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Dan R Berlowitz

Publications and source records attributed to Dan R Berlowitz.

43 records · Page 3Linked to original sources
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Disparities in diabetes care: impact of mental illness.

BACKGROUND: Emerging evidence indicates that patients with mental health conditions (MHCs) may receive less intensive medical care. Diabetes serves as a useful condition in which to test for MHC-related disparities in care. We examined whether quality measures for diabetes care are worse for patients with or without MHCs. METHODS: This national, cross-sectional study included 313 586 noninstitutionalized Veterans Health Administration patients with diabetes (identified from diagnostic codes and prescriptions) whose Veterans Health Administration facility transmitted laboratory data to a central database; 76 799 (25%) had MHCs (based on diagnostic codes for depressed mood, anxiety, psychosis, manic symptoms, substance use disorders, personality disorders, and other categories). National data from Veterans Health Administration records, Medicare claims, and a national survey were linked to characterize 1999 diabetes care. RESULTS: Failure to meet diabetes performance measures was more common in patients with MHCs: unadjusted odds ratio (95% confidence interval) was 1.24 (1.22-1.27) for no hemoglobin A(1c) testing, 1.25 (1.23-1.28) for no low-density lipoprotein cholesterol testing, 1.05 (1.03-1.07) for no eye examination, 1.32 (1.30-1.35) for poor glycemic control, and 1.17 (1.15-1.20) for poor lipemic control. Disparities persisted after case mix adjustment and were more pronounced with specific MHCs (psychotic, manic, substance use, and personality disorders). The percentage not meeting diabetes care standards increased with increasing number of MHCs. CONCLUSION: Patients with mental illness merit special attention in national diabetes quality improvement efforts.

Age Factors↗
PubMedDate not supplied

The effects of changes in nursing home staffing on pressure ulcer rates.

OBJECTIVE: To examine the relationships between various components of nursing home staffing (total staffing levels and staff mix, staff turnover, and changes in staffing patterns) to an important measure of quality, risk-adjusted rates of pressure ulcer development. DESIGN, SETTING, AND MEASUREMENTS: Staffing records from 35 Department of Veterans Affairs (DVA) nursing homes were reviewed and nursing home administrators from each of the facilities were interviewed. Incidence rates for pressure ulcers were obtained from DVA's national long-term care database and risk adjusted using patients' baseline characteristics. The relationships of risk-adjusted pressure ulcer rates to staffing patterns were tested. RESULTS: Although there was no linear association between staffing levels and pressure ulcer rates, data analysis revealed a strong trend (P = .07) that among the nursing homes meeting staffing guidelines, 60% were among the best performing. Ten nursing homes reduced staffing levels from their baseline levels at the beginning of the study and/or changed their staffing mix by replacing licensed personnel with nursing assistants. This change was associated with a 2.1% higher rate of pressure ulcer development (P = .004). CONCLUSION: Changes in nursing home staffing patterns (either a decrease in overall staffing levels or a change in staffing mix) are related to the quality of nursing home care. Staff stability is associated with better outcomes.

Cross-Sectional Studies↗
PubMedDate not supplied

Do different case-mix measures affect assessments of provider efficiency? Lessons from the Department of Veterans Affairs.

Although case-mix adjustment is critical for provider profiling, little is known regarding whether different case-mix measures affect assessments of provider efficiency. We examine whether two case-mix measures, Adjusted Clinical Groups (ACGs) and Diagnostic Cost Groups (DCGs), result in different assessments of efficiency across service networks within the Department of Veterans Affairs (VA). Three profiling indicators examine variation in resource use. Although results from the ACGs and DCGs generally agree on which networks have greater or lesser efficiency than average, assessments of individual network efficiency vary depending upon the case-mix measure used. This suggests that caution should be used so that providers are not misclassified based on reported efficiency.

Aged↗
PubMedDate not supplied

Pressure-related deep tissue injury under intact skin and the current pressure ulcer staging systems.

OBJECTIVE: To identify how current pressure ulcer staging systems and experts describe pressure-related deep tissue injury under intact skin in the published research literature. DESIGN: A systematic review of published English-language literature as of November 2002 with the words decubitus or pressure ulcer(s) in the title. Additional relevant articles were identified by National Pressure Ulcer Advisory Panel members and were included in the analysis. An expert commentary was developed by iterative review by the National Pressure Ulcer Advisory Panel members. MAIN OUTCOME MEASURES: Manuscripts were reviewed for staging systems cited or described, definitions of Stage I pressure ulcers, and descriptions or definitions of pressure-related deep tissue injury under intact skin. MAIN RESULTS: Ninety-four relevant articles were identified. Seventy-three articles (78%) described a staging system, and 55 of 73 (75%) cited the staging definitions from Shea, the National Pressure Ulcer Advisory Panel, or the Agency for Health Care Policy and Research. The National Pressure Ulcer Advisory Panel's staging definitions were the most frequently cited overall. Twenty-three articles (25%) included some discussion that could be interpreted as relevant to the topic of pressure-related deep tissue injury under intact skin; however, no consistency in definitions of Stage I pressure ulcers or terminology for pressure-related deep tissue injury under intact skin was found. CONCLUSIONS: Several pressure ulcer staging systems are frequently cited, but none define pressure-related deep tissue injury under intact skin. The National Pressure Ulcer Advisory Panel recommends using the terms "pressure-related deep tissue injury under intact skin" or "deep tissue injury under intact skin" for describing these lesions and encourages investigators to establish the epidemiology and natural history of these lesions.

Humans↗
PubMedDate not supplied

The PUSH tool: a survey to determine its perceived usefulness.

OBJECTIVE: To determine the perceived usefulness of the Pressure Ulcer Scale for Healing (PUSH). PARTICIPANTS: A convenience sample identified through the National Pressure Ulcer Advisory Panel Web site as users or registered users of the PUSH tool. MAIN OUTCOME MEASURE: A survey instrument was developed to capture experience, ease of use, and perceived utility and weakness of the PUSH tool. RESULTS: Of 103 respondents, most (79) agreed or strongly agreed that PUSH required an appropriate amount of time to complete. It was also found to be reliable and easy to use and teach to others. Respondents were not as positive regarding usefulness, with 75% indicating that increased PUSH scores prompt patient and treatment reassessment. Respondents agreed or strongly agreed that improvement is possible in the size subscale (59%), the tissue type subscale (49%), and the exudate amount subscale (32%). Most commonly indicated for improvement was the addition of wound depth information. CONCLUSION: Respondents generally found PUSH easy to use and helpful in pressure ulcer management. Specific areas of improvement were also identified.

Attitude of Health Personnel↗
PubMedDate not supplied

Identifying hypertension-related comorbidities from administrative data: what's the optimal approach?

The objective was to determine the best strategy for identifying outpatients with hypertension-related diagnoses using Veterans Affairs (VA) administrative databases. We reviewed 1176 outpatient charts from 10 VA sites in 1999, taking the presence of 11 diagnoses relevant to hypertension management as the "gold standard" for identifying the comorbidity. We calculated agreement, sensitivity, and specificity for the chart versus several administrative data-based algorithms. Using 1999 data and requiring 1 administrative diagnosis, observed agreement ranged from 0.98 (atrial fibrillation) to 0.85 (hyperlipidemia), and kappas were generally high. Sensitivity varied from 38% (tobacco use) to 97% (diabetes); specificity exceeded 91% for 10 of 11 diagnoses. Requiring 2 years of data and 2 diagnoses improved most measures, with minimal sensitivity decrease. Agreement between the database and charts was good. Administrative data varied in its ability to identify all patients with a given diagnosis but identified accurately those without. The best strategy for case-finding required 2 diagnoses in a 2-year period.

Algorithms↗