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Biomedical subjects

Carol S Weisman

Publications and source records attributed to Carol S Weisman.

At least 19 recordsLinked to original sources
PubMed2006

Patient preferences, satisfaction, and resource use in office evacuation of early pregnancy failure.

OBJECTIVE: To examine patient treatment preferences and satisfaction with an office-based procedure for early pregnancy failure and to compare resource use and cost between office and operating room management of early pregnancy failure. METHODS: This study was a prospective observational study of 165 women presenting for surgical management of early pregnancy failure. Participants completed a preoperative questionnaire addressing treatment preferences and expectations and a postoperative questionnaire measuring level of pain experienced and satisfaction with care. Resource use was determined by measuring the time patients spent at the health care facility and the actual procedure time. Cost was estimated using an institutional database. RESULTS: One hundred fifteen women from the office and 50 from the operating room were enrolled. Patients selecting outpatient management scored "privacy," "avoiding going to sleep," and "previous experience" higher than the operating room group (P < .05). Patients who perceived that their physicians preferred one procedure over the other were more likely to select that procedure (P < .001). Satisfaction was high in both groups, and underestimating the procedure's discomfort was negatively associated with satisfaction (P < .002). Costs were greater than two-fold higher in the operating room group compared with the office group (P < .01). Complications were uncommon, but hemorrhage-related complications were four times more common in the operating room group than in the office group (P < .01). CONCLUSION: Office-based surgical management of early pregnancy failure is an acceptable option for many women and offers substantial resource and cost savings. LEVEL OF EVIDENCE: II-2.

Abortion, Incomplete↗
PubMed2006

Gender disparities in percutaneous coronary interventions for acute myocardial infarction in Pennsylvania.

BACKGROUND: It has been shown that women are at greater risk than men of not receiving screening and treatment services for coronary heart disease. The purpose of this research was to determine whether there were gender disparities in the use of percutaneous coronary interventions (PCI) in the treatment of acute myocardial infarction (AMI) in Pennsylvania in 2000 and, if so, whether outcomes were affected. METHODS: Data included 10,170 patients treated with PCI and 21,181 patients medically managed in Pennsylvania hospitals. Multivariate analyses were performed using logistic regression to estimate the impact of gender on PCI. In addition, we performed retrospective matching on propensity scores to compare outcomes for women who were treated with PCI to comparable groups of women and men. RESULTS: After controlling for age, race/ethnicity, severity at admission, location of infarct, and source of admission, women had 24% lower odds than men of receiving PCI (P<0.0001). In a propensity score-matched sample of 3023 women who received PCI and 3023 women who did not, women who received PCI were significantly less likely to die (2.3% vs. 10.4%, P<0.0001). In a second propensity score-matched sample of 3329 women and 3329 similar men who received PCI, the difference in mortality was not statistically significant (1.59% vs. 1.92%, P=0.39). CONCLUSIONS: These results suggest that the morbidity and mortality associated with AMI in women could be reduced by increased use of PCI and that more women admitted for AMI should receive consideration for PCI.

Aged↗
PubMed2005

Women's patterns of provider use across the lifespan and satisfaction with primary care coordination and comprehensiveness.

BACKGROUND: Women have different patterns of provider use across the lifespan, but few studies have investigated women's evaluations of their primary care providers at different ages. OBJECTIVE: We sought to investigate the relationship between patterns of regular provider use and women's satisfaction with primary care across the lifespan. RESEARCH DESIGN: A sample of 1197 women ages 18 to 87 making primary health care visits was surveyed. Satisfaction with primary care in the past year was measured with a subscale the Care Coordination and Comprehensiveness subscale of the Primary Care Satisfaction Survey for Women (PCSSW). Bivariate comparisons and age stratified multivariate ordinal logistic regression models were estimated. RESULTS: Women in their early reproductive years (ages 18 to 34) are more satisfied with care coordination and comprehensiveness when their regular provider is a reproductive health specialist, primarily obstetrician gynecologist (ob/gyn) physicians. The odds of higher satisfaction are reduced with a generalist regular provider (OR = 0.38, P < 0.01), a generalist regular provider plus an ob/gyn (OR = 0.47, P < 0.05), or no regular provider (OR = 0.52, P < 0.05). The pattern of regular provider use is not significantly associated with satisfaction for women in other age categories. CONCLUSIONS: Most adult women see generalists for their primary health care, either alone or in combination with ob/gyns. Among younger women satisfaction is higher when an ob/gyn is the regular provider. Further research must consider women's perspectives on their provider use patterns and the appropriate role of ob/gyns in women's primary care across the lifespan.

Adult↗
PubMed2005

Variations among Institutional Review Board reviews in a multisite health services research study.

OBJECTIVE: To document the Institutional Review Board (IRB) review process and to explore the impact of different patient notification procedures. DATA SOURCES/STUDY SETTING: Review of IRB application and correspondence records prospectively collected during a multisite study of health care quality involving telephone interviews of 3,000 participants across 15 primary care sites. STUDY DESIGN: Records were reviewed to ascertain: (1) the type of IRB review conducted, (2) the number of days from submission to approval of the IRB application, (3) whether the IRB required patient notification and/or consent prior to the release of names, and (4) patient participation rates. DATA COLLECTION/EXTRACTION METHODS: The study coordinating center prepared a common study protocol for IRB submission and assisted sites with submission. The application, correspondence with the IRB, consent script, and patient letters were collected, reviewed, coded, and analyzed. PRINCIPAL FINDINGS: IRBs at the 15 sites and survey center varied in the type of IRB required and the number of days from submission to approval (range of 5-172 days). Four sites required patient notification in advance of the study; 2-11 percent of patients refused in opt-out sites and 37 percent in the single opt-in site. Participation among contacted patients did not appear to be related to patient notification procedures. CONCLUSIONS: Variations in IRB requirements can affect response rates and sample generalizability.

Adult↗
PubMed2005

Survival strategies for Michigan's health care safety net providers.

OBJECTIVE: To understand key adaptive strategies considered by health care safety net organizations serving uninsured and underinsured populations in Michigan. DATA SOURCES/STUDY SETTING: Primary data collected through interviews at community-based free clinics, family planning clinics, local public health departments, and Federally Qualified Health Centers from 2002 to 2003. RESEARCH DESIGN: In each of six service areas in Michigan, we conducted a multiple-site case study of the four organizations noted above. We conducted interviews with the administrator, the medical or clinical director, the financial or marketing director, and a member of the board of directors. We interviewed 74 respondents at 20 organizations. PRINCIPAL FINDINGS: Organizations perceive that unmet need is expanding faster than organizational capacity; organizations are unable to keep up with demand. Other threats to survival include a sicker patient population and difficulty in retaining staff (particularly nurses). Most clinics are adopting explicit business strategies to survive. To maintain financial viability, clinics are: considering or implementing fees; recruiting insured patients; expanding fundraising activities; reducing services; or turning away patients. Collaborative strategies, such as partnerships with hospitals, have been difficult to implement. Clinics are struggling with how to define their mission given the environment and threats to survival. CONCLUSIONS: Adaptive strategies remain a work in progress, but will not be sufficient to respond to increasing service demands. Increased federal funding, or, ideally, a national health insurance program, may be the only viable option for expanding organizational capacity.

Administrative Personnel↗
PubMedDate not supplied

The development and validation of the primary care satisfaction survey for women.

Assessing patient satisfaction with health care is becoming an integral component of quality monitoring in health care systems, but existing tools typically were developed to minimize differences related to gender. This paper reports the development and psychometric properties of a new survey instrument to measure women's satisfaction with their primary care. A multisite, cross-sectional validation survey of 1,202 women receiving care in primary care settings in Michigan, North Carolina, and Pennsylvania was conducted. Item response theory (IRT) and factor analysis methods were used to identify three scales in the Primary Care Satisfaction Survey for Women (PCSSW): Communication, Administration and Office Procedures, and Care Coordination and Comprehensiveness. Internal consistency reliability is reported, as well as convergent validity in relation to two generic measures (Medical Outcomes Study [MOS] Visit Satisfaction and Consumer Assessment of Health Plans Survey [CAHPS] overall quality rating); discriminant validity in relation to groups expected to have differing satisfaction levels based on previous literature; predictive validity in relation to behavioral intentions; and explanatory power in overall satisfaction ratings. The 24-item PCSSW may be self-administered or conducted by telephone and may be used in studies to evaluate or improve the quality of primary care for women.

Adult↗
PubMedDate not supplied

The role of physician gender in the evaluation of the National Centers of Excellence in Women's Health: test of an alternate hypothesis.

A 2002 evaluation of the National Centers of Excellence in Women's Health (CoE) provided evidence that women receive higher-quality primary health care, as indicated by receipt of recommended preventive care and patient satisfaction, when they receive their care in comprehensive women's health centers. A potential rival explanation for the CoE evaluation findings, however, is that the higher quality of care in the CoE may be attributable to a predominance of female physicians in CoE settings. More women who receive health care in a CoE have a female regular physician and female physicians may provide more preventive health services. Additionally, women may self-select into the CoE because of their preference for female providers. This paper presents results of an analysis examining the role of physician gender in the CoE evaluation. Women seen in three CoE clinics and women seen in other settings in the same communities who had a female physician are compared to assess the CoE effect while controlled for physician gender. The findings confirm a positive CoE effect for many of the quality of care indicators that were observed in the original evaluation. Women seen in CoEs are more likely to receive physical breast examinations and mammograms (ages > or =50). In addition, positive CoE findings for counseling on domestic violence, sexually transmitted diseases, family or relationship concerns, and sexual function or concerns were upheld. The CoE model of care delivers advantages to women that are not explained by the greater number of female physicians in these settings.

Adult↗
PubMedDate not supplied

Threats to family planning services in Michigan: organizational responses to economic and political challenges.

Title X is the only federal funding specifically for contraception and family planning services. This study identifies the threats and challenges Title X family planning organizations face in Michigan, and examines organizational responses to these challenges. We hypothesized that organizational responses to current challenges, including recent legislation, would differ between organizational types. We used a multiple case study design to examine safety net providers that received Title X funding in 2001. Cases were selected to represent economic and geographic diversity and included a mix of population densities. Key informants at each organization participated in face-to-face, semistructured interviews. Interviews collected data on current challenges, organizational planning processes, and organizational responses. All Title X organizations reported significant challenges, including rising costs, increasing need, and inadequate funding. Private organizations were more concerned about political challenges, especially recent Michigan legislation, than health departments. Organizational type was associated with the type of response. Health departments tended to close clinics or cut services, whereas private organizations recruited insured populations and increased patient fees. Based on these findings, the family planning safety net in Michigan appears to be undergoing significant change. These changes may decrease the availability of affordable family planning services in Michigan.

Community Health Centers↗
PubMedDate not supplied

Mental health services provided through the National Centers of Excellence in Women's Health: do they reach rural women?

The National Centers of Excellence in Women's Health (CoEs) were established in part to provide integrated, comprehensive health care including mental health services to women. The purpose of this study was to identify mental health services currently provided by each of the 19 CoEs throughout the United States and to assess the extent to which these services are targeted to and utilized by rural women. Methods included both website review and semistructured interviews with knowledgeable informants in the CoEs. Center websites varied widely in mental health services mentioned: one CoE described services for nine different types of mental health issues, while one-fourth of the CoEs included no mention of any specific mental health services. Only four websites indicated that rural women were part of the CoE target population. Knowledgeable informant interviews indicated that seven of the CoEs had mental health staff onsite providing mental and behavioral health services. These services most often included treatment for depression and other mood disorders and for stress, as well as counseling for domestic violence issues. None of the CoEs offered mental or behavioral health services specifically targeted to rural women. We conclude that although they have not done so to date, the CoEs would be good sites in which to develop and test mental health outreach services for rural women.

Adult↗
PubMedDate not supplied

Contraceptive use by diabetic and obese women.

PURPOSE: Women with chronic medical conditions are at increased risk for adverse pregnancy outcomes, yet contraceptive use by these women has not been well described. The purpose of this study was to describe contraceptive use by diabetic and overweight/obese women compared with women without these conditions. METHODS: Using cross-sectional data from the 11 states participating in the optional Family Planning Module of the Behavioral Risk Factor Surveillance System in 2000, we analyzed contraceptive use among 7,943 sexually active women of reproductive age (18-44) who were not trying to conceive. Using logistic regression techniques, we modeled the effect of diabetes and overweight/obesity on contraceptive nonuse, controlling for age, race/ethnicity, marital status, education, income, and health insurance coverage. MAIN FINDINGS: Contraceptive nonuse was reported by 1,500 (18.9%) of the total sample, 31 (25.8%) diabetic women, 371 (20.0%) overweight women, and 385 (23.4%) obese women. In the multivariable model, obesity was significantly associated with contraceptive nonuse (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.16-1.55), but there were no significant differences in contraceptive nonuse for diabetic women (adjusted OR 1.23, 95% CI 0.80-1.87) or overweight women (adjusted OR 1.14, 95% CI 0.99-1.31). Older, Black, Hispanic, married, less educated, and women without health insurance were more likely to report contraceptive nonuse. CONCLUSION: Among women with need for contraception, obese women were more likely to report contraceptive nonuse than normal weight women. Because women with chronic conditions like obesity are at higher risk of pregnancy-related complications and adverse pregnancy outcomes, proper contraceptive use and unintended pregnancy avoidance is a priority.

Adolescent↗
PubMedDate not supplied

Preconceptional health: risks of adverse pregnancy outcomes by reproductive life stage in the Central Pennsylvania Women's Health Study (CePAWHS).

This study used population-based data to examine how health status and risks vary by reproductive life stage, with particular focus on the proximal risks for preterm birth and low birthweight (LBW) infants in preconceptional and interconceptional women. Data are from the Central Pennsylvania Women's Health Study (CePAWHS), which included a telephone survey of a representative sample of 2,002 women ages 18-45 years residing in largely rural central Pennsylvania. Women were classified according to reproductive stage--preconceptional, interconceptional, and postconceptional--on the basis of pregnancy history and reproductive capacity. Multiple indicators of health status and health risks were examined by reproductive stage, stratified by age group (ages 18-34 and ages 35-45). Results show that many risk factors varied significantly by reproductive stage and by age group within reproductive stage. Preconceptional and interconceptional women exhibited several unhealthy behaviors (e.g., binge drinking, nutritional deficits, physical inactivity). Younger pre- and interconceptional women (ages 18-34) had more gynecologic infections, some less favorable health behaviors, and more psychosocial stress than older women (ages 35-45) in the same reproductive stages. Older preconceptional women were more likely to have chronic conditions (hypertension, high cholesterol) than younger preconceptional women. Results suggest how interventions could be tailored to women's reproductive stages.

Adult↗
PubMedDate not supplied

Performance indicators in women's health: incorporating women's health in the health plan employer data and information set (HEDIS).

The Health plan Employer Data and Information Set (HEDIS) is limited in its scope of women's health-related performance measures. Realizing this, the National Committee for Quality Assurance developed the Women's Health Measurement Advisory Panel (MAP) to expand and develop HEDIS measures to better represent women's health issues. This paper outlines the development of several new women's health-related performance measures and highlights the complexities of creating new measures to assess the quality of care provided to women through our nation's managed care organizations.

Contraception Behavior↗
PubMedDate not supplied

Contraceptive counseling in managed care: preventing unintended pregnancy in adults.

This study examines contraceptive counseling received by adult women in their managed care plans and the relationship between counseling and women's contraceptive attitudes and practices. Telephone interviews were conducted with a random sample of 898 women ages 18 to 44 enrolled in a commercial health maintenance organization (HMO) or point-of-service (POS) health plan. Counseling received in the past 2 years was measured on three dimensions: exposure through any communication channel; content of information; and personalization of discussion. Multiple logistic regression analysis was used to examine the determinants of counseling and the relationship between counseling and four outcomes: satisfaction with counseling received, self-efficacy for preventing unintended pregnancy, current use of contraception (if at risk of unintended pregnancy), and intent to contracept in the next year (if at risk). Overall, 60.5% of women were at risk of unintended pregnancy; among those at risk, 69% received any counseling in the past 2 years, compared with 38% among those not at risk. Receiving personalized counseling (as opposed to no counseling or only informational counseling) significantly increases the odds of satisfaction with counseling, current contraceptive use, and intent to contracept. Informational counseling alone (without personalization) significantly increases the odds of contraceptive use. Women ages 40-44 were less likely than younger women to receive counseling and to use contraception if at risk of unintended pregnancy. We conclude that receiving contraceptive counseling in managed care is associated with contraceptive attitudes and practices among adults and that there is substantial room for quality improvement in the provision of contraceptive counseling.

Adult↗
PubMedDate not supplied

Are two doctors better than one? Women's physician use and appropriate care.

This study examines nonelderly women's concurrent use of two types of physicians (generalists and obstetrician-gynecologists) for regular health care and associations with receipt of preventive care, including a range of recommended screening, counseling, and heart disease prevention services. Data are from the 1999 Women's Health Care Experiences Survey conducted in Baltimore, Maryland, using random digit dialing (N = 509 women ages 18 to 64). Key findings are: 58% of women report using two physicians (a generalist and an ob/gyn) for regular care; seeing both a generalist and an ob/gyn, compared with seeing a generalist alone, is consistently associated with receiving more clinical preventive services, including screening, counseling, and preventive services related to heart disease. Because seeing an ob/gyn in addition to a generalist physician is associated with receiving recommended preventive services (even for heart disease), the findings suggest that non-elderly women who rely on a generalist alone may receive substandard preventive care. The implications for women's access to ob/gyns and for appropriate design of women's primary care are discussed.

Adolescent↗
PubMedDate not supplied

Evaluation of the quality of care in the clinical care centers of the National Centers of Excellence in Women's Health.

This study evaluated the quality of primary care services provided in 15 National Centers of Excellence in Women's Health (CoE) clinical sites in operation in 2001 using self-reported clinical preventive services and patient satisfaction as indicators of quality of care. A sample of 3,111 women served by the CoE program was surveyed and compared with quality of care benchmarks from national and local community surveys. The benchmark surveys were: a nationally representative sample of 2,075 women from the 1998 Commonwealth Fund Survey of Women's Health; a community sample of women who lived within a geographical catchment area for three CoEs; and a sample of 71,438 women in the 1999 Consumer Assessment of Health Plans Study (CAHPS) of commercial managed care plans. Adjusting for region, age, education, perceived health status, and managed care enrollment, women in the CoEs were more satisfied with their care and had received significantly more screening tests and counseling services than women in the benchmark samples. The largest effects among primary care services were for physical breast examination, mammogram (ages 50+), and counseling for smoking, domestic violence, and sexually transmitted diseases.

Benchmarking↗
PubMedDate not supplied

A disease-specific Medicaid expansion for women. The Breast and Cervical Cancer Prevention and Treatment Act of 2000.

The Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) allows states the option of extending Medicaid eligibility to women diagnosed with breast or cervical cancer through a large federal screening program that does not include resources for treatment. Using qualitative data from interviews with 22 key informants and other sources, we present an analysis of the history and passage of the BCCPTA as a policy response to a perceived "treatment gap" in a national screening program. The results suggest that organizational policy entrepreneurs-primarily the National Breast Cancer Coalition-constructed an effective problem definition (that the government screening program was "unethical" and "broken") with a viable policy solution (an optional disease-specific Medicaid expansion), and pushed this proposal through a policy window opened by a budget surplus and an election year in which women's health issues had broad bipartisan appeal.

Breast Neoplasms↗