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Brian C Martinson

Publications and source records attributed to Brian C Martinson.

9 recordsLinked to original sources
PubMed2006

Normal Misbehavior: Scientists Talk about the Ethics of Research.

Those concerned with protecting the Integrity of science generally focus on the serious but rare infractions of falsification, fabrication, and plagiarism (FFP). While the violations of FFP are clear threats to the quality of scientific work and public trust in science, are they the behaviors that researchers themselves find most troubling? Noticing that scientists seldom are asked to report their perceptions of the behaviors that pose problems for the enterprise of science, we conducted six focus groups with researchers from major research universities. A total of 51 scientists participated in our focus-group discussions, which lasted from 1.5 to 2 hours each. We found that while researchers were aware of the problems of FFP, in their eyes misconduct generally is associated with more mundane, everyday problems in the work environment. These more common problems fall into four categories: the meaning of data, the rules of science, life with colleagues, and the pressures of production in science. Focus on the "normal misbehaviors" that are part of the ordinary life of researchers allows us to see the way the organization of science generates both compliance and deviance from ethical norms.

Journal Article↗
PubMed2006

Scientists' perceptions of organizational justice and self-reported misbehaviors.

Policymakers concerned about maintaining the integrity of science have recently expanded their attention from a focus on misbehaving individuals to characteristics of the environments in which scientists work. Little empirical evidence exists about the role of organizational justice in promoting or hindering scientific integrity. Our findings indicate that when scientists believe they are being treated unfairly they are more likely to behave in ways that compromise the integrity of science. Perceived violations of distributive and procedural justice were positively associated with self-reports of misbehavior among scientists.

Journal Article↗
PubMed2005

Health care charges associated with physical inactivity, overweight, and obesity.

INTRODUCTION: Physical inactivity, overweight, and obesity are associated with increased morbidity and mortality. The objective of this study was to estimate the proportion of total health care charges associated with physical inactivity, overweight, and obesity among U.S. populations aged 40 years and older. METHODS: A predictive model of health care charges was developed using data from a cohort of 8000 health plan members aged 40 and older. Model cells were defined by physical activity status, body mass index, age, sex, smoking status, and selected chronic diseases. Total health care charges were estimated by multiplying the percentage of the population in each cell by the predicted charges per cell. Counterfactual estimates were computed by reclassifying all individuals as physically active and of normal weight while leaving other characteristics unchanged. Charges associated with physical inactivity, overweight, and obesity were computed as the difference between current risk profile total charges and counterfactual total charges. National population percentage estimates were derived from the National Health Interview Survey; those estimates were multiplied by the predicted charges per cell from the health plan analysis. RESULTS: Physical inactivity, overweight, and obesity were associated with 23% (95% confidence interval [CI], 10%-34%) of health plan health care charges and 27% (95% CI, 10%-37%) of national health care charges. Although charges associated with these risk factors were highest for the oldest group (aged 65 years and older) and for individuals with chronic conditions, nearly half of aggregate charges were generated from the group aged 40 to 64 years without chronic disease. CONCLUSION: Charges associated with physical inactivity, overweight, and obesity constitute a significant portion of total medical expenditures. The results underscore the importance of addressing these risk factors in all segments of the population.

Adult↗
PubMed2005

Health plan members' views on forgiving medical errors.

BACKGROUND: How patients respond to medical errors may influence how physicians approach disclosure of medical errors, but information on patients' responses is limited. Research is needed on how the circumstances that surround a medical error affect how patients respond. OBJECTIVE: To investigate whether patients' tendency to forgive a physician following a medical error varied under different circumstances. STUDY DESIGN: Cross-sectional survey. METHODS: We mailed a questionnaire to 1500 randomly selected health plan members; the response rate was 66%. Questionnaire items assessed the likelihood of forgiveness following a medical error under 12 circumstances drawn from a review of the literature. RESULTS: Respondents were most likely to forgive a physician if the patient failed to provide complete information (93% would or might forgive) and least likely to forgive if the error was due to efforts to keep costs down (11% would or might forgive). Most respondents would not forgive a physician when the physician was tired or distracted (68%), was incomplete in data collection (76%), lacked knowledge (78%), or failed to follow up (85%). Men were more likely to forgive than women; the most educated respondents were most likely to forgive. CONCLUSIONS: Our findings suggest that patients are not likely to forgive a physician in circumstances in which they suspect incompetence, inattention, or a lack of caring on the part of the physician involved. A more comprehensive understanding of forgiveness and the effect of forgiveness on the physician-patient relationship following a medical error is needed.

Cross-Sectional Studies↗
PubMed2004

Health plan members' views about disclosure of medical errors.

BACKGROUND: Various authorities and national organizations encourage disclosing medical errors, but there is little information on how patients respond to disclosure. OBJECTIVE: To examine how the type of error, severity of adverse clinical outcome, and level of disclosure affect patients' responses to error and disclosure. DESIGN: Mail questionnaire survey (8 versions were developed) varying 3 factors in a completely crossed, randomized, factorial design. Each questionnaire included a vignette describing 1) a medical error (failure to check for penicillin allergy or inadequate monitoring of antiepileptic medication); 2) an associated clinical outcome (life-threatening or less serious); and 3) a physician-patient dialogue, with either full disclosure (acceptance of responsibility and an apology) or nondisclosure (expression of regret without acceptance of responsibility or an apology). SETTING: New England-based health plan. PARTICIPANTS: Random sample of 1500 adult members received the questionnaire, with a 66% response rate. MEASUREMENTS: Likelihood of changing physicians, likelihood of seeking legal advice, ratings of patient satisfaction, trust and emotional reaction in response to a vignette and dialogue, and views on medical error and disclosure. RESULTS: Full disclosure reduced the reported likelihood of changing physicians and increased patient satisfaction, trust, and positive emotional response. Full disclosure reduced the reported likelihood of seeking legal advice in only 1 error-and-outcome vignette. In the other vignettes, the percentage of patients indicating that they would seek legal advice was relatively high even with full disclosure. Almost all respondents (98.8%) wanted to be told of errors, most (83%) favored financial compensation if harm occurred, and few (12.7%) favored compensation if no harm occurred. LIMITATIONS: Since the study was done in the context of a managed care plan in one geographic area, it could not assess whether the results are generalizable to other populations. In addition, it could not determine whether responses to the simulated situations used predict responses to real situations. CONCLUSIONS: Patients will probably respond more favorably to physicians who fully disclose medical errors than to physicians who are less forthright, but the specifics of the case and the severity of the clinical outcome also affect patients' responses. In some circumstances, the desire to seek legal advice may not diminish despite full disclosure.

Adult↗
PubMed2004

Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members.

BACKGROUND: Whereas much is known about single lifestyle-related health risk factor prevalence and covariates, more research is needed to elucidate the interactions among multiple healthy lifestyle factors and variables that may predict adherence to these factors. Such data may guide both clinical and health policy decision making and person-centered approaches to population health improvement. METHODS: We document the prevalence and cluster patterns of multiple healthy lifestyle factors among a random sample of adolescents (n =616), adults (n =585), and seniors (n =685) from a large Midwestern health plan. Modifiable, lifestyle-related health factors assessed included physical activity, nonsmoking, high-quality diet, and healthy weight for all subjects; adults and seniors were also asked about their alcohol consumption. Second, we sought to identify characteristics associated with the likelihood of meeting recommendations for healthy lifestyle factors. The healthy lifestyle factors sum score was categorized into three levels, that is, 0 to 2, 3, or 4 to 5 healthy lifestyle factors (4 for adolescents), and we used ordinal logistic regression to estimate the odds of meeting each of these criteria from several demographic characteristics and disease states. RESULTS: Overall, only 14.5% of adolescent, adult, and senior health plan members meet recommended guidelines for four common healthy lifestyle factors. Only 10.8% of adults and 12.8% of seniors met all five behavior-related factors. For adolescents, only being nondepressed was associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors (odds ratio [OR]=2.15; p <0.05). For adults, being in the 50- to 64-year-old cohort (OR=1.46, p<0.05), having a college degree (OR=1.65; p <0.05), and having no chronic disease (OR=1.92; p <0.05) were all associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. For seniors, having a college degree (OR=1.61; p <0.05), was the only variable associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. CONCLUSIONS: A small proportion of health plan members meet multiple recommended healthy lifestyle guidelines at once. This analysis identifies population subgroups of specific interest and importance based on adherence to multiple healthy lifestyle factors, and predictors for increased likelihood to be in adherence to multiple healthy lifestyle factors. It presents a potentially useful summary measure based on person-centered measures of healthy lifestyle factors. Clinicians may derive meaningful information from analyses that address adherence to multiple healthy lifestyle factors. Health systems administrators may use this information to influence health policy and resource allocation decisions. Further studies are needed to assess the usefulness of this comprehensive lifestyle-related health measure as a metric of progress toward public health goals, or as a clinical metric that conveys information on future health status and directs interventions at the individual level.

Adolescent↗
PubMed2003

Changes in physical activity and short-term changes in health care charges: a prospective cohort study of older adults.

BACKGROUND: Better understanding the impact of changes in physical activity behavior on short-term health care charges may inform resource allocation decisions to increase population levels of physical activity. This study examines the prospective relationship of changes in physical activity status on short-term changes in health care charges for older adults. METHODS: A prospective cohort study was done on a stratified random sample of 2,393 adults aged 50 and older enrolled in a Minnesota health plan, predicting changes in resource use between two periods (September 1994 to August 1995 and September 1996 to August 1997) based on billed health care charges. RESULTS: After adjustment for age, gender, comorbidity, smoking status, and body mass index, all physical activity states had declining health care charges, relative to those who were consistently inactive. Subjects who increased their physical activity from 0-1 to 3+ days/week had significant declines in their mean annualized total charges (-2,202 dollars, P < 0.01) relative to those who remained inactive. CONCLUSIONS: Increased physical activity among older adults is associated with lower health care charges within 2 years, relative to charges for those who were persistently inactive. These cost savings may justify investments in effective interventions to increase physical activity in older adults.

Adult↗
PubMedDate not supplied

Smoking cessation attempts in relation to prior health care charges: the effect of antecedent smoking-related symptoms?

PURPOSE: We hypothesize that elevated charges among former smokers reflect differential cessation of sicker individuals. We ascertained the relationship between prior health care charges and time to smoking cessation. DESIGN: Prospective, observational study using panel survey data and administrative health plan records. SETTING: A large managed care organization in Minnesota. SUBJECTS: A stratified random sample of 8000 health plan members 40 years and older, yielding 611 current smokers at baseline. MEASURES: Smoking cessation measured via self-report survey. Health care charges, mortality, and disenrollment data derived from automated health plan databases. RESULTS: Among smoking adults without chronic disease diagnoses at baseline, a first attempt at quitting smoking was positively associated with the presence of any inpatient charges (relative risk [RR], 1.9; p < .05) or any emergency department or urgent care charges (RR, 1.4; p < .10). We also observed positive associations between total charges and ambulatory charges in the top textile (RR, 1.5 and 1.6, respectively; p < .05) with a first attempt at quitting smoking, further suggesting graded relationships. Among smoking adults with one or more of four chronic disease diagnoses at baseline, being in the top two tertiles of total charges or ambulatory care charges was predictive of a subsequent attempt at quitting smoking. CONCLUSIONS: Higher health care charges, particularly from ambulatory (primary care clinic) settings, predicted smoking cessation among both individuals with and without chronic diseases. These charges may be proxies for other factors, such as smoking-related symptoms or physician advice or messaging regarding smoking cessation.

Adult↗