Search PubMed⌕ Search

Biomedical subjects

C S Weisman

Publications and source records attributed to C S Weisman.

At least 19 recordsLinked to original sources
PubMed2001

Physician gender effects on preventive screening and counseling: an analysis of male and female patients' health care experiences.

BACKGROUND: Studies have documented that patients of female physicians receive higher levels of preventive services. However, most studies include patients of only one gender, examine mainly gender-specific screening services, and do not examine patient education and counseling. OBJECTIVES: This study tests both physician- and patient-gender effects on screening and counseling services received in the past year and considers effects of gender-matched patient-physician pairs. RESEARCH DESIGN: Multivariate analyses are conducted to assess direct and interactive (physician x patient) gender effects and to control for important covariates. SUBJECTS: Data are from the 1998 Commonwealth Fund Survey of Women's Health, a nationally representative sample of U.S. adults. The analytic sample includes 1,661 men and 1,288 women ages 18 and over. MEASURES: Dependent variables are measures of patient-reported screening and counseling services received, including gender-specific and gender-nonspecific services and counseling on general health habits and sensitive topics. RESULTS: Female physician gender is associated with a greater likelihood of receiving preventive counseling for both male and female patients. For female patients, there is an increased likelihood of receiving more gender-specific screening (OR = 1.36, P <0.05) and counseling (OR = 1.40, P <0.05). These analyses provide no evidence that gender-matched physician-patient pairs provide an additional preventive care benefit beyond the main effect of female physician gender. CONCLUSIONS: Female physician gender influences the provision of both screening and counseling services. These influences may reflect physicians' practice and communication styles as well as patients' preferences and expectations.

Counseling↗
PubMed2001

Quality management in public and community health: examples from women's health.

Quality assessment and improvement activities are as relevant to the public health sector and community-based health care organizations as they are to the rest of the health care industry. This article provides a framework for the types of quality assessment and improvement approaches available to public health and community-based health care organizations and provides two examples drawn from the field of women's health. The first focuses on a population-based assessment of the performance of the health care system using indicators for the nation as a whole and for the states specifically in a women's health report card. The second focuses on measuring quality of care provided to clients of one type of safety-net organization, Title X family planning clinics. Either type of approach can serve as the basis for developing strategies for improving the performance of health care organizations.

Community Health Planning↗
PubMed2001

Ownership type and community benefits of women's health centers.

An important aspect of the changing health care system is the growth of women's health centers--organizations that design and deliver services to women. This growth has generated interest in the behavior of centers, especially because of increasing awareness of women's health issues. Using data from the 1994 National Survey of Women's Health Centers, the authors examined the association between ownership of centers and 12 measures of community benefits, and 296 nonprofit and 108 for-profit centers were compared. Overall, the nonprofits performed better than the for-profits in terms of serving underserved women, delivering comprehensive primary care services, providing training for health professionals and education services for clients and the community, and involving the community in center governance. Among women's health centers, the results show that ownership matters, and indicate the importance of supporting providers who serve the underserved and developing a standard of community benefits.

Community-Institutional Relations↗
PubMed2000

Improving cervical cancer screening in hospital settings.

BACKGROUND: Identifying opportunities to offer cervical cancer screening to underscreened women is important for increasing early detection. Maryland law mandates offering Pap tests during hospital admissions. We examined organizational and physician attitudes and practices regarding inpatient screening, to identify mechanisms for increasing the law's effectiveness. METHODS: We analyzed state admission data, a hospital administrators telephone survey, and a mailed survey of Maryland primary and specialty care physicians, to identify overall patterns and subgroup differences regarding screening. RESULTS: Overall, we found significant concern regarding cancer, and evidence of policies and procedures for screening. However, most hospitals and providers offered screening without assessing clinical need or including persuasive recommendations. Providers with significantly less engagement in preventive assessment and screening included medical and surgical subspecialists and non-primary care providers. Providers to African-American and Medical Assistance women were also less likely to have knowledge, attitudes, and practices conducive to inpatient screening. CONCLUSIONS: Adequate support and infrastructure for preventive screening exist within hospitals. Adding clinical assessment and persuasive education could in crease the impact of these mechanisms, and improve prevention among underscreened inpatient populations.

Attitude of Health Personnel↗
PubMed2000

The trends in health care delivery for women: challenges for medical education.

The author discusses four key trends in the U.S. health care delivery system that affect how women's health care is delivered: the restructuring of primary care, particularly in the context of managed care organizations; initiatives in quality assessment; changes in patterns of health insurance coverage; and threats to the health care safety net. She concludes that medical educators need to link training to these changes in the health care delivery system to prepare physicians to work effectively for women's health in the changing system and to help bring about appropriate, needed transformations of the institutions in which women's health care is provided. Specific recommendations for medical educators are given after the discussion of each trend.

Delivery of Health Care↗
PubMed2000

Measuring quality in women's health care: issues and recent developments.

This article provides a discussion of some key quality issues in women's health care and of some recent developments in quality measurement in women's health. The work of the Women's Health Measurement Advisory Panel of the National Committee for Quality Assurance is described to illustrate some challenges and avenues for development of quality measures that address key health concerns of women and reflect their perspectives. The development of quality measures in women's health is essential for quality reporting that is meaningful for women, for quality improvement efforts within health care organizations, and for research to identify the conditions that optimize quality in women's health care.

Adolescent↗
PubMed1998

The accuracy of substituted judgments in patients with terminal diagnoses.

BACKGROUND: Patients' loved ones often make end-of-life treatment decisions, but the accuracy of their substituted judgments and the factors associated with accuracy are poorly understood. OBJECTIVE: To assess the accuracy of judgments made by surrogate decision makers; ascertain the beliefs, practices, and clinical and sociodemographic factors associated with accuracy of surrogates' decisions; assess the preferences of patients for life-sustaining treatments; and compare differences in accuracy across diagnoses. DESIGN: Cross-sectional paired interviews. SETTING: Outpatient practices of three university hospitals. PATIENTS: 250 patients with terminal diagnoses of congestive heart failure, AIDS, amyotrophic lateral sclerosis, lung cancer, and chronic obstructive pulmonary disease (50 patient-surrogate pairs in each group) and 50 general medical patients and their surrogates. MEASUREMENTS: The accuracy of surrogate predictions was measured by using scales based on 10 potential treatments in each of three hypothetical clinical scenarios. RESULTS: Preferences varied according to mode of treatment and scenario. On average, surrogates made correct predictions in 66% of instances. Accuracy was better for the permanent coma scenario than for the scenarios of severe dementia or coma with a small chance of recovery (P < 0.001). In a binary logit model, the accuracy of substituted judgments was positively associated with the patient having spoken with the surrogate about end-of-life issues (odds ratio [OR], 1.9 [95% CI, 1.6 to 2.3]), the patient having private insurance (OR, 1.4 [CI, 1.1 to 1.7]), the surrogate's level of education (OR, 1.5 [CI, 1.2 to 1.9]), and the patient's level of education (OR, 1.7 [CI, 1.4 to 2.2]). Accuracy was negatively associated with the patient's belief that he or she would live longer than 10 years (OR, 0.6 [CI, 0.5 to 0.7]), surrogate experience with life-sustaining treatment (OR, 0.4 [CI, 0.3 to 0.5]), surrogate participation in religious services (OR, 0.67 [CI, 0.50 to 0.91]), and a diagnosis of heart failure (OR, 0.6 [CI, 0.5 to 0.8]). Age, ethnicity, marital status, religion, and advance directives were not associated with accuracy. CONCLUSIONS: The accuracy of substituted judgments is associated with multiple clinically apparent patient and surrogate factors. This information can help clinicians identify conditions under which substituted judgments are likely to be accurate or inaccurate and can help target populations for education designed to improve the accuracy of surrogate decision making.

Adult↗
PubMed1998

Provision of mental health services in women's health centers.

Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of comprehensive care was implemented with respect to mental health services. Specifically, we examined the rates of screening and treatment for a subset of mental health and behavioral and social problems in women's health centers and the structural, staffing, philosophical, and patient factors associated with the provision of services. Across 12 services, the overall rates of provision ranged from 7.7% for screening for dementing disorders to 27.6% for smoking cessation counseling and treatment. In a series of logistic regressions, center type (primary care) and having a mental health staff person were consistently associated with service provision; other important variables were having a high percentage of women using the center as their usual source of care and having a belief in women-centered care. Findings indicate that the majority of women using women's health centers do not receive services in a comprehensive care environment that includes key mental health services.

Adolescent↗
PubMed1997

Changing definitions of women's health: implications for health care and policy.

OBJECTIVES: To present an overview of how and why normative conceptions of women's health are changing and to discuss some implications of definitional shifts in the context of the changing U.S. health care system. METHOD: The paper describes the historical development of views of women's health and health care, contrasts the biomedical and biopsychosocial perspectives on women's health, and presents some evidence of challenges and opportunities for change in health care and policy. RESULTS: While women's health has generally been equated with reproductive functions, expanded definitions focus on health through the life span and in the context of women's multiple roles and diverse social circumstances. This expanded view highlights the limitations of health services and policy based on narrower conceptions and program mandates and the need for strategies for integrated, continuous care. There is evidence of change in women's health care, including in Title V programs. CONCLUSIONS: New understandings of women's health are particularly relevant to maternal and child health programs, which are positioned to provide model approaches for improving women's health care.

Adolescent↗
PubMed1997

Characteristics of current hospital-sponsored and nonhospital birth centers.

OBJECTIVES: (1) To describe contemporary birth centers in terms of the population served, organizational and financial characteristics, services provided, mission and philosophy, and planning and marketing techniques. (2) To compare hospital-sponsored and nonhospital models with regard to the above characteristics. METHOD: Data from the National Survey of Women's Health Centers conducted in 1994 are analyzed using t-tests and chi-square tests. RESULTS: Contemporary birth centers serve a diverse population of women and provide a range of clinical and nonclinical services. Birth centers are both hospital-sponsored and nonhospital, with the former growing at a faster rate. Compared to hospital-sponsored centers, nonhospital centers serve a larger proportion of uninsured women, provide a broader range of clinical services, and are more committed to women-centered care. Centers utilize different marketing methods and are involved in a number of organizational changes to better position themselves in the changing health care environment. CONCLUSIONS: Birth centers offer an attractive option to consumers and are a viable model for delivering women-centered care. Given that all "birth center" facilities do not share the same philosophy and service mix, women need to have some assurance of what a "birth center" will, and will not, provide.

Adult↗
PubMed1997

Physician gender and women's preventive services.

OBJECTIVE: To determine whether the gender of women's regular physicians, controlling for physician specialty, is associated with women's receiving key preventive services within recommended intervals. DESIGN: Cross-sectional, nationally representative women's health telephone survey conducted by Louis Harris and Associates in February and March 1993 for The Commonwealth Fund. PARTICIPANTS: A total of 2,525 women in the continental United States, > or = 18 years old, including oversamples of African-American and Hispanic women. MAIN OUTCOME MEASURES: Receipt of each of five preventive services (blood pressure reading, Pap smear, cholesterol test, clinical breast examination, and mammogram) within specific periods. RESULTS: Physician gender makes a significant difference for two specialty areas and for three preventive services. Patients of women family or general practitioners are more likely than the patients of men to have received a Pap smear or a blood cholesterol test within the last 3 years, and the patients of women internists are more likely to have received a Pap test. Physician gender is associated with a higher likelihood of mammography, but this finding was limited to patients ages 40-49 of women family or general practitioners. Physician gender does not affect receipt of blood pressure screening or breast examination. CONCLUSIONS: Analyses reveal limited evidence that physician gender affects women's receipt of preventive services. Physician specialty appears to be a more powerful predictor of preventive services received. The limited evidence for a physician gender effect, however, is relevant for those women who rely on a family or general practitioner or an internist for regular care.

Adolescent↗
PubMed1995

Management education for nurses: hospital executives' opinions and hiring practices.

Because registered nurses are assuming expanded roles in hospital management, the appropriate educational preparation for these roles has become a widely debated issue. A national survey of hospital CEOs and CNOs was conducted to assess their personal preferences for management education for nurses and to gather information about their hospitals' policies and practices in hiring nurses for management positions at various levels within the hospital (from unit-level management to executive level). Both CEOs and CNOs preferred the joint MSN/MBA degree option as the best model for graduate management education for nurses, and they perceived greater demand in the future for hospital nurses with graduate management degrees. However, hospital policies and practices with regard to degree requirements and preferences for nurses hired in management positions at all levels varied widely.

Attitude of Health Personnel↗
PubMed1994

The acceptance and growth of MSN/MBA programs.

The value of graduate programs that enable nurses to earn masters degrees in nursing (MSN) and business administration (MBA) through coordinated courses of study has been debated repeatedly. This article describes the subsequent development of the dual degree option (MSN/MBA) within US nursing graduate programs, explores the opportunities and problems reported by programs offering this form of education, and considers the future development of these types of programs. The article is based on a survey of 167 schools of nursing offering graduate programs. The authors describe the challenges to these programs' continued expansion and the role that healthcare reform may have in shaping the education market.

Curriculum↗