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Duplicate Publications as Topic↗
Biomedical subjects
M Graney
Publications and source records attributed to M Graney.
Demographic bias in physician smoking cessation counseling.
To determine if smoking cessation counseling is affected by physician or patient demographics, patient exit interviews and chart audits were administered between January 1991, and February 1992, in an inner-city teaching clinic. Patients who received medical care on an ongoing basis in the clinic were eligible for the study. Patients with dementia or inability to verbally communicate in English were excluded. According to patient self-report, 26% (167) of the 642 patients who participated were never asked about smoking. Of the 168 current smokers, 23% (39) were never advised to quit. Male patients were more likely to report being asked about smoking on the day of the clinic visit (odds ratio = 2.37, 95% confidence interval [CI] = 1.62 to 3.46). Male smokers were more likely to report being advised to quit (odds ratio 2.39, 95% CI = 1.25 to 4.58), as were white smokers (odds ratio 3.66, 95% CI = 1.37 to 9.82). According to patient report (smokers and nonsmokers), white physicians were more apt to ask about smoking on the day of the clinic visit (odds ratio = 2.68, 95% CI = 1.31 to 5.48). Physician and patient demographic characteristics may significantly influence the rate of smoking cessation counseling. Additional studies are needed to confirm the presence of such biases.
Adolescent↗
Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race.
OBJECTIVES: Utilization rates for cardiac catheterization and cardiac surgery in the Department of Veterans Affairs (VA) health care system were studied to determine whether racial differences existed in a delivery plan in which access is not determined by patient finances. BACKGROUND: Prior studies have demonstrated significant differences in utilization of cardiac diagnostic and therapeutic resources by white and black patients. Reasons for the reduced utilization by black patients include socioeconomic, biologic and sociocultural effects. METHODS: Computerized discharge records of 30,300 patients with coronary artery disease and 1,335 patients with valvular heart disease who were discharged from any of 172 VA Medical Centers between October 1, 1990 and September 30, 1991 were studied. RESULTS: For patients with coronary artery disease, utilization rates of cardiac catheterization were significantly greater for white patients (503.4 procedures/1,000 patients) than for black patients (433.2/1,000 patients), with a relative odds ratio of 1.33. Rates for surgery (179.0 vs. 124.5/1,000 patients) were also greater for whites than for blacks, with a relative odds ratio of 1.53. For the subset with valve disease, the catheterization rate was significantly greater for whites than for blacks (575.4 vs. 432.6 procedures/1,000 patients), with a relative odds ratio of 1.78. Surgical rates were not significantly different (423.8 vs. 354.6 operations/1,000 patients). Racial differences for both catheterization and surgery varied widely as a function of geographic region and the level of complexity of the local VA facility. CONCLUSIONS: Racial differences in resource utilization exist in a health care system in which economic influences are minimized. The pattern of these differences depends on numerous variables and suggests both biologic and sociocultural factors as underlying causes.
Black or African American↗
Evaluation and correction for a 'training effect' in the cognitive assessment of older adults.
BACKGROUND: Repeated administration of psychometric instruments frequently results in a higher score on retesting, the so-called training effect. Yet, a training effect has been poorly considered in longitudinal studies of cognitive changes in older persons. METHODS: We investigated the presence, magnitude and potential adjustments for training effect in the older participants of the Systolic Hypertension in the Elderly Program (SHEP). SHEP evaluated the cognitive status effects of a diuretic-based treatment of isolated systolic hypertension versus placebo. Changes in the short Comprehensive Assessment and Referral Evaluation (short-CARE) questionnaire score, from baseline through 4 years of follow-up, were assessed in 4,718 participants. In this study, we used two regression techniques to adjust data for the training effect. RESULTS: In both study groups, a training effect was evident as a progressive improvement in the short-CARE score throughout year 1. Thereafter, cognitive scores tended to deteriorate, more in the placebo than in the active treatment group (p = 0.055). When follow-up scores were adjusted based upon baseline data, the difference between the study groups reached statistical significance (p = 0.019), but the apparent overall trend towards deterioration in cognitive score was no longer observed. Adjustment of baseline data preserved this apparent temporal course, but did not improve the discrimination between the two study groups (p = 0.165). CONCLUSIONS: In SHEP, repeated cognitive assessments were likely biased by a training effect which could be only partially corrected by statistical techniques. Studies of changes in the cognitive status of older persons should be designed appropriately to estimate and minimize the consequences of a training effect in follow-up data.
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