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Biomedical subjects

Robert M Kaplan

Publications and source records attributed to Robert M Kaplan.

At least 19 recordsLinked to original sources
PubMed2004

Validity of self-administered quality of well-being scale in musculoskeletal disease.

OBJECTIVE: To evaluate the self-administered Quality of Well-Being (QWB-SA) Scale for patients with rheumatic diseases. METHODS: Family medicine patients (n = 562) and rheumatology patients (n = 334) were assessed using the following tools: QWB-SA, Health Assessment Questionnaire (HAQ), Arthritis Impact Measurement Scales (AIMS), and Rapid Assessment of Disease Activity in Rheumatology (RADAR). RESULTS: Patients with arthritis had significantly lower QWB-SA scores and significantly higher HAQ scores than family medicine patients with and without adjustment for covariates. The QWB-SA was significantly associated with quartiles from the RADAR, AIMS, and HAQ, providing evidence for the validity of the generic measure in patients with arthritis. Discriminant function analysis was used to create an arthritis-specific scoring system for the QWB-SA. Analyses demonstrated systematic relationships between the Quality of Well-Being arthritis composite and the disease-specific RADAR, AIMS, and HAQ. CONCLUSIONS: Evidence supports the validity of the QWB-SA for patients with rheumatic diseases. QWB-SA items can be used to calculate an arthritis-specific score. The QWB-SA can be used to gain generic information for cost-utility analysis and disease-specific outcomes information for patients with arthritis.

Arthritis↗
PubMed2004

Body mass index and quality of well-being in a community of older adults.

BACKGROUND: The impact of obesity and associated conditions on health has not been assessed in older adults using a generic, utility-based measure of health-related quality of life (HRQOL). This study evaluates the relationship between body mass index (BMI) and HRQOL scores and gives estimates of quality-adjusted life years (QALYs) lost to overweight, obesity, and associated conditions. METHODS: A total of 1326 adults from the Rancho Bernardo longitudinal cohort study, with a mean age of 72 years, completed the Quality of Well-Being Scale (QWB), a generic health-related quality of life measure. Height, weight, exercise, and smoking status were also assessed. Differences in QWB scores between obese adults and those with a normal BMI were used to estimate the QALYs lost due to obesity and associated conditions. RESULTS: Participants were divided into four groups based on BMI: <20 (underweight); 20 to 24.9 (normal); 25 to 29.9 (overweight); >30 kg/m(2) (obese). Analysis of covariance controlling for age, gender, smoking history, and exercise showed a significant difference between group means (F(7,1310)=30.79; p <0.001). The normal BMI group had the highest QWB score (0.709), followed by the underweight (0.698), overweight (0.695), and obese (0.663) groups. The QWB score for the obese group was significantly lower than that for the normal and overweight groups. An estimated 2.93 million QALYs are lost in this country each year from obesity and associated conditions. CONCLUSIONS: Obese older adults tend to have lower HRQOL than those who are overweight or of normal BMI. The lower QWB scores associated with obesity translate into millions of QALYs lost each year. Being overweight but not obese did not have a significant impact on HRQOL in this population.

Aged↗
PubMed2004

Treatment options for localized prostate cancer: quality-adjusted life years and the effects of lead-time.

OBJECTIVES: The purposes of this study were to estimate the difference in quality-adjusted life-years between conservative management and prostatectomy or radiotherapy (RT) by clinical Gleason score (2 to 4, 5 to 6, 7, and 8 to 10) for patients aged 55 years and older with clinically localized prostate cancer and to adjust for and explore the effects of lead-time. For localized prostate cancer, it is not known whether treatment (prostatectomy or RT) results in longer quality-adjusted survival than conservative management. Observed survival benefits after treatment may be biased by the lead-time resulting from early diagnosis with prostate-specific antigen screening. METHODS: A Markov simulation was developed, and transition probabilities were derived from a review of published studies. Utility weights were measured in male volunteers older than 60 years. Estimates of disease progression during conservative management were adjusted for lead-time. Sensitivity analyses were performed on all parameters (including estimates for lead-time). RESULTS: For Gleason score 2 to 4 cancer, conservative management yielded the greatest number of quality-adjusted life-years. For Gleason score 5 to 6 cancer, any of the options appeared beneficial, depending on the estimates for disease progression. For Gleason score 7 to 10 cancer, prostatectomy and RT resulted in more quality-adjusted life-years than conservative management; with a lead-time adjustment of greater than 10 years, the outcomes with conservative management and prostatectomy were similar. The choice between prostatectomy and RT was sensitive to estimates of disease progression after treatment. CONCLUSIONS: Conservative management is a reasonable option for Gleason score 2 to 4 cancer and for some patients with Gleason score 5 to 6 cancer. Prostatectomy or RT is recommended for Gleason score 7 to 10 cancer. The survival benefits after treatment were not explained by the lead-time alone.

Adenocarcinoma↗
PubMed2004

Diagnostic and treatment decisions in US healthcare.

The practice of medicine links diagnosis to treatment. However, for many diagnosed conditions diagnosis and treatment may not affect health outcome. Examples include low-grade cancers that do not influence life expectancy or quality of life. Further, there is considerable uncertainty about the point along a biologic continuum where treatment should begin. Changes in diagnostic thresholds often increase healthcare costs even though the benefit of the treatment is uncertain. Although this uncertainty is understood by the healthcare providers, it often is not shared with patients. We advocate a new paradigm called shared medical decision making that makes uncertainty about diagnosis and treatment transparent to patients and engages them in the treatment decision process.

Decision Making↗
PubMed2004

Measurement of health-related quality of life in the national emphysema treatment trial.

PURPOSES: To evaluate two generic and two disease-specific measures of health-related quality of life (QOL) using prerandomization data from the National Emphysema Treatment Trial (NETT). METHOD: The analyses used data collected from the 1,218 subjects who were randomized in the NETT. Patients completed evaluations before and after completion of the prerandomization phase of the NETT pulmonary rehabilitation program. Using data obtained prior to participation in the rehabilitation program, QOL measures were evaluated against physiologic and functional criteria using correlational analysis. The physiologic criteria included estimates of emphysema severity based on FEV(1) and measures of Pao(2) obtained with the subject at rest and breathing room air. Functional measures included the 6-min walk distance (6MWD), maximum work, and hospitalizations in the prior 3 months. RESULTS: Correlation coefficients between QOL measures ranged from -0.31 to 0.70. In comparison to normative samples, scores on general QOL measures were low, suggesting that the NETT participants were quite ill. All QOL measures were modestly but significantly correlated with FEV(1), maximum work, and 6MWD. Patients who had stayed overnight in a hospital in the prior 3 months reported lower QOL on average than those who had not been hospitalized. There were significant improvements for all QOL measures following the rehabilitation program, and improvements in QOL were correlated with improvements in 6MWD. COMMENT: The disease-specific and general QOL measures used in the NETT were correlated. Analyses suggested that these measures improved significantly following the rehabilitation phase of the NETT.

Activities of Daily Living↗
PubMed2003

Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema.

BACKGROUND: The National Emphysema Treatment Trial, a randomized clinical trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema, included a prospective economic analysis. METHODS: After pulmonary rehabilitation, 1218 patients at 17 medical centers were randomly assigned to lung-volume-reduction surgery or continued medical treatment. Costs for the use of medical care, medications, transportation, and time spent receiving treatment were derived from Medicare claims and data from the trial. Cost effectiveness was calculated over the duration of the trial and was estimated for 10 years of follow-up with the use of modeling based on observed trends in survival, cost, and quality of life. RESULTS: Interim analyses identified a group of patients with excess mortality and little chance of improved functional status after surgery. When these patients were excluded, the cost-effectiveness ratio for lung-volume-reduction surgery as compared with medical therapy was 190,000 dollars per quality-adjusted life-year gained at 3 years and 53,000 dollars per quality-adjusted life-year gained at 10 years. Subgroup analyses identified patients with predominantly upper-lobe emphysema and low exercise capacity after pulmonary rehabilitation who had lower mortality and better functional status than patients who received medical therapy. The cost-effectiveness ratio in this subgroup was 98,000 dollars per quality-adjusted life-year gained at 3 years and 21,000 dollars at 10 years. Bootstrap analysis revealed substantial uncertainty for the subgroup and 10-year estimates. CONCLUSIONS: Given its cost and benefits over three years of follow-up, lung-volume-reduction surgery is costly relative to medical therapy. Although the predictions are subject to substantial uncertainty, the procedure may be cost effective if benefits can be maintained over time.

Cost-Benefit Analysis↗
PubMed2003

Quality of well-being in older people with osteoarthritis.

OBJECTIVE: To examine the sensitivity of the Quality of Well-Being Scale (QWB) as a measure of health-related quality of life (HRQOL) in people with osteoarthritis (OA). METHODS: The QWB was administered, along with the Arthritis Impact Measurement Scale (AIMS) and other health measures. Health care utilization data were also obtained. RESULTS: People with OA had a mean QWB score of 0.643. The QWB scores were significantly correlated with total AIMS scores, self-rated health status, health care costs, depression scores, and most AIMS subscales. In addition, changes in QWB scores after 1 year were significantly correlated with changes in total AIMS scores and some AIMS subscales. CONCLUSION: The QWB appears to be a useful and sensitive generic, utility-based measure of HRQOL in people with OA.

Aged↗
PubMed2003

Use of the quality of well-being self-administered version (QWB-SA) in assessing health-related quality of life in depressed patients.

BACKGROUND: This study evaluated the cross-sectional and longitudinal relationship between depression severity and the Quality of Well-Being scale self-administered version (QWB-SA) in subjects diagnosed with current major depression. METHODS: The research design was prospective and observational. Data were collected on a convenience sample of 58 subjects. Additional measures included the Quality of Well-Being scale interviewer-version (interviewer-QWB), Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory, and each were collected at baseline, 4 weeks, and 4 months postmedication treatment. RESULTS: Cross-sectional and longitudinal QWB-SA scores were significantly correlated with depression severity and the interviewer-QWB. Treatment response, defined as 50% improvement in HRSD-17, was associated with 0.10 and 0.16 unit changes in the QWB-SA at 4 weeks and 4 months, respectively. The QWB-SA was significantly and negatively correlated with cross-sectional and longitudinal depression severity. LIMITATIONS: The study design was observational and used a convenience sample of subjects. CONCLUSIONS: The QWB-SA is less expensive to administer than the interviewer-QWB and is a useful alternative for determining the effectiveness and cost-effectiveness of treatments for depression relative to other physical and mental illness treatments.

Adult↗
PubMed2003

The significance of quality of life in health care.

This paper compares a traditional biomedical model with an outcomes model for evaluating health care. The traditional model emphasizes diagnosis and disease-specific outcomes. In contrast, the outcomes model emphasizes life expectancy and health-related quality of life. Although the models are similar, they lead to different conclusions with regard to some interventions. For some conditions, diagnosis and treatment may reduce the impact of a particular disease without extending life expectancy or improving quality of life. Older individuals with multiple co-morbidities may not benefit from treatments for a particular disease if competing health problems threaten life or reduce quality of life. In preventive medicine, diagnosis of disease is made more difficult because of ambiguity, uncertainty, lead-time bias, and length bias. In some circumstances, successful diagnosis and treatment may actually reduce life expectancy or overall life quality. Example applications of the outcomes model from clinical policy analysis, individual decision making and shared decision-making are offered. The outcomes model has received little attention in dental health care but may have parallels to applications in other areas of medicine.

Decision Making↗
PubMed2003

Factor structure and measurement invariance of the Women's Health Initiative Insomnia Rating Scale.

As part of the Women's Health Initiative Study, the 5-item Women's Health Initiative Insomnia Rating Scale (WHIIRS) was developed. This article summarizes the development of the scale through the use of responses from 66,269 postmenopausal women (mean age = 62.07 years, SD = 7.41 years). All women completed a 10-item questionnaire concerning sleep. A novel resampling technique was introduced as part of the data analysis. Principal-axes factor analysis without iteration and rotation to a varimax solution was conducted for 120,000 random samples of 1,000 women each. Use of this strategy led to the development of a scale with a highly stable factor structure. Structural equation modeling revealed no major differences in factor structure across age and race-ethnic groups. WHIIRS norms for race-ethnicity and age subgroups are detailed.

Age Factors↗
PubMed2003

Reliability and validity of the Women's Health Initiative Insomnia Rating Scale.

The reliability and construct validity of the 5-item Women's Health Initiative Insomnia Rating Scale (WHIIRS) were evaluated in 2 studies. In Study 1, using a sample of 66,269 postmenopausal women, validity of the WHIIRS was assessed by examining its relationship to other measures known to be related to sleep quality. Reliability of the WHIIRS was estimated using a resampling approach; the mean alpha coefficient was .78. Test-retest reliability coefficients were .96 for same-day administration and .66 after a year or more. Correlations of the WHIIRS with the other measures were in the predicted directions. Study 2 used a sample of 459 women and compared the WHIIRS with objective indicators of sleep quality. Results showed that differences in the objective indicators could be detected by the WHIIRS. Findings suggest that a between-group mean difference of approximately 0.50 of a standard deviation on the WHIIRS may be clinically meaningful.

Aged↗
PubMed2003

A randomized controlled trial comparing internet and video to facilitate patient education for men considering the prostate specific antigen test.

BACKGROUND: Little is known about the relative advantages of video versus internet-based decision aids to facilitate shared medical decision making. This study compared internet and video patient education modalities for men considering the prostate specific antigen (PSA) test. METHODS: Two hundred and twenty-six men, aged 50 years or older, and scheduled to complete a physical examination at an HMO Health Appraisal Clinic were randomly assigned to access a website (N = 114) or view a 23-minute videotape in the clinic (N = 112) prior to deciding whether they wanted to be screened for prostate cancer. RESULTS: There were no between-groups differences in participants' ratings of convenience, effort, or satisfaction following exposure to the decision aid. Participants assigned to the video group were more likely to review the materials than individuals assigned to the internet group (98.2% vs 53.5%). Participants in the video group showed significantly greater increases in PSA knowledge and were more likely to decline the PSA test than individuals assigned to the internet group. However, participants in the internet group who reviewed the entire online presentation showed similar increases in PSA knowledge as video participants. Only 5% of all participants visited other websites to inform themselves about the PSA test. CONCLUSIONS: Overall, the video was significantly more effective than the Internet in educating participants about benefits and risks of PSA screening.

Confidence Intervals↗
PubMed2003

Quality of life in patients with chronic venous disease: San Diego population study.

BACKGROUND: Chronic venous disease in the lower extremities may have a substantial effect on functioning and quality of life. We report quality of life data for an ethnically diverse population that had been systematically evaluated for venous disease. SUBJECTS: Current and retired employees from a large public university were randomly selected within strata of age, sex, and ethnicity. The sample included 2404 men and women ages 40 to 79 years. MEASURES: Quality of life was measured with the Medical Outcomes Study 36-Item Short Form (SF-36). Venous disease of the lower extremities was evaluated with two methods. Visual inspection was used to place participants into four categories: normal, telangiectasias and spider veins, varicose veins, and trophic changes. Duplex ultrasound scanning was used to place participants into three categories: normal, superficial venous disease, and deep vein disease. RESULTS: There were significant associations between quality of life and venous disease severity as assessed with both visual and ultrasound methods. These differences were observed for both men and women for functional scales of the SF-36. The relationships were significant, and were graded with degree of disease severity. Differences categories were not statistically significant for the mental health scales of the SF-36. CONCLUSION: Chronic venous disease in the lower extremities has a substantial effect on physical health aspects of quality of life but not on mental health components.

Adult↗