The purpose of this study was to examine the relationship between the Harris Hip Score (HHS), a traditional method of patient assessment of a total hip arthroplasty (THA), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), a commonly used health-related quality-of-life survey. One hundred forty patients returning for routine clinical follow-up evaluation of a primary THA were asked to fill out the SF-36 quality-of-life survey, as well as questions concerning their perceptions of their THA. The patient's surgeon assessed the THA with the traditional HHS. The correlations between the HHS and the SF-36 domains were highest in the physical component summary scores for male patients of all ages and female patients 65 years of age or older. The correlations were lower for the mental component summary scores of all patients, but particularly in female patients younger than 65. When the SF-36 scores were compared with age and sex-matched population norms, both age and sex were found to be important. Men younger than 65 had scores lower than norms in the physical function domains, but were comparable in the mental health domains. The older men had scores comparable to the norms in all domains. Female patients of all ages, however, had lower scores in the physical function domains. The greatest differences were noted in the female patients younger than 65. The HHS is commonly used to assess disease-specific pain and function in THA patients; however, the results of this study suggest that the SF-36 health survey can capture additional important quality-of-life domains that are influenced by a THA and that these domains are influenced by the age and sex of the patient. The combination of a disease-specific scoring system and a quality-of-life survey would allow a more global assessment of a THA in all patients. Studies evaluating the results of THAs should either assess the results of male and female patients separately when sample size is sufficiently large or use sex as a possible covariate in a multivariate analysis.

Adolescent↗

PubMed1997

Is the quality of diabetes care better in a diabetes clinic or in a general medicine clinic?

OBJECTIVE: To compare the quality of ambulatory diabetes care delivered by physicians in the diabetes clinic versus the general medicine clinic of a university-affiliated Veterans Administration medical center. RESEARCH DESIGN AND METHODS: This is a retrospective study that involved the review of medical records against predetermined process-of-care criteria. A total of 112 patients with diabetes were randomly selected, of whom 56 were cared for in the general medicine clinic and 56 in the diabetes clinic. The following main outcome measures were examined: 1) the compliance with individual criteria; and 2) the proportion of patient visits in each clinic receiving minimally acceptable quality, defined as a blood pressure measurement, a record of type of hypoglycemic medication, a glycated hemoglobin measurement within the past year, a urinalysis within the past year, an ophthalmologist or optometrist eye examination within the past year or scheduled in the next six months, a record of change in therapeutic management, and a scheduled return visit. RESULTS: The diabetes clinic performed significantly better than the general medicine clinic on the following criteria: a record of a patient's self-monitoring of blood glucose levels; a foot examination; a comprehensive eye examination; a glycated hemoglobin measurement; and a referral for diabetic education. The proportion of patient visits meeting the minimally acceptable levels of quality was better in the diabetes clinic than the general medicine clinic (73 vs. 52%, P = 0.02). CONCLUSIONS: Patients cared for by physicians in the diabetes clinic receive better quality of diabetes care than do patients cared for by physicians in the general medical clinic. If patient care is to be shifted from specialists to generalists, additional attention needs to be paid to ensure that generalists have the knowledge and system resources necessary to deliver an acceptable quality of diabetes care.

Blood Glucose Self-Monitoring↗

PubMed1996

The relationship between anatomic disease and appropriateness ratings of coronary angiography.

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Coronary Angiography↗

PubMed1996

The effect of a medical school's admission and curriculum policies on increasing the number of physicians in primary care specialties.

PURPOSE: The Charles R. Drew University of Medicine and Science, which is affiliated with the University of California, Los Angeles, UCLA School of Medicine, has a mission to increase the number of physicians pursuing careers in primary care and/or providing care to the underserved. The authors sought to determine whether Drew's initial classes are pursuing career paths consistent with the institution's mission. METHOD: In June 1992 the alumni from the Drew and UCLA classes of 1985 through 1987 were mailed questionnaires to ascertain their specialty choices and practice settings. Responses were analyzed using bivariate analyses and multiple logistic regression. RESULTS: The response rates were 89% (402 of 454) for the UCLA graduates and 76% (44 of 58) for the Drew graduates. Bivariate analyses showed that Hispanics, women, older individuals, and Drew graduates were more likely to choose primary care specialties (p < .001 for each variable). Multiple logistic regression also showed that these variables predicted primary care career choice: for being a Hispanic, odds ratio (OR) = 3.2, 95% CI (1.66, 6.35); for being a woman, OR = 1.9, 95% CI (1.28, 2.97); for being older, OR = .92, 95% CI (.86, .99); and for being a Drew graduate, OR = 2.4, 95% CI (1.09, 5.27). Older graduates practiced in underserved areas more than did younger ones (26% vs 13%, p = .03). CONCLUSION: To some degree, Drew has fulfilled its mission of graduating physicians who are primary care specialists and/or practice in underserved areas; however, the results raise questions regarding possible early influences on career choice.

Adult↗

PubMed1996

Differences between patients' and physicians' evaluations of outcome after total hip arthroplasty.

The purpose of this study was to compare patients' and physicians' evaluations of the results of 147 total hip arthroplasties. The patients and physicians independently evaluated pain and over-all satisfaction with the outcome of the procedure using a 10.0-centimeter visual-analog scale. They also answered a questionnaire with which they assessed general health, functional ability, and pain. The mean (and standard deviation) analog rating for pain (with 0.0 centimeters indicating no pain and 10.0 centimeters, severe pain) was 1.7 +/- 2.6 centimeters as assessed by the patients and 1.1 +/- 1.8 centimeters as assessed by the physicians (p < 0.001, paired t test). The mean analog rating for over-all satisfaction (with 0.0 centimeters indicating poor and 10.0 centimeters, excellent) was 8.6 +/- 2.1 centimeters as assessed by the patients and 8.8 +/- 1.7 centimeters as assessed by the physicians (p = 0.07, paired t test). There was a marked disparity between the patients' and the physicians' scores when the patients assigned a low score to a particular area. For the thirty patients who rated the pain as more than 4.0 centimeters, the mean analog rating was 6.8 +/- 2.1 centimeters according to the patients, while it was 3.6 +/- 2.7 centimeters according to the physicians (p < 0.001, linear regression). The mean analog rating for over-all satisfaction according to the nineteen patients who rated this parameter as less than 7.0 centimeters was 3.8 +/- 2.0 centimeters, while the mean rating according to the physicians 6.5 +/- 2.8 centimeters (p < 0.001, linear regression). The patients' and physicians' evaluations were similar regarding the results of the total hip arthroplasty when the patients had little or no pain and were satisfied with the result. However, the disparity increased as the patients' ratings for pain increased and their ratings for over-all satisfaction decreased. This study highlights a discrepancy between patients' and physicians' evaluations of the results of total hip arthroplasty. This discrepancy increased when the patient was not satisfied with the outcome. The use of patients' self-administered questionnaires as well as traditional physician-generated assessments may provide a more complete evaluation of the results of total hip arthroplasty.

Activities of Daily Living↗

PubMed1995

Impact of varying panel membership on ratings of appropriateness in consensus panels: a comparison of a multi- and single disciplinary panel.

OBJECTIVE: The objective of the study was to examine the appropriateness ratings for the use of spinal manipulation for low back pain of a multidisciplinary panel of medical and chiropractic physicians, and those of a panel composed only of chiropractic physicians. DATA SOURCES: The study analyzed data from two consensus panels conducted at RAND in 1990 and 1991. STUDY DESIGN: The study design followed that of the traditional RAND consensus panels. Nine individuals comprised each panel, and each panelist was asked to rate, on a nine-point scale, the indications for spinal manipulation twice, the first time alone and the second time jointly with the panel. DATA COLLECTION: The ratings of the panelists from both groups, for both round one and round two, were collated and compared. PRINCIPAL FINDINGS: While both panels were more likely to rate the indications as inappropriate than appropriate, the single disciplinary panel was more likely to rate an indication as appropriate than the multidisciplinary panel. CONCLUSION: The composition of a panel clearly influences the ratings and those who use a given procedure in practice, in this case manipulation, are more likely to rate it as appropriate than those who do not use the procedure.

Chiropractic↗

PubMed1994

Outcome measures for studying patients with low back pain.

There is growing recognition in the treatment of back pain that patient perspectives are essential in judging the results of treatment. Improving the patient's "quality of life" is often the main goal of therapy. Thus, although clinical research in the past has focused on physiologic outcomes, such as range of motion, muscle strength, or neurologic deficits, increasing attention is being given to the rigorous measurement of symptoms, functional status, role function, satisfaction with treatment, and health care costs. In many cases, these so-called "soft" outcomes can be measured with a level of reproducibility similar to more conventional clinical data such as imaging test results. Because symptoms and functional outcomes are sometimes only loosely associated with physiologic phenomena, the former outcomes should be measured directly. Modern questionnaires for measuring patient quality of life combine the expertise of social scientists and clinicians and have demonstrated validity. Furthermore, they have some important advantages over simple ratings of "excellent, good, fair, and poor" outcomes, or work status alone. Several modern instruments for measuring health-related quality of life in patients with low back pain are reviewed briefly, describing their content and length. Wider use of these instruments would help to increase clinician familiarity with their meaning and avoid duplication of effort in questionnaire development.

Health Status Indicators↗

PubMed1994

Strategies for outcome research in spinal disorders. An introduction.

The evaluation of the clinical utility of the clinical diagnostic tests and procedures, what works in spinal disorders, and for whom and how treatment affects a patient's symptoms and function are key questions of outcomes research. This paper describes the advantages and limitations of the main study approaches used. Examples from the spine literature on spinal stenosis are used for illustration.

Female↗

PubMed1994

An introduction to therapeutic trials for low back pain.

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Clinical Trials as Topic↗