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Biomedical subjects

R L Kane

Publications and source records attributed to R L Kane.

At least 145 records · Page 8Linked to original sources
PubMed1989

Who is the family doctor? Relating primary care to family care.

Many families receive care as intact family units. To determine which specialists provide this family care, a subset of families (N = 447) enrolled in the Rand Health Insurance Experiment were examined. Among families designating a single primary care physician, family physicians and general practitioners provided 65.9% to 89.7% of their family care. Internists provided 20.0% and 27.3% of family care for younger and older couples, respectively. The remaining specialties, including pediatrics and obstetrics-gynecology, each provided less than 5% of family care; these small proportions of family care may reflect the specialists' self-imposed limits in primary care roles. As family members matured, families used fewer pediatricians and obstetrician-gynecologists for primary care and concurrently increased their use of family physicians or general practitioners. Care for intact families is provided predominantly by family physicians or general practitioners, although in families without children, internists also play an important role. Self-defined limits in primary care roles by physicians in various specialties and the changing use of specialties during the family life cycle largely determined which specialties provided family care.

Adolescent↗
PubMed1988

What are we measuring? An examination of self-reported functional status measures.

Functional status questionnaires are being used in various types of studies. To determine factors related to self-reported functional ability for rheumatoid arthritis patients, we examined the relationship between a functional and mental health questionnaire and objective disease-specific measures. Using 3-5 predictor variables, we explained 43-57% of the variance in patients' self-reported functioning. Mental and physical health perceptions were significant predictors for each self-reported functional measure. The relationships among mental health and self-reported functioning should be considered when interpreting studies that use functional status questionnaires.

Activities of Daily Living↗
PubMed1988

Improved survival for frail elderly inpatients on a geriatric evaluation unit (GEU): who benefits?

Previously reported data from a randomized controlled trial showed that admission to the geriatric evaluation unit (GEU) and follow-up clinic at the Sepulveda VA Medical Center leads to significantly improved outcomes for frail elderly hospital patients--including a 50% reduction of one-year mortality (p less than 0.005). In the present paper, two-year survival curves for GEU and control groups are reported. In addition, we subdivided the population by potential baseline risk factors (both patient- and treatment-related) and examined one-year survival using 12-month survival curves and odds ratios. There is evidence for GEU-related survival effects in specific subgroups of patients (e.g. patients with heart and pulmonary disease, patients with low baseline scores in functional status and mental status, and patients with high baseline morale scores). Finally, employing stepwise logistic regression, we determined the predictors of one-year survival in the pooled study population. These factors were: assignment to the GEU (adjusted odds ratio = 2.45; p less than 0.001); not having a heart diagnosis (2.24; p less than 0.001); and having primarily "geriatric/rehabilitation" problems (1.95; p less than 0.005). A predictive model derived from the regression defines patient subgroups likely to survive only when assigned to the GEU: cardiac patients with primarily "geriatric" or "rehabilitation" problems, and non-cardiac patients whose problems are primarily "medical". The dramatic effect of the GEU on survival appears to be concentrated on certain identifiable subgroups of patients who might be targeted to maximize program cost-effectiveness.

Activities of Daily Living↗
PubMed1988

Beyond caring: the challenge to geriatrics.

Geriatrics has established itself in the past decade as a recognized part of health care, but several issues remain unsolved about its place in the system. It has been addressed as both an approach to primary care of the elderly and a specialty in its own right. It relies excessively on the technology of assessment. Although geriatrics responds to a pervasive need for coordinating clinical and social care for a subset of the elderly, its potential contributions to this challenge have not yet been well modeled. As it comes of age, there is a need for greater conceptual clarity and a series of demonstrations that its abilities fit the needs identified.

Aged↗
PubMed1988

Do physicians spend less time with older patients?

In view of the additional time that older persons require for giving and receiving information, as well as for the examination process, it is important for manpower and reimbursement planning to better understand the nature of the physician-patient encounter with the elderly. We examined a series of national surveys of physicians' professional activities and found that physicians tend to spend less time with their older patients and also that encounter time by physicians in different specialties varies widely. Internists and cardiologists spend substantially more time with patients compared with general and family practitioners. For 65-74-year-old ambulatory patients, the average visit lengths are 18.3 minutes for internists, 18.0 for cardiologists, 11.2 for general practitioners, and 12.1 for family practitioners. Compared with ambulatory visit lengths for patients aged 45 to 64 years, average encounter times for 75-year-olds with family physicians were 0.8 minutes shorter, with general practitioners 1.2 minutes shorter, with internists 2.3 minutes shorter, and with cardiologists 3.0 minutes shorter. However, when all characteristics of the visit were considered, the effect of patient age remained significant only for general practitioners. A multivariate analysis of factors related to physician time for ambulatory care showed that more time is associated with multiple problems, problem severity, and the use of diagnostic testing. For general and family practice, the greater the number of previous visits for a problem, the shorter the encounter time is. Additional characteristics associated with shorter physician-patient encounter times include the volume of patients per week and the use of physician assistants within the practice. These findings have implications for medical education and manpower projections.

Age Factors↗
PubMed1988

Are physicians sensitive to the special problems of older patients?

The sensitivity of primary care physicians to the health care needs of older patients was explored by means of an analysis of the use of diagnostic tests and therapeutic procedures during ambulatory visits. Survey data on a total of 28,265 visits to internists, family and general practitioners were examined to determine possible age-related differences in care. The study found that diagnostic testing falls off significantly for patients 75 years of age or older and that internists use substantially more tests for each age group than do family and general practitioners. The pattern of use of diagnostic tests in this secondary analysis does not address the issue of "appropriateness" but does suggest a pattern that makes little sense based on the known distribution of disease and functional disability in aging populations.

Age Factors↗
PubMed1988

Long-term care: variations on a quality assurance theme.

Quality assurance in long-term care (LTC) diverges from approaches in acute care because of inherent features of LTC: the slower pace, the reliance on "low technology" services, the goals of LTC, and the multiple transitions across care sites typical of LTC users. LTC quality assurance activities should focus on outcomes, using process measures only when they are related to desirable outcomes or are intrinsic to respectful treatment of patients. Outcome measures should compare what is achieved with what can be reasonably expected. Because LTC services can be given interchangeably at various LTC sites (e.g., home care, day care, nursing homes), a data base must be developed that permits monitoring and comparing outcomes across diverse LTC programs.

Aged↗
PubMed1987

Do families get family care?

To determine the prevalence of family care, we measured the extent to which a subset of 732 families, from those enrolled in the Rand Health Insurance Experiment, perceive and use a single primary care physician. Although only 16.7% of these families had all members with a majority of their visits to the same physician, 45.4% identified a single primary care physician for all family members. (For older couples, this percentage reached 73.5%). An intermediate proportion of families had visits by all family members to a single physician. Children received less family care, but as families matured, family care increased for both children and parents. Our results suggest an inverse relationship between family care and education level. The availability of general-family practitioners, family income, insurance coverage, and population size were not significant determinants of family care. We conclude that family members share the perception of having a single "family physician," which is reflected in their patterns of utilization.

Adult↗
PubMed1987

Classification with the Luria-Nebraska neuropsychological battery: an application of cluster and ipsative profile analysis.

A sample of 114 subjects, 23 with predominantly left hemisphere brain damage, 25 with predominantly right hemisphere brain damage, 26 with diffuse brain damage, and 40 with adult learning disability were administered the Luria-Nebraska Neuropsychological Battery (LNNB). The clinical scale data were cluster analyzed and subjected to an ipsative analysis of the cluster profiles. A four cluster solution was utilized. It was found that while stable clusters were produced, they were relatively unrelated to actual diagnoses. The first cluster had a normal mean profile, the second reflected specific language impairment, the third, nonverbal skill, memory, and intellectual impairment and the fourth, generalized impairment. The results were discussed in terms of the capacity of the LNNB to generate meaningful neuropsychological profiles.

Journal Article↗
PubMed1987

What are we measuring? An examination of walk time and grip strength.

Are walk time and grip strength measures of disease activity or functional ability? Ninety-two patients with rheumatoid arthritis were examined initially and 12 months later for clinical measures including joint deformity, and answered a functional status questionnaire. Walk time and grip strength were strongly related to joint deformity and functional questionnaire measures, and appeared insensitive in showing changes in disease activity over time. They could serve as objective functional measures in studies primarily directed towards changing functional ability, but appeared to be poor major outcome measures for trials aimed at altering disease activity.

Activities of Daily Living↗
PubMed1986

Rehabilitation for rheumatoid arthritis patients. A controlled trial.

For 1 year we obtained questionnaire and clinical measures from 2 cohorts of rheumatoid arthritis patients: 49 experimental patients who were admitted for an average of 13 days to a university-based rheumatology rehabilitation unit, and 43 control patients who received care from rheumatologists associated with another teaching hospital. At 1 year, after controlling for groups differences, the experimental patients demonstrated significant (P less than 0.05) improvement compared with control patients in several functional status, mental health, and disease activity measures.

Aged↗
PubMed1986

The role of hospice in reducing the impact of bereavement.

Survivors of patients in a randomized controlled trial of a hospital-based hospice were followed for 18 months after the patient's death. There were no significant differences in the anxiety or depression between hospice survivors (N = 56) and controls (N = 40). Neither were there significant differences in bed days, physician visits or scores on a 6-item health scale, even when the survivor's initial health status was held constant. No clear pattern of differences emerged in social participation, contacts with friends or relatives, smoking or drinking behaviors. We conclude that hospice care did not provide any protective effect for the bereavement period.

Alcohol Drinking↗