. S. Preventive Services Task Force. Data Sources: English-language studies of adults (age > 18 years) indexed in PubMed and the Cochrane Library and published from 1 January 2002 through 30 April 2007. Study Selection: For benefits of screening or treatment for screened populations, systematic reviews; meta-analyses; and randomized, controlled trials were included. For harms of screening, systematic reviews; meta-analyses; randomized, controlled trials; cohort studies; case-control studies; and case series of large multisite databases were included. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion. Data Extraction: Two reviewers extracted data from studies on benefits of screening and treatment (including decreases in the incidence of adverse maternal and fetal outcomes, symptomatic urinary tract infections, hypertension, and renal function decline). Data Synthesis: An updated Cochrane systematic review of 14 randomized, controlled trials of treatment supports screening for asymptomatic bacteriuria in pregnant women. A randomized, controlled trial and a prospective cohort study show that screening nonpregnant women with diabetes for asymptomatic bacteriuria is unlikely to produce benefits. No new evidence on screening men for asymptomatic bacteriuria or on harms of screening was found. Limitation: The focused search strategy may have missed some smaller studies on the benefits and harms of screening for asymptomatic bacteriuria. Conclusion: The available evidence continues to support screening for asymptomatic bacteriuria in pregnant women, but not in other groups of adults. C1 [Lin, Kenneth; Fajardo, Kevin] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. RP Lin, K (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM kenneth.lin@ahrq.hhs.gov NR 9 TC 47 Z9 48 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 JUL 1 PY 2008 VL 149 IS 1 BP W20 EP W24 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 323EZ UT WOS:000257428200008 PM 18591632 ER PT J AU Pylypchuk, Y Selden, TM AF Pylypchuk, Yuriy Selden, Thomas M. TI Discrete choice decomposition analysis of racial and ethnic differences in children's health insurance coverage SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE health insurance; children; minorities; decomposition ID RACIAL/ETHNIC DISPARITIES; MEDICAL-CARE; ACCESS; IMMIGRANTS; LATINO; DISCRIMINATION; ELIGIBILITY; EMPLOYMENT; AMERICAN; TRENDS AB This paper presents a multivariate decomposition analysis of racial and ethnic differences in children's health insurance using the 2004-2005 Medical Expenditure Panel Survey. We present two methodological contributions. First, we adapt a recently-developed matching decomposition method for use with sample-weighted data. Second, we develop a fully nonparametric approach that implements decomposition through weight adjustments. Accounting for the black-white wealth gap: a nonparametric approach. Journal of the American Statistical Association 97, 663-673]. Differences in observed characteristics explain large percentages of racial and ethnic coverage differences. Important contributors include poverty levels, parent education, family structure (for black children), and immigration-related factors (for Hispanic children). We also examine racial and ethnic differences in parent offers of employer-sponsored insurance and in children's coverage conditional on having a parent offer. Comparison of our linear, nonlinear, and nonparametric results suggests researchers may face a trade-off between robustness and precision when selecting among decomposition methodologies for discrete outcomes. Published by Elsevier B.V. C1 [Selden, Thomas M.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. [Pylypchuk, Yuriy] Social & Scientif Syst, Silver Spring, MD 20910 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 49 TC 13 Z9 13 U1 0 U2 5 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 EI 1879-1646 J9 J HEALTH ECON JI J. Health Econ. PD JUL PY 2008 VL 27 IS 4 BP 1109 EP 1128 DI 10.1016/j.healeco.2007.12.001 PG 20 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 325LU UT WOS:000257591200021 PM 18242743 ER PT J AU Ho, K Brady, J Clancy, CM AF Ho, Karen Brady, Jeffrey Clancy, Carolyn M. TI Improving quality and reducing disparities - The role of nurses SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 [Ho, Karen; Brady, Jeffrey; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Ho, K (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Salina.Prasad@ahrq.hhs.gov NR 4 TC 6 Z9 6 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 JUL-SEP PY 2008 VL 23 IS 3 BP 185 EP 188 PG 4 WC Nursing SC Nursing GA 317QM UT WOS:000257034700001 PM 18562857 ER PT J AU Bergstrom, N Smout, R Horn, S Spector, W Hartz, A Limcangco, MR AF Bergstrom, Nancy Smout, Randall Horn, Susan Spector, William Hartz, Arthur Limcangco, M. Rhona TI Stage 2 pressure ulcer healing in nursing homes SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE pressure ulcers; nursing homes; long-term care; survival analysis ID LONG-TERM-CARE; PREVENTION; RESIDENTS; QUALITY AB OBJECTIVES: To identify resident and wound characteristics associated with Stage 2 pressure ulcer (PrU) healing time in nursing home residents. DESIGN: Retrospective cohort study with convenience sampling. SETTING: One hundred two nursing homes participating in the National Pressure Ulcer Long-Term Care Study (NPULS) in the United States. PARTICIPANTS: Seven hundred seventy-four residents aged 21 and older with length of stay of 14 days or longer who had at least one initial Stage 2 (hereafter Stage 2) PrU. MEASUREMENTS: Data collected for each resident over a 12-week period included resident characteristics and PrU characteristics, including area when first reached Stage 2. Data were obtained from medical records and logbooks. RESULTS: There were 1,241 initial Stage 2 PrUs on 774 residents; 563 (45.4%) healed. Median time to heal was 46 days. Initial area was significantly associated with days to heal. Using Kaplan-Meier survival analyses, median days to heal was 33 for small (<= 1 cm(2)), 53 days for medium (> 1 to <= 4 cm(2)), and 73 days for large (> 4 cm(2)) ulcers. Using Cox proportional hazard regression models to examine effects of multiple variables simultaneously, small and medium ulcers and ulcers on residents with agitation and those who had oral eating problem healed more quickly, whereas ulcers on residents who required extensive assistance with seven to eight activities of daily living (ADLs), who temporarily left the facility for the emergency department (ED) or hospital, or whose PrU was on an extremity healed more slowly. CONCLUSION: PrUs on residents with agitation or with oral eating problems were associated with faster healing time. PrUs located on extremities, on residents who went temporarily to the ED or hospital, and on residents with high ADL disabilities were associated with slower healing time. Interaction between PrU size and place of onset was also associated with healing time. For PrU onset before or after admission to the facility, smaller size was associated with faster healing time. C1 [Bergstrom, Nancy] Univ Texas Houston, Ctr Aging, Sch Nursing, Houston, TX USA. [Smout, Randall; Horn, Susan] Inst Clin Outcomes Res, Salt Lake City, UT USA. [Spector, William] Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD USA. [Hartz, Arthur] Univ Utah, Sch Med, Huntsman Canc Inst, Salt Lake City, UT USA. [Limcangco, M. Rhona] Social & Sci Syst Inc, Rockville, MD USA. RP Bergstrom, N (reprint author), UTSON H Ctr Aging, 6901 Bertner Ave,SON 625, Houston, TX USA. EM Nancy.Bergstrom@uth.tmc.edu FU AHRQ HHS [5 UC1 HS015350] NR 25 TC 15 Z9 15 U1 0 U2 1 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 JUL PY 2008 VL 56 IS 7 BP 1252 EP 1258 DI 10.1111/j.1532-5415.2008.01765.x PG 7 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 332HJ UT WOS:000258073800012 PM 18482291 ER PT J AU Lee, LY Kortepeter, CM Willy, ME Nourjah, P AF Lee, Lauren Y. Kortepeter, Cindy M. Willy, Mary E. Nourjah, Parivash TI Drug-risk communication to pharmacists: Assessing the impact of risk-minimization strategies on the practice of pharmacy SO JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION LA English DT Article DE risk management; pharmacists; medication safety; Food and Drug Administration; adverse drug effects; black box warnings ID DEAR DOCTOR LETTERS; INFORMATION AB Objectives: To gain insight on the knowledge, opinions, barriers, and practices of pharmacists regarding drug risk-minimization tools. Design: Descriptive, nonexperimental, cross-sectional survey. Setting: 20 states in the United States, fall 2004. Participants: 2,052 randomly selected licensed pharmacists employed in a position requiring an active pharmacist license at the time of the survey and who responded to the survey. Intervention: Participants completed a four-page survey regarding their experience with different types of risk-minimization tools. Main outcome measure: Univariate distributions for each question were analyzed. Results: 50% of survey recipients responded to the mailing; 88% of respondents had an active pharmacist license. Of respondents, 18% reported never having received a Dear Healthcare Professional letter and 29% stated that they were not familiar with Medication Guides. Patient package inserts were thought to be somewhat effective by 53% of respondents. Of pharmacists who dispensed a drug with programs for special stickers to be affixed on prescriptions to indicate that the labeled risk had been addressed by the prescriber, 41% reported receiving a prescription without a sticker; 45% dispensed the prescription when stickers were missing. Sixty percent of pharmacists stated that risk-minimization programs have a negative impact on the daily practice of pharmacy; nevertheless, many acknowledged that it was a necessary duty. Conclusion: Pharmacists might benefit from additional training on risk-minimization strategies. The successful implementation and impact of risk-minimization programs on the practice of pharmacy should be carefully considered by drug manufacturers and regulators. C1 [Lee, Lauren Y.; Kortepeter, Cindy M.; Willy, Mary E.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Nourjah, Parivash] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Lee, LY (reprint author), 10903 New Hampshire Ave,Bldg 22,Room 3432, Silver Spring, MD 20993 USA. EM lauren.lee@fda.hhs.gov NR 7 TC 5 Z9 6 U1 1 U2 3 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 JUL-AUG PY 2008 VL 48 IS 4 BP 494 EP 500 DI 10.1331/JAPhA.2008.07045 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 336BW UT WOS:000258340300016 PM 18653425 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Gordis, L Gregory, KD Harris, R Isham, G 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 Isham, George 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 Universal screening for hearing loss in newborns: US preventive services task force recommendation statement SO PEDIATRICS LA English DT Article DE hearing loss; newborn screening; preventive services ID CONTROLLED-TRIAL; INTERVENTION PROGRAMS; EARLY IDENTIFICATION; POSITION STATEMENT; IMPAIRMENT; PRINCIPLES; GUIDELINES AB DESCRIPTION. This is the 2008 update of the 2001 US Preventive Services Task Force recommendation on universal newborn hearing screening. METHODS. The US Preventive Services Task Force weighed the benefits and harms of universal newborn hearing screening, incorporating new evidence addressing gaps identified in the 2001 US Preventive Services Task Force recommendation statement. Published literature on this topic was identified ( by using Medline and Cochrane databases) and systematically reviewed. RECOMMENDATION. Screen for hearing loss in all newborn infants ( B recommendation). C1 [Calonge, Ned] USPSTF, Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Petitti, Diana B.] Univ So Calif, Keck Sch Med, Los Angeles, CA 90033 USA. [DeWitt, Thomas G.] Childrens Hosp Med Ctr, Cincinnati, OH USA. [Gordis, Leon] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Harris, Russell] Univ N Carolina, Sch Med, Chapel Hill, NC USA. [Isham, George] Hlth Partners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. [Marion, Lucy N.] Med Coll Georgia, Augusta, GA 30912 USA. [Moyer, Virginia A.] Univ Texas Houston, Hlth Sci Ctr, Houston, TX USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Siu, Albert L.] Mt Sinai Med Ctr, New York, NY 10029 USA. [Teutsch, Steven M.] Merck & Co Inc, West Point, PA USA. [Yawn, Barbara P.] Olmsted Med Ctr, Rochester, MN USA. RP Calonge, N (reprint author), USPSTF, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM uspstf@ahrq.hhs.gov NR 16 TC 58 Z9 63 U1 1 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 JUL PY 2008 VL 122 IS 1 BP 143 EP 148 DI 10.1542/peds.2007-2210 PG 6 WC Pediatrics SC Pediatrics GA 320YN UT WOS:000257271200019 ER PT J AU Clancy, C AF Clancy, Carolyn TI Improving care quality and reducing disparities - Physicians' roles SO ARCHIVES OF INTERNAL MEDICINE LA English DT Editorial Material ID PAY-FOR-PERFORMANCE; RACIAL DISPARITIES; OF-CARE C1 Agcy Healthcare Res & Qual, Rockville, MD 20910 USA. RP Clancy, C (reprint author), Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20910 USA. EM carolyn.clancy@ahrq.hhs.gov NR 12 TC 6 Z9 6 U1 0 U2 0 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 JUN 9 PY 2008 VL 168 IS 11 BP 1135 EP 1136 DI 10.1001/archinte.168.11.1135 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 309UK UT WOS:000256485500001 PM 18541819 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Dietrich, AJ Gordis, L Gregory, KD Harris, R Isham, G Leipzig, R LeFevre, ML Loveland-Cherry, C Marion, LN Moyer, VA Ockene, JK Sawaya, GF Yawn, BP AF Calonge, Ned Petitti, Diana B. DeWitt, Thomas G. Dietrich, Allen J. Gordis, Leon Gregory, Kimberly D. Harris, Russell Isham, George Leipzig, Rosanne LeFevre, Michael L. Loveland-Cherry, Carol Marion, Lucy N. Moyer, Virginia A. Ockene, Judith K. Sawaya, George F. Yawn, Barbara P. CA US Preventive Serv Task Force TI Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID CORONARY-HEART-DISEASE; IMPAIRED FASTING GLUCOSE; NUTRITION EXAMINATION SURVEY; CONVERTING-ENZYME-INHIBITOR; CARDIOVASCULAR RISK-FACTORS; PLACEBO-CONTROLLED TRIAL; LOW-DOSE ASPIRIN; RANDOMIZED-TRIAL; SYSTOLIC HYPERTENSION; GLYCATED HEMOGLOBIN AB Description: Updated U. S. Preventive Services Task Force (USPSTF) recommendation about screening for type 2 diabetes mellitus in adults. Methods: To estimate the balance of benefits and harms of screening, the USPSTF updated its 2003 evidence review, adding evidence from new trials as well as updates on earlier studies. The review for this current recommendation focused on evidence that early treatment prevented long-term adverse outcomes of diabetes, including cardiovascular events, visual impairment, renal failure, and amputation. Recommendations: Screen for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg. (B recommendation) Current evidence is insufficient to assess the balance of benefits and harms of routine screening in asymptomatic adults with blood pressure of 135/80 mm Hg or lower. (I statement). C1 [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Petitti, Diana B.] Univ So Calif, Keck Sch Med, Sierra Madre, CA USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Dietrich, Allen J.] Dartmouth Med Sch, Hanover, NH USA. [Gordis, Leon] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Harris, Russell] Univ N Carolina, Sch Med, Chapel Hill, NC USA. [Isham, George] HealthPartners, Minneapolis, MN USA. [Leipzig, Rosanne] Mt Sinai Sch Med, New York, NY USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. [Marion, Lucy N.] Med Coll Georgia, Augusta, GA 30912 USA. [Moyer, Virginia A.] Univ Texas Houston, Hlth Sci Ctr, Houston, TX USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Yawn, Barbara P.] Olmsted Med Ctr, Rochester, MN USA. RP Calonge, N (reprint author), US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. NR 52 TC 89 Z9 89 U1 0 U2 6 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 2008 VL 148 IS 11 BP 846 EP U63 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA 308CG UT WOS:000256365300006 ER PT J AU Monheit, AC Vistnes, JP AF Monheit, Alan C. Vistnes, Jessica Primoff TI Health insurance enrollment decisions: Preferences for coverage, worker sorting, and insurance take-up SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID DEMAND; MARKET; AVAILABILITY; BENEFITS; PREMIUMS; TAXATION AB The weak response by the uninsured to initiatives encouraging voluntary enrollment in health insurance has raised concerns regarding the extent to which the uninsured value insurance. This concern is also relevant for proposals to mandate health insurance coverage since workers will suffer welfare losses if compelled to purchase coverage their perceive to be of little value. To address this issue, we use the 2001 Medical Expenditure Panel Survey to examine decisions by, single workers to seek out and enroll in employer sponsored insurance. We find that single workers with weak or uncertain preferences for health insurance are less likely to have jobs that offer coverage or to enroll in coverage when offered Our results suggest a dual approach to expanding coverage that includes both subsides and educational efforts regarding the value of health insurance. C1 [Monheit, Alan C.] Univ Med & Dent New Jersey, Dept Hlth Syst & Policy, Sch Publ Hlth, Piscataway, NJ 08854 USA. [Monheit, Alan C.] Natl Bur Econ Res, Cambridge, MA 02138 USA. [Vistnes, Jessica Primoff] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Monheit, AC (reprint author), Univ Med & Dent New Jersey, Dept Hlth Syst & Policy, Sch Publ Hlth, 683 Hoes Lane W, Piscataway, NJ 08854 USA. EM monheiac@umdnj.edu NR 28 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 SUM PY 2008 VL 45 IS 2 BP 153 EP 167 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 341UE UT WOS:000258739800003 PM 18767381 ER PT J AU Murphy, TV Syed, SB Holman, RC Haberung, DL Singleton, RJ Steiner, CA Pagano, EL Cheek, JE AF Murphy, Trudy V. Syed, Shamsuzzoha B. Holman, Robert C. Haberung, Dana L. Singleton, Rosalyn J. Steiner, Claudia A. Pagano, Edna L. Cheek, James E. TI Pertussis-associated hospitalizations in American Indian and Alaska Native infants SO JOURNAL OF PEDIATRICS LA English DT Article ID INFECTIOUS-DISEASE HOSPITALIZATIONS; IMMUNIZATION PRACTICES ACIP; ADVISORY-COMMITTEE; PREVENTING TETANUS; UNITED-STATES; RECOMMENDATIONS; POPULATION; DIPHTHERIA; CHILDREN; ACCESS AB Objective To investigate the burden of pertussis in American Indian and Alaska Native (AI/AN) infants. Study design AI/AN pertussis-associated hospitalizations between 1980 and 2004 were evaluated using Indian Health Service (IHS)/tribal inpatient data, which include all reported hospitalizations within the IHS/tribal health care system. Results Between 1980 and 2004, 483 pertussis-associated hospitalizations in AI/AN infants were documented; 88% of cases involved infants age < 6 months. For this entire period, the average annual hospitalization rate was 132.7 per 100,000 AI/AN infants (95% confidence interval [CI] = 121.3 to 145.2), and 234.5 per 100,000 AI/AN infants age < 6 months (95% CI = 213.1 to 258.1). Between 2000 and 2004, the annual hospitalization rate was 100.5 per 100,000 AI/AN infants (95% CI = 81.6 to 123.7), which exceeds the estimated 2003 pertussis hospitalization rate of 67.7 per 100,000 in the general US infant population (95% CI = 61.9 to 73.5). The highest pertussis hospitalization rates in 2000 to 2004 were in AI/AN infants in the Alaska and Southwestern IHS regions of the United States. Conclusions The burden of pertussis in,WAN infants is high, particularly so in infants age < 6 months in the Alaska and the Southwestern HIS regions of the United States. Ensuring implementation of vaccination strategies to reduce the incidence of pertussis in AI/AN, infants, adolescents, and adults alike is warranted to reduce the burden of pertussis in AI/AN infants. C1 [Murphy, Trudy V.] CDC, Natl Ctr Immunizat & Resp Dis, Div Bacterial Dis, Off Director, Atlanta, GA 30333 USA. [Syed, Shamsuzzoha B.; Cheek, James E.] Indian Hlth Serv, Off Publ Hlth Support, Div Epidemiol, Albuquerque, NM USA. [Syed, Shamsuzzoha B.] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Gen Prevent Med Residency Program, Baltimore, MD USA. [Holman, Robert C.; Haberung, Dana L.] CDC, Div Viral & Rickettsial Dis, Off Director, Natl Ctr Zoonot Vector Borne & Enter Dis, Atlanta, GA 30333 USA. [Singleton, Rosalyn J.] Alaska Native Tribal Hlth Consortium, Anchorage, AK USA. [Singleton, Rosalyn J.] Ctr Dis Control & Prevent, Natl Ctr Preparedness Detect & Control Infect Dis, Arctic Invest Program, Anchorage, AK USA. [Steiner, Claudia A.] US Dept HHS, Healthcare Cost & Utilizat Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. [Pagano, Edna L.] Indian Hlth Serv, Div Program Stat, Off Publ Hlth Support, US Dept HHS, Rockville, MD USA. RP Murphy, TV (reprint author), CDC, Natl Ctr Immunizat & Resp Dis, Div Bacterial Dis, Off Director, 1600 Clifton Rd NE,Mail Stop C-25, Atlanta, GA 30333 USA. EM tkm4@cdc.gov NR 29 TC 12 Z9 12 U1 0 U2 1 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0022-3476 J9 J PEDIATR JI J. Pediatr. PD JUN PY 2008 VL 152 IS 6 BP 839 EP 843 DI 10.1016/j.jpeds.2007.11.046 PG 5 WC Pediatrics SC Pediatrics GA 308FN UT WOS:000256373800025 PM 18492528 ER PT J AU Curns, AT Steiner, CA Sejvar, JJ Schonberger, LB AF Curns, Aaron T. Steiner, Claudia A. Sejvar, James J. Schonberger, Lawrence B. TI Hospital charges attributable to a primary diagnosis of infectious diseases in older adults in the United States, 1998 to 2004 SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE infectious disease; older adults; lower respiratory tract infection; hospitalizations ID INFLUENZA VACCINATION; COST-EFFECTIVENESS; PNEUMONIA; TRENDS AB OBJECTIVES: To describe total and average hospital charges associated with infectious disease (ID) hospitalizations and specific ID categories and to estimate ID hospitalization rates in adults aged 65 and older in the United States from 1998 through 2004. DESIGN: Retrospective analysis of hospital discharge data obtained from the Nationwide Inpatient Sample for 1998 through 2004. SETTING: United States. PATIENTS: Older adults hospitalized in the United States from 1998 through 2004. MEASUREMENTS: Hospital charges and hospitalization rates for IDs described according to year, age group, sex, U.S. Census region, and ID category. Charges for non-ID hospitalizations were also described. Hospital charges were adjusted for inflation. RESULTS: From 1998 through 2004, total charges for ID hospitalizations exceeded $261 billion and accounted for 13% of all hospital charges for older adults. Total charges for ID hospitalizations increased from $31.4 billion in 1998 to $45.7 billion in 2004. The average annual ID hospital charge was lower than the average annual non-ID hospital charge during the study period ($21,342 vs $22,787, P <.001). The average annual rate for ID hospitalizations was 503 per 10,000 older adults, which remained stable during the study period. CONCLUSION: The total charges for ID hospitalizations and for all hospitalizations in older adults in the United States increased 45% and nearly 40%, respectively, during the 7-year study period, whereas the population of older adults grew by only 5%. Sustained increases of such magnitude will have major implications for the U.S. healthcare system as it prepares for the more than doubling of the older U.S. adult population during the first 30 years of this century. C1 [Curns, Aaron T.; Sejvar, James J.; Schonberger, Lawrence B.] Ctr Dis Control & Prevent, Natl Ctr Zoonot Vector Borne & Enter Dis, Atlanta, GA 30333 USA. [Curns, Aaron T.] Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, Atlanta, GA 30333 USA. [Steiner, Claudia A.] Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Curns, AT (reprint author), Ctr Dis Control & Prevent, Natl Ctr Zoonot Vector Borne & Enter Dis, 1600 Clifton Rd NE,MS-A47, Atlanta, GA 30333 USA. EM agc8@cdc.gov NR 27 TC 14 Z9 14 U1 0 U2 0 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 JUN PY 2008 VL 56 IS 6 BP 969 EP 975 DI 10.1111/j.1532-5415.2008.01712.x PG 7 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 308SU UT WOS:000256411100001 PM 18410319 ER PT J AU Hearld, LR Alexander, JA Fraser, I Jiang, HJ AF Hearld, Larry R. Alexander, Jeffrey A. Fraser, Irene Jiang, H. Joanna TI How do hospital organizational structure and processes affect quality of care? A critical review of research methods SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Review DE hospital; quality of care; organizational factors; research methods ID PHYSICIAN ORDER ENTRY; ADVERSE DRUG EVENTS; PATIENT SAFETY; INTENSIVE-CARE; US HOSPITALS; MORTALITY-RATES; MEDICAL ERRORS; IMPROVEMENT IMPLEMENTATION; MYOCARDIAL-INFARCTION; CALIFORNIA HOSPITALS AB Interest in organizational contributions to the delivery of care has risen significantly in recent years. A challenge facing researchers, practitioners, and policy makers is identifying ways to improve care by improving the organizations that provide this care, given the complexity of health care organizations and the role organizations play in influencing systems of care. This article reviews the literature on the relationship between the structural characteristics and organizational processes of hospitals and quality of care. The review uses Donabedian's structure-process-outcome and level of analysis frameworks to organize the literature. The results of this review indicate that a preponderance of studies are conducted at the hospital level of analysis and are predominantly focused on the organizational structure - quality outcome relationship. The article concludes with recommendations of how health services researchers can expand their research to enhance one's understanding of the relationship between organizational characteristics and quality of care. C1 [Hearld, Larry R.; Alexander, Jeffrey A.] Univ Michigan, Sch Publ Hlth, Ann Arbor, MI 48109 USA. [Fraser, Irene; Jiang, H. Joanna] Agcy Hlth Care Res & Qual, Rockville, MD USA. RP Hearld, LR (reprint author), Univ Michigan, Sch Publ Hlth, Ann Arbor, MI 48109 USA. NR 117 TC 52 Z9 53 U1 15 U2 35 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 2008 VL 65 IS 3 BP 259 EP 299 DI 10.1177/1077558707309613 PG 41 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 302IE UT WOS:000255961200001 PM 18089769 ER PT J AU Dougherty, D Conway, PH AF Dougherty, Denise Conway, Patrick H. TI The "3T's" road map to transform US health care - The "how" of high-quality care SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID CLINICAL-RESEARCH C1 [Dougherty, Denise; Conway, Patrick H.] Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, Rockville, MD 20850 USA. [Conway, Patrick H.] Childrens Hosp, Med Ctr, Ctr Hlth Care Qual, Div Hlth Policy & Clin Effectiveness, Cincinnati, OH 45229 USA. [Conway, Patrick H.] Childrens Hosp, Med Ctr, Div Gen Pediat, Cincinnati, OH 45229 USA. RP Dougherty, D (reprint author), Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, 540 Gaither Rd, Rockville, MD 20850 USA. EM denise.dougherty@ahrq.hhs.gov NR 14 TC 174 Z9 184 U1 2 U2 12 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 21 PY 2008 VL 299 IS 19 BP 2319 EP 2321 DI 10.1001/jama.299.19.2319 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 302QN UT WOS:000255984500028 PM 18492974 ER PT J AU Calonge, N Petitti, DB DeWitt, TG Gordis, L Gregory, KD Harris, R Isham, G 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 Isham, George 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 gestational diabetes mellitus: US preventive services task force recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID PREGNANCY; DIAGNOSIS AB Description: Update of 2003 U. S. Preventive Services Task Force (USPSTF) recommendation about screening for gestational diabetes. Methods: The USPSTF weighed the evidence on maternal and neonatal benefits (reduction in preeclampsia, mortality, brachial plexus injury, clavicular fractures, admission to the neonatal intensive care unit for serious illnesses) and harms (physical and psychological harms) of screening for gestational diabetes identified for their 2003 recommendation and the accompanying systematic review of articles published since the 2003 review for screening after 24 weeks' gestation. Additional searches were performed for evidence published from 1966 to 1999 on screening before 24 weeks. Recommendation: Current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes mellitus, either before or after 24 weeks' gestation. (I statement.) C1 [Calonge, Ned] Colorado Dept Publ Hlth & Environm, Denver, CO USA. [Petitti, Diana B.] Univ So Calif, Keck Sch Med, Sierra Madre, CA USA. [DeWitt, Thomas G.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. [Gordis, Leon] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Gregory, Kimberly D.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Harris, Russell] Univ N Carolina, Sch Med, Chapel Hill, NC USA. [Isham, George] HealthPartners, Minneapolis, MN USA. [LeFevre, Michael L.] Univ Missouri, Sch Med, Columbia, MO USA. [Loveland-Cherry, Carol] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA. [Marion, Lucy N.] Med Coll Georgia, Sch Nursing, Augusta, GA 30912 USA. [Moyer, Virginia A.] Univ Texas Houston, Hlth Sci Ctr, Houston, TX USA. [Ockene, Judith K.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Sawaya, George F.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Siu, Albert L.] Mt Sinai Sch Med, New York, NY USA. [Teutsch, Steven M.] Merck & Co Inc, West Point, PA USA. [Yawn, Barbara P.] Olmsted Med Ctr, Rochester, MN USA. US Prevent Serv Task Force, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Calonge, N (reprint author), Colorado Dept Publ Hlth & Environm, Denver, CO USA. NR 21 TC 48 Z9 51 U1 0 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 MAY 20 PY 2008 VL 148 IS 10 BP 759 EP U67 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 308EX UT WOS:000256372200005 ER PT J AU Lin, KW AF Lin, Kenneth W. TI Lung age - Study's conclusion about screening is unwarranted SO BRITISH MEDICAL JOURNAL LA English DT Letter C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Lin, KW (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM Kenneth.Lin@ahrq.hhs.gov NR 2 TC 3 Z9 3 U1 0 U2 0 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 MAY 10 PY 2008 VL 336 IS 7652 BP 1034 EP 1034 DI 10.1136/bmj.39556.492176.80 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 304IN UT WOS:000256103300009 PM 18467391 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Evidence shows cost and patient safety benefits of emergency pharmacists 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 9 TC 4 Z9 4 U1 0 U2 3 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 2008 VL 23 IS 3 BP 231 EP 233 DI 10.1177/1062860608316108 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 304ML UT WOS:000256113500011 PM 18539985 ER PT J AU Mukamel, DB Glance, LG Li, Y Weimer, DL Spector, WD Zinn, JS Mosqueda, L AF Mukamel, Dana B. Glance, Laurent G. Li, Yue Weimer, David L. Spector, William D. Zinn, Jacqueline S. Mosqueda, Laura TI Does risk adjustment of the CMS quality measures for nursing homes matter? SO MEDICAL CARE LA English DT Article DE nursing homes; quality of care; risk adjusted outcome measures of quality; quality report cards; nursing home compare ID PRESSURE ULCER DEVELOPMENT; MINIMUM DATA SET; LONG-TERM-CARE; RESIDENT ASSESSMENT; OUTCOME MEASURES; OF-CARE; MODEL; INFORMATION; RELIABILITY; FACILITIES AB Background: The Centers for Medicare and Medicaid Services (CMS) publish a report card for nursing homes with 19 clinical quality measures (QMs). These measures include minimal risk adjustment. Objectives: To develop QMs with more extensive risk adjustment and to investigate the impact on quality rankings. Research Design: Retrospective analysis of individual level data reported in the Minimum Data Set (MDS). Random effect logistic models were used to estimate risk adjustment models for 5 outcomes: pressure ulcers for high and low risk patients, physical restraints, and pain for long- and short-stay patients. These models were used to create 5 QMs with extended risk adjustment, enhanced QMs (EQMs). The EQMs were compared with the corresponding QMs. Subjects: All (17,469) nursing homes that reported MDS data in the period 2001-2005, and their 9.6 million residents. Measures: QMs were compared with EQMs for all nursing homes in terms of agreement on outlier identification: Kappa, false positive and false negative error rates. Results: Kappa values ranged from 0.63 to 0.90. False positive and negative error rates ranged from 8% to 37%. Agreement between QMs and EQMs was better on high quality rather than on low quality. Conclusions: More extensive risk adjustment changes quality ranking of nursing homes and should be considered as potential improvement to the current QMs. Other methodological issues related to construction of the QMs should also be investigated to determine if they are important in the context of nursing home care. C1 [Mukamel, Dana B.] Univ Calif Irvine, Ctr Hlth Policy Res, Irvine, CA 92697 USA. [Glance, Laurent G.] Univ Rochester, Anesthesiol M&D, Rochester, NY USA. [Li, Yue] SUNY Buffalo, Dept Med, Buffalo, NY 14215 USA. [Weimer, David L.] Univ Wisconsin, LaFollette Sch Publ Affairs, Madison, WI USA. [Spector, William D.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Zinn, Jacqueline S.] Temple Univ, Philadelphia, PA 19122 USA. [Mosqueda, Laura] Univ Calif Irvine, Med Ctr, Family Med & Program Genet, Irvine, CA 92717 USA. RP Mukamel, DB (reprint author), Univ Calif Irvine, Ctr Hlth Policy Res, 111 Acad,Suite 220, Irvine, CA 92697 USA. EM dmukamel@uci.edu FU NIA NIH HHS [AG023177, AG029608, R01 AG023177, R01 AG023177-05, R03 AG029608] NR 48 TC 41 Z9 41 U1 5 U2 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0025-7079 EI 1537-1948 J9 MED CARE JI Med. Care PD MAY PY 2008 VL 46 IS 5 BP 532 EP 541 DI 10.1097/MLR.0b013e31816099c5 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 295CH UT WOS:000255452100012 PM 18438202 ER PT J AU Tate, JE Simonsen, L Viboud, C Steiner, C Patel, MM Curns, AT Parashar, UD AF Tate, Jacqueline E. Simonsen, Lone Viboud, Cecile Steiner, Claudia Patel, Manish M. Curns, Aaron T. Parashar, Umesh D. TI Trends in intussusception hospitalizations among US infants, 1993-2004: Implications for monitoring the safety of the new rotavirus vaccination program SO PEDIATRICS LA English DT Article DE intussusception; rotavirus vaccine; vaccine safety monitoring ID UNITED-STATES; ADENOVIRUS INFECTION; CHILDREN; CHILDHOOD; DIARRHEA; EPIDEMIOLOGY; ASSOCIATION; MANAGEMENT; AUSTRALIA; AGE AB OBJECTIVES. In 2006, a new rotavirus vaccine was recommended for routine immunization of US infants. Because a previous rotavirus vaccine was withdrawn in 1999 after it was associated with intussusception, monitoring for this adverse event with the new vaccine is important. The objectives of this study were to assess intussusception hospitalizations trends among US infants for 1993 to 2004; provide estimates of hospitalization rates for intussusception for 2002-2004; and assess variations in background rates by age, race/ethnicity, and surgical management. METHODS. By using the Healthcare Cost and Utilization Project's State Inpatient Database that captures US hospital discharges from 16 states representing 49% of the birth cohort during 1993-2004 and from 35 states representing 85% of the birth cohort in 2002-2004, we examined hospitalizations among infants (< 12 months of age) with an International Classification of Disease, Ninth Revision, Clinical Modification code for intussusception (560.0). Incidence rates were calculated by using census data, and rate ratios with 95% confidence intervals were calculated by using Poisson regression data. RESULTS. Annual intussusception hospitalization rates declined 25% from 1993 to 2004 but have remained stable at similar to 35 cases per 100 000 infants since 2000. Rates were very low for infants younger than 9 weeks (< 5 per 100 000) then increased rapidly, peaking at similar to 62 per 100 000 at 26 to 29 weeks, before declining gradually to 26 per 100 000 at 52 weeks. Compared with rates among non-Hispanic white infants (27 per 100 000), rates were greater among non-Hispanic black infants (37 per 100 000) and Hispanic infants (45 per 100 000); however, rates did not differ by race/ethnicity for infants who were younger than 16 weeks. CONCLUSIONS. This assessment of US hospitalizations provides up-to-date and nationally representative prevaccine rates of intussusception. Because rates varied almost 12-fold by week of age and to a lesser extent by race/ethnicity during the age of vaccination, adjusting baseline rates to reflect the demographics of the vaccinated population will be crucial for assessing risk for intussusception after rotavirus vaccination. C1 [Tate, Jacqueline E.; Patel, Manish M.; Curns, Aaron T.; Parashar, Umesh D.] Ctr Dis Control & Prevent, Div Viral Dis, Epidemiol Branch, Natl Ctr Immunizat & Resp Dis, Atlanta, GA USA. [Simonsen, Lone] NIAID, Infect Dis Lab, NIH, Bethesda, MD 20892 USA. [Viboud, Cecile] Fogarty Int Ctr, NIH, Bethesda, MD USA. [Steiner, Claudia] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Tate, JE (reprint author), 1600 Clifton Rd NE,MS-A47, Atlanta, GA 30333 USA. EM jqt8@cdc.gov OI Simonsen, Lone/0000-0003-1535-8526 FU Intramural NIH HHS [Z99 TW999999] NR 38 TC 52 Z9 52 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 MAY PY 2008 VL 121 IS 5 BP E1125 EP E1132 DI 10.1542/peds.2007-1590 PG 8 WC Pediatrics SC Pediatrics GA 295VL UT WOS:000255501900054 PM 18450856 ER PT J AU Chen, FN Curran, PJ Bollen, KA Kirby, J Paxton, P AF Chen, Feinian Curran, Patrick J. Bollen, Kenneth A. Kirby, James Paxton, Pamela TI An empirical evaluation of the use of fixed cutoff points in RMSEA test statistic in structural equation models SO SOCIOLOGICAL METHODS & RESEARCH LA English DT Article DE RMSEA; SEM; goodness-of-fit; computer simulations ID CHI-SQUARE DISTRIBUTION; FIT INDEXES; GOLDEN RULES; MONTE-CARLO; SAMPLE-SIZE; MISSPECIFICATION; APPROXIMATION; ERROR; POWER AB This article is an empirical evaluation of the choice of fixed cutoff points in assessing the root mean square error of approximation (RMSEA) test statistic as a measure of goodness-of-fit in Structural Equation Models. Using simulation data, the authors first examine whether there is any empirical evidence for the use of a universal cutoff, and then compare the practice of using the point estimate of the RMSEA alone versus that of using it jointly with its related confidence interval. The results of the study demonstrate that there is little empirical support for the use of .05 or any other value as universal cutoff values to determine adequate model fit, regardless of whether the point estimate is used alone or jointly with the confidence interval. The authors' analyses suggest that to achieve a certain level of power or Type I error rate, the choice of cutoff values depends on model specifications, degrees of freedom, and sample size. C1 [Chen, Feinian] N Carolina State Univ, Raleigh, NC 27695 USA. [Curran, Patrick J.; Bollen, Kenneth A.] Univ N Carolina, Dept Psychol, LL Thurstone Psychometr Lab, Chapel Hill, NC USA. [Kirby, James] Agcy Healthcare Res & Qual, Rockville, MD USA. [Paxton, Pamela] Ohio State Univ, Columbus, OH 43210 USA. RP Chen, FN (reprint author), N Carolina State Univ, Raleigh, NC 27695 USA. FU NICHD NIH HHS [K01 HD047369, K01 HD047369-03] NR 36 TC 292 Z9 293 U1 7 U2 42 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0049-1241 J9 SOCIOL METHOD RES JI Sociol. Methods. Res. PD MAY PY 2008 VL 36 IS 4 BP 462 EP 494 DI 10.1177/0049124108314720 PG 33 WC Social Sciences, Mathematical Methods; Sociology SC Mathematical Methods In Social Sciences; Sociology GA 291OE UT WOS:000255205900003 PM 19756246 ER PT J AU Lin, K Watkins, B Johnson, T Rodriguez, JA Barton, MB AF Lin, Kenneth Watkins, Bradley Johnson, Tamara Rodriguez, Joy Anne Barton, Mary B. TI Screening for chronic obstructive pulmonary disease using spirometry: Summary of the evidence for the US preventive services task force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID SMOKING-CESSATION; INHALED CORTICOSTEROIDS; CARDIOVASCULAR SAFETY; NUTRITION-EXAMINATION; RANDOMIZED-TRIAL; GENERAL-PRACTICE; NATIONAL-HEALTH; OXYGEN-THERAPY; CLINICAL-TRIAL; BETA-AGONISTS AB Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. Fewer than half of the estimated 24 million Americans with airflow obstruction have received a COPD diagnosis, and diagnosis often occurs in advanced stages of the disease. Purpose: To summarize the evidence on screening for COPD using spirometry for the U.S. Preventive Services Task Force (USPSTF). Data Sources: English-language articles identified in PubMed and the Cochrane Library through January 2007, recent systematic reviews, expert suggestions, and reference lists of retrieved articles. Study Selection: Explicit inclusion and exclusion criteria were used for each of the 8 key questions on benefits and harms of screening. Eligible study types varied by question. Data Extraction: Studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria. Data Synthesis: Pharmacologic treatments for COPD reduce acute exacerbations in patients with severe disease. However, severe COPD is uncommon in the general U.S. population. Spirometry has not been shown to independently increase smoking cessation rates. Potential harms from screening include false-positive results and adverse effects from subsequent unnecessary therapy. Data on the prevalence of airflow obstruction in the U.S. population were used to calculate projected outcomes from screening groups defined by age and smoking status. Limitation: No studies provide direct evidence on health outcomes associated with screening for COPD. Conclusion: Screening for COPD using spirometry is likely to identify a predominance of patients with mild to moderate airflow obstruction who would not experience additional health benefits if labeled as having COPD. Hundreds of patients would need to undergo spirometry to defer a single exacerbation. C1 [Lin, Kenneth] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. Washington DC Vet Affairs Med Ctr, Washington, DC USA. Univ Maryland, Sch Med, Baltimore, MD 21201 USA. Brooks Air Force Base, Brooks AFB, TX USA. RP Lin, K (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM kenneth.lin@ahrq.hhs.gov NR 38 TC 74 Z9 76 U1 1 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 APR 1 PY 2008 VL 148 IS 7 BP 535 EP 543 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 284IV UT WOS:000254701000006 PM 18316746 ER PT J AU Wang, YF Beydoun, MA Liang, L Caballero, B Kumanyika, SK AF Wang, Youfa Beydoun, May A. Liang, Lan Caballero, Benjamin Kumanyika, Shiriki K. TI Will all Americans become overweight or obese? Obesity prevalence and health care cost projections SO FASEB JOURNAL LA English DT Meeting Abstract C1 [Wang, Youfa; Beydoun, May A.; Caballero, Benjamin] Johns Hopkins Univ, Ctr Human Nutr, Baltimore, MD USA. [Liang, Lan] Agcy Healthcare Res & Qual, Rockville, MD USA. [Kumanyika, Shiriki K.] Univ Penn, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA. NR 0 TC 0 Z9 0 U1 1 U2 3 PU FEDERATION AMER SOC EXP BIOL PI BETHESDA PA 9650 ROCKVILLE PIKE, BETHESDA, MD 20814-3998 USA SN 0892-6638 J9 FASEB J JI Faseb J. PD APR PY 2008 VL 22 PG 1 WC Biochemistry & Molecular Biology; Biology; Cell Biology SC Biochemistry & Molecular Biology; Life Sciences & Biomedicine - Other Topics; Cell Biology GA V25GZ UT WOS:000208467800244 ER PT J AU Zinn, JS Spector, WD Weimer, DL Mukamel, DB AF Zinn, Jacqueline S. Spector, William D. Weimer, David L. Mukamel, Dana B. TI Strategic orientation and nursing home response to public reporting of quality measures: An application of the Miles and Snow typology SO HEALTH SERVICES RESEARCH LA English DT Article DE nursing homes; quality measures; strategy ID VALIDITY; OUTCOMES AB Objectives. To assess whether differences in strategic orientation of nursing homes as identified by the Miles and Snow typology are associated with differences in their response to the publication of quality measures on the Nursing Home Compare website. Data Sources. Administrator survey of a national 10 percent random sample (1,502 nursing homes) of all facilities included in the first publication of the Nursing Home Compare report conducted in May-June 2004; 724 responded, yielding a response rate of 48.2 percent. Study Design. The dependent variables are dichotomous, indicating whether or not action was taken and the type of action taken. Four indicator variables were created for each of the four strategic types: Defender, Analyzer, Prospector, and Reactor. Other variables were included in the seven logistic regression models to control for factors other than strategic type that could influence nursing home response to public disclosure of their quality of care. Data Collection/Extraction Methods. Survey data were merged with data on quality measures and organizational characteristics from the first report (November 2002). Principal Finding. About 43 percent of surveyed administrators self-typed as Defenders, followed by Analyzers (33 percent), and Prospectors (19 percent). The least self-selected strategic type was the Reactor (6.6 percent). In general, results of the regression models indicate differences in response to quality measure publication by strategic type, with Prospectors and Analyzers more likely, and Reactors less likely, to respond than Defenders. Conclusions. While almost a third of administrators took no action at all, our results indicate that whether, when, and how nursing homes reacted to publication of federally reported quality measures is associated with strategic orientation. C1 [Zinn, Jacqueline S.] Temple Univ, Dept Risk Insurance & Healthcare Management, Philadelphia, PA 19122 USA. [Spector, William D.] Agcy Healthcare Res & Qual, Ctr Delivery Org & Mkt, Rockville, MD USA. [Weimer, David L.] Univ Wisconsin, Robert M La Follette Sch Publ Affairs, Madison, WI USA. [Mukamel, Dana B.] Univ Calif Irvine, Dept Med, Irvine, CA 92717 USA. RP Zinn, JS (reprint author), Temple Univ, Dept Risk Insurance & Healthcare Management, 413 Ritter Annex, Philadelphia, PA 19122 USA. FU NIA NIH HHS [AG023177, R01 AG023177] NR 28 TC 14 Z9 15 U1 1 U2 5 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 2008 VL 43 IS 2 BP 598 EP 615 DI 10.1111/j.1475-6773.2007.00781.x PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 280GO UT WOS:000254414000010 PM 18370969 ER PT J AU Clancy, CM White, PJ AF Clancy, Carolyn M. White, P. Jonathan TI Introduction to the JGIM special issue on health information technology SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material C1 [Clancy, Carolyn M.; White, P. Jonathan] Agcy Healthcare Res & Qual, Rockville, MD USA. [White, P. Jonathan] Agcy Healthcare Res & Qual, Hlth IT, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 1 Z9 1 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 2008 VL 23 IS 4 BP 353 EP 354 DI 10.1007/s11606-008-0562-8 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 280WD UT WOS:000254456400001 PM 18373128 ER PT J AU Rosko, MD Mutter, RL AF Rosko, Michael D. Mutter, Ryan L. TI Stochastic frontier analysis of hospital inefficiency SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Review DE hospital efficiency; stochastic frontier analysis ID COST EFFICIENCY; HEALTH-CARE; X-INEFFICIENCY; MODELS; VARIABLES; IMPACT; MARKET AB Twenty stochastic frontier analysis ( SFA) studies of hospital inefficiency in the United States were analyzed. Results from best-practice methods were compared against previously used methods in hospital studies to ascertain the robustness of SFA in estimating cost inefficiency. To compare past studies and analyze new data, SFA methods were varied by ( a) the assumptions of the structure of costs and distribution of the error term, (b) inclusion of quality and product descriptor measures, and ( c) use of simultaneous and two-stage estimation techniques. SFA results were relatively insensitive to several model variations. C1 [Rosko, Michael D.] Widener Univ, Chester, PA 19013 USA. [Mutter, Ryan L.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Rosko, MD (reprint author), Widener Univ, Chester, PA 19013 USA. NR 60 TC 44 Z9 47 U1 1 U2 13 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 EI 1552-6801 J9 MED CARE RES REV JI Med. Care Res. Rev. PD APR PY 2008 VL 65 IS 2 BP 131 EP 166 DI 10.1177/1077558707307580 PG 36 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 276GT UT WOS:000254130000001 PM 18045984 ER PT J AU Meyers, D Wolff, T Gregory, K Marion, L Moyer, V Nelson, H Petitti, D Sawaya, GF AF Meyers, David Wolff, Tracy Gregory, Kimberly Marion, Lucy Moyer, Virginia Nelson, Heidi Petitti, Diana Sawaya, George F. TI USPSTF recommendations for STI screening SO AMERICAN FAMILY PHYSICIAN LA English DT Article ID SEXUALLY-TRANSMITTED-DISEASES; STATEMENT; GONORRHEA; ADULTS AB Since 2000, the U.S. Preventive Services Task Force (USPSTF) has issued eight clinical recommendation statements on screening for sexually transmitted infections. This article, written on behalf of the USPSTF, is an overview of these recommendations. The USPSTF recommends that women at increased risk of infection be screened for chlamydia, gonorrhea, human immunodeficiency virus, and syphilis. Men at increased risk should be screened for human immunodeficiency virus and syphilis. All pregnant women should be screened for hepatitis B, human immunodeficiency virus, and syphilis; pregnant women at increased risk also should be screened for chlamydia and gonorrhea. Nonpregnant women and men not at increased risk do not require routine screening for sexually transmitted infections. Engaging in high-risk sexual behavior places persons at increased risk of sexually transmitted infections. The USPSTF recommends that all sexually active women younger than 25 years be considered at increased risk of chlamydia and gonorrhea. Because not all communities present equal risk of sexually transmitted infections, the USPSTF encourages physicians to consider expanding or limiting the routine sexually transmitted infection screening they provide based on the community and populations they serve. C1 [Meyers, David; Wolff, Tracy] Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD 20850 USA. [Gregory, Kimberly; Marion, Lucy; Moyer, Virginia; Petitti, Diana; Sawaya, George F.] US Prevent Serv Task Force, Rockville, MD USA. [Nelson, Heidi] Oregon Hlth & Sci Univ Evidence Based Practice Ct, Portland, OR USA. RP Meyers, D (reprint author), Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, 540 Gaither Rd, Rockville, MD 20850 USA. EM David.Meyers@ahrq.hhs.gov NR 25 TC 70 Z9 73 U1 0 U2 3 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 2008 VL 77 IS 6 BP 819 EP 824 PG 6 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 277NA UT WOS:000254218500012 PM 18386598 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 impact of poison control centers on poisoning-related visits to EDs - United States, 2003 SO AMERICAN JOURNAL OF EMERGENCY MEDICINE LA English DT Article AB Purpose: This study analyzes the association between center usage rates and the rates of nonadmitted visits to emergency departments (EDs) for poisoning. Basic Procedures: With a log-normal regression model, we analyzed the association between the number of human exposure calls per hospitalized poisoning patient and the number of nonhospitalized ED visits. The data were from 14 states at county level. Main Findings: A 1% higher poison control center (PCC) human exposure call rate for unintentional poisoning is associated, but not necessarily causally, with a 0.18% lower ED visit rate (P <.000 1). If the observed association is causative, 15.5 PCC human poison exposure calls prevent one nonadmitted ED visit, yielding a $205 net cost saving and a benefit-cost ratio of 1.4. The savings ignore any reduction in hospital admissions. Principal conclusions: Increased PCC exposure calls appear to be associated with reduced ED use for unintentional poisoning and appear to reduce net medical spending. (c) 2008 Elsevier Inc. All rights reserved. C1 [Zaloshnja, Eduard; Miller, Ted; Jones, Paul; Sheppard, Monique] Pacific Inst Res & Evaluat, Beltsville, MD 20705 USA. [Litovitz, Toby] Natl Capital Poison Ctr, Washington, DC 20016 USA. [Coben, Jeffrey] W Virginia Univ, Injury Control Res Ctr, Morgantown, WV 26506 USA. [Steiner, Claudia] Agcy Healthcare Res & Qual, Off Commun & Knowledge Transfer, Rockville, MD 20850 USA. RP Zaloshnja, E (reprint author), Pacific Inst Res & Evaluat, Beltsville, MD 20705 USA. EM zaloshnja@pire.org OI Litovitz, Toby/0000-0003-0262-5509; Miller, Ted/0000-0002-0958-2639 NR 11 TC 17 Z9 17 U1 0 U2 1 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0735-6757 J9 AM J EMERG MED JI Am. J. Emerg. Med. PD MAR PY 2008 VL 26 IS 3 BP 310 EP 315 DI 10.1016/j.ajem.2007.10.014 PG 6 WC Emergency Medicine SC Emergency Medicine GA 284LC UT WOS:000254706900010 PM 18358942 ER PT J AU Evon, DM Verma, A Simpson, K Smith, S Fried, MW AF Evon, Donna M. Verma, Amit Simpson, Kelly Smith, Scott Fried, Michael W. TI Association between depression and perceived barriers to care among patients with hepatitis C SO ANNALS OF BEHAVIORAL MEDICINE LA English DT Meeting Abstract C1 [Evon, Donna M.; Verma, Amit; Simpson, Kelly; Fried, Michael W.] Univ N Carolina, GI & Hepatol, Chapel Hill, NC USA. [Smith, Scott] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. EM donna_evon@med.unc.edu NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0883-6612 J9 ANN BEHAV MED JI Ann. Behav. Med. PD MAR PY 2008 VL 35 SU 1 BP S120 EP S120 PG 1 WC Psychology, Multidisciplinary SC Psychology GA 348YH UT WOS:000259245500464 ER PT J AU Moy, E Greenberg, LG Borsky, AE AF Moy, Ernest Greenberg, Linda G. Borsky, Amanda E. TI Community variation: Disparities in health care quality between Asian and white Medicare beneficiaries SO HEALTH AFFAIRS LA English DT Article ID ETHNIC-DIFFERENCES; AMERICANS; CHINESE; BREAST AB Few studies have focused on Asian-white disparities. This study examines the use of selected cancer screening and diabetes services under the traditional Medicare program of whites and Asians by socioeconomic status and among U.S. metropolitan statistical areas in which elderly Asians reside. It demonstrates that existing data, with enrichment, can be used to examine Asian-white disparities. It finds that Asians often receive poorer quality of care than whites, but disparities differ among metropolitan areas. This research enables policymakers to better understand and target resources to address Asian-white disparities at the national and local community levels. C1 [Moy, Ernest; Greenberg, Linda G.] AHRQ, Rockville, MD USA. [Borsky, Amanda E.] CNA Corp, Alexandria, VA USA. RP Moy, E (reprint author), AHRQ, Rockville, MD USA. EM ernest.moy@ahrq.hhs.gov NR 27 TC 10 Z9 10 U1 1 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 MAR-APR PY 2008 VL 27 IS 2 BP 538 EP 549 DI 10.1377/hlthaff.27.2.538 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 319UA UT WOS:000257188500029 PM 18332512 ER PT J AU Cohen, SB Clancy, CM AF Cohen, Steven B. Clancy, Carolyn M. TI AHRQ and data collection SO HEALTH AFFAIRS LA English DT Letter C1 [Cohen, Steven B.; Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Cohen, SB (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 MAR-APR PY 2008 VL 27 IS 2 BP 586 EP 587 DI 10.1377/hlthaff.27.2.586-a PG 2 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 319UA UT WOS:000257188500040 PM 18332519 ER PT J AU Hagan, M Encinosa, W AF Hagan, Michael Encinosa, William TI Health care markets: Concepts, data, measures, and current research challenges SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Editorial Material C1 [Hagan, Michael; Encinosa, William] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Hagan, M (reprint author), Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. NR 0 TC 0 Z9 0 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 2008 VL 45 IS 1 BP 15 EP 18 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 301YZ UT WOS:000255933900003 PM 18524289 ER PT J AU Korthuis, PT Zephyrin, LC Fleishman, JA Saha, S Josephs, JS Mcgrath, MM Hellinger, J Gebo, KA AF Korthuis, P. T. Zephyrin, L. C. Fleishman, J. A. Saha, S. Josephs, J. S. Mcgrath, M. M. Hellinger, J. Gebo, K. A. CA Hiv Res Network TI Health related quality of life in HIV-infected patients: The role of substance use SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 31st Annual Meeting of the Society-of-General-Internal-Medicine CY APR 09-12, 2008 CL Pittsburgh, PA SP Soc Gen Internal Med C1 [Korthuis, P. T.; Saha, S.; Mcgrath, M. M.] Oregon Hlth & Sci Univ, Portland, OR 97201 USA. [Zephyrin, L. C.] Columbia Univ, Dept Gynecol & Obstet, New York, NY USA. [Fleishman, J. A.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Saha, S.] Portland VA Med Ctr, Portland, OR USA. [Josephs, J. S.; Gebo, K. A.; Hiv Res Network] Johns Hopkins Univ, Baltimore, MD USA. [Hellinger, J.] Community Med Alliance, Boston, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 1 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 MAR PY 2008 VL 23 SU 2 BP 312 EP 312 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 277TH UT WOS:000254237100606 ER PT J AU Selassie, AW Zaloshnja, E Langlois, JA Miller, T Jones, P Steiner, C AF Selassie, Anbesaw W. Zaloshnja, Eduard Langlois, Jean A. Miller, Ted Jones, Paul Steiner, Claudia TI Incidence of long-term disability following traumatic brain injury hospitalization, United States, 2003 SO JOURNAL OF HEAD TRAUMA REHABILITATION LA English DT Article DE traumatic brain injury; long-term disabiliy ID HEALTH SURVEY SF-36; SEVERE HEAD-INJURY; PREEXISTING CONDITIONS; MORTALITY; CHILDREN; CARE; RELIABILITY; COMPLAINTS; PROGNOSIS; SURVIVAL AB Objective: Develop and validate a predictive model of the incidence of long-term disability following traumatic brain injury (TBI) and obtain national estimates for the United States in 2003. Data/methods: A logistic regression model was built, using a population-based sample of persons with TBI from the South Carolina Traumatic Brain Injury Follow-up Registry. The regression coefficients were applied to the 2003 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample data to estimate the incidence of long-term disability following traumatic brain injury hospitalization. Results: Among 288,009 (95% CI, 287,974-288,043) hospitalized TBI survivors in the United States in 2003, an estimated 124,626 (95% CI, 123,706-125,546) had developed long-term disability. Conclusion: TBI-related disability is a significant public health problem in the United States. The substantial incidence suggests the need for comprehensive rehabilitative care and services to maximize the potential of persons with TBI. C1 [Zaloshnja, Eduard; Miller, Ted; Jones, Paul] Pacific Inst Res & Evaluat, Calverton, MD 20705 USA. [Selassie, Anbesaw W.] Med Univ S Carolina, Charleston, SC 29425 USA. [Langlois, Jean A.] Ctr Dis Control & Prevent, Natl Ctr Injury Prevent & Control, Atlanta, GA USA. [Steiner, Claudia] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Zaloshnja, E (reprint author), Pacific Inst Res & Evaluat, 11720 Beltsville Dr,Suite 900, Calverton, MD 20705 USA. EM zaloshnja@pire.org OI Miller, Ted/0000-0002-0958-2639 NR 52 TC 179 Z9 181 U1 5 U2 19 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0885-9701 J9 J HEAD TRAUMA REHAB JI J. Head Trauma Rehabil. PD MAR-APR PY 2008 VL 23 IS 2 BP 123 EP 131 DI 10.1097/01.HTR.0000314531.30401.39 PG 9 WC Clinical Neurology; Rehabilitation SC Neurosciences & Neurology; Rehabilitation GA 280KW UT WOS:000254426700007 PM 18362766 ER PT J AU Hoflund, AB Farquhar, M AF Hoflund, A. Bryce Farquhar, Marybeth TI Challenges of democratic experimentalism: A case study of the National Quality Forum in health care SO REGULATION & GOVERNANCE LA English DT Article DE democratic experimentalism; health care; network; new governance; regulation ID GENERAL-THEORY; GOVERNANCE; DEATHS AB Networks are an increasingly common aspect of administrative life in almost any public policy arena. In health care, networks have emerged in order to address "wicked" quality problems. One Such network organization, the National Quality Forum (NQF), was created as a response to the fragmentation and information deficit that have plagued the health care industry's efforts to improve health care quality. Its purpose is to bring diverse health care stakeholders from the public and private sectors together to discuss and debate quality and performance measurement issues. Democratic experimentalism offers one way of assessing the NQF's efforts. The purpose of this article is to examine the NQF's efforts through the lens of democratic experimentalism and to explore some of the virtues and shortcomings of applying a democratic experimentalist approach to health care regulation. C1 [Hoflund, A. Bryce] Virginia Tech, Ctr Publ Adm & Policy, Blacksburg, VA 24060 USA. [Farquhar, Marybeth] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Hoflund, AB (reprint author), Virginia Tech, Ctr Publ Adm & Policy, 104 Draper Rd, Blacksburg, VA 24060 USA. EM ahoflund@vt.edu NR 33 TC 1 Z9 1 U1 1 U2 8 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1748-5983 EI 1748-5991 J9 REGUL GOV JI Regul. Gov. PD MAR PY 2008 VL 2 IS 1 BP 121 EP 135 DI 10.1111/j.1748-5991.2007.00031.x PG 15 WC Law; Political Science; Public Administration SC Government & Law; Public Administration GA 348TK UT WOS:000259232800008 ER PT J AU Coben, JH Owens, PL Steiner, CA Crocco, TJ AF Coben, Jeffrey H. Owens, Pamela L. Steiner, Claudia A. Crocco, Todd J. TI Hospital and demographic influences on the disposition of transient ischemic attack SO ACADEMIC EMERGENCY MEDICINE LA English DT Article DE transient ischemic attack; emergency care; disease management ID SHORT-TERM PROGNOSIS; STROKE; EMERGENCY; CARE AB Objectives: There is substantial variation in the emergency department (ED) disposition of patients with transient ischemic attack (TIA), and the factors responsible for this variation have not been determined. In this study, the authors examined the influence of clinical, sociodemographic, and hospital characteristics on ED disposition. Methods: All ED-treated TIA cases from community hospitals in 11 states were identified from the 2002 Healthcare Cost and Utilization Project (HCUP). Using the aggregate data, descriptive analyses compared admitted and discharged cases. Pearson's chi-square test was used to determine the statistical significance of these comparisons. Based on the results of the bivariate analyses, logistic regression models of the likelihood of hospital admission were derived, using a stepwise selection process. Adjusted risk ratios and 95% confidence intervals (CI) were calculated from the logistic regression models. Results: A total of 34,843 cases were identified in the 11 states, with 53% of cases admitted to the hospital. In logistic regression models, differences in admission status were found to be strongly associated with clinical characteristics such as age and comorbidities. After controlling for comorbidities, differences in admission status were also found to be associated to hospital type and with sociodemographic characteristics, including county of residence and insurance status. Conclusions: While clinical factors predictably and appropriately impact the ED disposition of patients diagnosed with TIA, several nonclinical factors are also associated with differences in disposition. Additional research is needed to better understand the basis for these disparities and their potential impact on patient outcomes. C1 [Coben, Jeffrey H.; Crocco, Todd J.] W Virginia Univ, Dept Emergency Med, Morgantown, WV 26506 USA. [Coben, Jeffrey H.] W Virginia Univ, Dept Community Med, Morgantown, WV 26506 USA. [Coben, Jeffrey H.] W Virginia Univ, Ctr Rural Emergency Med, Morgantown, WV 26506 USA. [Coben, Jeffrey H.; Owens, Pamela L.; Steiner, Claudia A.] AHRQ, HCUP, Ctr Delivery Org & Markets, Rockville, MD USA. RP Coben, JH (reprint author), W Virginia Univ, Dept Emergency Med, Morgantown, WV 26506 USA. EM jcoben@hsc.wvu.edu NR 17 TC 3 Z9 3 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 1069-6563 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD FEB PY 2008 VL 15 IS 2 BP 171 EP 176 DI 10.1111/j.1553-2712.2008.00041.x PG 6 WC Emergency Medicine SC Emergency Medicine GA 260WO UT WOS:000253041300008 PM 18275447 ER PT J AU Fleishman, JA Moore, RD Conviser, R Lawrence, PB Korthuis, PT Gebo, KA AF Fleishman, John A. Moore, Richard D. Conviser, Richard Lawrence, Perrin B. Korthuis, P. Todd Gebo, Kelly A. TI Associations between outpatient and inpatient service use among persons with HIV infection: A positive or negative relationship? SO HEALTH SERVICES RESEARCH LA English DT Article DE HIV infection; inpatient service use; outpatient service use ID ACTIVE ANTIRETROVIRAL THERAPY; HOSPITALIZATION RATES; SOCIOECONOMIC-STATUS; UNITED-STATES; CARE; DISEASE; ADULTS; IMPACT; ADMISSIONS; ACCESS AB Objective. To examine the prospective association between frequency of outpatient visits and subsequent inpatient admissions. Data Sources. Medical record data on 13,942 patients with HIV infection seen in 10 HIV speciality care sites across the United States. Study Design. This observational study followed a cohort of HIV-infected patients who were in care in the first half of 2001. Numbers of inpatient admissions and outpatient visits were calculated for each patient for each 3-month period, from 2001 through 2004. Analysis. Negative binomial and logistic regression analyses using random-effects models examined the effects of inpatient admissions and outpatient visits in the previous period on inpatient and outpatient service utilization, controlling for background characteristics and HIV disease stage. Results. For 3-month periods, between 5 and 9 percent of patients had an inpatient admission. The linear association between number of outpatient visits and any inpatient admission in the subsequent period was positive (adjusted odds ratio=1.05; 95 percent confidence interval [CI]=1.04, 1.06). However, patients with zero prior outpatient visits had significantly greater admission rates than those with one prior visit. Hospitalization rates were also higher among those with a prior hospitalization and those with more advanced HIV disease. Conclusions. These results suggest a J-shaped relationship between outpatient use and inpatient use among persons with HIV disease. Those in worse health have greater utilization of both inpatient and outpatient care. However, having no outpatient visits may also increase the likelihood of subsequent hospitalization. Although outpatient care cannot be justified as a cost-saving mechanism, maintaining regular clinical monitoring of patients is important. C1 [Fleishman, John A.] Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, Rockville, MD 20850 USA. [Moore, Richard D.; Lawrence, Perrin B.; Gebo, Kelly A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Conviser, Richard] US Hlth Resources & Serv Adm, HIV AIDS Bur, Rockville, MD 20857 USA. [Korthuis, P. Todd] Oregon Hlth & Sci Univ, Dept Med, Portland, OR 97201 USA. RP Fleishman, JA (reprint author), Agcy Healthcare Res & Qual, Ctr Cost & Financing Studies, 540 Gaither Rd, Rockville, MD 20850 USA. RI Gebo, Kelly/B-9223-2009 FU NIAAA NIH HHS [R01 AA016893]; NIDA NIH HHS [R01 DA011602-10, K24 DA000432-09, R01 DA011602, K23 DA019809, K24 DA000432] NR 27 TC 13 Z9 13 U1 0 U2 0 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 FEB PY 2008 VL 43 IS 1 BP 76 EP 95 DI 10.1111/j.1475-6773.2007.00750.x PN 1 PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 252FX UT WOS:000252433500005 PM 18211519 ER PT J AU Hellinger, F AF Hellinger, Fred TI Practice makes perfect - A volume-outcome study of hospitol potients with HIV disease SO JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES LA English DT Article DE hospital care; hospital experience; hospital mortality; physician experience ID PNEUMOCYSTIS-CARINII-PNEUMONIA; ACQUIRED-IMMUNODEFICIENCY-SYNDROME; HEALTH-INSURANCE; VIRUS-INFECTION; AIDS; EXPERIENCE; MORTALITY; CARE; HOSPITALIZATIONS; PHYSICIANS AB Objective: There is considerable evidence that patients with HIV fare better in hospitals that treat more HIV-positive patients. Yet, it is possible that much of this benefit is attributable to the care provided by physicians who treat high volumes of HIV-positive patients. This study examines the relation between 2 measures of volume (the number of HIV-positive patients treated in a hospital and the number of HIV-positive patients treated by the attending physician) and the probability of dying in the hospital. Data: This study uses discharge data from 43,325 patients hospitalized with HIV disease in 5 states (Colorado, Maryland, New Jersey, New York, and Washington State) in 2002. These data were obtained from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project State Inpatient Databases. Study Design: Volume-outcome studies have demonstrated an inverse relation between the number of HIV-positive patients treated at a hospital and the mortality rate for these patients. Yet, the most current of these studies is based on data more than a decade old, and none of these account for the volume of HIV-positive patients treated by the physician. This study uses multivariate logistic regression analyses to estimate the impact of hospital and physician volume on patient mortality. Results: This study found that when measures of physician and hospital volume are included in a regression equation explaining patient mortality, only the variable measuring physician volume remains statistically significant. Moreover, when a variable is defined for each patient based on the quartile rankings of the patient's hospital volume and the patient's physician volume, the quartile ranking of physician volume is a better predictor of survival than the quartile ranking of hospital volume. Conclusion: These findings suggest that the volume of patients treated by the attending physician is the key measure of volume associated with the survival of hospitalized HIV-positive patients. C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Hellinger, F (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM fhelling@ahrq.gov NR 37 TC 10 Z9 10 U1 0 U2 2 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 FEB 1 PY 2008 VL 47 IS 2 BP 226 EP 233 PG 8 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 255VA UT WOS:000252684600013 PM 18340652 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Clinical research training: Scientific literacy for the twenty-first century SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, John M Eisenberg Bldg,540 Gaither Rd, Rockville, MD 20850 USA. EM carolyn.clancy@ahrq.hhs.gov NR 1 TC 2 Z9 2 U1 0 U2 1 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 FEB PY 2008 VL 23 IS 2 BP 219 EP 220 DI 10.1007/s11606-007-0485-9 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 259MY UT WOS:000252944600020 PM 18183469 ER PT J AU Konetzka, RT Spector, W Limcangco, MR AF Konetzka, R. Tamara Spector, William Limcangco, M. Rhona TI Reducing hospitalizations from long-term care settings SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Review DE hospitalization; long-term care; intervention; nursing home; home health care ID NURSING-HOME RESIDENTS; CONGESTIVE-HEART-FAILURE; OBSTRUCTIVE PULMONARY-DISEASE; RANDOMIZED CONTROLLED-TRIAL; ELDERLY-PATIENTS; UNPLANNED READMISSIONS; ACUTE EXACERBATIONS; TRANSITIONAL CARE; OWNERSHIP TYPE; HEALTH-CARE AB Hospital spending represents approximately one third of total national health spending, and the majority of hospital spending is by public payers. Elderly individuals with long-term care needs are at particular risk for hospitalization. While some hospitalizations are unavoidable, many are not, and there may be benefits to reducing hospitalizations in terms of health and cost. This article reviews the evidence from 55 peer-reviewed articles on interventions that potentially reduce hospitalizations from formal long-term care settings. The interventions showing the strongest potential are those that increase skilled staffing, especially through physician assistants and nurse practitioners; improve the hospital-to-home transition; substitute home health care for selected hospital admissions; and align reimbursement policies such that providers do not have a financial incentive to hospitalize. Much of the evidence is weak and could benefit from improved research design and methodology. C1 [Konetzka, R. Tamara] Univ Chicago, Chicago, IL 60637 USA. [Spector, William] Agcy Healthcare Res & Qual, Rockville, MD USA. [Limcangco, M. Rhona] Social & Sci Syst, Silver Spring, MD USA. RP Konetzka, RT (reprint author), Univ Chicago, Chicago, IL 60637 USA. NR 80 TC 75 Z9 76 U1 5 U2 10 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 FEB PY 2008 VL 65 IS 1 BP 40 EP 66 DI 10.1177/1077558707307569 PG 27 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 251UW UT WOS:000252401800002 PM 17895516 ER PT J AU Yorita, KL Holman, RC Sejvar, JJ Steiner, CA Schonberger, LB AF Yorita, Krista L. Holman, Robert C. Sejvar, James J. Steiner, Claudia A. Schonberger, Lawrence B. TI Infectious disease hospitalizations among infants in the United States SO PEDIATRICS LA English DT Article DE infant; infectious disease; hospitalization ID RESPIRATORY SYNCYTIAL VIRUS; URINARY-TRACT-INFECTION; HEALTH-CARE UTILIZATION; US CHILDREN; EPIDEMIOLOGIC TRANSITION; YOUNG-CHILDREN; MORTALITY; TRENDS; BRONCHIOLITIS; SURVEILLANCE AB OBJECTIVE. This study describes the burden and epidemiologic features of infectious disease hospitalizations among infants in the United States. METHODS. Hospitalizations with an infectious disease listed as a primary diagnosis for infants ( 1 year of age) in the United States during 2003 were examined by using the Kids' Inpatient Database. National estimates of infectious disease hospitalizations, hospitalization rates, and various hospital parameters were examined. RESULTS. During 2003, an estimated 286 739 infectious disease hospitalizations occurred among infants in the United States and accounted for 42.8% of all infant hospitalizations. The national infectious disease hospitalization rate was 7010.8 hospitalizations per 100 000 live births, or similar to 1 infectious disease hospitalization for every 14 infants. The median length of stay was 3 days, and stays totaled 1 million hospital days for infants. Infectious disease hospitalization rates were highest among boys and nonwhite infants. The most commonly listed diagnoses among the infant infectious disease hospitalizations included lower respiratory tract infections (59.0%), kidney, urinary tract, and bladder infections (7.6%), upper respiratory tract infections (6.5%), and septicemia (6.5%). The median cost of an infectious disease hospitalization was $2235, with total annual hospital costs of approximately $690 million, among infants in the United States. CONCLUSIONS. Infectious disease hospitalizations among infants account for substantial health care expenditures and hospital time in the United States, with respiratory disease hospitalizations constituting more than one half of all hospitalizations. Younger infants, boys, and nonwhite infants were at increased risk for infectious disease hospitalization. Measures to reduce racial disparities and the occurrence of respiratory tract infections should substantially decrease the infectious disease burden among infants. C1 [Yorita, Krista L.; Holman, Robert C.; Sejvar, James J.; Schonberger, Lawrence B.] Ctr Dis Control & Prevent, Natl Ctr Zoonot Vector Borne & Enter Dis, Div Viral & Rickettsial Dis, Atlanta, GA 30333 USA. [Steiner, Claudia A.] Ctr Delivery Org & Market, Agcy Healthcare Res & Qual, Healthcare Cost & Utilizat Project, Rockville, MD USA. RP Yorita, KL (reprint author), Ctr Dis Control & Prevent, Natl Ctr Zoonot Vector Borne & Enter Dis, Div Viral & Rickettsial Dis, Mail Stop A-39, Atlanta, GA 30333 USA. EM kyorita@cdc.gov NR 43 TC 79 Z9 79 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 2008 VL 121 IS 2 BP 244 EP 252 DI 10.1542/peds.2007-1392 PG 9 WC Pediatrics SC Pediatrics GA 258OQ UT WOS:000252877600003 PM 18245414 ER PT J AU Clancy, CM AF Clancy, Carolyn M. TI Designing for safety: Evidence-based design and hospitals - Commentary SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Editorial Material C1 Agcy Hlth Care Res & Qual, Rockville, MD USA. RP Clancy, CM (reprint author), Agcy Hlth Care Res & Qual, Rockville, MD USA. NR 20 TC 9 Z9 9 U1 2 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 JAN-FEB PY 2008 VL 23 IS 1 BP 66 EP 69 DI 10.1177/1062860607311034 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 251ON UT WOS:000252383200009 PM 18187593 ER PT J AU Dreyer, NA Sheth, N Trontell, A Gliklich, RE AF Dreyer, Nancy A. Sheth, Neho Trontell, Anne Gliklich, Richard E. TI Good practices for handling adverse events detected through patient registries SO DRUG INFORMATION JOURNAL LA English DT Article DE registries; adverse event reporting; SAE AB As the number of patient registries for marketed products increases, it is important for investigators and manufacturers to understand the public health responsibilities and potential regulatory requirements for reporting adverse drug events (AEs). Requirements for reporting AEs will vary depending upon sponsorship of the registry (regulated versus non-regulated industry). If registries are sponsored or supported by a regulated entity and AEs are noted in the course of a regisby's direct patient contact concerning a marketed drug product, the seriousness, expectedness, and possible relationship of the AE to the drug product should be assessed. Recommendations are presented for good registry practices for detecting, processing, and reporting adverse events. C1 [Dreyer, Nancy A.; Gliklich, Richard E.] Outcome Sci Inc, Cambridge, MA 02139 USA. [Dreyer, Nancy A.; Gliklich, Richard E.] Outcome DEclDE Ctr, Cambridge, MA USA. [Sheth, Neho] Pfizer, Safety & Risk Management, Ann Arbor, MI USA. [Trontell, Anne] Agcy Healthcare Res & Qual, Ctr Educ & Res Therapeut, Rockville, MD USA. RP Dreyer, NA (reprint author), Outcome Sci Inc, 201 Broadway, Cambridge, MA 02139 USA. EM ndreyer@outcome.com NR 15 TC 1 Z9 1 U1 0 U2 1 PU DRUG INFORMATION ASSOC PI HORSHAM PA 800 ENTERPRISE ROAD, SUITE 200, HORSHAM, PA 19044-3595 USA SN 0092-8615 J9 DRUG INF J JI Drug Inf. J. PY 2008 VL 42 IS 5 BP 421 EP 428 PG 8 WC Health Care Sciences & Services; Pharmacology & Pharmacy SC Health Care Sciences & Services; Pharmacology & Pharmacy GA 345JF UT WOS:000258991800002 ER PT J AU Banthin, JS Cunningham, P Bernard, DM AF Banthin, Jessica S. Cunningham, Peter Bernard, Didem M. TI Fianancial burden of health care, 2001-2004 SO HEALTH AFFAIRS LA English DT Article ID EXPENDITURE BURDENS; ADULTS; ENROLLMENT; COVERAGE; BENEFITS AB Analysis of data from the Medical Expenditure Panel Survey (MEPS) shows that rising out-of-pocket expenses and stagnant incomes increased health spending's financial burden for families in 2001-2004, especially for the privately insured. High financial burdens among those with nongroup coverage increased by more than one-third. Despite evidence of increased cost sharing in private insurance plans, our analysis does not show that privately insured people paid a higher share of their total health care bill in 2004 compared to 2001. Financial burdens have increased to the point at which private insurance is no longer able to provide financial protection for an increasing number of families. C1 [Banthin, Jessica S.; Bernard, Didem M.] Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat Res, Rockville, MD USA. RP Banthin, JS (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Div Modeling & Simulat Res, Rockville, MD USA. EM pcunningham@hschange.org NR 15 TC 71 Z9 71 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 JAN-FEB PY 2008 VL 27 IS 1 BP 188 EP 195 DI 10.1377/hlthaff.27.1.188 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 319TZ UT WOS:000257188400022 PM 18180494 ER PT J AU Tice, JA Hoffman, RM Steiner, C Feldman, MD AF Tice, Jeffrey A. Hoffman, Richard M. Steiner, Claudia Feldman, Mitchell D. TI Introduction SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material C1 [Tice, Jeffrey A.; Feldman, Mitchell D.] Univ Calif San Francisco, Dept Med, Div Gen Internal Med, San Francisco, CA 94143 USA. [Hoffman, Richard M.] Univ New Mexico, Dept Med, Albuquerque, NM 87131 USA. [Hoffman, Richard M.] New Mexico VA Hlth Care Syst, Med Serv, Albuquerque, NM USA. [Steiner, Claudia] Agcy Healthcare Res & Qual, Ctr Delivery Organizat & Markets, Rockville, MD USA. RP Tice, JA (reprint author), Univ Calif San Francisco, Dept Med, Div Gen Internal Med, 1701 Divisadero St, San Francisco, CA 94143 USA. EM jtice@medicine.ucsf.edu NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JAN PY 2008 VL 23 SU 1 BP 1 EP 1 DI 10.1007/s11606-007-0458-z PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 249FG UT WOS:000252212300001 PM 18095035 ER PT J AU Zhon, C Boine, WB Sedrokyan, A Steiner, C AF Zhon, Chunliu Boine, Williom B. Sedrokyan, Artyom Steiner, Cloudio TI Cardiac device implantation in the United States from 1997 through 2004: A population-based analysis SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article; Proceedings Paper CT 29th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 27-29, 2006 CL Los Angeles, CA SP Soc Gen Internal Med DE pacemaker; implantable cardioverter-defibrillator; cardiac resynchronization therapy; administrative data; ICD-9-CM ID PERMANENT PACEMAKER IMPLANTATION; CHRONIC HEART-FAILURE; CARDIOVERTER-DEFIBRILLATORS; COMPLICATION RATES; RESYNCHRONIZATION; MANAGEMENT; METAANALYSIS; THERAPY; INTERFERENCE; ENDOCARDITIS AB OBJECTIVE: Use of cardiac devices has been increasing rapidly along with concerns over their safety and effectiveness. This study used hospital administrative data to assess cardiac device implantations in the United States, selected perioperative outcomes, and associated patient and hospital characteristics. METHODS: We screened hospital discharge abstracts from the 1997-2004 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. Patients who underwent implantation of pacemaker (PM), automatic cardioverter/defibrillator (AICD), or cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) were identified using ICD-9-CM procedure codes. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed. MEASUREMENTS AND MAIN RESULTS: Approximately 67,000 AICDs and 178,000 PMs were implanted in 2004 in the United States, increasing 60% and 19%, respectively, since 1997. After FDA approval in 2001, CRT-D and CRT-P reached 33,000 and 7,000 units per year in the United States in 2004. About 70% of the patients were aged 65 years or older, and more than 75% of the patients had 1 or more comorbid diseases. There were substantial decreases in length of stay, but marked increases in charges, for example, the length of stay of AICD implantations halved (from 9.9 days in 1997 to 5.2 days in 2004), whereas charges nearly doubled (from $66,000 in 1997 to $117,000 in 2004). Rates of in-hospital mortality and complications fluctuated slightly during the period. Overall, adverse outcomes were associated with advanced age, comorbid conditions, and emergency admissions, and there was no consistent volume-outcome relationship across different outcome measures and patient groups. CONCLUSIONS: The numbers of cardiac device implantations in the United States steadily increased from 1997 to 2004, with substantial reductions in length of stay and increases in charges. Rates of in-hospital mortality and complications changed slightly over the years and were associated primarily with patient frailty. C1 [Zhon, Chunliu; Boine, Williom B.; Sedrokyan, Artyom] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Steiner, Cloudio] Agcy Healthcare Res & Qual, Ctr Delivery Organizat & Markets, Rockville, MD USA. RP Zhon, C (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD USA. EM chunliu.zhan@ahrq.hhs.gov NR 47 TC 12 Z9 13 U1 0 U2 4 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 JAN PY 2008 VL 23 SU 1 BP 13 EP 19 DI 10.1007/s11606-007-0392-0 PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 249FG UT WOS:000252212300004 ER PT J AU Coopey, M James, MD Lawrence, W Clancy, CM AF Coopey, Margaret James, Marian D. Lawrence, William Clancy, Carolyn M. TI The challenge of comparative effectiveness: Getting the right information to the right people at the right time SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material C1 [Coopey, Margaret; James, Marian D.; Lawrence, William; Clancy, Carolyn M.] 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, Rockville, MD 20850 USA. EM margaret.coopey@ahrq.hhs.gov NR 7 TC 2 Z9 2 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 JAN-MAR PY 2008 VL 23 IS 1 BP 1 EP 5 PG 5 WC Nursing SC Nursing GA 243LY UT WOS:000251800000001 PM 18281868 ER PT J AU Ortega-Sanchez, IR Lee, GM Jacobs, RJ Prosser, LA Molinari, NA Zhang, XZ Baine, WB McCauley, MM Miller, T AF Ortega-Sanchez, Ismael R. Lee, Grace M. Jacobs, R. Jake Prosser, Lisa A. Molinari, Noelle-Angelique Zhang, Xinzhi Baine, William B. McCauley, Mary M. Miller, Ted CA Working Grp Leading Economic TI Projected cost-effectiveness of new vaccines for adolescents in the United States SO PEDIATRICS LA English DT Article DE cost-effectiveness; adolescents; vaccines ID ACELLULAR PERTUSSIS-VACCINE; HUMAN-PAPILLOMAVIRUS VACCINE; IMMUNIZATION PRACTICES ACIP; HEPATITIS-A VACCINATION; ECONOMIC-ANALYSIS; MENINGOCOCCAL DISEASE; INFLUENZA VACCINATION; CONJUGATE VACCINATION; ADVISORY-COMMITTEE; STATISTICAL LIFE AB BACKGROUND. Economic assessments that guide policy making on immunizations are becoming increasingly important in light of new and anticipated vaccines for adolescents. However, important considerations that limit the utility of these assessments, such as the diversity of approaches used, are often overlooked and should be better understood. OBJECTIVE. Our goal was to examine economic studies of adolescent vaccines and compare cost-effectiveness outcomes among studies on a particular vaccine, across adolescent vaccines, and between new adolescent vaccines versus vaccines that are recommended for young children. METHODS. A systematic review of economic studies on immunizations for adolescents was conducted. Studies were identified by searching the Medline, Embase, and EconLit databases. Each study was reviewed for appropriateness of model design, baseline setup, sensitivity analyses, and input variables (ie, epidemiologic, clinical, cost, and quality-of-life impact). For comparison, the cost-effectiveness outcomes reported in key studies on vaccines for younger children were selected. RESULTS. Vaccines for healthy adolescents were consistently found to be more costly than the health care or societal cost savings they produced and, in general, were less cost-effective than vaccines for younger children. Among the new vaccines, pertussis and human papillomavirus vaccines were more cost-effective than meningococcal vaccines. Including herd-immunity benefits in studies significantly improved the cost-effectiveness estimates for new vaccines. Differences in measurements or assumptions limited further comparisons. CONCLUSION. Although using the new adolescent vaccines is unlikely to be cost-saving, vaccination programs will result in sizable health benefits. C1 [Ortega-Sanchez, Ismael R.; Molinari, Noelle-Angelique; McCauley, Mary M.] Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, Atlanta, GA 30333 USA. [Lee, Grace M.; Prosser, Lisa A.] Harvard Univ, Sch Med, Ctr Child Hlth Care Studies, Dept Ambulatory Care & Prevent, Boston, MA USA. [Lee, Grace M.] Childrens Hosp, Div Infect Dis, Boston, MA 02115 USA. [Jacobs, R. Jake] Capitol Outcomes Res Inc, Alexandria, VA USA. [Zhang, Xinzhi] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA. [Baine, William B.] Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. [Miller, Ted] Pacific Inst Res & Evaluat, Calverton, MD USA. RP Ortega-Sanchez, IR (reprint author), Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, 1600 Clifton Rd NE,Mail Stop A-47, Atlanta, GA 30333 USA. EM iortegasanchez@cdc.gov OI Miller, Ted/0000-0002-0958-2639 NR 68 TC 20 Z9 20 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 2008 VL 121 SU S BP S63 EP S78 DI 10.1542/peds.2007-1115H PG 16 WC Pediatrics SC Pediatrics GA 271IK UT WOS:000253781900008 PM 18174323 ER PT J AU Hill, SC Liang, L AF Hill, S. C. Liang, L. TI Smoking in the home and children's health SO TOBACCO CONTROL LA English DT Article ID ENVIRONMENTAL TOBACCO-SMOKE; PASSIVE SMOKING; EXPOSURE; ASTHMA; VISITS AB Objectives: We estimate for young children the annual excess health service use, healthcare expenditures, and disability bed days for respiratory conditions associated with exposure to smoking in the home in the United States. Methods: Health service use, healthcare expenditures and disability bed days data come from the 1999 and 2001 Medical Expenditure Panel Survey (MEPS). Reported smoking in the home comes from the linked National Health Interview Survey, from which the MEPS sample is drawn. Multivariate statistical analysis controls for potential confounding factors. The sample is 2759 children aged 0-4. Results: Smoking in the home is associated with an increase in the probability of emergency department visits for respiratory conditions by five percentage points and the probability of inpatient use for these conditions by three percentage points. There is no relation between indoor smoking by adults and either ambulatory visits or prescription drug expenditures. Overall, indoor smoking is associated with $117 in additional healthcare expenditures for respiratory conditions for each exposed child aged 0-4. Indoor smoking is also associated with an eight percentage point increase in the probability of having a bed day because of respiratory illness for children aged 1-4. Conclusions: Despite the significant progress made in tobacco control, many children are still exposed to secondhand smoke in their home. Reducing exposure to smoking in the home would probably reduce healthcare expenditures for respiratory conditions and improve children's health. C1 [Hill, S. C.; Liang, L.] Agcy Healthcare Res & Qual, Ctr Financing Cost & Access Trends, Rockville, MD 20850 USA. RP Liang, L (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Cost & Access Trends, 540 Gaither Rd,Suite 5000, Rockville, MD 20850 USA. EM lliang@ahrq.gov NR 18 TC 30 Z9 30 U1 0 U2 2 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0964-4563 J9 TOB CONTROL JI Tob. Control PD JAN PY 2008 VL 17 IS 1 BP 32 EP 37 DI 10.1136/tc.2007.020990 PG 6 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 256BT UT WOS:000252703400016 PM 18218804 ER PT J AU Wolff, T Miller, T AF Wolff, Tracy Miller, Therese TI Evidence for the reaffirmation of the U. S. preventive services task force recommendation on screening for high blood pressure SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID HYPERTENSION AB Background: High blood pressure is common, and screening is a well-established evidence-based standard of current medical practice. Purpose: To perform a literature search for new, substantial evidence on screening for high blood pressure that would inform the reaffirmation of the U. S. Preventive Services Task Force recommendation on screening for high blood pressure. Data Sources: The PubMed and Cochrane databases were searched. The searches were limited to English-language articles on studies of adult humans (age > 18 years) that were published between 1 October 2001 and 31 March 2006 in core clinical journals. Study Selection: For the literature on benefits, meta-analyses; systematic reviews; and randomized, controlled trials were included. For harms, meta-analyses; systematic reviews; randomized, controlled trials; cohort studies; case-control studies; and case series of large, multisite databases were included. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion. Data Extraction: No new evidence was found on benefits or harms of screening. Two reviewers extracted data from studies on the harms of early treatment, including adverse effects of drug therapy and adverse quality-of-life outcomes. Data Synthesis: No new evidence was found for the benefits of screening for high blood pressure. New evidence on the harms of treatment of early hypertension shows that pharmacologic therapy is associated with common side effects; serious adverse events are uncommon. Limitations: The nonsystematic search may have missed some smaller studies on the benefits and harms of screening and treatment for high blood pressure. Conclusion: No new evidence was found on the benefits of screening. Pharmacotherapy for early hypertension is associated with common side effects. C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, Rockville, MD 20850 USA. RP Wolff, T (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force Program, 540 Gaither Rd, Rockville, MD 20850 USA. NR 10 TC 19 Z9 20 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 4 PY 2007 VL 147 IS 11 BP 787 EP U47 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 239SX UT WOS:000251539100006 PM 18056663 ER PT J AU Atkins, D AF Atkins, David TI SYNTHESIZING EVIDENCE TO INFORM DECISION MAKING SO ANNALS OF BEHAVIORAL MEDICINE LA English DT Meeting Abstract C1 [Atkins, David] Agcy Healthcare Res & Qual, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0883-6612 J9 ANN BEHAV MED JI Ann. Behav. Med. PD DEC PY 2007 VL 33 BP S115 EP S115 PG 1 WC Psychology, Multidisciplinary SC Psychology GA 376LO UT WOS:000261185300448 ER PT J AU Spring, B Helfand, M Ammerman, A Atkins, D Whitlock, E AF Spring, Bonnie Helfand, Mark Ammerman, Alice Atkins, David Whitlock, Evelyn TI CURRENT ISSUES IN SYSTEMATIC REVIEWS SO ANNALS OF BEHAVIORAL MEDICINE LA English DT Meeting Abstract C1 [Spring, Bonnie] Northwestern Univ, Chicago, IL 60610 USA. [Helfand, Mark; Whitlock, Evelyn] Oregon Hlth & Sci Univ, Portland, OR 97201 USA. [Ammerman, Alice] Univ N Carolina, Chapel Hill, NC USA. [Atkins, David] Agcy Hlth Care Res & Qual, Rockville, MD USA. EM bspring@northwestern.edu NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0883-6612 J9 ANN BEHAV MED JI Ann. Behav. Med. PD DEC PY 2007 VL 33 BP S114 EP S114 PG 1 WC Psychology, Multidisciplinary SC Psychology GA 376LO UT WOS:000261185300446 ER PT J AU Finlayson, TL Siefert, K Ismail, AI Sohn, W AF Finlayson, Tracy L. Siefert, Kristine Ismail, Amid I. Sohn, Woosung TI Psychosocial factors and early childhood caries among low-income African-American children in Detroit SO COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY LA English DT Article DE African-American; Early Childhood Caries (ECC); International Caries Detection and Assessment System (ICDAS); parenting stress; preschool aged children; psychological factors ID DENTAL-HEALTH EDUCATION; BOTTLE TOOTH-DECAY; ORAL-HEALTH; PRESCHOOL-CHILDREN; DEPRESSIVE SYMPTOMS; SINGLE MOTHERS; NURSING CARIES; SELF-EFFICACY; PREVALENCE; WELFARE AB Objectives: This study sought to advance knowledge of the social determinants of oral health, by examining how several specific maternal health beliefs, behaviors, and psychosocial factors relate to young children's early childhood caries (ECC) status in a lower-income African-American population. Methods: Data were collected by the Detroit Dental Health Project (NIDCR grant), a population-based study of 1021 African-American families with at least one child under 6 years of age and living in 39 low-income Census tracts in Detroit, Michigan. Analyses were limited to 719 children aged 1-5 years and their biological mothers, and conducted in SUDAAN to account for the complex sampling design. Survey data included health belief scales on mothers' self-efficacy, feelings of fatalism, knowledge about appropriate bottle use and children's oral hygiene needs, brushing habits, psychosocial measures of depressive symptoms (CES-D), parenting stress, and availability of instrumental social support. The child's age, dental insurance status, dental visit history, and 1-week brushing frequency were also included in the model. Children's ECC status, based on a dental examination, was the main outcome. The dental team used the International Caries Detection and Assessment System (ICDAS) criteria for caries detection. Each child was classified as either caries-free or having ECC or severe ECC (S-ECC) based on the case definition of ECC proposed by an expert panel for research purposes with preschool-aged children. Results: The dental team followed a specific examination protocol and established reliable and consistent ratings of ECC based on the ICDAS criteria. The inter-rater reliability kappa was 0.83 overall, and the intra-rater reliability kappa was 0.74 overall. One-third of the children had ECC, and 20% had severe ECC. Age of the child and lower parenting stress scores were each positively associated with ECC, while higher education and income were protective. Maternal oral health fatalism and knowledge of children's hygiene needs were associated with ECC among preschool-aged children. ECC was higher among younger children who had past restorative care. Conclusions: These findings call attention to the high prevalence of ECC in this population and the need to consider psychosocial as well as traditional risk factors in developing interventions to reduce oral health disparities. C1 Univ Calif Berkeley, Sch Publ Hlth, AHRQ, Berkeley, CA 94720 USA. Univ Michigan, NIMH Res Ctr Poverty Risk & Mental Hlth, Sch Social Work, Ann Arbor, MI 48109 USA. Univ Michigan, Sch Dent, Ann Arbor, MI 48109 USA. RP Finlayson, TL (reprint author), Univ Calif Berkeley, Sch Publ Hlth, AHRQ, 140 E Warren Hall MC 7360, Berkeley, CA 94720 USA. EM tracyf@berkeley.edu OI Sohn, Woosung/0000-0002-7486-9652 FU NIDCR NIH HHS [U-54 DE14261]; NIMH NIH HHS [5 T32MH16806] NR 74 TC 66 Z9 67 U1 2 U2 24 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0301-5661 J9 COMMUNITY DENT ORAL JI Community Dentist. Oral Epidemiol. PD DEC PY 2007 VL 35 IS 6 BP 439 EP 448 DI 10.1111/j.1600-0528.2006.00352.x PG 10 WC Dentistry, Oral Surgery & Medicine; Public, Environmental & Occupational Health SC Dentistry, Oral Surgery & Medicine; Public, Environmental & Occupational Health GA 234TK UT WOS:000251186700005 PM 18039285 ER PT J AU Kane, RA Wilson, KB Spector, W AF Kane, Rosalie A. Wilson, Keren Brown Spector, William TI Developing a research agenda for assisted living SO GERONTOLOGIST LA English DT Article DE research priorities; working conference; residential care; personal care services; physical environments ID RESIDENTIAL CARE; NURSING-HOMES; FACILITIES; MANAGEMENT AB Purpose: We describe an approach to identifying knowledge gaps, research questions, and methodological issues for assisted living (AL) research. Design and Methods: We undertook an inventory of AL literature and research in progress and commissioned background papers critiquing knowledge on selected subtopics. With an advisory committee, we identified a comprehensive list of researchable questions of potential utility to consumers, providers, and/or policy makers, which AL researchers then rated as to their importance. The preliminary work facilitated a structured working conference of AL researchers. Results: The top five priority topics identified as a result of the polling before the conference were consumer preferences, cost and financing, developing an information system for consumer decision making, developing quality measures, and resident outcomes. From conference discussion, conferees added other emphasis areas and refined the original ones. They flagged lack of standardized definitions and measures as barriers to building an empirically based AL literature. Conferees also identified distinctions between research on AL as a whole and research on interventions within AL. Implications: In an emerging area in which the literature cannot yet support rigorous comparisons, meta-analysis, or consensus conferences, the systematic approaches, including assembling researchers who use widely different methods, generated substantial agreement on a research agenda. C1 [Kane, Rosalie A.] Univ Minnesota, Sch Publ Hlth, Div Hlth Policy & management, Minneapolis, MN 55408 USA. [Wilson, Keren Brown] Jessie F Richardson Fdn, Clackamas, OR USA. [Spector, William] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Kane, RA (reprint author), Univ Minnesota, Sch Publ Hlth, Div Hlth Policy & management, 420 Delaware St Se,MMC 197, Minneapolis, MN 55408 USA. EM kanex002@umn.edu FU PHS HHS [1R13HSO14027-01] NR 62 TC 5 Z9 5 U1 3 U2 4 PU GERONTOLOGICAL SOC AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD DEC PY 2007 VL 47 SI 3 BP 141 EP 154 PG 14 WC Gerontology SC Geriatrics & Gerontology GA 272FA UT WOS:000253844100013 PM 18162576 ER PT J AU Cawley, J Meyerhoefer, C Newhousec, D AF Cawley, John Meyerhoefer, Chad Newhousec, David TI The impact of state physical education requirements on youth physical activity and overweight SO HEALTH ECONOMICS LA English DT Article DE obesity; physical activity; education; instrumental variables ID BODY-MASS INDEX; CHILDHOOD OBESITY; US CHILDREN; SCHOOL; ADULTS; IDENTIFICATION; ADOLESCENTS; PREVALENCE; PROGRAMS; VALIDITY AB To combat childhood overweight in the US, which has risen dramatically in the past three decades, many medical and public health organizations have called for students to spend more time in physical education (PE) classes. This paper is the first to examine the impact of state PE requirements on student PE exercise time. It also exploits variation in state laws as quasi-natural experiments in order to estimate the causal impact of PE on overall student physical activity and weight. We study nationwide data from the Youth Risk Behavior Surveillance System for 1999, 2001, and 2003 merged with data on state minimum PE requirements from the 2001 Shape of the Nation Report. We find that high school students with a binding PE requirement report an average of 31 additional minutes per week spent physically active in PE class. Our results also indicate that additional PE time raises the number of days per week that girls report having exercised vigorously or having engaged in strength-building activity. We find no evidence that PE lowers BMI or the probability that a student is overweight. We conclude that raising PE credit requirements may make girls more physically active overall but there is not yet the scientific base to declare raising PE requirements an anti-obesity initiative for either boys or girls. Copyright (c) 2007 John Wiley & Sons, Ltd. C1 [Cawley, John] Cornell Univ, Dept Hlth Anal & Management, Ithaca, NY 14853 USA. [Meyerhoefer, Chad] Agcy Healthcare Res & Qual, Washington, DC USA. [Newhousec, David] Int Monetary Fund, Washington, DC 20431 USA. RP Cawley, J (reprint author), Cornell Univ, Dept Hlth Anal & Management, 124 MVR Hall, Ithaca, NY 14853 USA. EM JHC38@cornell.edu RI Cawley, John/E-6734-2010 OI Cawley, John/0000-0002-4805-9883 NR 42 TC 68 Z9 68 U1 1 U2 18 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 DEC PY 2007 VL 16 IS 12 BP 1287 EP 1301 DI 10.1002/hec.1218 PG 15 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 244VD UT WOS:000251892500002 PM 17328052 ER PT J AU Hill, SC AF Hill, Steven C. TI The accuracy of reported insurance status in the MEPS SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID COVERAGE AB Estimates of the number of insured and uninsured Americans are watched by numerous policymakers and the public, yet studies find respondents do not report their insurance status perfectly. Using four sources of validation data, including surveys of employers and providers, this paper assesses the quality of respondents' reports of private insurance and uninsurance in the Medical Expenditure Panel Survey Household Component (MEPS-HC), a nationally representative household survey. Regression analysis is used to assess the extent to which factors are associated with disagreements in reported insurance status across sources. C1 AHRQ, Ctr Finance Access & Cost Trends, Rockville, MD 20850 USA. RP Hill, SC (reprint author), AHRQ, Ctr Finance Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM shill@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 WIN PY 2007 VL 44 IS 4 BP 443 EP 468 PG 26 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 264ZI UT WOS:000253328500006 PM 18338518 ER PT J AU Wildiers, H Kunkler, I Biganzoli, L Fracheboud, J Vlastors, G Bernard-Marty, C Hurria, A Extermann, M Girre, V Brain, E Audisio, RA Bartelink, H Barton, M Giordano, SH Muss, H Aapro, M AF Wildiers, Hans Kunkler, Ian Biganzoli, Laura Fracheboud, Jacques Vlastors, George Bernard-Marty, Chantal Hurria, Arti Extermann, Martine Girre, Veronique Brain, Etienne Audisio, Riccardo A. Bartelink, Harry Barton, Mary Giordano, Sharon H. Muss, Hyman Aapro, Matti TI Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology SO LANCET ONCOLOGY LA English DT Review ID RANDOMIZED CLINICAL-TRIAL; SENTINEL-NODE BIOPSY; IRRADIATION FOLLOWING LUMPECTOMY; COLONY-STIMULATING FACTOR; OLDER WOMEN; ADJUVANT CHEMOTHERAPY; RADIATION-THERAPY; AXILLARY DISSECTION; PHASE-III; POSTOPERATIVE RADIOTHERAPY AB Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality in women worldwide. Elderly individuals make up a large part of the breast cancer population, and there are important specific considerations for this population. The international Society of Geriatric Oncology created a task force to assess the available evidence on breast cancer in elderly individuals, and to provide evidence-based recommendations for the diagnosis and treatment of breast cancer in such individuals. A review of the published work was done with the results of a search on Medline for English-language articles published between 1990 and 2007 and of abstracts from key international conferences. Recommendations are given on the topics of screening, surgery, radiotherapy, (neo)adjuvant hormone treatment and chemotherapy, and metastatic disease. Since large randomised trials in elderly patients with breast cancer are scarce, there is little level I evidence for the treatment of such patients. The available evidence was reviewed and synthesised to provide consensus recommendations regarding the care of breast cancer in older adults. C1 [Wildiers, Hans] Univ Hosp Gasthuisberg, Dept Gen Med Oncol, B-3000 Louvain, Belgium. [Kunkler, Ian] Univ Edinburgh, Edinburgh Canc Ctr, Edinburgh, Midlothian, Scotland. [Biganzoli, Laura] Hosp Prato, Ist Toscano Tumori, Sandro Pitigliani Med Oncol Unit, Prato, Italy. [Fracheboud, Jacques] Erasmus Univ, Med Ctr, Dept Publ Hlth, Rotterdam, Netherlands. [Vlastors, George] Geneva Univ Hosp, Senol & Surg Gynecol Unit, Geneva, Switzerland. [Bernard-Marty, Chantal] Univ Libre Bruxelles, Inst Jules Bordet, Med Oncol Clin, Brussels, Belgium. [Hurria, Arti] City Hope Natl Med Ctr, Div Med Oncol & Expt Therapeut, Duarte, CA 91010 USA. [Extermann, Martine] Univ S Florida, H Lee Moffitt Canc Ctr, Tampa, FL 33682 USA. [Girre, Veronique] Inst Curie, Dept Med Oncol, Paris, France. [Brain, Etienne] Rene Huguenin Canc Ctr, St Cloud, France. [Audisio, Riccardo A.] Univ Liverpool, Whiston Hosp, Prescot, England. [Bartelink, Harry] Netherlands Canc Inst, Dept Radiotherapy, Amsterdam, Netherlands. [Barton, Mary] Agcy Healthcare Res & Qual, Rockville, MD USA. [Giordano, Sharon H.] Univ Texas MD Anderson Canc Ctr, Dept Breast Med Oncol, Houston, TX USA. [Muss, Hyman] Univ Vermont, Hematol Oncol Unit, Burlington, VT USA. [Muss, Hyman] Vermont Canc Ctr, Burlington, VT USA. [Aapro, Matti] Inst Multidisciplinaire Oncol, Clin Genolier, Genolier, Switzerland. RP Wildiers, H (reprint author), Univ Hosp Gasthuisberg, Dept Gen Med Oncol, B-3000 Louvain, Belgium. EM hans.wildiers@uzleuven.be NR 147 TC 193 Z9 198 U1 5 U2 14 PU LANCET LTD PI LONDON PA 84 THEOBALDS RD, LONDON WC1X 8RR, ENGLAND SN 1470-2045 J9 LANCET ONCOL JI Lancet Oncol. PD DEC PY 2007 VL 8 IS 12 BP 1101 EP 1115 DI 10.1016/S1470-2045(07)70378-9 PG 15 WC Oncology SC Oncology GA 242YR UT WOS:000251762600027 PM 18054880 ER PT J AU Yorita, KL Holman, RC Steiner, CA Effler, PV Miyamura, J Forbes, S Anderson, LJ Balaraman, V AF Yorita, Krista L. Holman, Robert C. Steiner, Claudia A. Effler, Paul V. Miyamura, Jill Forbes, Susan Anderson, Larry J. Balaraman, Venkataraman TI Severe bronchiolitis and respiratory syncytial virus among young children in Hawaii SO PEDIATRIC INFECTIOUS DISEASE JOURNAL LA English DT Article DE respiratory syncytial virus; RSV; bronchiolitis; pneumonia; hospitalizations; epidemiology; children; infants; Hawaii ID TRACT INFECTIONS; US CHILDREN; UNITED-STATES; COUNTRIES; HOSPITALIZATIONS; POPULATION; MORTALITY; INFANTS; DEATHS; RISK AB Background: Lower respiratory tract infections are a leading cause of hospitalization and mortality among children worldwide. Our objective was to describe the incidence and epidemiology of severe bronchiolitis, respiratory syncytial virus (RSV), and pneumonia among children in Hawaii. Methods: Retrospective analysis of the patient-linked hospital discharge data associated with bronchiolitis, RSV, and pneumonia among Hawaii residents younger than 5 years of age during 1997 through 2004 using the Hawaii State Inpatient Database. Results: During 1997 through 2004, the average annual incidence rates for bronchiolitis, RSV, and pneumonia were 3.8, 2.7, and 6.8 per 1000 children younger than 5 years, respectively. The incidence of each condition was higher for infants younger than 1 year (15.1, 9.8, and 15.9 per 1000 infants, respectively) than the incidence for children 1-4 years of age, and higher for boys compared with girls. The incidence of each condition was highest among Native Hawaiian and other Pacific Islander children compared with children of other race groups living in Hawaii. Most hospitalizations occurred during the months of October through February. Estimated median hospital charges were $4806 (bronchiolifs), $5465 (RSV) and $5240 (pneumonia), with overall average annual charges of $11.5 million. Conclusion: The incidence and hospitalization rates for bronchiolitis, RSV, and pneumonia among children younger than 5 years of age in Hawaii were low; the corresponding hospitalization rates were lower than those for the general U.S. population. However, the hospitalization rates for each condition among Hawaiian and other Pacific Islander children were much higher than those for other race groups or for the U.S. population. C1 US Dept HHS, Off Director, DVRD, NCID,Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. US Dept HHS, Helathcare Cost & Util Project, Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. Hawaii Dept Hlth, Honolulu, HI USA. Hawaii Hlth Informat Corp, Honolulu, HI USA. Univ Hawaii, John A Burns Sch Med, Dept Pediat, Honolulu, HI 96822 USA. Kapiolani Med Specialists, Honolulu, HI USA. US Dept HHS, Resp & Enter Dis Branch, DVRD, NCID,CDC, Atlanta, GA 30333 USA. RP Yorita, KL (reprint author), US Dept HHS, Off Director, DVRD, NCID,Ctr Dis Control & Prevent, MS A-39, Atlanta, GA 30333 USA. EM KYorita@cdc.gov NR 41 TC 23 Z9 24 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 DEC PY 2007 VL 26 IS 12 BP 1081 EP 1088 DI 10.1097/INF.0b013e31812e62c2 PG 8 WC Immunology; Infectious Diseases; Pediatrics SC Immunology; Infectious Diseases; Pediatrics GA 238IF UT WOS:000251440100001 PM 18043442 ER PT J AU Barton, MB Torchia, MM AF Barton, Mary B. Torchia, Marion M. TI Aspirin and nonsteroidal anti-inflammatory drugs for the primary prevention of colorectal cancer: Weighing the evidence - In response SO ANNALS OF INTERNAL MEDICINE LA English DT Letter C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Barton, MB (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 1 TC 0 Z9 0 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 NOV 6 PY 2007 VL 147 IS 9 BP 674 EP 675 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 227QM UT WOS:000250672900018 ER PT J AU Fry, DE Pine, M Jordan, HS Elixhauser, A Hoaglin, DC Jones, B Warner, D Meimban, R AF Fry, Donald E. Pine, Michael Jordan, Harmon S. Elixhauser, Anne Hoaglin, David C. Jones, Barbara Warner, David Meimban, Roger TI Combining administrative and clinical data to stratify surgical risk SO ANNALS OF SURGERY LA English DT Article ID QUALITY IMPROVEMENT PROGRAM; HOSPITAL MORTALITY-RATES; CLAIMS DATA; SURGERY; ENHANCEMENT; PREDICTIONS; CARE AB Objective: To evaluate whether administrative claims data (ADM) from hospital discharges can be transformed by present-on-admission (POA) codes and readily available clinical data into a refined database that can support valid risk stratification (RS) of surgical outcomes. Summary Background Data: ADM from hospital discharges have been used for RS of medical and surgical outcomes, but results generally have been viewed with skepticism because of limited clinical information and questionable predictive accuracy. Methods: We used logistic regression analysis to choose predictor variables for RS of mortality in abdominal aortic aneurysm repair, coronary artery bypass graft surgery, and craniotomy, and for RS of 4 postoperative complications (ie, physiologic/metabolic derangement, respiratory failure, pulmonary embolism/deep vein thrombosis, and sepsis) after selected operations. RS models were developed for age only (Age model), ADM only (ADM model), ADM enhanced with POA codes for secondary diagnoses (POA-ADM model), POA-ADM supplemented with admission laboratory data (Laboratory model), Laboratory model supplemented with admission vital signs and additional laboratory data (VS model), VS model supplemented with key clinical findings abstracted from medical records (KCF model), and KCF model supplemented with composite clinical scores (Full model). Models were evaluated using c-statistics, case-based errors in predictions, and measures of hospital-based systematic bias. Results: The addition of POA codes and numerical laboratory results to ADM was associated with substantial improvements in all measures of analytic performance. In contrast, the addition of difficult-to-obtain key clinical findings resulted in only small improvements in predictions. Conclusions: Enhancement of ADM with POA codes and readily available laboratory data can efficiently support accurate risk-stratified measurements of clinical outcomes in surgical patients. C1 Michael Pine & Associates Inc, Chicago, IL 60615 USA. Univ Chicago, Div Cardiol, Dept Med, Chicago, IL 60637 USA. ABT Associates Inc, Cambridge, MA 02138 USA. Tufts Univ, Sch Med, Inst Clin Res & Hlth Policy, Boston, MA 02111 USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. RP Fry, DE (reprint author), Michael Pine & Associates Inc, 5020 S Lake Shore Dr 304N, Chicago, IL 60615 USA. EM dfry@mpine-ine.com FU PHS HHS [233-02-0088] NR 35 TC 49 Z9 49 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-4932 J9 ANN SURG JI Ann. Surg. PD NOV PY 2007 VL 246 IS 5 BP 875 EP 885 DI 10.1097/SLA.0b013e3180cc2e7a PG 11 WC Surgery SC Surgery GA 229AJ UT WOS:000250773400027 PM 17968182 ER PT J AU Hughes, RG Clancy, CM AF Hughes, Ronda G. Clancy, Carolyn M. TI So what? The challenge of doing "need to know" versus "would like to know" research SO APPLIED NURSING RESEARCH LA English DT Editorial Material ID NURSING KNOWLEDGE; CLINICAL-RESEARCH C1 US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. RP Hughes, RG (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. EM Ronda.Hughes@ahrq.lihs.gov NR 9 TC 1 Z9 1 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 2007 VL 20 IS 4 BP 210 EP 213 DI 10.1016/j.apnr.2007.07.003 PG 4 WC Nursing SC Nursing GA 233OR UT WOS:000251100700009 PM 17996809 ER PT J AU Meyerhoefer, CD Sahn, DE Younger, SD AF Meyerhoefer, Chad D. Sahn, David E. Younger, Stephen D. TI The joint demand for health care, leisure, and commodities: Implications for health care finance and access in Vietnam SO JOURNAL OF DEVELOPMENT STUDIES LA English DT Article ID USER FEES; SYSTEM; SERVICES; CHOICE; EQUITY AB This paper explores linkages between the demand for health care providers and the consumption of food, non-food goods, and leisure in Vietnam, using a mixed continuous/discrete dependent variable model. Cross-price elasticities calculated from the model suggest there are strong substitution effects between health care, leisure, and certain commodities. The model allows us to explore the implications of replacing user fees with alternative forms of health care finance, such as commodity taxes. In particular, the results suggest financing public health care services with a non-food sales tax rather than user fees would be more progressive and would improve access to care. C1 [Meyerhoefer, Chad D.] CFACT DSER, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Sahn, David E.; Younger, Stephen D.] Cornell Univ, Ithaca, NY 14853 USA. RP Meyerhoefer, CD (reprint author), CFACT DSER, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM chad.meyerhoefer@ahrq.hhs.gov NR 30 TC 2 Z9 2 U1 0 U2 3 PU ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD PI ABINGDON PA 4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXFORDSHIRE, ENGLAND SN 0022-0388 J9 J DEV STUD JI J. Dev. Stud. PD NOV PY 2007 VL 43 IS 8 BP 1475 EP 1500 DI 10.1080/00220380701611527 PG 26 WC Economics; Planning & Development SC Business & Economics; Public Administration GA 250QK UT WOS:000252314900006 ER PT J AU Hudson, JL Miller, E Kirby, JB AF Hudson, Julie L. Miller, Edward Kirby, James B. TI Explaining racial and ethnic differences in children's use of stimulant medications SO MEDICAL CARE LA English DT Article DE psychotherapeutic drugs; stimulant use; ADHD; child health ID ATTENTION-DEFICIT/HYPERACTIVITY DISORDER; DEFICIT-HYPERACTIVITY DISORDER; CLINICAL-PRACTICE GUIDELINE; EXPENDITURE PANEL SURVEY; PSYCHOTROPIC MEDICATIONS; EXPLANATORY MODELS; ADHD; TRENDS; DISPARITIES; ADOLESCENTS AB Objectives: To document and explain racial/ethnic differences in the use of stimulant drugs among US children. Data and Methods: We use a nationally representative sample of children ages 5-17 years old from the Medical Expenditure Panel Survey (MEPS) for the years 2000-2002. We estimate race-specific means and regressions to highlight differences across groups in individual/family characteristics that may affect stimulant use and differences in responses to these characteristics. Then, we use Oaxaca-Blinder decomposition methods to quantify the portion of differential use explained by differences in individual/family characteristics. Finally, we use pooled regressions with race/ethnicity interactions to formally test the hypothesis that responses to perceived mental health and behavioral problems vary across groups. Results: White children are about twice as likely to use stimulants as either Hispanic or Black children. Differences in individual/family characteristics account for about 25% of the difference between whites and Hispanics, but for none of the difference between whites and blacks. Pooled regressions show that racial/ethnic gaps in stimulant use persist among children with otherwise similar reported mental health conditions. Conclusions: Our finding that the majority of racial/ethnic differences in children's stimulant use is explained by differences in responses to individual/family characteristics highlights the importance of further research to examine the reasons for these differences. It is striking that children with other-wise similar reports of mental health problems have such different outcomes in terms of stimulant use. Potential explanations range from discrimination to cultural differences by race/ethnicity or community. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD 20850 USA. RP Hudson, JL (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, 540 Gaither Rd, Rockville, MD 20850 USA. EM jhudson@ahrq.gov NR 36 TC 29 Z9 29 U1 4 U2 8 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 2007 VL 45 IS 11 BP 1068 EP 1075 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 227EI UT WOS:000250639600009 PM 18049347 ER PT J AU Moy, E Dayton, E AF Moy, Ernest Dayton, Elizabeth TI Frontiers in gender-based research: Health care quality data - Commentary SO WOMENS HEALTH ISSUES LA English DT Editorial Material C1 [Moy, Ernest; Dayton, Elizabeth] Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Moy, E (reprint author), Ctr Qual Improvement & Patient Safety, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM ernest.moy@ahrq.hhs.gov NR 8 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 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD NOV-DEC PY 2007 VL 17 IS 6 BP 334 EP 337 DI 10.1016/j.whi.2007.08.002 PG 4 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 240AX UT WOS:000251560500001 PM 17951071 ER PT J AU Gray, DT Hollingworth, W Onwudiwe, N Deyo, RA Jarvik, JG AF Gray, Darryl T. Hollingworth, William Onwudiwe, Nneka Deyo, Richard A. Jarvik, Jeffrey G. TI Thoracic and lumbar vertebroplasties performed in US Medicare enrollees, 2001-2005 SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter ID SURGERY C1 Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. Univ Bristol, Dept Social Med, Bristol, Avon, England. Univ Maryland, Sch Pharm, Baltimore, MD 21201 USA. Univ Washington, Dept Med, Seattle, WA USA. Univ Washington, Dept Radiol, Seattle, WA 98195 USA. RP Gray, DT (reprint author), Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD 20850 USA. EM darryl.gray@ahrq.hhs.gov FU NIAMS NIH HHS [5R01AR049373-04, P60 AR48093] NR 4 TC 16 Z9 17 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 OCT 17 PY 2007 VL 298 IS 15 BP 1760 EP 1762 DI 10.1001/jama.298.15.1760-b PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 220WF UT WOS:000250187300018 PM 17940230 ER PT J AU Hicks, PL Mulvey, KP Chander, G Fleishman, JA Josephs, JS Korthuis, PT Hellinger, J Gaist, P Gebo, KA AF Hicks, P. L. Mulvey, K. P. Chander, G. Fleishman, J. A. Josephs, J. S. Korthuis, P. T. Hellinger, J. Gaist, P. Gebo, K. A. CA Hiv Research Network TI The impact of illicit drug use and substance abuse treatment on adherence to HAART SO AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV LA English DT Article ID ACTIVE ANTIRETROVIRAL THERAPY; SELF-REPORTED ADHERENCE; CLINICAL-TRIALS; HIV-INFECTION; UNITED-STATES; OUTCOMES; MEDICATIONS; DRINKING; ALCOHOL; PEOPLE AB High levels of adherence to highly active antiretroviral therapy (HAART) are essential for virologic suppression and longer survival in patients with HIV. We examined the effects of substance abuse treatment, current versus former substance use, and hazardous/binge drinking on adherence to HAART. During 2003, 659 HIV patients on HAART in primary care were interviewed. Adherence was defined as >= 95% adherence to all antiretroviral medications. Current substance users used illicit drugs and/or hazardous/binge drinking within the past six months, while former users had not used substances for at least six months. Logistic regression analyses of adherence to HAART included demographic, clinical and substance abuse variables. Sixty-seven percent of the sample reported 95% adherence or greater. However, current users (60%) were significantly less likely to be adherent than former (68%) or never users (77%). In multivariate analysis, former users in substance abuse treatment were as adherent to HAART as never users (Adjusted Odds Ratio (AOR) = 0.82; p > 0.5). In contrast, former users who had not received recent substance abuse treatment were significantly less adherent than never users (AOR = 0.61; p = 0.05). Current substance users were significantly less adherent than never users, regardless of substance abuse treatment (p < 0.01). Substance abuse treatment interacts with current versus former drug use status to affect adherence to HAART. Substance abuse treatment may improve HAART adherence for former substance users. C1 [Hicks, P. L.; Chander, G.; Josephs, J. S.; Gebo, K. A.] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA. [Mulvey, K. P.] Substance Abuse & Mental Hlth Serv Adm, Ctr Substances Abuse Prevent, Rockville, MD USA. [Fleishman, J. A.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Korthuis, P. T.] Oregon Hlth & Sci Univ, Dept Med, Portland, OR 97201 USA. [Hellinger, J.] Commun Med Alliance, Boston, MA USA. [Gaist, P.] Natl Inst Hlth, Off AIDS Res, Bethesda, 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 FU NIAAA NIH HHS [K23 AA015313, K23 AA015313-04]; NIDA NIH HHS [K23-DA00523, K23 DA000523]; PHS HHS [290-01-0012] NR 23 TC 42 Z9 43 U1 1 U2 2 PU ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD PI ABINGDON PA 4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXFORDSHIRE, ENGLAND SN 0954-0121 J9 AIDS CARE JI Aids Care-Psychol. Socio-Med. Asp. Aids-Hiv PD OCT PY 2007 VL 19 IS 9 BP 1134 EP 1140 DI 10.1080/09540120701351888 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 251TN UT WOS:000252398200009 PM 18058397 ER PT J AU Cawley, J Meyerhoefer, C Newhouse, D AF Cawley, John Meyerhoefer, Chad Newhouse, David TI The correlation of youth physical activity with state policies SO CONTEMPORARY ECONOMIC POLICY LA English DT Article ID RATIONAL ADDICTION; CHILDHOOD OBESITY; US CHILDREN; ADOLESCENTS; OVERWEIGHT; INTERVENTIONS; EDUCATION; PROGRAMS; PREVALENCE; PREVENT AB Childhood overweight has risen dramatically in the United States during the past three decades. The search for policy solutions is limited by a lack of evidence regarding the effectiveness of state policies for increasing physical activity among youths. This paper estimates the correlation of student physical activity with a variety of state policies. We study nationwide data on high school students from the Youth Risk Behavior Surveillance System for 1999, 2001, and 2003 merged with data on state policies from several sources. We control for a variety of characteristics of states and students to mitigate bias due to the endogenous selection of policies, but we conservatively interpret our results as correlations, not causal impacts. Two policies are positively correlated with participation in physical education (PE) class for both boys and girls: a binding PE unit requirement and a state PE curriculum. We also find that state spending on parks and recreation is positively correlated with two measures of girls' overall physical activity. C1 Cornell Univ, Dept Policy Anal & Management, Ithaca, NY 14853 USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Int Monetary Fund, Poverty & Social Impact Anal Grp, Washington, DC 20431 USA. RP Newhouse, D (reprint author), Cornell Univ, Dept Policy Anal & Management, 124 MVR Hall, Ithaca, NY 14853 USA. EM jhc38@cornell.edu; Chad.Meyerhoefer@ahrq.hhs.gov; dnewhouse@imf.org RI Cawley, John/E-6734-2010 OI Cawley, John/0000-0002-4805-9883 NR 40 TC 7 Z9 7 U1 1 U2 5 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1074-3529 J9 CONTEMP ECON POLICY JI Contemp. Econ. Policy PD OCT PY 2007 VL 25 IS 4 BP 506 EP 517 DI 10.1111/j.1465-7287.2007.00070.x PG 12 WC Economics; Public Administration SC Business & Economics; Public Administration GA 225XY UT WOS:000250552800003 ER PT J AU Mularski, RA Dy, SM Shugarman, LR Wilkinson, AM Lynn, J Shekelle, PG Morton, SC Sun, VC Hughes, RG Hilton, LK Maglione, M Rhodes, SL Rolon, C Lorenz, KA AF Mularski, Richard A. Dy, Sydney M. Shugarman, Lisa R. Wilkinson, Anne M. Lynn, Joanne Shekelle, Paul G. Morton, Sally C. Sun, Virginia C. Hughes, Ronda G. Hilton, Lara K. Maglione, Margaret Rhodes, Shannon L. Rolon, Cony Lorenz, Karl A. TI A systematic review of measures of end-of-life care and its outcomes SO HEALTH SERVICES RESEARCH LA English DT Review DE quality of health care; outcome and process assessment (health care); end-of-life care; measures; dying ID CANCER-SYMPTOM-SCALE; FUNCTIONAL ASSESSMENT-TOOL; PALLIATIVE CARE; LUNG-CANCER; FAMILY-MEMBERS; TERMINALLY-ILL; ONCOLOGY PATIENTS; INCURABLE CANCER; NEEDS-ASSESSMENT; HEART-FAILURE AB Objective To identify psychometrically sound measures of outcomes in end-of-life care and to characterize their use in intervention studies. Data Sources English language articles from 1990 to November 2005 describing measures with published psychometric data and intervention studies of end-of-life care. Study Design Systematic review of end-of-life care literature. Extraction Methods Two reviewers organized identified measures into 10 major domains. Eight reviewers extracted and characterized measures from intervention studies. Principal Findings Of 24,423 citations, we extracted 200 articles that described 261 measures, accepting 99 measures. In addition to 35 measures recommended in a prior systematic review, we identified an additional 64 measures of the end-of-life experience. The most robust measures were in the areas of symptoms, quality of life, and satisfaction; significant gaps existed in continuity of care, advance care planning, spirituality, and caregiver well-being. We also reviewed 84 intervention studies in which 135 patient-centered outcomes were assessed by 97 separate measures. Of these, 80 were used only once and only eight measures were used in more than two studies. Conclusions In general, most measures have not undergone rigorous development and testing. Measure development in end-of-life care should focus on areas with identified gaps, and testing should be done to facilitate comparability across the care settings, populations, and clinical conditions. Intervention research should use robust measures that adhere to these standards. C1 Oregon Hlth & Sci Univ, Kaiser Permanente NW, Ctr Hlth Res, Portland, OR 97227 USA. Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. Sch Med, Baltimore, MD USA. RAND Hlth, So Calif Evidence Based Practice Ctr, Santa Monica, CA USA. RAND Corp, Arlington, VA USA. RTI Int, Res Triangle Pk, NC USA. City Hope Natl Med Ctr, Duarte, CA 91010 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. RP Mularski, RA (reprint author), Oregon Hlth & Sci Univ, Kaiser Permanente NW, Ctr Hlth Res, 3800 N Interstate,WIN 1060, Portland, OR 97227 USA. FU NCI NIH HHS [K07 CA096783, K07CA96783] NR 88 TC 88 Z9 90 U1 3 U2 20 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 2007 VL 42 IS 5 BP 1848 EP 1870 DI 10.1111/j.1475-6773.2007.00721.x PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 210AL UT WOS:000249429000005 PM 17850523 ER PT J AU Smith, RB Cheung, R Owens, P Wilson, RM Simpson, L AF Smith, Richard B. Cheung, Robyn Owens, Pamela Wilson, R. Mark Simpson, Lisa TI Medicaid markets and pediatric patient safety in hospitals SO HEALTH SERVICES RESEARCH LA English DT Article DE Medicaid; patient safety; child health ID HEALTH-CARE; MANAGED CARE; CONSOLIDATION; MORTALITY; QUALITY AB Objective To examine the association of Medicaid market characteristics to potentially preventable adverse medical events for hospitalized children, controlling for patient- and hospital-level factors. Data Sources/Study Setting Two carefully selected Agency for Healthcare Research and Quality (AHRQ) pediatric patient safety indicators (decubitus ulcers and laceration) are analyzed using the new pediatric-specific, risk-adjusting, patient safety algorithm from the AHRQ. All pediatric hospital discharges for patients age 0-17 in Florida, New York, and Wisconsin, and at risk of any of these two patient safety events, are examined for the years 1999-2001 (N=859,922). Study Design Logistic regression on the relevant pool of discharges estimates the probability an individual patient experiences one of the two PSI events. Data Extraction Methods Pediatric discharges from the 1999 to 2001 State Inpatient Databases (SIDs) from the AHRQ Healthcare Cost and Utilization Project, merged with hospital-level data from the American Hospital Association's Annual Survey, Medicaid data obtained from the Centers for Medicare and Medicaid Services and state Medicaid offices, and private and Medicaid managed care enrollment data obtained from InterStudy, are used in the estimations. Principal Findings At the market level, patients in markets in which Medicaid payers face relatively little competition are more likely to experience a patient safety event (odds ratio [OR]=1.602), while patients in markets in which hospitals face relatively little competition are less likely to experience an adverse event (OR=0.686). At the patient-discharge and hospital levels, Medicaid characteristics are not significantly associated with the incidence of a pediatric patient safety event. Conclusions Our analysis offers additional insights to previous work and suggests a new factor-the Medicaid-payer market-as relevant to the issue of pediatric patient safety. C1 Univ S Florida, Coll Business, St Petersburg, FL 33701 USA. Univ Penn, Sch Nursing, Ctr Hlth Outcomes & Policy Res, Philadelphia, PA 19104 USA. Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. Univ S Florida, Div Child Hlth Outcomes, Hlth Sci Ctr, St Petersburg, FL 33701 USA. RP Smith, RB (reprint author), Univ S Florida, Coll Business, 140 7th Ave S,COB 348, St Petersburg, FL 33701 USA. RI Smith, Richard/C-2701-2013 FU PHS HHS [R60 MC 00003-01] NR 26 TC 7 Z9 7 U1 1 U2 5 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 2007 VL 42 IS 5 BP 1981 EP 1998 DI 10.1111/j.1475-6773.2007.00698.x PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 210AL UT WOS:000249429000011 PM 17850529 ER PT J AU Verma, A Simpson, K Evon, D Smith, S Fried, MW AF Verma, Amit Simpson, Kelly Evon, Donna Smith, Scott Fried, Michael W. TI Barriers to healthcare access among chronic hepatitis C patients SO HEPATOLOGY LA English DT Meeting Abstract CT 58th Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases CY NOV 02-06, 2007 CL Boston, MA SP Amer Assoc Study Liver Dis C1 Univ N Carolina, Chapel Hill, NC 27515 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU JOHN WILEY & SONS INC PI HOBOKEN PA 111 RIVER ST, HOBOKEN, NJ 07030 USA SN 0270-9139 J9 HEPATOLOGY JI Hepatology PD OCT PY 2007 VL 46 IS 4 SU S MA 877 BP 626A EP 626A PG 1 WC Gastroenterology & Hepatology SC Gastroenterology & Hepatology GA 216WT UT WOS:000249910401140 ER PT J AU Hughes, RG Clancy, CM AF Hughes, Ronda G. Clancy, Carolyn M. TI Improving the complex nature of care transitions SO JOURNAL OF NURSING CARE QUALITY LA English DT Editorial Material ID DISCHARGE; ERRORS 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@abrq.bbs.gov NR 10 TC 9 Z9 9 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 2007 VL 22 IS 4 BP 289 EP 292 PG 4 WC Nursing SC Nursing GA 215TO UT WOS:000249832100001 PM 17873723 ER PT J AU Atkins, D AF Atkins, David TI Creating and synthesizing evidence with decision makers in mind - Integrating evidence from clinical trials and other study designs SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Symposium on Emerging Methods in Comparative Effectiveness and Safety CY JUN, 2006 CL Rockville, MD DE evidence-based medicine; health policy ID RANDOMIZED CONTROLLED-TRIALS; SERVICES-TASK-FORCE; LOW-DOSE ASPIRIN; CAROTID-ENDARTERECTOMY; PREVENTION; METAANALYSIS; POPULATION; MORTALITY; MEDICINE; OUTCOMES AB Background: Randomized controlled trials (RCTs) remain the accepted "gold standard" for determining the efficacy of new drugs or medical procedures. Randomized trials alone, however, cannot provide all the relevant information decision makers need to determine the relative risks and benefits when choosing the best treatment of individual patients or weighing the implications of particular policies affecting medical therapies. Objectives: To demonstrate the limitations of RCTs in providing the information needed by medical decision makers, and to show how information from observational studies can supplement evidence from RCTs. Methods: Qualitative description of the limitations of RCTs in providing the information needed by medical decision makers, and demonstration of how evidence from additional sources can aid in decision making, using the examples of deciding whether a 60-year-old woman with mildly elevated blood pressure should take daily low-dose aspirin, and whether a hospital network should implement carotid artery surgery for asymptomatic patients. Conclusions: Even the most rigorously designed RCTs leave many questions central to medical decision making unanswered. Research using cohort and case-control designs, disease and intervention registries, and outcomes studies based on administrative data can all shed light on who is most likely to benefit from the treatment, and what the important tradeoffs are. This suggests the need to revise the traditional evidence hierarchy, whereby evidence progresses linearly from basic research to rigorous RCTs. This revised hierarchy recognizes that other research designs can provide important evidence to strengthen our understanding of how to apply research findings in practice. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Atkins, D (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM david.atkins@ahrq.hhs.gov NR 31 TC 36 Z9 36 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 OCT PY 2007 VL 45 IS 10 SU 2 BP S16 EP S22 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 222YG UT WOS:000250333800006 PM 17909376 ER PT J AU Sedrakyan, A Shih, C AF Sedrakyan, Artyom Shih, Chuck TI Improving depiction of benefits and harms - Analyses of studies of well-known therapeutics and review of high-impact medical journals SO MEDICAL CARE LA English DT Article; Proceedings Paper CT Symposium on Emerging Methods in Comparative Effectiveness and Safety CY JUN, 2006 CL Rockville, MD DE risk communication; benefits and harms; patient education; informed choice; systematic review ID HORMONE REPLACEMENT THERAPY; CONTROLLED TRIAL; STROKE; TREAT; RISK; METAANALYSIS; ASSOCIATION; DEMENTIA; WOMEN AB The issues of weighing benefits and harms and of shared decision-making have become increasingly important in recent years. There is limited knowledge and lack of adequate data on the most transparent method of communicating the information. In this article we discuss examples of communicating benefits and harms for well-known therapeutics, illustrating that relative risk estimates are not helpful for communicating the chance of experiencing adverse events. In addition, we show that asymmetric presentation of the data for benefits and harms is likely to bias toward showing greater benefits and diminishing the importance of the harms (or vice versa). We also present preliminary results of a brief review of high-impact medical journals that show limitations of current Systematic reviews. In the review we found that every second published study does not discuss frequency data and I in 3 studies that report information on both benefits and harms does not report information in the same metric. We conclude that consistently depicting benefit and harm information in frequencies can substantially improve the communication of benefits and harms. Investigators should be requested to provide frequency data along with relative risk information in the publication of their scientific findings. Currently, even in the highest impact medical journals, evidence of benefits and harms is not consistently presented in ways that facilitate accurate interpretation. C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. London Sch Hyg & Trop Med, Dept Publ Hlth & Policy, London, England. Yale Univ, Sch Med, New Haven, CT USA. RP Sedrakyan, A (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, 540 Gaither Rd, Rockville, MD 20850 USA. EM asedraky@ahrq.gov NR 28 TC 21 Z9 21 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 OCT PY 2007 VL 45 IS 10 SU 2 BP S23 EP S28 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 222YG UT WOS:000250333800007 PM 17909378 ER PT J AU Smith, SR AF Smith, Scott R. TI Comparative effectiveness and safety: Emerging methods SO MEDICAL CARE LA English DT Editorial Material C1 US Dept HHS, Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. RP Smith, SR (reprint author), US Dept HHS, Ctr Outcomes & Evidence, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Scott.Smith@ahrq.hhs.gov NR 0 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 OCT PY 2007 VL 45 IS 10 SU 2 BP S1 EP S2 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 222YG UT WOS:000250333800001 ER PT J AU Basu, J Mobley, LR AF Basu, Jayasree Mobley, Lee R. TI Do HMOs reduce preventable hospitalizations for Medicare beneficiaries? SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article; Proceedings Paper CT Meeting of the American-Society-of-Health-Economists CY JUN, 2006 CL Madison, WI SP Amer Soc Hlth Economists DE Medicare managed care; elderly; preventable hospitalizations; severity of illness ID CARE SENSITIVE CONDITIONS; MANAGED CARE; HEALTH-INSURANCE; SOCIOECONOMIC-STATUS; RATES; IMPACT; CHILDREN; ACCESS; POPULATION; ENROLLEES AB This study assesses the association of HMO enrollment with preventable hospitalizations among the elderly in four states. Using 2001 hospital discharge abstracts for elderly Medicare enrollees (age 65 and above) residing in four states (New York, Pennsylvania, Florida, and California), from the Healthcare Cost and Utilization Project (HCUP-SID) database of the Agency for Healthcare Research and Quality, we use a multivariate cross-sectional design with patient-level data for each state. Holding other factors such as demographics and illness severity constant, we find that in three out of four states, Medicare HMO patients had lower odds of a preventable admission versus marker admission than Medicare fee-for-service (FFS) patients. Moreover, in the two states with longest tenure and greatest Medicare HMO penetration, California and Florida, the reduction in preventable admissions among Medicare HMO patients was mainly concentrated among more ill patients. These findings add to the evidence that managed care outperforms traditional care among the elderly, rather than simply skimming off the healthiest populations. C1 Agcy Healthcare Res & Qual, Rockville, MD USA. Res Triangle Inst, Res Triangle Pk, NC 27709 USA. RP Basu, J (reprint author), Agcy Healthcare Res & Qual, Rockville, MD USA. EM jayasree.basu@ahrq.hhs.gov NR 53 TC 17 Z9 17 U1 1 U2 1 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 OCT PY 2007 VL 64 IS 5 BP 544 EP 567 DI 10.1177/1077558707301955 PG 24 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 214UX UT WOS:000249764800003 PM 17881621 ER PT J AU Andrulis, DP Brach, C AF Andrulis, Dennis P. Brach, Cindy TI Integrating literacy, culture, and language to improve health care quality for diverse populations SO AMERICAN JOURNAL OF HEALTH BEHAVIOR LA English DT Article DE communication; cultural competence; health literacy; language barriers; literacy; linguistic competence; minority health; quality improvement ID LIMITED ENGLISH PROFICIENCY; IDENTIFY PATIENTS; SKILLS; DISPARITIES; OUTCOMES; INTERVENTIONS; COMPREHENSION; COMPETENCE; RESIDENTS; MEDICINE AB Objective: To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods: Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results: Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups' needs. A vision for integrated care is presented. Conclusion: Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. C1 Drexel Univ, Sch Publ Hlth, Ctr Hlth Equal, Philadelphia, PA 19102 USA. Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Andrulis, DP (reprint author), Drexel Univ, Sch Publ Hlth, Ctr Hlth Equal, 1505 Race St,13th Floor,MS 660, Philadelphia, PA 19102 USA. EM dpa28@drexel.edu FU Intramural AHRQ HHS [HS999999] NR 62 TC 67 Z9 68 U1 3 U2 23 PU PNG PUBLICATIONS PI STAR CITY PA PO BOX 4593, STAR CITY, WV 26504-4593 USA SN 1087-3244 J9 AM J HEALTH BEHAV JI Am. J. Health Behav. PD SEP-OCT PY 2007 VL 31 SU 1 BP S122 EP S133 PG 12 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 205ML UT WOS:000249118000016 PM 17931131 ER PT J AU Hudson, JL Selden, TM AF Hudson, Julie L. Selden, Thomas M. TI Children's eligibility and coverage: Recent trends and a look ahead SO HEALTH AFFAIRS LA English DT Article ID HEALTH-INSURANCE; PRIVATE COVERAGE; ACCESS; SCHIP; CARE; CHALLENGES AB We used data from the 1996-2005 Medical Expenditure Panel Survey to track changes in children's public insurance eligibility and coverage. During the 200-12005 "postexpansion" period, eligibility was approximately constant, while public enrollment increased rapidly and uninsurance declined. Nevertheless, as of 2005, 62 percent of all uninsured children (5.5 million) continued to be eligible but not enrolled. We present detailed estimates of their characteristics by age, income, race/ethnicity, health status, and nativity/citizenship. We also examine the impact of potential changes in SCHIP income thresholds-both an expansion and a rollback-and estimate the number and characteristics of the children potentially affected. C1 Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. RP Hudson, JL (reprint author), Agcy Healthcare Res & Qual, Ctr Financing Access & Cost Trends, Rockville, MD USA. EM jhudson@ahrq.gov NR 32 TC 39 Z9 39 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 2007 VL 26 IS 5 BP W618 EP W629 DI 10.1377/hIthaff.26.5.w618 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 209WZ UT WOS:000249420000058 PM 17702792 ER PT J AU Hennessy, S Bilker, WB Leonard, CE Chittams, J Palumbo, CM Karlawish, JH Yang, YX Lautenbach, E Baine, WB Metlay, JP AF Hennessy, Sean Bilker, Warren B. Leonard, Charles E. Chittams, Jesse Palumbo, Cristin M. Karlawish, Jason H. Yang, Yu-Xiao Lautenbach, Ebbing Baine, William B. Metlay, Joshua P. TI Observed association between antidepressant use and pneumonia risk was confounded by comorbidity measures SO JOURNAL OF CLINICAL EPIDEMIOLOGY LA English DT Article DE aged; antidepressive agents; pneumonia; pneumonia; aspiration; pharmacoepidemiology; confounding factors ID COMMUNITY-ACQUIRED PNEUMONIA; ASPIRATION PNEUMONIA; TRENDS; ADULTS; OLDER AB Objective: A prior study suggested that antidepressants might increase the risk of hospitalization for pneumonia in the elderly. This study sought to confirm or refute this hypothesis. Study Design and Setting: Case-control study of persons aged 65 and above nested in the UK General Practice Research Database. Results: We identified 12,044 cases of the hospitalization for pneumonia (the primary outcome) and 48,176 controls. The odds ratio (OR) for any antidepressant use, adjusting for age, sex, and calendar year was 1.61 (95% confidence interval 1.46-1.78). After further adjustment for comorbidity measures, the OR was 0.89 (0.79-1.00). We also identified 159 cases of hospitalization for aspiration pneumonia (the secondary outcome) and 636 controls. The OR for any antidepressant use, adjusted for age, sex, and calendar year was 1.45 (0.65-3.24). After further adjustment for comorbidity measures, the OR was 0.63 (0.23-1.71). Conclusion: These findings refute the prior hypothesis that use of antidepressants by elderly patients increases the risk of hospitalization for pneumonia or for aspiration pneumonia. Decisions regarding use of antidepressants in elderly persons should not be affected by concern about pneumonia risk. Data-derived hypotheses should be independently confirmed before being acted upon. (c) 2007 Elsevier Inc. All rights reserved. C1 Univ Penn, Sch Med, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA. Univ Penn, Sch Med, Developing Evidence Inform Decis Effectiveness Ct, Philadelphia, PA 19104 USA. Univ Penn, Sch Med, Ctr Educ & Res Therapeut, Philadelphia, PA 19104 USA. Univ Penn, Sch Med, Dept Med, Philadelphia, PA 19104 USA. US Dept HHS, Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20852 USA. Dept Vet Affairs Med Ctr, Philadelphia, PA 19104 USA. RP Hennessy, S (reprint author), 824 Blockley Hall,423 Guardian Dr, Philadelphia, PA 19104 USA. EM shenness@cceb.med.upenn.edu RI CPRD, CPRD/B-9594-2017; Leonard, Charles/K-3447-2012; Research Datalink, Clinical Practice/H-2477-2013 FU NIA NIH HHS [K23 AG000987-02, K23 AG000987, K23 AG000987-01A1, K23 AG000987-03, K23 AG000987-04, K23 AG000987-05, K23AG000987]; NIDDK NIH HHS [K08 DK062978, K08 DK062978-01A1, K08 DK062978-02, K08 DK062978-03, K08 DK062978-04, K08 DK062978-05, K08DK062978] NR 17 TC 10 Z9 10 U1 0 U2 0 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 SEP PY 2007 VL 60 IS 9 BP 911 EP 918 DI 10.1016/j.jclinepi.2006.11.022 PG 8 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 202VI UT WOS:000248931700007 PM 17689807 ER PT J AU Subramanian, S Hoover, S Gilman, B Field, TS Mutter, R Gurwitz, JH AF Subramanian, Sujha Hoover, Sonja Gilman, Boyd Field, Terry S. Mutter, Ryan Gurwitz, Jerry H. TI Computerized physician order entry with clinical decision support in long-term care facilities: Costs and benefits to stakeholders SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE long-term care; economics; computer decision support ID ADVERSE DRUG EVENTS; MEDICATION ERRORS; SYSTEMS; SAFETY AB Nursing homes are the setting of care for growing numbers of our nation's older people, and adverse drug events are an increasingly recognized safety and quality concern in this population. Health information technology, including computerized physician/provider order entry (CPOE) with clinical decision support (CDS), has been proposed as an important systems-based approach for reducing medication errors and preventable drug-related injuries. This article describes the costs and benefits of CPOE with CDS for the various stakeholders involved in long-term care (LTC), including nurses, physicians, the pharmacy, the laboratory, the payer (e.g., the insurer), nursing home residents, and the LTC facility. Critical barriers to adoption of these systems are discussed, primarily from an economic perspective. The analysis suggests that multiple stakeholders will incur the costs related to implementation of CPOE with CDS in the LTC setting, but the costs incurred by each may not be aligned with the benefits, which may present a major barrier to broad adoption. Physicians and LTC facilities are likely to bear a large burden of the costs, whereas residents and payers will enjoy a large portion of the benefits. Consideration of these costs and benefits suggests that financial incentives to physicians and facilities may be necessary to encourage and accelerate widespread use of these systems in the LTC setting. C1 Univ Massachusetts, Sch Med, Meyers Primary Care Inst, Fallon Clin Fdn, Worcester, MA 01605 USA. Fallon Community Hlth Plan, Worcester, MA USA. RTI Int, Waltham, MA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Gurwitz, JH (reprint author), Univ Massachusetts, Sch Med, Meyers Primary Care Inst, Fallon Clin Fdn, 630 Plantat St, Worcester, MA 01605 USA. EM jgurwitz@meyersprimary.org FU AHRQ HHS [HS010481, HS15430] NR 21 TC 23 Z9 23 U1 1 U2 1 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 SEP PY 2007 VL 55 IS 9 BP 1451 EP 1457 DI 10.1111/j.1532-5415.2007.01304.x PG 7 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 206IZ UT WOS:000249178400020 PM 17915344 ER PT J AU Harrison, MI Koppel, R Bar-Lev, S AF Harrison, Michael I. Koppel, Ross Bar-Lev, Shirly TI Unintended consequences of information technologies in health care - An interactive sociotechnical analysis SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article ID PHYSICIAN ORDER ENTRY; DECISION-SUPPORT-SYSTEMS; MEDICATION ERRORS; E-IATROGENESIS; IMPLEMENTATION; SAFETY; ORGANIZATIONS; BARRIERS; QUALITY; WORK AB Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization's sociotechnical system-its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical Analysis (ISTA). ISTA captures common types of interaction with special emphasis on recursive processes, i.e., feedback loops that alter the newly introduced HIT and promote second-level changes in the social system. ISTA draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social. informatics, technology-in-practice, and social construction of technology. We present five types of sociotechnical interaction and illustrate each with cases from published research. The ISTA model should further research on emergent and recursive processes in HIT implementation and their unintended consequences. Familiarity with the model can also foster practitioners' awareness of unanticipated consequences that only become evident during HIT implementation. C1 Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Univ Penn, Philadelphia, PA 19104 USA. Ruppin Acad Ctr SB L, Emek Hefer, Israel. RP Harrison, MI (reprint author), Ctr Delivery Org & Markets, Agcy Healthcare Res & Qual, 540 Gaither Rd, Rockville, MD 20850 USA. EM Michael.Harrison@ahrq.hhs.gov FU AHRQ HHS [P01 HS11530, P01 HS011530] NR 71 TC 221 Z9 224 U1 6 U2 57 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 SEP-OCT PY 2007 VL 14 IS 5 BP 542 EP 549 DI 10.1197/jamia.M2384 PG 8 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 214WU UT WOS:000249769700002 PM 17600093 ER PT J AU Sedrakyan, A AF Sedrakyan, Artyom TI Evaluating off-pump coronary artery bypass grafting - Response SO STROKE LA English DT Letter ID MYOCARDIAL-INFARCTION; TRIALS; METAANALYSIS C1 Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. RP Sedrakyan, A (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD 20850 USA. NR 11 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 SEP PY 2007 VL 38 IS 9 BP E84 EP E85 DI 10.1161/STROKEAHA.107.491340 PG 2 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 204FF UT WOS:000249028400046 ER PT J AU Lin, KW Duane, MR AF Lin, Kenneth W. Duane, Marguerite R. TI Are some screening tests doing more harm than good? SO AMERICAN FAMILY PHYSICIAN LA English DT Editorial Material ID UNITED-STATES; PRIMARY-CARE C1 Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Columbia Rd Hlth Serv, Washington, DC USA. RP Lin, KW (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM kenneth.lin@ahrq.hhs.gov NR 11 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 AUG 1 PY 2007 VL 76 IS 3 BP 351 EP 352 PG 2 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 198LX UT WOS:000248630700004 PM 17708134 ER PT J AU Mercer, SL DeVinney, BJ Fine, LJ Green, LW Dougherty, D AF Mercer, Shawna L. DeVinney, Barbara J. Fine, Lawrence J. Green, Lawrence W. Dougherty, Denise TI Study designs for effectiveness and translation research - Identifying trade-offs SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID PUBLIC-HEALTH INTERVENTIONS; RANDOMIZED CLINICAL-TRIALS; PREVENTIVE-SERVICES; QUALITY; POLICY; CARE; IMPLEMENTATION; STATEMENT; PROMOTION; TREND AB Background: Practitioners and policymakers need credible evidence of effectiveness to justify allocating resources to complex, expensive health programs. Investigators, however, face challenges in designing sound effectiveness and translation research with relevance for "real-world" settings. Methods: Research experts and federal and foundation funders (n=similar to 120) prepared for and participated in a symposium, held May 4-5, 2004, to weigh the strengths, limitations, and trade-offs between alternate designs for studying the effectiveness and translation of complex, multilevel health interventions. Results: Symposium attendees acknowledged that research phases (hypothesis generating, efficacy, effectiveness, translation) are iterative and cyclical, not linear, since research in advanced phases may reveal unanswered questions in earlier phases. Research questions thus always need to drive the choice of study design. When randomization and experimental control are feasible, participants noted that the randomized controlled trial with individual random assignment remains the gold standard for safeguarding internal validity. Attendees highlighted trade-offs of randomized controlled trial variants, quasi-experimental designs, and natural experiments for use when randomization or experimental control or both are impossible or inadequately address external validity. Participants discussed enhancements to all designs to increase confidence in causal inference while accommodating greater external validity. Since no single study can establish causality, participants encouraged replication of studies and triangulation using different study designs. Participants also recommended participatory research approaches for building population relevance, acceptability, and usefulness. Conclusions: Consideration of the study design choices, trade-offs, and enhancements discussed here can guide the design, funding, completion, and publication of appropriate policy- and practice-oriented effectiveness and translational research for complex, multilevel health interventions. C1 Ctr Dis Control & Prevent, Natl Ctr Hlth Stat Mkt, Guide Community Prevent Serv, Atlanta, GA 30333 USA. Agcy Healthcare Res & Qual, Child Hlth & Qual Improvement Off Extramural Res, Rockville, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. NIH, NHLBI, Clin Prevent & Translat, Bethesda, MD 20892 USA. Univ Calif San Francisco, Sch Med, Ctr Comprehens Canc, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA. RP Mercer, SL (reprint author), Ctr Dis Control & Prevent, Natl Ctr Hlth Stat Mkt, Guide Community Prevent Serv, 1600 Clifton Rd,NE,Mailbox E-69, Atlanta, GA 30333 USA. EM SMercer@cdc.gov NR 68 TC 125 Z9 127 U1 2 U2 22 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 2007 VL 33 IS 2 BP 139 EP 154 DI 10.1016/j.amepre.2007.04.005 PG 16 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 197UP UT WOS:000248582300011 PM 17673103 ER PT J AU Finlayson, TL Siefert, K Ismail, AI Sohn, W AF Finlayson, T. L. Siefert, K. Ismail, A. I. Sohn, W. TI Maternal self-efficacy and 1-5-year-old children's brushing habits SO COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY LA English DT Article DE African-Americans; dental hygiene; oral hygiene; preschool-aged children; psychosocial risk factors; self-efficacy ID EARLY-CHILDHOOD CARIES; DEPRESSIVE SYMPTOMS; PRESCHOOL-CHILDREN; DENTAL-CARIES; HEALTH-PROMOTION; SOCIAL SUPPORT; YOUNG-CHILDREN; MOTHERS; SAMPLE; ROLES AB Objectives: This study investigates the relationships between maternal cognitive, behavioral, and psychosocial factors and brushing practices in low-income African-American preschool children. Methods: Data are from a population-based sample of 1021 African-American families with at least one child < 6 years of age and living in the 39 low-income Census tracts in Detroit, Michigan. Analyses were limited to 1-5-year-old children and their mothers (n = 719). Mothers were surveyed about oral health-related self-efficacy (OHSE), knowledge about appropriate bottle use (KBU), knowledge about children's oral hygiene (KCOH), oral health fatalism (OHF), their own toothbrushing behavior, depressive symptoms (CES-D), parenting stress, practical social support, and their child's dental history. Children's 1-week reported brushing frequency was the main outcome measure. Analyses were conducted in sudaan to account for the complex sampling design. Results: Children's 1-week brushing frequency (range 0-40) averaged 8.50 times per week among 1-3-year olds and 9.75 among the 4-5-year olds. Maternal OHSE was a strong and significant predictor of children's brushing frequency; for each unit increase in OHSE, 1-3-year olds were expected to brush 18% more frequently on average during 1 week [incidence density ratios (IDR) 1.18, 95% confidence interval (CI) 1.08-1.28; P < 0.001], and 4-5-year olds were expected to brush 9% more often (IDR = 1.09, 95% CI 1.00-1.19; P < 0.10). Mothers' KCOH score was also significantly positively associated with brushing frequency; for each unit increase on the KCOH scale, 1-3-year olds were expected to brush 22% more frequently (IDR = 1.22, 95% CI 1.10-1.35; P < 0.001) and 4-5-year olds were expected to brush 13% more frequently (IDR = 1.13, 95% CI 1.02-1.26; P < 0.05). If a mother brushed her own teeth at bedtime during the week, her 1-3-year old child's brushing frequency was expected to increase by one-third (IDR = 1.34, 95% CI 1.12-1.60; P < 0.01) and among the 4-5-year olds, the child's frequency was expected to increase by one-quarter (IDR = 1.26, 95% CI 1.12-1.42; P < 0.001). Availability of help with transportation and financial support were also relevant variables for 1-3-year olds. Higher family income and dental insurance coverage were both positively associated with brushing among 4-5-year olds. Conclusions: Several maternal cognitive, behavioral, and psychosocial factors were associated with young children's brushing practices. Oral health-specific self-efficacy and knowledge measures are potentially modifiable cognitions; findings suggest that intervening on these factors could help foster healthy dental habits and increase children's brushing frequency early in life. C1 Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA. Univ Calif Berkeley, Agcy Healthcare Res & Qual, Berkeley, CA 94720 USA. Univ Michigan, Sch Social Work, NIMH, Res Ctr Poverty Risk & Mental Hlth, Ann Arbor, MI 48109 USA. Univ Michigan, Sch Dent, Ann Arbor, MI 48109 USA. RP Finlayson, TL (reprint author), Univ Calif Berkeley, Sch Publ Hlth, 140 Warren Hall MC 7360, Berkeley, CA 94720 USA. EM tracyf@berkeley.edu FU NIDCR NIH HHS [U54 DE14261-01]; NIMH NIH HHS [5 T32 MH16806] NR 44 TC 57 Z9 58 U1 1 U2 11 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0301-5661 J9 COMMUNITY DENT ORAL JI Community Dentist. Oral Epidemiol. PD AUG PY 2007 VL 35 IS 4 BP 272 EP 281 DI 10.1111/j.1600-0528.2007.00313.x PG 10 WC Dentistry, Oral Surgery & Medicine; Public, Environmental & Occupational Health SC Dentistry, Oral Surgery & Medicine; Public, Environmental & Occupational Health GA 186VE UT WOS:000247805700005 PM 17615014 ER PT J AU Stewart, KA Neumann, PJ Fletcher, SW Barton, MB AF Stewart, Kate A. Neumann, Peter J. Fletcher, Suzanne W. Barton, Mary B. TI The effect of immediate reading of screening mammograms on medical care utilization and costs after false-positive mammograms SO HEALTH SERVICES RESEARCH LA English DT Article DE mammography; immediate reading; controlled trial; utilization; costs ID BREAST-CANCER; ABNORMAL MAMMOGRAMS; MORBIDITY; QUALITY; ANXIETY; IMPACT; WOMEN AB Objective. To investigate whether decreased anxiety associated with immediate reading of screening mammograms resulted in lower downstream utilization and costs among women with false-positive mammograms. Data Sources/Study Setting. We identified 1,140 women,>= age 40, with false-positive mammograms and 12-month follow-up after participating in a trial of immediate versus batch mammographic reading between February 1999 and January 2001 in a multispecialty group managed care practice in Massachusetts. Study Design. We determined downstream utilization and costs for study participants by immediate and batch reading status. Data Collection/Extraction Methods. Demographic, comorbidity, and medical care utilization data were obtained from survey data and computerized medical record databases. Costs included direct medical costs, patient time, travel and copayments, and additional professional time costs associated with immediate reading. Principal Findings. Immediate reading cost an additional $4.40 per screening mammogram. Women with immediate readings had more follow-up mammograms (781 versus 750, p=.018) and fewer diagnostic ultrasounds (176 versus 219, p=.016) than women with batch readings. Costs to the health plan for breast care were approximately 10 percent higher for immediate readings in multivariable analyses (p=.046), but no significant difference was seen in total societal costs (p=.072). Conclusions. Immediate mammogram reading was associated with increased costs to the health plan and changes in follow-up radiology procedures. These costs must be examined alongside beneficial effects of immediate reading. C1 Harvard Univ, Dept Hlth Care Policy, Boston, MA 02115 USA. Tufts Univ, Sch Med, Boston, MA 02111 USA. Tufts Univ New England Med Ctr, Ctr Evaluat Value & Risk Hlth, Inst Clin Res & Hlth Policy Studies, Boston, MA USA. Dept Ambulatory Care & Prevent, Boston, MA USA. US Prevent Serv Task Force, Ctr Primary Care Prevent & Clin Partnerships, Agcy Healthcare Res & Qual, Rockville, MD USA. RP Stewart, KA (reprint author), Harvard Univ, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA. FU NCI NIH HHS [R01 CA72570]; NIA NIH HHS [T32 AG000186, T32 AG00186]; NIAID NIH HHS [R01 AI072570] NR 25 TC 3 Z9 3 U1 1 U2 5 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 2007 VL 42 IS 4 BP 1464 EP 1482 DI 10.1111/j.1475-6773.2006.00660.x PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 184SM UT WOS:000247662300003 PM 17610433 ER PT J AU Klabunde, CN Lanier, D Breslau, ES Zapka, JG Fletcher, RH Ransohoff, DF Winawer, SJ AF Klabunde, Carrie N. Lanier, David Breslau, Erica S. Zapka, Jane G. Fletcher, Robert H. Ransohoff, David F. Winawer, Sidney J. TI Improving colorectal cancer screening in primary care practice: Innovative strategies and future directions SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE colorectal cancer; screening; primary care; prevention ID FECAL OCCULT BLOOD; PREVENTIVE CARE; CONTROLLED-TRIAL; INFORMATION-TECHNOLOGY; FINANCIAL INCENTIVES; FAMILY PHYSICIANS; NATIONAL-SURVEY; UNITED-STATES; BARRIERS; DELIVERY C1 NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. Agcy Healthcare Res & Qual, Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. NCI, Appl Canc Screening Res Branch, Behav Res Program, Div Canc Control & Populat Sci, Bethesda, MD USA. Med Univ S Carolina, Charleston, SC 29425 USA. Harvard Univ, Sch Med, Dept Ambulatory Care & Prevent, Boston, MA USA. Univ N Carolina, Sch Med, Chapel Hill, NC USA. Mem Sloan Kettering Canc Ctr, Dept Med, New York, NY 10021 USA. RP Klabunde, CN (reprint author), NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, EPN 4005,6130 Execut Blvd, Bethesda, MD 20892 USA. EM klabundc@mail.nih.gov NR 66 TC 83 Z9 85 U1 0 U2 5 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 AUG PY 2007 VL 22 IS 8 BP 1195 EP 1205 DI 10.1007/s11606-007-0231-3 PG 11 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 189SF UT WOS:000248008100023 PM 17534688 ER PT J AU Dreyer, NA Berliner, E Smith, SR Hakim, R Gliklich, R AF Dreyer, Nancy A. Berliner, Elise Smith, Scott R. Hakim, Rosemarie Gliklich, Richard TI Understanding and assessing registries for evaluating patient outcomes SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 Outcome Sci Inc, Sci Affairs, Cambridge, MA USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Ctr Med & Med Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 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 AUG PY 2007 VL 16 SU 2 BP S239 EP S240 DI 10.1002/pds PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 201GT UT WOS:000248820200502 ER PT J AU Tilson, H Hennessy, S Trontell, A AF Tilson, Hugh Hennessy, Sean Trontell, Anne TI CERTs annual roundtable SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 Univ N Carolina, Sch Publ Hlth, Chapel Hill, NC USA. Univ Penn, Sch Med, Philadelphia, PA 19104 USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 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 AUG PY 2007 VL 16 SU 2 MA 548 BP S260 EP S261 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 201GT UT WOS:000248820200546 ER PT J AU Bollen, KA Kirby, JB Curran, PJ Paxton, PM Chen, FN AF Bollen, Kenneth A. Kirby, James B. Curran, Patrick J. Paxton, Pamela M. Chen, Feinian TI Latent variable models under misspecification - Two-stage least squares (2SLS) and maximum likelihood (ML) estimators SO SOCIOLOGICAL METHODS & RESEARCH LA English DT Article DE 2SLS; misspecification; latent variable models; structural equation models; FIML; specification error ID CONFIRMATORY FACTOR-ANALYSIS; STRUCTURAL-EQUATION; MONTE-CARLO; INSTRUMENTAL VARIABLES; ROBUSTNESS; EXISTENCE; MOMENTS; ERROR; BIAS AB This article compares maximum likelihood (ML) estimation to three variants of two-stage least squares (2SLS) estimation in structural equation models. The authors use models that are both correctly and incorrectly specified. Simulated data are used to assess bias, efficiency, and accuracy of hypothesis tests. Generally, 2SLS with reduced sets of instrumental variables performs similarly to ML when models are correctly specified. Under correct specification, both estimators have little bias except at the smallest sample sizes and are approximately equally efficient. As predicted, when models are incorrectly specified, 2SLS generally performs better, with less bias and more accurate hypothesis tests. Unless a researcher has tremendous confidence in the correctness of his or her model, these results suggest that a 2SLS estimator should be considered. C1 Univ N Carolina, Odum Inst Res Social Sci, Chapel Hill, NC 27599 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Ohio State Univ, Columbus, OH 43210 USA. N Carolina State Univ, Raleigh, NC 27695 USA. Univ N Carolina, Dept Psychol, LL Thurstone Quantitat Lab, Chapel Hill, NC USA. RP Bollen, KA (reprint author), Univ N Carolina, Odum Inst Res Social Sci, Chapel Hill, NC 27599 USA. EM bollen@unc.edu NR 56 TC 30 Z9 30 U1 4 U2 12 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0049-1241 J9 SOCIOL METHOD RES JI Sociol. Methods. Res. PD AUG PY 2007 VL 36 IS 1 BP 48 EP 86 DI 10.1177/0049124107301947 PG 39 WC Social Sciences, Mathematical Methods; Sociology SC Mathematical Methods In Social Sciences; Sociology GA 193WO UT WOS:000248306100003 ER PT J AU Guirguis-Blake, J Calonge, N Miller, T Siu, A Teutsch, S Whitlock, E AF Guirguis-Blake, Janelle Calonge, Ned Miller, Therese Siu, Albert Teutsch, Steven Whitlock, Evelyn CA U S Prevent Serv Task Force TI Current processes of the US preventive services task force: Refining evidence-based recommendation development SO ANNALS OF INTERNAL MEDICINE LA English DT Article AB The U.S. Preventive Services Task Force (USPSTF), an independent panel that has provided the gold standard for evidence-based guidelines in prevention for the past 2 decades, continuously refines its methodology. To keep up with the evolving field of evidence-based medicine and to update recommendations in a timely, efficient, and transparent manner, the USPSTF has developed new methods for evidence reviews and recommendation development. This article summarizes the most recent changes in the recommendation development process, including how the USPSTF solicits and prioritizes topics for review, updates evidence reviews and recommendations, and communicates with its audience. C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. RP Guirguis-Blake, J (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. EM AHRQPubs@ahrq.hhs.gov NR 4 TC 68 Z9 70 U1 1 U2 3 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 117 EP 122 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 192CV UT WOS:000248179300006 PM 17576998 ER PT J AU Barton, MB Miller, T Wolff, T Petitti, D LeFevre, M Sawaya, G Yawn, B Guirguis-Blake, J Calonge, N Harris, R AF Barton, Mary B. Miller, Therese Wolff, Tracy Petitti, Diana LeFevre, Michael Sawaya, George Yawn, Barbara Guirguis-Blake, Janelle Calonge, Ned Harris, Russell CA U S Preventive Services Task Force TI How to read the new recommendation statement: methods update from the US preventive services task force SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID STRENGTH; QUALITY; SYSTEMS AB Since 2001, the U.S. Preventive Services Task Force (USPSTF) has worked to refine its methods of evidence review and assessment and to create more usable documents in response to clinicians' needs. These changes have resulted in a revised grading system, as well as a new format and new language for the recommendation statement. This paper focuses on the changes to and the new look of the USPSTF recommendation statement. The new recommendation statement comprises 9 sections. Important changes include standardization of the format of the summary statement to specify what service is being recommended in what population; standardization of the headings in the rationale section; a change in the wording of the grade C recommendation and the I statement; and a new section, called "Other Considerations," in which salient issues related to cost-effectiveness, mandates, and other implementation issues are described. C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. RP Barton, MB (reprint author), Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. EM AHRQPubs@ahrq.hhs.gov NR 8 TC 40 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 JUL 17 PY 2007 VL 147 IS 2 BP 123 EP 127 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA 192CV UT WOS:000248179300007 PM 17576997 ER PT J CA US Preventive Services Task Force TI Screening for chlamydial infection: US preventive services task force recommendation statement SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID TRACHOMATIS AB Description: Update of 2001 U.S. Preventive Services Task Force (USPSTF) recommendations about screening sexually active adolescents and adults for chlamydial infection. Methods: The USPSTF weighed the benefits (improved fertility, pregnancy outcomes, and infection transmission) and harms (anxiety, relationship problems, and unnecessary treatment of false-positive results) of chlamydial screening identified in their 2001 recommendations and the accompanying systematic review of English-language articles published between July 2000 and July 2005. Recommendations: Screen for chlamydial infection in all sexually active nonpregnant young women age 24 years or younger and for older nonpregnant women who are at increased risk. (A recommendation) Screen for chlamyclial infection in all pregnant women age 24 years or younger and in older pregnant women who are at increased risk. (B recommendation) Do not routinely screen for chlamyclial infection in women age 25 years or older, regardless of whether they are pregnant, if they are not at increased risk. (C recommendation) Current evidence is insufficient to assess the balance of benefits and harms of screening for chlamyclial infection for men. C1 Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. RP Agcy Healthcare Res & Qual, US Prevent Serv Task Force, Rockville, MD USA. NR 9 TC 0 Z9 0 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 JUL 17 PY 2007 VL 147 IS 2 BP 128 EP 134 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 192CV UT WOS:000248179300008 ER EF