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Biomedical subjects

J E Ware

Publications and source records attributed to J E Ware.

At least 127 records · Page 7Linked to original sources
PubMed1987

Standards for validating health measures: definition and content.

Adherence to standards for judging the content validity of health measures and for labeling them is needed for the field of health assessment to proceed in an orderly fashion. This paper discusses the dimensionality of health and the range of health states that can be measured within each dimension. These two attributes of published definitions of health are used to derive minimum standards for judging the validity of health measures in terms of their content. Five generic health concepts are defined: physical health, mental health, social functioning, role functioning, and general health perceptions. Items from widely used health measures are presented to clarify distinctions among these concepts and the different health states they encompass. It is recommended that labels be assigned to health measures in a manner consistent with their content and other evidence of validity.

Health Status Indicators↗
PubMed1987

Cost-sharing and the use of general medical physicians for outpatient mental health care.

Many patients with emotional disorders receive their mental health care from general medical physicians. In this article, we examine differences in costs and style between mental health care delivered by mental health specialists and that provided by general medical physicians, and the sensitivity to insurance of the patient's choice of mental health care provider. We use data from a randomized trial of cost-sharing, the RAND Health Insurance Experiment. Even when all outpatient mental health care was free (up to 52 visits a year), one-half of the users of outpatient mental health services visited general medical providers only. This half accounted for only 5 percent of outpatient mental health care expenditures, because the treatment delivered by general medical providers was much less intensive than that delivered by mental health specialists. Mental health status, at enrollment, was similar for those who received their mental health care from either provider group. Despite the large difference in cost of care, the choice of provider (mental health specialist versus general medical provider) was not sensitive to the generosity of insurance.

Adult↗
PubMed1986

How cost sharing affects the use of ambulatory mental health services.

The less generous insurance coverage for mental health care has generated some controversy. The major unresolved question is how the demand for outpatient mental health care responds to cost sharing. We used data from a randomized trial of fee-for-service health insurance for the nonelderly to address this question. The study enrolled 5809 persons. The results are based on 19 819 person-years of data. One hundred thirty-three percent more is spent on outpatient psychotherapy when care is free to patients than when they pay 95% of the fee, subject to an annual catastrophic limit. But, the absolute level of expenditure is low on all plans; $32 per person per year with free care. The response to psychotherapy services to cost sharing is insignificantly larger than that for outpatient general medical services. We found no evidence that more generous coverage for outpatient psychotherapy decreases total health expenditures.

Ambulatory Care↗
PubMed1986

Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care.

To determine whether health outcomes in a health maintenance organisation (HMO) differed from those in the fee-for-service (FFS) system, 1673 individuals ages 14 to 61 were randomly assigned to one HMO or to an FFS insurance plan in Seattle, Washington for 3 or 5 years. For non-poor individuals assigned to the HMO who were initially in good health there were no adverse effects. Health outcomes in the two systems of care differed for high and low income individuals who began the experiment with health problems. For the high income initially sick group, the HMO produced significant improvements in cholesterol levels and in general health ratings by comparison with free FFS care. The low income initially sick group assigned to the HMO reported significantly more bed-days per year due to poor health and more serious symptoms than those assigned free FFS care, and a greater risk of dying by comparison with pay FFS plans.

Adolescent↗
PubMed1986

Health as a value: methodological and theoretical considerations.

The concept of value placed on health is very important in several different theoretical approaches to the study of health behavior. In practice, however, health value is generally assumed to be universally high rather than being directly measured. If this assumption is incorrect, then theories that include health value have rarely been adequately tested. This paper presents a short 4-item Likert scale designed to measure the value placed on health. Norms from the utilization of this scale in five different samples are presented. Health value is found to increase with age among girls, but the increase apparently stops by late adolescence, before full adult levels of health value are achieved. Middle-aged women place a higher value on health than do middle-aged men, although no comparable sex difference appears in a sample of undergraduates. Consistent with theoretical predictions, both health locus of control beliefs and beliefs in the efficacy of certain preventive health behaviors correlate more highly with the performance of those same behaviors 5 to 9 months later among respondents who place a high value of health relative to those who do not value health so highly. However, this interaction is found only when it can be safely assumed that health is the primary value underlying the behavior. The importance of considering a variety of values in addition to health as possible motivators of preventive health behavior is stressed.

Adolescent↗
PubMed1986

Sociodemographic factors and the use of outpatient mental health services.

What are the effects of sociodemographic factors on the use of outpatient mental health services when different demographic groups have identical health insurance coverage? The authors answer this question using data from the Rand Health Insurance Experiment. Health insurance was randomly assigned to families representative of the nonaged, noninstitutionalized civilian population in six U.S. sites. Income has no significant total effect on use when all income groups have the same coverage. When the effects of variables correlated with socioeconomic status are removed, users with higher socioeconomic status are significantly more likely to choose a mental health specialist rather than only general medical providers for their mental health care (P less than 0.05); among those who visit mental health specialists, those with higher socioeconomic status incur significantly greater expenses (P less than 0.10). Women use significantly more mental health services than men (P less than 0.05), who in turn use significantly more mental health services than children (P less than 0.05), even after controlling for demographic factors, health status, and insurance coverage. Similarly, there are large differences (roughly sixfold) by site in outpatient mental health expenses even when all sites have identical coverage.

Adolescent↗
PubMed1986

My medical care is better than yours. Social desirability and patient satisfaction ratings.

It is well-documented that ratings of medical care received personally (personal referent) yield more favorable responses than ratings of care received by people in general (general referent). Hence general items are useful in achieving greater variation in responses to satisfaction surveys. However, the validity of general items relative to personal items is being debated currently. It has been hypothesized that bias due to socially desirable response set (SDRS) would be greatest for items with a personal referent. To test this hypothesis, the authors compared both kinds of satisfaction ratings for adults (N = 3,918) who scored high and low on SDRS during Rand's Health Insurance Experiment. Across sites and years of the experiment, the rating item with a personal referent was consistently biased upward for those manifesting SDRS. The rating item with a general referent was not. Further, the correlation between SDRS and the difference between ratings on the personal and general referent items was statistically significant, suggesting that more favorable ratings of medical care received personally compared with ratings of care received by people in general are in part due to SDRS bias. Results are discussed in terms of implications for constructing a valid satisfaction survey.

Adult↗
PubMed1986

Use of outpatient mental health services by a general population with health insurance coverage.

Characteristics of use of mental health services by 4,254 persons enrolled in the Rand Health Insurance Study were analyzed in an attempt to predict patterns of use by a general population with assigned insurance coverage. Families in the study, whose members ranged in age from birth through 62 years, were randomly assigned to one of 14 insurance plans covering a wide variety of services by all licensed provider groups. During a one-year period less than 4 percent of the enrollees visited a mental health specialist, and only 7.1 percent saw any provider for mental health care. About half of those receiving outpatient mental health care visited general medical providers only. Annual outpatient mental health expenses per enrollee were about $25 (1983 dollars). The authors compare their findings with those of other studies and discuss their implications for insurance coverage of mental health services.

Ambulatory Care↗
PubMed1986

Effects of cost sharing on seeking care for serious and minor symptoms. Results of a randomized controlled trial.

To estimate the effect of cost sharing on seeking care for serious and minor symptoms, we analyzed data for 3539 persons aged 17 to 61 from the Rand Health Insurance Experiment. Participants were randomly assigned to a free-care group or to insurance plans requiring them to pay part of the costs (cost-sharing group). Annual surveys were administered to determine if participants had serious and minor symptoms during the preceding month and whether they saw a physician. Serious symptoms were judged by a panel of physicians to warrant care in most instances; minor symptoms were judged neither to be severe nor to warrant care in most instances. The cost-sharing group was nearly one third less likely than the free-care group to see a physician when they had minor symptoms (6.3% compared with 9.0%; p less than 0.04). The free-care and cost-sharing groups did not differ significantly in seeking care for serious symptoms (22.3% compared with 17.9%; p = 0.095). However, for participants with low socioeconomic status who began the study in poor health, the prevalence of serious symptoms was higher in the cost-sharing than the free-care group (29.1% compared with 23.8%, p less than 0.004).

Adolescent↗
PubMed1986

Consumer acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial.

Do consumers find the care provided by health maintenance organizations (HMOs) and that provided in the fee-for-service (FFS) system equally acceptable? To address this question, we randomly assigned 1,537 people ages 17 to 61 either to FFS insurance plans that allowed choice of physicians or to a well-established HMO. We also studied 486 people who had already selected the HMO (control group). Those who had chosen the HMO were as satisfied overall with medical care providers and services as their FFS counterparts. The typical person assigned to the HMO, however, was significantly less satisfied overall relative to FFS participants. Attitudes toward specific features of care favored both FFS and HMO, depending on the feature rated. Four differences (length of appointment waits, parking arrangements, availability of hospitals, and continuity of care) favored FFS; two (length of office waits, costs of care) favored the HMO. HMO versus FFS differences in ratings of access to care and availability of resources mirror differences in the organizational features of these two systems that are generally considered responsible for the significantly lower medical expenditures at HMOs. Regardless of their origin, less favorable attitudes toward interpersonal and technical quality of care in the HMO have marked consequences: dissatisfaction and disenrollment.

Adolescent↗
PubMed1985

Expanding patient involvement in care. Effects on patient outcomes.

An intervention was developed to increase patient involvement in care. Using a treatment algorithm as a guide, patients were helped to read their medical record and coached to ask questions and negotiate medical decisions with their physicians during a 20-minute session before their regularly scheduled visit. In a randomized controlled trial we compared this intervention with a standard educational session of equal length in a clinic for patients with ulcer disease. Six to eight weeks after the trial, patients in the experimental group reported fewer limitations in physical and role-related activities (p less than 0.05), preferred a more active role in medical decision-making, and were as satisfied with their care as the control group. Analysis of audiotapes of physician-patient interactions showed that patients in the experimental group were twice as effective as control patients in obtaining information from physicians (p less than 0.05). Results of the intervention included increased involvement in the interaction with the physician, fewer limitations imposed by the disease on patients' functional ability, and increased preference for active involvement in medical decision-making.

Adult↗
PubMed1985

Consequences of cost-sharing for children's health.

Do children whose families bear a percentage of their health care costs reduce their use of ambulatory care compared with those families who receive free care? If so, does the reduction affect their health? To answer these questions, 1,844 children aged 0 to 13 years were randomly assigned (for a period of 3 or 5 years) to one of 14 insurance plans. The plans differed in the percentage of their medical bills that families paid. One plan provided free care. The others required up to 95% coinsurance subject to a +1,000 maximum. Children whose families paid a percentage of costs reduced use by up to one third. For the typical child in the study, this reduction caused no significant difference in either parental perceptions of their child's health or in physiologic measures of health. Confidence intervals are sufficiently narrow for most measures to rule out the possibility that large true differences went undetected. Nor were statistically significant differences observed for children at risk of disease. Wider confidence intervals for these comparisons, however, mean that clinically meaningful differences, if present, could have been undetected in certain subgroups.

Child↗
PubMed1984

Methodology in behavioral and psychosocial cancer research. Conceptualizing disease impact and treatment outcomes.

The focus of assessment of disease impact is moving beyond survival and biomedical outcomes to include a comprehensive set of health status and quality of life concepts. We have discussed four socially relevant concepts that can be thought of as dimensions of health status or well being: physiologic status, personal (physical) functioning, mental health, and social well-being. Quality of life was also discussed briefly as a very global concept encompassing these health status dimensions and a broader set of concepts including finances, housing, and employment. Five categories of measures based on manifest content were also discussed, including measures of disease/diagnostic status, personal functioning, mental health, general health perceptions, and social/role functioning. The physiologic dimension of health is very heterogeneous and includes many concepts and measures that vary largely independently of each other and that differ in terms of their impact on the other dimensions of health status. The physical, mental, and social dimensions of health and well-being also can be measured many different ways, and each can be broken down into distinct concepts that may vary in importance from one study to another. Of these three concepts, social well-being is the most heterogeneous. To assist investigators searching for valid measures of specific health status and quality of life concepts, we recommended formal estimations of measurement models. A preliminary model of 15 health status measures was presented to illustrate the usefulness of such a model.

Activities of Daily Living↗
PubMed1984

Physicians' practices in counseling patients about health habits.

The authors developed and tested a model of two dimensions of physicians' behavior in counseling patients about four health habits (smoking, weight control, alcohol consumption, and regular exercise). The two dimensions are the indications for routine counseling and the aggressiveness of counseling style. To test these dimensions, a questionnaire was administered to a random sample of members of a Western County Medical Society in 1978. The response rate was 76%. Indications and Aggressiveness subscales were developed for each habit. Reliability and discriminant validity for all subscales was excellent. Descriptive results were consistent with expectations, e.g., physicians counseled more about smoking and weight control than about alcohol and exercise. The results support the dimensions and suggest that the questionnaire will be useful for future research on counseling behavior.

Alcohol Drinking↗