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Biomedical subjects

J F Fries

Publications and source records attributed to J F Fries.

242 records · Page 14Linked to original sources
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Randomized controlled trial of cost reductions from a health education program: the California Public Employees' Retirement System (PERS) study.

Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p less than .001), 2) reduction of subject reported medical utilization from baseline (p less than .05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.

Age Factors↗
PubMedDate not supplied

The Health Assessment Questionnaire (HAQ).

Patient-reported outcomes (PROs) provide intrinsic knowledge about a patient's health, functional status, symptoms, treatment preferences, satisfaction, and quality of life. They have become an established approach for assessing health outcomes. The Health Assessment Questionnaire (HAQ), introduced in 1980, is among the first PRO instruments designed to represent a model of patient-oriented outcome assessment. The HAQ is based on five patient-centered dimensions: disability, pain, medication effects, costs of care, and mortality. It has been validated by mail, in the office, by telephone, and by comparison with paraprofessional and physician judgments as a reliable instrument, and has been significantly correlated with other PRO instruments. Typically, one of two HAQ versions is used: the Full HAQ, which assesses all five dimensions, and the Short or 2-page HAQ, which contains only the HAQ disability index (HAQ-DI) and the HAQ's patient global and pain visual analog scales (VAS). The HAQ-DI and the global and pain VAS (i.e., the short HAQ) have essentially retained their original content since their inception, while the Full HAQ undergoes periodic revision to address issues of contemporary scientific interest. The HAQ-DI has been translated or culturally adapted into more than 60 different languages or dialects and has become part of the National Institutes of Health "Road-map" Project, the Patient-Reported Outcomes Measurement Information System (PROMIS).

Activities of Daily Living↗
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The promise of PROMIS: using item response theory to improve assessment of patient-reported outcomes.

PROMIS (Patient-Reported-Outcomes Measurement Information System) is an NIH Roadmap network project intended to improve the reliability, validity, and precision of PROs and to provide definitive new instruments that will exceed the capabilities of classic instruments and enable improved outcome measurement for clinical research across all NIH institutes. Item response theory (IRT) measurement models now permit us to transition conventional health status assessment into an era of item banking and computerized adaptive testing (CAT). Item banking uses IRT measurement models and methods to develop item banks from large pools of items from many available questionnaires. IRT allows the reduction and improvement of items and assembles domains of items which are unidimensional and not excessively redundant. CAT provides a model-driven algorithm and software to iteratively select the most informative remaining item in a domain until a desired degree of precision is obtained. Through these approaches the number of patients required for a clinical trial may be reduced while holding statistical power constant. PROMIS tools, expected to improve precision and enable assessment at the individual patient level which should broaden the appeal of PROs, will begin to be available to the general medical community in 2008.

Diagnosis, Computer-Assisted↗
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The Arthritis, Rheumatism and Aging Medical Information System (ARAMIS): still young at 30 years.

Chronic diseases such as atherosclerosis, arthritis, diabetes, and cancer are among major public health concerns. To understand their cumulative risk factors and antecedents, a chronic disease databank consisting of time-oriented, multidisciplinary longitudinal data, prospectively collected on consecutive patients and describing their clinical courses, provides a systematic anthology of patient reported outcome (PRO) data. ARAMIS, which began in the mid-1970s, was the first large-scale chronic disease data bank system. Outcomes data are collected using the Health Assessment Questionnaire (HAQ), a well established PRO instrument that collects patient-centered data in the areas of disability, pain and other symptoms, adverse effects of treatment, economic impact, and mortality. More than 900 peer-reviewed studies have emanated from ARAMIS since its inception. In the earlier days, and even today, ARAMIS had to invent its own tools for the study of these new sciences. ARAMIS has made dominant contributions to the understanding of PROs and to helping improve treatment and health outcomes in rheumatoid arthritis (RA), osteoarthritis (OA), scleroderma, lupus, aging, and drug side effects. It continues to traverse terrain with participation in the NIH "Roadmap" project, the Patient Reported Outcome Measurement Information System (PROMIS). PROMIS is designed to provide improved assessment of health status across all chronic illnesses as part of an improved infrastructure for clinical research. As initiator of the rich history of chronic disease data banks with "rolling" consecutive open patient cohorts, ARAMIS has enabled the study of real-world PROs in rheumatology, with a wealth of resultant improved approaches to treatment, outcome, cost effectiveness, and quality of life.

Aging↗
PubMedDate not supplied

The variability of immunologic laboratory tests.

To determine the clinical reliability of certain immunologic tests, serum complement (C3), DNA binding (DNAB), and fluorescent antinuclear antibody (FANA) were measured blindly at 2 university immunology laboratories on duplicate serum samples from 667 patients with connective tissue diseases. Twenty-seven percent of patients were differently classified as normal or abnormal for C3 by the 2 laboratories. The mean of paired differences was 25 mg% and large variability remained even after adjustment. Repeat assays on a random subset of 91 sera showed persistent variability. Fifteen percent of patients were differently classified by their DNAB results in 11% by FANA tests. Considering this variability, these "objective" laboratory tests alone are not sufficiently reliable for accurately defining diseases or disease activity.

Antibodies↗