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PubMed1994

A comparison of working postures of parcel sorters using three different working methods.

The postures of the trunk of eight parcel sorters were measured continuously under three different working conditions, during whole shifts. The working methods used were two different sorting tables and a hydraulic lifting platform on which the carts were to be placed. The question posed by the PTT-Post occupational health service was whether the latter method proved to be the better one with respect to the load on the musculoskeletal system. This study will help them to make a well-considered decision on which working method to choose for the new distribution centre in Rotterdam. The method used for measuring the working postures and movements of the trunk is the Portable Posture Registration Set (PPRS). This method was developed at the department of Biomedical Physics and Technology of the Erasmus University Rotterdam. While using the lifting platform, the subjects stood 8-11% more erect compared to the work at the sorting tables, thereby reducing the load on the lumbar spine. For this reason the lifting platform is preferred, although sagittal flexion of the back was somewhat more. It is stressed that the way in which sorters use the lifting platform is very important.

Adult↗
PubMed1993

Defining rural hospital markets.

OBJECTIVE: The purpose of this study is to examine the geographic scope of rural hospital markets. DATA SOURCES: The study uses 1988 Medicare patient discharge records (MedPAR) and hospital financial information (HCRIS) for all rural hospitals participating in the Medicare Program. STUDY DESIGN: Hospital-specific market areas are compared to county-based market areas using a series of geographic and socioeconomic-demographic dimensions as well as indicators of market competitiveness. The potential impact of alternative market configurations on health services research is explored by estimating a model of rural hospital closure. DATA COLLECTION/EXTRACTION METHODS: Hospital-specific market areas were defined using the zip code of patient origin. Zip code-level data were subsequently aggregated to the market level. FINDINGS: Using the county as the hospital market area results not only in the inclusion of areas from which the hospital does not draw patients but also in the exclusion of areas from which it does draw patients. The empirical estimation of a model of rural hospital closure shows that the definition of a hospital market area does not jeopardize the ability to identify major risk factors for closure. CONCLUSIONS: Market area definition may be key to identifying and monitoring populations at risk from rural hospital decisions to downsize or close their facilities. Further research into the market areas of rural hospitals that have closed would help to develop alternative, and perhaps more relevant, definitions of the population at risk.

Catchment Area, Health↗
PubMed2005

Postcards from the EDge project: randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self poisoning.

OBJECTIVE: To determine whether an intervention using postcards (postcards from the EDge project) reduces repetitions of hospital treated deliberate self poisoning. DESIGN: Randomised controlled trial. SETTING: Regional referral service for general hospital treated deliberate self poisoning in Newcastle, Australia. PARTICIPANTS: 772 patients aged over 16 years with deliberate self poisoning. INTERVENTION: Non-obligatory intervention using eight postcards over 12 months along with standard treatment compared with standard treatment alone. MAIN OUTCOME MEASURES: Proportion of patients with one or more repeat episodes of deliberate self poisoning and the number of repeat episodes for deliberate self poisoning per person in 12 months. RESULTS: The proportion of repeaters with deliberate self poisoning in the intervention group did not differ significantly from that in the control group (57/378, 15.1%, 95% confidence interval 11.5% to 18.7% v 68/394, 17.3%, 13.5% to 21.0%: difference between groups -2%, -7% to 3%). In unadjusted analysis the number of repetitions were significantly reduced (incidence risk ratio 0.55, 0.35 to 0.87). CONCLUSION: A postcard intervention reduced repetitions of deliberate self poisoning, although it did not significantly reduce the proportion of individual repeaters.

Adolescent↗
PubMedDate not supplied

"Understanding AIDS"--the national AIDS mailer.

The Centers for Disease Control (CDC) of the Public Health Service made public health history in 1988 by mailing the pamphlet, "Understanding AIDS," to every household in the United States. Approximately 126 million copies were distributed, reaching at least 60 percent of the population according to several national polls. The pamphlet was produced and mailed at a cost of about 20 cents per copy. The impact of "Understanding AIDS" by itself on AIDS-related behavior was not fully assessed. Extensive message pretesting and other commercial marketing techniques to improve the effectiveness of the brochure, however, helped "Understanding AIDS" achieve an increase in awareness and concern about AIDS. A number of lessons were learned during the process. They included the importance in such an enterprise of setting a deadline, doing formative research, receiving active support from senior management, achieving a consensus on scientific knowledge, using communications experts, centralizing the final decision-making function, maximizing publicity surrounding the mailing, building a base of support among constituency groups, planning distribution logistics from the very start, and designing evaluation into the process from the beginning.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Occupational and regional associations of death, disablement, and sickness absence among Post Office staff 1972-75.

Rates of death in service and rates of premature retirement due to disability in an employed population of more than 400 000 people under the age of 60 years have been compared with duration rates of certified sickness absence for three years from April 1972. Standardized for age, rates of sickness absence and of death, combined with retirement (medical wastage) for men and women differed between 11 occupational groups by a factor of three. Significant rank correlations were observed between these two measures of ill health, rs = 0-827 for men, rs = 0-857 for women. Similar comparisons for 1974/75 of rates for staff employed in 10 geographical regions of the United Kingdom standardized for age and occupation, revealed twofold differences of rate, and rank correlation coefficients of + 0-794 for men and + 0-649 for women. These observations show that the duration of certified sickness absence is higher in groups of people showing other objective evidence of ill health and who are most in need of preventive health care. The need is discussed for a balanced view of the complex aetiology of sickness absence.

Absenteeism↗
PubMed2002

Coding of pediatric behavioral and mental disorders.

BACKGROUND: In response to changing reimbursement and other pressures in the health care environment, many physicians have reported the use of alternate coding to substitute for certain clinical diagnoses. However, very little information is available on how physicians who care for children approach diagnosis and coding dilemmas for behavioral and mental disorders, which often present unique additional challenges. OBJECTIVE: Our study sought to describe the frequency of alternate coding, different approaches to coding, and attitudes toward diagnosis and coding practices by physician specialty. METHODS: We conducted a mail survey of 1492 physicians--497 developmental/behavioral pediatricians (DBP), 500 pediatricians (PED), and 495 child and adolescent psychiatrists (PSY). The main outcomes were survey items on frequency of alternate coding (never, rarely, monthly, weekly, daily), use of different coding strategies (use of somatic symptoms, modifiers, and substitution with other terms), and attitudes on coding practices (Likert scales of agreement). We analyzed outcomes by physician specialty and demographics using Pearson's chi2 and multivariate logistic regression. RESULTS: Overall response rate was 62% (787 of 1269 eligible physicians). The majority of physicians had used an alternate code (DBP 83%, PED 68%, PSY 58%), and many respondents reported monthly-daily alternate coding (DBP 60%, PED 36%, PSY 27%). Physicians used multiple approaches to diagnosis and a variety of coding options, which varied by physician specialty. Financial issues were commonly cited reasons for alternate coding--both to obtain patient services and to receive physician reimbursement. However, challenges of diagnostic classification and coding subthreshold symptoms were cited as frequently as reimbursement issues. Stigmatization, confidentiality, and parental acceptance were mentioned, but reported less frequently. Very few practices and providers have organized administrative methods of alternate coding (26%) or receive feedback on denied claims (46%). Most physicians believe that alternate coding is justified in the present system; however, some physicians expressed concerns that these practices may contribute to stigmatization or lead to improper management decisions. CONCLUSIONS: Alternate coding is commonly reported; however, approaches to diagnostic coding vary by provider specialty. Reimbursement issues are important, but other challenges in diagnosis and classification hold special relevance to children with behavioral and mental disorders. There seems to be a great need to reconsider the separate goals and uses of clinical diagnosis and administrative coding. Additional study is needed to assess how reported coding practices may affect administrative data, patient care, and health care economics.

Adolescent Psychiatry↗
PubMed2005

Failed appointments in an orthodontic clinic.

BACKGROUND: The aim of this study was to retest the hypotheses of Reekie and Devlin (1998) by conducting a similar randomized controlled trial in an orthodontic clinic in the Netherlands. It was hypothesized that a reminder would reduce the failed attendance rate and that the form of the reminder would be irrelevant. METHODS: All patients with appointments in the orthodontic clinic at the Academic Centre of Dentistry Amsterdam during a 3-week period were divided into 4 groups. Three groups received a reminder 1 day before the appointment, either by telephone, mail, or short message service (SMS, a service used to send and receive short text messages to and from cell phones). A control group did not receive a reminder. In a follow-up study, random subsamples in each group were interviewed by telephone. Subjects were asked how they felt about receiving a reminder and which reminder they preferred. RESULTS: The hypothesis that a reminder would reduce the failed attendance rate was not confirmed. Also, no differences were found between the 4 conditions, indicating that the form of the reminder is irrelevant. However, most of the interviewed participants felt positive or very positive about receiving a reminder. There was a significant preference for a reminder by mail (56.3%), followed by a telephone reminder (26.0%) and a reminder by SMS (17.7%). No less than 20% of the interviewed participants felt negative or very negative about the reminders and considered them to be a waste of time and money. CONCLUSIONS: The hypothesis that reminders are useful in the prevention of failed appointments was not confirmed. This study underlines the importance of replication studies. It demonstrates that every research result, whether it is generated by evidence-based or tradition-based research, should be interpreted with care and should be replicated in other studies before the results can be generalized.

Adolescent↗
PubMed2000

Enhancing influenza immunization. Postcard and telephone reminders and the challenge of immunization site shift.

OBJECTIVE: To determine if postcard and telephone reminders increased the rate of influenza immunization of Medicare beneficiaries. DESIGN: Before and after trial (postcard reminders) with systematically allocated control group (telephone reminder intervention). SETTING: A semirural family practice residency program. PATIENTS AND OTHER PARTICIPANTS: All 475 noninstitutionalized persons older than 65 years who had received at least 1 office service in the previous 2 years. INTERVENTION: In September 1996, each of 475 patients received a postcard urging prompt influenza immunization. Those not responding within 1 month were systematically allocated either to a group receiving further telephone contact or to a control group. At the time of telephone contact, any offered information about influenza immunization received outside the Smoky Hill Family Practice Center, Salina, Kan, was recorded. MAIN OUTCOME MEASURES: We measured the percentage of change in practice-administered influenza immunizations compared with the baseline rate of the preceding 2 years; the difference in immunization rates between the telephone intervention group and controls; and the number of patients contacted by telephone who reported receiving influenza immunization at a site other than the Family Practice Center. RESULTS: Twenty-eight percent of patients who received a postcard obtained office influenza immunizations within 1 month, but no additional immunizations could be attributed to the telephone intervention. Thirty-five percent of patients contacted by telephone reported receiving influenza immunization at a site other than the Family Practice Center. CONCLUSIONS: The postcard intervention was associated with a significant increase in the office immunization rate. This increase may have been confounded by "site shift" in which individuals came to the office for an immunization that they might otherwise have received at other community sites.

Aged↗
PubMed1999

Use of the Food Animal Residue Avoidance Databank (FARAD).

OBJECTIVES: To report the results of 3 surveys evaluating the extent that the Food Animal Residue Avoidance Databank (FARAD) is used by veterinarians, the profession's perception of the need for the program, barriers that prevent veterinarians from fully using the service, and the perceptions that animal production industry groups have regarding FARAD. DESIGN: Telephone and mail surveys were used to collect information using cross-sectional, case-control, and directed sample studies. SAMPLE POPULATION: Food animal veterinarians and veterinarians and nonveterinarians in allied animal industries or with special interest in production animal medicine. RESULTS: The use of FARAD was high among dairy and general practitioners, but low among beef practitioners and veterinarians with minor commitment to food animal medicine. Solo practitioners and veterinarians with less than 13 years in practice were less likely to use FARAD. Dairy practitioners who had not used FARAD were most likely to prescribe extralabel products. CLINICAL IMPLICATIONS: Results imply that dairy and general food animal practitioners have either greater need or access through educational networks and are more aware of FARAD than practitioners who work with beef and those with a minor component of their practice involving food animals. The difference in familiarity and use of FARAD between practice type is an important finding, but the root of the difference is not clear; it may be attributable to a difference in the effectiveness of knowledge transfer for the groups, or the message is ignored because the issue of drug residues is less compelling for veterinarians and their clients in the beef sector.

Animal Husbandry↗
PubMed1998

Randomized controlled study of customized preventive medicine reminder letters in a community practice.

OBJECTIVE: To test the effectiveness of customized, family-oriented reminder letters in activating patients to seek appropriate preventive services. DESIGN: Randomized clinical trial. One group received computer-generated, customized letters explaining recommended preventive procedures for each family member. A second group received a form letter listing recommendations for all preventive procedures for all age and sex groups. A third group (control group) received no letters. SETTING: A private medical centre, without university affiliation, in rural Quebec. PARTICIPANTS: From 8770 patients who met study criteria, 719 families were randomly selected. Data were available for 1971 of 1998 patients in these families. MAIN OUTCOME MEASURES: The Family Received Index is the proportion of all procedures for which a family was overdue that they received. The Family End-of-study Up-to-date Index is the proportion of procedures for which the family was eligible and for which they were up-to-date at the end of the study. RESULTS: The Family Received Index for families mailed customized letters was more than double the index for patients not mailed letters (Kruskal-Wallis P = .0139). Comparison of the Family End-of-study Up-to-date indices also demonstrated that families of patients sent customized letters were more likely to be up-to-date than families not sent letters (Kruskal-Wallis P = .0054). No statistically significant difference appeared between the number of preventive measures received by the control group and the form-letter group. CONCLUSIONS: This study demonstrates a clinically small but statistically significant value to customizing reminder letters.

Analysis of Variance↗
PubMed1993

Estimating hospital admission patterns using Medicare data.

It is often necessary in health services research and strategic planning to simultaneously describe the geographic pattern of admissions to multiple hospitals. Obtaining the data necessary to accomplish this can often be problematic. In some states discharge abstract data on all admissions to all hospitals in the state are compiled and maintained by a government agency, but in 23 states these data are not available. Furthermore, problems arise when a substantial fraction of admissions cross state borders, such that data from more than one state is required for description of 'patient flows'. Individual hospitals typically maintain data on the geographic source of their own admissions, but are not likely to have access to such data regarding other hospitals in their area. Patient flow data on Medicare admissions are available for all states and are readily accessible, but heretofore it has not been known how closely the admission patterns of Medicare patients approximate those of other types of patients. We examine the accuracy of using data on Medicare admissions to estimate, at the hospital level, the admission patterns of other types of patients. Using zip code-to-hospital patient flow data for all non-federal hospitals in California, we calculated the correlation between Medicare admission patterns and those of three other groups of patients (other adults, pediatrics and obstetrics) for each hospital. For the majority of hospitals, Medicare data predict the admissions of other adults quite well, and the admissions of pediatric and obstetric admissions moderately well.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Surveying physicians: do components of the "Total Design Approach" to optimizing survey response rates apply to physicians?

BACKGROUND: Surveys serve essential roles in clinical epidemiology and health services research. However, physician surveys frequently encounter problems achieving adequate response rates. Research on enhancing response rates to surveys of the general public has led to the development of Dillman's "Total Design Approach" to the design and conduct of surveys. The impact of this approach on response rates among physicians is uncertain. OBJECTIVE: To determine the extent to which the components of the total design approach have been found to be effective in physician surveys. DESIGN: A systematic review. RESULTS: The effectiveness of prepaid financial incentives, special contacts, and personalization to enhance response rates in surveys of physicians have been confirmed by the existing research. There is suggestive evidence supporting the use of first class stamps on return envelopes and multiple contacts. The optimum amount for incentives and the number of contacts necessary have not been established. Details of questionnaire design and their impact on response rates have received almost no attention from researchers. Few studies have assessed the usefulness of combinations of components of the total design approach. CONCLUSIONS: Despite the number of surveys conducted among physicians, their cost, the level of interest in their findings, and in spite of inadequate response rates, there have been few randomized trials conducted on important aspects of enhancing response in this population. Until this gap has been filled, researchers conducting surveys of physicians should consider including all components of the total design approach whenever feasible.

Attitude of Health Personnel↗
PubMed2005

Response rates to a mailed survey targeting childhood cancer survivors: a comparison of conditional versus unconditional incentives.

OBJECTIVE: Mailed surveys are widely used to collect epidemiologic and health service data. Given that nonresponse can threaten the validity of surveys, modest incentives are often used to increase response rates. A study was undertaken among childhood cancer survivors and their parents to determine if response rate to a mailed survey differed with provision of immediate versus delayed incentives. DESIGN: A self-administered survey designed to ascertain health behaviors was mailed to 397 childhood cancer survivors (and their parents if the survivor was <18 years of age). Subjects were randomized into two groups based on gender, age, race, and cancer type. One group received a 10 US dollars incentive with their blank survey (unconditional incentive), whereas the other group received the incentive upon receipt of their completed survey (conditional incentive). If children were minors, both the parent and the child received incentives. RESULTS: No significant differences in response rates were observed with respect to gender, age, race, or cancer type. However, significant differences in response rates were observed between incentive groups, with unconditional incentives yielding significantly higher response rates than conditional incentives for child survivors who were > or =18 years (64.4% versus 49.0%), as well as younger child survivors (62.5% versus 43.6%) and their parents (64.8% versus 41.5%; all P < 0.05). CONCLUSIONS: The provision of an immediate incentive generated significantly higher response rates to this mailed health survey among childhood cancer survivors and their parents. Given that survey studies are commonly conducted across various pediatric populations, these findings may help inform the design of future pediatric survey research.

Adolescent↗
PubMed1997

Assessing inner-city patients' hospital experiences. A controlled trial of telephone interviews versus mailed surveys.

OBJECTIVES: Obtaining accurate and representative patient-centered data may be difficult among poor, inner-city patients because of changing addresses, variable access to telephones, and a higher prevalence of illiteracy than in the populations in which many survey instruments were developed and tested. Assumptions about the usefulness of mailed surveys versus telephone interviews may not hold for the urban poor. Therefore, identifying the most efficient mode of survey administration in this population becomes an important methodological question. METHODS: We conducted a randomized trial of patients discharged from the inpatient medicine service of an urban teaching hospital to compare telephone interview with mailed self-administration of a detailed instrument for measuring patients' experiences with hospital care. Our primary outcomes were response rate, missing data, and data collection costs. Patients were excluded if they were not discharged to home or were mentally or physically unable to complete mailed or telephone interviews. The research assistant contacted eligible patients while hospitalized, informed them of the postdischarge survey, and obtained current phone numbers and addresses. Patients then were randomized to receive a 116-item satisfaction survey via one of two survey methods: mail-first (mailed surveys with follow-up on nonrespondents by telephone) or telephone-first (telephone interviews with follow-up of nonrespondents by mail). RESULTS: Of the 252 patients enrolled, 130 were randomized to the mail-first and 122 to the telephone-first method. Response rates were higher with the telephone-first (73%) compared with the mail-first method (50%; P < 0.0001). Surveys obtained by the telephone-first method had fewer missing data (0.7 +/- 2.39) for those items not involved in skip patterns compared with the mail-first method (7.1 +/- 12.3; P < 0.001) and were 42% less expensive per completed survey ($26.32 versus $37.35; P < 0.0001). CONCLUSIONS: In this survey of patients served by an urban teaching hospital, a strategy of telephone interviews with mail follow-up proved less expensive and yielded a higher response rate with more complete data than using a method where mailed surveys were followed by back-up telephone interviews. In addition, we believe that the improved response rate for telephone interviews compared with those reported in the literature for similar populations is the result of informing inpatients of the survey and obtaining telephone numbers and addresses in the hospital.

Female↗
PubMed1994

Adolescent measles vaccination. Response rates to mailings addressed to patients vs parents.

OBJECTIVE: To determine the measles vaccination rate in adolescents that could be achieved with a mailed notification of the recommendation, and to determine if the response rate differed if the mailing was addressed to the parents or to the adolescents. DESIGN: Randomized trial. SETTING: A family medicine residency training clinic serving a low-socioeconomic population. PATIENTS OR OTHER PARTICIPANTS: Four hundred forty-nine adolescents aged 12 through 18 years who were seen in the clinic within the previous 21 months without receiving a documented second dose of measles vaccine were randomized into two groups. INTERVENTION: A letter recommending measles revaccination was sent to the parents in one group (parent group) and to the adolescents themselves in the second group (adolescent group). The content of both letters was basically the same, but they differed in style and reading level. MAIN OUTCOME MEASURE: Measles vaccinations administered to adolescents during the 2-month period following mailing of the letters. RESULTS: Twenty-eight patients were excluded after randomization. Fifty-six letters were undeliverable after two mailing attempts. Eleven (6.3%) of 176 adolescents in the parent group and five (2.6%) of 189 adolescents in the adolescent group received the measles vaccination (P > .05). CONCLUSIONS: Although the adolescents whose parents received the letter were twice as likely to be vaccinated, the response rate was poor in both groups. The letter campaign was not an effective method to reach adolescents for measles revaccination.

Adolescent↗
PubMed2000

The impact of outreach efforts in reaching underimmunized children in a Medicaid managed care practice.

BACKGROUND: National immunization standards call for all primary care providers to implement immunization tracking systems that include contacting families when children are overdue for vaccines. The restructuring of Medicaid systems toward managed care models with a greater emphasis on having defined medical homes for children presents opportunities to expand the use of immunization recall systems among low-income children. OBJECTIVE: To assess the impact of telephone, mail, and a combined approach to reaching underimmunized children enrolled in a hospital-based Medicaid managed care practice. DESIGN AND METHODS: All underimmunized children younger than 6 years who had been continuously enrolled in the hospital-based Medicaid managed care practice for 3 months were randomly assigned to 1 of 4 groups: (1) control group with no intervention, (2) telephone reminder group, (3) mail reminder group, or (4) sequential mail/telephone reminder group. After a 10-week follow-up, medical records and the hospital's computerized appointment scheduling system were reviewed to determine the effect of the outreach effort on appointments made, visits attended, immunizations received, and immunization status. RESULTS: Outreach efforts had a positive impact on the proportion of children immunized and on the resulting immunization coverage rates. The percentage of children receiving immunizations during the 10-week follow-up was 4.2% (3/71) for the control group, 16.7% (10/60) for the telephone reminder group, 19.0% (12/63) for the mail reminder group, and 25.7% (18/70) for the sequential mail/telephone reminder group. The percentage of children up-to-date for all immunizations at the end of the 10-week follow-up was 2.8% (2/71) for the control group, 13.3% (8/60) for the telephone reminder group, 14.3% (9/63) for the mail reminder group, and 17.1% (12/70) for the sequential mail/telephone reminder group. Forty-eight children were seen during follow-up without receiving all indicated vaccines. CONCLUSIONS: Outreach efforts were modestly successful in reaching underimmunized children in a Medicaid managed care practice, although the lack of accurate information on telephone numbers and addresses limited the effectiveness. Missed opportunities for immunization also reduced the impact of outreach on immunization coverage. Arch Pediatr Adolesc Med. 2000;154:1243-1247.

Child↗