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Choosing an appropriate unit of analysis in trials of interventions that attempt to influence practice.

The choice of an appropriate unit of analysis in evaluations in health policy is problematic and errors are frequently made which may undermine study conclusions. This paper describes the structure of randomized trials, issues concerning randomization and replication, and the factors that should be considered when deciding upon the appropriateness of a unit of analysis.

Data Interpretation, Statistical↗

Market orientation in the hospital industry.

Using the more recent methodological developments in the assessment of the unidemensionality, reliability, and validity, the authors developed and examined a scale of market orientation for the hospital industry. The scale is based on a clear definition of the content of the construct of market orientation in the hospital industry. To this end, a national random sample of 237 hospital administrators was used. In addition to the support for the reliability and validity, the scale promises parsimony, pragmatism, and wide-ranging applicability.

Factor Analysis, Statistical↗

Understanding variation in revenue and expenses.

Control charts offer a way for healthcare organizations to react appropriately to unexpected changes in performance indicators. Control charts demonstrate whether an immediate remedy or a redesign of a process is needed. An understanding of variation in processes can help in comprehending performance and avoiding identification of data trends that do not exist. Control charts can be used to more accurately estimate revenue and expenses over the long-term.

Accounts Payable and Receivable↗

[Factors influencing intelligence in elderly population in a community-based study in Taiyuan city].

OBJECTIVE: To explore the factors which influencing the intelligence in elderly in a community, so as to provide reference on primary prevention of dementia. METHODS: A door to door survey was conducted. A total number of 830 elderly were assessed using WAIS-RC, H-NTLA and data collected through questionnaires on lifestyles, family and social activity were analysed, using the factor analysis, stepwise regression and canonical correlation analysis. RESULTS: The main variables related to the verbal were eggs diet, blood pressure, fruit, visit their children, alcohol intake (standard coefficients of regression are -0.118, -0.079, -0.060, -0.036, -0.117, respectively). The main variables related to cognition were recreation, sports and hereditary history of mental disorders (standard coefficients of regression were 0.035, -0.127, respectively). The main variables related to memory were contact to chemical materials, age of their parents during delivery, alcohol intake and the relationship between husband and wife (standard coefficients of regression were -0.063, 0.055, -0.030, -0.037, respectively). The variables related to canonical variable V(1) would include education and occupation (canonical correlation = 0.5993, P = 0.0001) while V(2) would include cerebrovascular accident (canonical correlation = 0.3925, P = 0.0005). CONCLUSION: Intelligent work, family harmony, prevention of cerebrovascular diseases were the main areas to prevent intellectual disability in the elderly.

Aged↗

Common methodological terms in health services research and their synonyms [correction of symptoms].

OBJECTIVE: Health services researchers use methods and terminology from a variety of disciplines to understand individual and organizational behavior related to health, health care, and health insurance. Although this diversity benefits the process of research, the resulting differences in terminology can occasionally lead to confusion among even the most experienced researchers. The purpose of this paper is to clarify different methodological terms used to represent common study designs and statistical concepts in health services research. METHOD: Faculty from the departments of Health Services, Biostatistics and Epidemiology at the University of Washington were asked to provide a list of terms commonly used in health services research that had one or more methodological terms with the same or similar meaning. Consistent with the Delphi method, the initial list was then circulated to internal and external methodologists and additional terms were added for completeness. Terms related to study designs, equation specification, and estimation problems with synonymous terminology were included. RESULTS: A "methodological thesaurus" is developed and described in this paper. Many terms were found which described essentially identical concepts. In other cases, terms had slight but important differences in meaning across disciplines, leading to potential confusion in their use. CONCLUSION: In light of these differences in terminology, it is not surprising that health services researchers with a particular disciplinary orientation currently find literature within their own discipline entirely readable and literature from another discipline considerably less accessible. The "methodological thesaurus" presented in this paper should be of value to health services researchers who are interested in exploring the full array of methods developed to address a particular problem. Teachers and students of health services research should also find this article of use in relating similar concepts across disciplines in quantitative health services research publications.

Bias↗

A follow-up comparison of patient satisfaction among prepaid and fee-for-service patients.

This study reports the results of a follow-up patient satisfaction survey that sampled patients enrolled in a capitation program and compared their satisfaction levels with otherwise similar patients in a fee-for-service program two years after the programs began. On a scale of 1 (very dissatisfied) to 5 (very satisfied), the mean general satisfaction level for 158 prepaid patients was 3.17 +/- 0.70, and 3.42 +/- 0.61 for 87 fee-for-service patients (P less than .05). This finding contrasts with no differences seen in a previous study of the same populations at six months after the programs began (mean general satisfaction levels of 3.26 and 3.36 for the prepaid and fee-for-service patients, respectively). A statistically significant difference also existed in the subdimension "technical aspects of quality of care": 3.38 +/- 0.65 for prepaid patients, and 3.61 +/- 0.53 for fee-for-service service patients (P less than .05). Levels of satisfaction within other individual constructs were similar for both groups and tended to remain the same over two years, although satisfaction with access to care decreased among prepaid patients, and satisfaction with continuity of care increased among fee-for-service patients. These data support the hypothesis that overall satisfaction levels and certain aspects of patient satisfaction may be compromised by a capitation program.

Consumer Behavior↗

Emergency department satisfaction: what matters most?

STUDY OBJECTIVE: To determine the relative importance of variables correlated with patient satisfaction with emergency department care and service. DESIGN: Retrospective telephone survey targeting all patients who visited the Panorama City Kaiser Permanente ED from April 4 to April 17, 1991. Patients were contacted within one week of their discharge from the ED or hospital. PARTICIPANTS: Two hundred fifty-eight ED patients completed telephone surveys. Fifty-one percent of the respondents were male, and the mean age was 53 years. The majority of the respondents were white (70%); the most common service received was medical (82%). MEASUREMENTS AND RESULTS: Of the 14 variables that were found to be correlated with overall ED satisfaction, a multiple regression analysis revealed that the five most important variables were patient satisfaction with the amount of time it took before being cared for in the ED; patients' ratings of how caring the nurses were, how organized the ED staff was, and how caring the physicians were; and patient satisfaction with the amount of information the nurses gave them about what was happening to them. CONCLUSION: The total time patients spend in the ED and patients' perceptions of their wait time for an ED bed are not as important to patient satisfaction as is receiving prompt and caring service. The above service variables are key areas that may be targeted to improve ED services.

Adolescent↗