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PubMed1989

[Hospital public health status in community health nursing units of the Potsdam district].

By the instruction of the country hygiene inspection 452 community health nurse departments were inspected with special regard to hospital hygiene by the district hygiene inspections in the district of Potsdam. In addition to insufficiencies concerning the situation from the point of view of communal hygiene mistakes concerning the disinfection- and sterilization-regime of the community health nurses were observed frequently. By the check-ups and instructions the situation could be improved.

Community Health Nursing↗
PubMed1992

Comparative measurement sensitivity of short and longer health status instruments.

Short measures of health status are used increasingly in health services research, yet their sensitivities to clinical change have not been compared with longer, established instruments. In this study, 5 health status measures were administered preoperatively and 3 months postoperatively to 54 patients undergoing total hip arthroplasty. These instruments included the Sickness Impact Profile (SIP)--an established, long measure--and 4 short forms: the SF-36, Functional Status Questionnaire, shortened Arthritis Impact Measurement Scales, and Modified Health Assessment Questionnaire. Scores for physical, psychological, and global dimensions were constructed by aggregating subscales. Sensitivity to change, or responsiveness, was expressed with the standardized response mean (SRM), calculated as the mean change in score divided by the standard deviation of the change in score. The sampling distribution of the SRM was estimated with a jackknife procedure. Preoperative scores were moderately to highly correlated across instruments. The physical and global dimension SRMs of the brief health status measures ranged from 0.85 to 1.27 and were as large as or larger than the corresponding SIP SRMs. The SIP had the highest SRM on the psychological dimension. None of the instruments was significantly more sensitive than the others at the critical value (P = 0.005) adjusted for multiple comparisons. The brief health status measures were equally or more responsive than the SIP after total hip arthroplasty in the physical and global dimensions. Much larger samples are required to demonstrate statistically significant differences in SRMs among instruments.

Activities of Daily Living↗
PubMed2005

Class matters: U.S. versus U.K. measures of occupational disparities in access to health services and health status in the 2000 U.S. National Health Interview Survey.

To inform current debates over whether occupational class is causally linked to health inequities, the authors used data from the 2000 U.S. National Health Interview Survey to compare occupational disparities in access to health services, socioeconomic resources, and health status, using (1) the United Kingdom's new National Statistics Socio-Economic Classification (NS-SEC), premised on type of labor contract (salaried vs. hourly wage) and class position (employer, self-employed, supervisory and non-supervisory employee), and (2) the conventional U.S. occupational categories, premised on status and skill. Analyses included all working-age adults (age 25 to 64) for whom data on occupation and race/ethnicity were available (N = 22,500). Risk of inadequate access to health services, poverty, and low education were two times greater for persons in NS-SEC class 5 versus class 1, compared with blue-collar versus white-collar, and for both measures persons with the worst health status were in jobs that afforded the least access to health care. Controlling for earned income and workplace health insurance markedly reduced health service disparities, especially for the NS-SEC measure, thereby implying structural characteristics of jobs are causally relevant for resources and benefits necessary to address health inequities in the United States.

Adult↗
PubMed2001

Effect of locale on health status and direct care time of rural versus urban home health patients.

OBJECTIVE: The study purpose was to determine if health status differed between rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time. BACKGROUND: Implemented in October 2000, the Medicare home health prospective payment system (PPS) made only temporary allowance for differences in cost of delivering home health services in rural versus urban environments. However, past research documented differences in health status and service utilization between rural and urban home health patients. METHODS: Data were collected retrospectively on a convenience sample of 2,788 patient episodes of care. Patient health status was measured using items form the Outcome Assessment and Information Set (OASIS). Obtained from itinerary records, direct care time was the time clinicians spent in the home. RESULTS: The results showed significant differences in rural versus urban patients health status, with urban patients being healthier than rural patients. Consistent with poorer health status, rural patients received more RN direct care time. Other study factors being equal, living in a rural locale increased total direct care time by 150 minutes over living in an urban environment. CONCLUSIONS: Given the poorer health status and increased time requirements for rural patients, the results support assertions that Medicare per episode reimbursement should be higher for rural than for urban home health patients.

Adult↗
PubMedDate not supplied

[Applicability of the Spanish version of the Belloc's Physical Status Inquiry-PSI: a perceived health status measurement scale].

The objective of this work is to present the adaptation into Spanish of the Belloc's Physical Status Inventory-PSI-, and to describe the results of the preliminary validity of the Spanish version of this instrument. The process of translation and back-translation of the PSI revealed a high linguistic compatibility of the English and Spanish versions of the instrument. The construct validity was verified, on the same patients, by comparison of the PSI's data with the diagnostic categories and the presence of chronicity reported by the primary care practitioner, with the mental health status established by the GHQ-28, and with the utilization of health resources. We could say dat, in general, the PSI is a reliable measure of health status, being especially useful for its application on the general population and in patients in contact with medical agencies. It is thus justifiable to continue analyzing, by means of more specific methodological designs, the performance of this instrument in different Spanish populations.

Adolescent↗
PubMed2001

A comparison of diabetes patient's self-reported health status with hemoglobin A1c test results in 11 California health plans.

PURPOSE: To examine the relationship between hemoglobin A1c (HbA1c) test rates and values and various self-reported measures of health status within a sample of diabetes patients drawn from 11 California health plans, with a focus on improving diabetes care in this patient population. DESIGN: The analysis relies on data obtained from medical records of a sample population of 4,747 diabetes patients and a patient survey mailed to a large subsample of patients included in the medical-records analysis. METHODS: Descriptive methods were used to compare the medical records and survey-data results. PRINCIPAL FINDINGS: There were substantive differences noted between diabetes patients' self-reported health status, their level of satisfaction with the care they received, and the actual care they received. There was a large discrepancy between diabetes patients' perceptions of the care they received for their diabetes, which was overwhelmingly positive, and the HbA1c test-frequency rates observed across the 11 health plans studied, which were low. CONCLUSIONS: Patients' self-reports of health status, satisfaction with care, and extent of control over diabetes--a chronic condition that may have few perceptible symptoms--are associated with significant methodological limitations. Our examination of the relationship between perceived levels of self-management of diabetes and test status indicated that for patients who had at least one HbA1c test, some education during that process may have resulted in behavioral change. Patients who received no tests, however, may remain unaware of their glycemic control and the long-term consequences associated with even mild hyperglycemia. A clear need thus exists to educate diabetes patients about their health status. Health plan and provider group investments in educational efforts aimed at increasing testing rates are likely to lead to improved glycemic control and a reduction in the incidence of diabetes-related complications and related expenditures.

California↗
PubMedDate not supplied

The occupational health status of African-American women health care workers.

Race, ethnicity, and gender are significant indicators of occupational status, general health status, and thus, occupational health status. Although African-American women constitute only 6.8% of the total U.S. labor force, they hold 20% of the jobs in the health care industry and are disproportionately represented in those jobs that have the highest levels of workplace exposure to hazards. As a result, they are therefore more likely to be at greater exposure and risk to the spectrum of occupational health problems. In order to gain insight into the effects of race and gender on the occupational health status of African-American women health care workers, this article uses three data sources that provide different but complementary sources of information on the demographic characteristics of workers, location of categories of occupations, working conditions of jobs, and other job and worker characteristics. Given the concentration of African-American women in health care positions where there exists a greater likelihood of being exposed to occupational hazards, it is therefore both logical and appropriate for primary care physicians, especially those engaged in office-based practices, to identify this target population for special services and to be more aware of the type of health issues with which these patients are more likely to present and to experience during their working lives. Health care providers have a responsibility to assess occupational factors related to a patient's health problems and to incorporate this information into their treatment protocols and into the design and explanation of each patient's care plan.

Black or African American↗
PubMed1992

Comparison of two approaches to measuring change in health status in rheumatoid arthritis: the Health Assessment Questionnaire (HAQ) and modified HAQ.

As an alternative to the calculation of change scores for health status questionnaires used in clinical trials or longitudinal studies, transitional questions have been developed for patients to assess changes directly themselves. Here the original Health Assessment Questionnaire (HAQ) is compared with a modified version of the HAQ (MHAQ) which contains transition questions used at follow up. These, together with a set of standard rheumatological tests, were all completed by 100 patients with rheumatoid arthritis on two occasions, three months apart. Change scores were calculated for the HAQ and for the clinical measures and compared with the MHAQ. The results were strikingly in favour of encouraging patients to assess their own degree of change through the use of transition questions in the MHAQ.

Activities of Daily Living↗
PubMed2003

Making culture visible: an examination of birthplace and health status.

Culture shapes beliefs about health and illness. It provides the context by which an individual evaluates his or her symptoms to decide whether he or she is healthy or ill. We have largely ignored the impact of culture on the health status of U.S.- and foreign-born Black women. We have operationalized the term Black or African American in a way that obscures cultural differences among women of African descent living in the United States. While we know that people of African descent living in the United States are composed of many different ethnic backgrounds (e.g., persons from the Caribbean and African countries), we have not systematically examined these differences using national data. In this study I examine the relationship between culture and health status using the U.S. Department of Health and Human Services 1991 National Health Interview Survey (NHIS). Significant differences were found between U.S.- and foreign-born Black women. Foreign-born Black women reported more favorable health status than U.S.-born Black women. Measures of socioeconomic status and social support accounted for many differences between the two groups. These findings suggest that culture may play a role in the evaluation of health status. Therefore, U.S.- and foreign-born Black women appear to use different criteria when assessing their health status.

Adolescent↗
PubMed1999

Comparing the health status of male and female veterans who use VA health care: results from the VA Women's Health Project.

BACKGROUND: In recent years the number of women serving in the military has increased substantially, resulting in more demand for VA services by women veterans. This paper describes the characteristics and health status of women veterans who use VA ambulatory services. METHODS: Respondents in the VA Women's Health Project (n = 719) represent a randomly selected subsample from all women who had an ambulatory visit between July 1, 1994 and June 30, 1995 at a large tertiary care VA facility in the Boston area. Summary statistics on eight dimensions of health status (using the SF-36) for women veterans who use VA ambulatory care are provided. Comparisons are made between women veterans and men veterans who use VA services. RESULTS: Women veterans reported consistently low scores on health status across multiple dimensions, reflecting considerable health needs. Among veterans using VA services, women were younger, better educated, and less likely to be married than male veterans. Women veterans who use VA ambulatory services scored lower on every scale except physical functioning and general health perceptions when compared to male VA users. There were more pronounced differences for women on scales measuring emotional health. CONCLUSIONS: Health status among women veterans is moderate to poor. Important differences in health status are observed between men and women who use VA services which have implications for improving health care to women veterans at VA facilities. These findings strongly indicate that increased mental health services need to be available for women veterans seeking VA health care.

Confounding Factors, Epidemiologic↗
PubMedDate not supplied

Public health performance related to selected health status and risk measures.

Many public health interventions are targeted for high-risk locales. For this reason, health status and public health effort may appear inversely related. We designed a study to relate public health performance to health status or risk measures. This study hypothesized that differences in local need might prompt divergent levels of public health response and that the resultant diversity might imply disarray. From a group of 62 local health departments that have been the subject of intensive study, 34 were chosen serving jurisdictions with populations in excess of 100,000. Data were collected on selected health status as well as socioeconomic and budget measures. The data were then examined in a four-cell format, aggregating levels of public health performance with health status or risk levels according to each measure. The analysis of public health performance, when related to selected measures, suggests that public health endeavors may differ appropriately in different jurisdictions.

Health Status Indicators↗
PubMed2002

Interpreting thresholds for a clinically significant change in health status in asthma and COPD.

Health status (or Health-Related Quality of Life) measurement is an established method for assessing the overall efficacy of treatments for asthma and chronic obstructive pulmonary disease (COPD). Such measurements can indicate the potential clinical significance of a treatment's effect. This paper is concerned with methods of estimating the threshold of clinical significance for three widely used health status questionnaires for asthma and COPD: the Asthma Quality of Life Questionnaire, Chronic Respiratory Questionnaire and St George's Respiratory Questionnaire. It discusses the methodology used to obtain such estimates and shows that the estimates appear to be fairly reliable; ie. for a given questionnaire, similar estimates may be obtained in different studies. These empirically derived thresholds are all mean estimates with confidence intervals around them. The presence of these confidence intervals affects the way in which the thresholds may be used to draw inferences concerning the clinical relevance of clinical trial results. A new system of judging the magnitude of clinically significant results is proposed. Finally, an attempt is made to translate these thresholds into scenarios that illustrate what a clinically significant change with treatment may mean to an individual patient.

Asthma↗
PubMed2002

Reliability and validity of comprehensive health status measures in children: The Child Health Questionnaire in relation to the Health Utilities Index.

UNLABELLED: This study assesses the feasibility, reliability and validity of the Child Health Questionnaire-Parent Form (CHQ-PF50), consisting of 11 multi-item scales covering the physical, emotional and social well-being of children. The Health Utilities Index mark 2 (HUI2) was selected for comparison. Parents of 467 Dutch schoolchildren (age 5-13) were sent CHQ and HUI questionnaires. A subgroup of 79 parents of children aged 10-11 were sent a retest after 2 weeks. Feasibility: 78% response with few missing/non-unique CHQ-answers (<1%). Internal consistency: Cronbach's alphas of.39-.96 (mean.72). Item-own scale correlations were higher than item-other scale correlations. Test-retest ICCs were statistically significant for all but two CHQ scales (ICCs.31-.84). Test-retest CHQ-scale means did not show statistically significant differences except for one scale ("Behavior"). VALIDITY: the CHQ-scales, with one exception, correlated better with predefined parallel HUI domains (ICCs.26-.53), than with non-parallel domains. Six CHQ scales discriminated clearly between children with and without chronic conditions and three scales discriminated between high and low medical consumption. This was at least equivalent to the discriminative ability of the HUI2 in this study. Additional studies of test-retest reliability and responsiveness to change of the CHQ in varied populations are needed. From the present study and literature data on other (clinical) populations we conclude that psychometric properties of CHQ-based health status measurement justify application in pediatric outcome studies, in addition to clinical measures.

Adolescent↗