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Biomedical subjects

William B Weeks

Publications and source records attributed to William B Weeks.

At least 37 records · Page 2Linked to original sources
PubMed2005

New York's statistical model accurately predicts mortality risk for veterans who obtain private sector CABG.

OBJECTIVE: To determine whether patients' use of the Veterans Health Administration health care system (VHA) is an independent risk factor for mortality following coronary artery bypass grafting (CABG) in the private sector in New York. DATA SOURCES: VHA administrative and New York Department of Health Cardiac Surgery Reporting System (CSRS) databases for surgeries performed in 1999 and 2000. STUDY DESIGN: Prospective cohort study comparing observed, expected, and risk-adjusted mortality rates following private sector CABG for 2,326 male New York State residents aged 45 years and older who used the VHA (VHA users) and 21,607 who did not (non-VHA users). DATA COLLECTION METHODS: We linked VHA administrative databases to New York's CSRS to identify VHA users who obtained CABG in the private sector in New York in 1999 and 2000. Using CSRS risk factors and previously validated risk-adjustment model, we compared patient characteristics and expected and risk-adjusted mortality rates of VHA users to non-VHA users. PRINCIPAL FINDINGS: Compared with non-VHA users, patients undergoing private sector CABG who had used the VHA were older, had more severe cardiac disease, and were more likely to have the following comorbidities associated with increased risk of mortality: diabetes, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, and history of stroke (p<.001 for all); a calcified aorta (p=.009); and a high creatinine level (p=.003). Observed (2.28 versus 1.80 percent) and expected (2.48 versus 1.78 percent) mortality rates were higher for VHA users than for non-VHA users. The risk-adjusted mortality rate for VHA users (1.70 percent; 95 percent confidence interval [CI]: 1.27-2.22) was not statistically different than that for the non-VHA users (1.87 percent; 95 percent CI: 1.69-2.06). Use of the VHA was not an independent risk factor for mortality in the risk-adjustment model. CONCLUSIONS: Although VHA users had a greater illness burden, use of the VHA was not found to be an independent risk factor for mortality following private sector CABG in New York. The New York Department of Health risk adjustment model adequately applies to veterans who obtain CABG in the private sector in New York.

Aged↗
PubMed2005

Veterans Health Administration and Medicare outpatient health care utilization by older rural and urban New England veterans.

CONTEXT: Older veterans often use both the Veterans Health Administration (VHA) and Medicare to obtain health care services. PURPOSE: The authors sought to compare outpatient medical service utilization of Medicare-enrolled rural veterans with their urban counterparts in New England. METHODS: The authors combined VHA and Medicare databases and identified veterans who were age 65 and older and enrolled in Medicare fee-for-service plans, and they obtained records of all their VHA services in New England between 1997 and 1999. The authors used ZIP codes to designate rural or urban residence and categorized outpatient utilization into primary care, individual mental health care, non-mental health specialty care, or emergency room care. FINDINGS: Compared with their urban counterparts, veterans living in rural settings used significantly fewer VHA and Medicare-funded primary care, specialist care, and mental health care visits in all 3 years examined (P<.001 for all). Compared with urban veterans, veterans living in rural settings used fewer VHA emergency department services in 1998 and 1999 but more Medicare-funded emergency department visits in 1997. The authors found some evidence of substitution of Medicare for VHA emergency visits in rural veterans, but no other evidence of like-service substitution. Rural veterans were more reliant on Medicare for primary care and on VHA services for specialty and mental health care. CONCLUSIONS: These findings suggest that rural access to federally funded health care is restricted relative to urban access. Older veterans may choose different systems of care for different health care services. With poor access to primary care, rural veterans may substitute emergency room visits for routine care.

Aged↗
PubMed2004

Substance abuse intensive outpatient treatment: does program graduation matter?

Program graduation, even after controlling for length of stay, may predict for improved outcomes in some substance abuse treatment settings. We investigated the role of program graduation by comparing social outcomes and inpatient utilization the years before and after treatment among graduates and dropouts of a Veterans Administration substance abuse intensive outpatient program. At enrollment, graduates and dropouts were similar in all spheres measured. Patients who completed the treatment program used significantly fewer psychiatric inpatient bed days of care the year after they completed the program, both in comparison to their own prior use and in comparison to program dropouts. Graduates were more likely to be abstinent and less likely to fully relapse or be incarcerated at 6-month followup. Further research is needed to discern optimal treatment length-that which maximizes both length of stay and completion rates, while optimizing use of limited treatment resources.

Female↗
PubMed2004

Changes in authorship patterns in prestigious US medical journals.

To improve identification of contributors to manuscripts, editors of medical journals have developed authorship responsibility criteria. Some have specified an acceptable number of authors per manuscript. We wanted to examine changes in patterns of authorship in the context of the development of these specifications. Therefore, we used a retrospective cohort design to calculate the average number of authors per manuscript and the prevalence of group and corporate authorship between 1980 and 2000 for original, scientific, non-serial articles published in four prestigious medical journals: the Annals of Internal Medicine, Archives of Internal Medicine, Journal of the American Medical Association, and the New England Journal of Medicine. Group authorship identifies individual authors in the byline who are writing for a group; in corporate authorship, contributors are not individually listed in the byline. We found that the number of authors per article increased dramatically over time in each journal, from an average of 4.5 in 1980 to 6.9 in 2000 across journals. As a proportion of published manuscripts, group authorship (authors listed in the byline) increased from virtually zero to over 15%, while corporate authorship (authors not listed in the byline) remained rare and stagnant. Manuscripts published by single authors all but vanished. Group authorship was most prevalent in journals that limited the acceptable number of authors per manuscript. These findings suggest that the number of authors per manuscript continues to grow. The growth in the number of authors on bylines and the proportion of group-authored manuscripts is likely to reflect the increasing complexity of medical research.

Authorship↗
PubMed2004

Characteristics of successful quality improvement teams: lessons from five collaborative projects in the VHA.

BACKGROUND: A pre-post observational design was used to study the aggregate results of five national Breakthrough Series (BTS) collaboratives run within Veterans Health Administration (VHA) to identify the organizational, interpersonal, and systemic characteristics of successful improvement teams. METHODS: One hundred thirty-one medical quality improvement teams participated in five BTS collaboratives in the VHA between 1999 and 2002. Team characteristics were assessed using a team questionnaire before and after the BTS collaboratives. RESULTS: Fifty-seven percent of participating teams were rated as successful (a > or = 20% improvement from baseline for at least two months before the collaboratives' end). More high-performing medical quality improvement teams perceived their work to be part of their organization's key strategic goals. By the end of the BTS collaboratives, high-performing teams had more front-line staff support and stronger team leadership. DISCUSSION: Strong organizational support, strong team leadership, and high levels of interpersonal team skills help medical quality improvement teams go further to improve clinical care. It is recommended that quality improvement teams become integrated with their organization's key strategic goals, that improvement teams stay together, and that leadership and team training be provided to improve clinical outcomes.

Analysis of Variance↗
PubMed2004

A cognitive aid for cardiac arrest: you can't use it if you don't know about it.

BACKGROUND: A cognitive aid developed by the Department of Veterans Affairs (VA) and distributed to all VA facilities provides caregivers with information to minimize omission of critical steps when diagnosing and treating cardiac arrest. In 2002, caregivers were surveyed about the usefulness of the cognitive aid and the success of its dissemination throughout the VA. METHODS: Fifty randomly selected VA hospitals were sent a letter to alert them of the upcoming survey. Twenty surveys were sent to each of the selected hospitals with instructions to distribute the survey to specific caregiver types. RESULTS: Nine (18%) of the VA hospitals had not used the cognitive aid tool because of dissemination problems. Of the 565 caregivers responding to the survey, 59% (332) were aware of the cognitive aid. Of these 332, 96% agreed that putting the cognitive aid on code carts is a good idea. There were 234 respondents who were both aware of the cognitive aid and had been involved in at least one code within the past 30 days. Of these 234, some 29 (12%) used the aid during a code, 28 of whom agreed that the cognitive aid was helpful during the code. DISCUSSION: Both new and experienced caregivers find the cognitive aid helpful when responding to "code" situations. However, cognitive aids cannot be helpful if theintended users are unaware of their availability. Dissemination and awareness of the aids can be problematic in large health care systems.

Audiovisual Aids↗
PubMed2004

Return on educational investment in geriatrics training.

The graying of America will increase demand for specialists in geriatric medicine, but the proportion of filled fellowship positions in geriatric medicine has been falling recently. The objective of this study was to examine the financial return of additional training in geriatric medicine for general internists by using survey data from the American Medical Association and standard financial techniques. The return on educational investment over a working lifetime for a third-year resident in internal medicine who was considering specialty training in geriatric medicine between 1993 and 1999 was calculated. Physicians self-identified as geriatricians had lower incomes and lower incomes per hour than age-matched general internists, although the disparities decreased somewhat over the period examined. Regression modeling suggested that incomes for geriatricians are lower than expected and that this disparity increased in the last 2 years of the study. Some of the income disparities may be attributable to the fact that geriatricians obtain a greater proportion of their total revenue from Medicare than is optimal in the generalist setting. Returns on educational investment for geriatrics training were negative, although less so in recent years. Analysis suggests that the pursuit of additional specialty training in geriatric medicine has a negative financial return. Financial returns and the incentives they create should be carefully considered in meeting the anticipated geriatrics workforce needs of the nation.

Economics, Medical↗
PubMed2004

Differences in health-related quality of life in rural and urban veterans.

OBJECTIVES: We sought to determine whether disparities in health-related quality of life exist between veterans who live in rural settings and their suburban or urban counterparts. METHODS: We determined health-related quality-of-life scores (physical and mental health component summaries) for 767109 veterans who had used Veterans Health Administration services within the past 3 years. We used rural/urban commuting area codes to categorize veterans into rural, suburban, or urban residence. RESULTS: Health-related quality-of-life scores were significantly lower for veterans who lived in rural settings than for those who lived in suburban or urban settings. Rural veterans had significantly more physical health comorbidities, but fewer mental health comorbidities, than their suburban and urban counterparts. Rural-urban disparities persisted in all survey subscales, across regional delivery networks, and after we controlled for sociodemographic factors. CONCLUSIONS: When compared with their urban and suburban counterparts, veterans who live in a rural setting have worse health-related quality-of-life scores. Policymakers, within and outside the Veterans Health Administration, should anticipate greater health care demands from rural populations.

Chi-Square Distribution↗
PubMed2003

Time and money: a retrospective evaluation of the inputs, outputs, efficiency, and incomes of physicians.

BACKGROUND: Physicians' concerns with the health care system focus on having less time with their patients and needing to work harder to maintain incomes. We sought to determine whether physicians are working longer hours and whether their incomes are declining. METHODS: Using survey data, we conducted a retrospective analysis of physician inputs, outputs, efficiency, and incomes for generalists, general internists, general surgeons, pediatricians, and obstetrician-gynecologists from 1987 to 1998. RESULTS: Physician inputs (as measured by the average hours worked in professional activities) showed little absolute change across specialties over time. Outputs (as measured by the total number of patient visits per week) decreased between 9% and 28%, depending on the specialty. Efficiency (the proportion of time spent in direct patient care and the amount of time spent during a typical office visit) remained stable over the time examined. Consumer price index inflation-adjusted annual incomes increased considerably over the time period examined (42% for general internists, 28% for pediatricians, 13% for generalists, and 8% for general surgeons); only obstetricians-gynecologists showed a net loss of annual income when adjusting for inflation (a 6% loss). CONCLUSIONS: Our findings do not confirm the prevailing concern that physicians are working harder or longer or that their incomes are declining, but they offer an explanation of how physicians are maintaining incomes without increasing work inputs. There is a great deal of dissatisfaction with the health care system among physicians; exploration of perceptual reasons for that dissatisfaction may outline a course of action needed to resolve it.

American Medical Association↗
PubMed2003

A multihospital safety improvement effort and the dissemination of new knowledge.

BACKGROUND: Research on the transfer of medical technology and guidelines suggests that this transfer is driven more by interpersonal relationships than by new research or available information and that it is inconsistent, largely unsuccessful, and strongly influenced by local factors. Yet studies of collaborative, multiple-hospital improvement efforts have shown these transfers to be effective for the specific microsystems participating in the project. The diffusion of medical innovations beyond the participating teams was studied during a 2000-2001 national collaborative safety improvement effort. METHODS: Twenty-two teams from Department of Veterans Affairs (VA) hospitals participated in a 9-month quality improvement project designed to improve safety in high-hazard areas. Participating hospitals and other regional hospitals were contacted to determine the level of dissemination of information generated during and after the project. RESULTS: While the participating hospitals benefited from the quality improvement effort, changes were implemented only 9% of the time on other units within the hospitals and only 2% of the time in other regional hospitals. After 12 months, there was no implementation within participating hospitals, and other regional hospitals were implementing changes 10% of the time. DISCUSSION: Personal commitment from senior leadership, dissemination strategies that push information to clinicians, and monitoring of progress at the regional level are all needed for dissemination of complex medical information to occur.

Cooperative Behavior↗
PubMed2003

Reduction in patient enrollment in the Veterans Health Administration after media coverage of adverse medical events.

BACKGROUND: Health care organizations may experience costs associated with preventable adverse events in the form of poor brand image and subsequent patient disenrollment. A retrospective cohort design was used to determine whether media coverage of adverse events that occurred in Veterans Health Administration (VHA) hospitals was associated with subsequent veteran disenrollment. METHODS: Twenty-four newspaper reports of medical adverse events that occurred between 1994 and 1999 within the VHA system were identified. Regionally adjusted changes in enrollment rates for VHA facilities that had reported adverse events were compared with those that had not one year before and one and three years after publication of the newspaper reports. RESULTS: Facilities that had published reports of adverse events had lower enrollment rates after publication of the report for two groups of veterans. CONCLUSIONS: Within the VHA system, health care organizations involved in adverse events that generated publicity suffered a greater rate of patient disenrollment. If safe patient care practices can reduce adverse publicity, they may enhance corporate value by maintaining enrollment of the patient population.

Bibliometrics↗
PubMed2003

Veterans' system-of-care preferences for percutaneous transluminal coronary angioplasty in a rural setting.

CONTEXT: In the Veterans Health Administration (VHA), regionalization of high-technology health care services may influence veterans who live far from referral centers to obtain care locally, through the private sector. PURPOSE: To understand veterans' system-of-care preferences for a high-technology regionalized service. METHODS: The charts of 142 veterans who were referred for percutaneous transluminal coronary angioplasty (PTCA) by their VHA cardiologists were reviewed. FINDINGS: Fifty-two percent of these veterans obtained the procedure outside the VHA system. Insurance coverage and out-of-pocket costs were strongly associated with veterans' obtaining PTCA outside of the VHA system; travel distance was not. CONCLUSIONS: As the VHA begins to understand veterans' use of multiple systems of care, it will be important to understand the relationship between out-of-pocket costs and the system of care used for high-technology health care services.

Angioplasty, Balloon↗