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PubMed1982

Radiological services throughout the world.

WHO's statistics show the doctor-to-population ratio in the Third World to have changed very little over the past decade, with radiological services among the least developed medical branches of a developing country's health care system. Data is presented on population/machine/personnel ratios, morbidity patterns, number of X-ray examinations per population and films taken, percentage of wasted film, and breakdown of types of procedures. Data collected from 89 countries show that of a total population of 1.2 billion, only 220 million have access to adequate diagnostic X-ray services. A well-structured diagnostic X-ray service at the country level should form a pyramid consisting of three levels of sophistication: (1) Basic Radiological Service (BRS), the broad base of the pyramid and available to the mass of the population requiring uncomplicated radiographic examinations; (2) General Purpose Radiological Service (GPRS), at the intermediate level, functioning as a backup service for the BRS facility and a filter station for the sophisticated department at the top; (3) Specialized Radiological Service (SRS), performing specialized radiodiagnostic procedures, and undertaking research and training. This pyramid structure does not at present exist in the majority of countries. Adequate coverage of the population cannot be achieved unless X-ray facilities are made available in places near to where the majority of the population live. The BRS comprises a technical concept and teaching/learning programme representing a solution to the present unsatisfactory situation.

Developing Countries↗
PubMed1997

Men and women residents' experiences with women's health care in a family medicine center.

PURPOSE: To address the experience in women's health care available at the Queen's University Faculty of Medicine family residency program and to compare the amounts and types of experiences of men and women residents. METHOD: A retrospective analysis was made of 70,805 patient encounters with family medicine residents at the Queen's University Family Medicine Centre over a five-year period (June 1988-May 1993). Patient-encounter files contained patient, staff, and resident information, as well as service and diagnostic codes. Statistical analysis was done using a two-tailed Student's t-test to compare the mean numbers of encounters with the women patients for the men and women residents in ten service and diagnostic categories. RESULTS: Of the 70,805 patients, 65.1% were women. The mean numbers of patients seen by the 45 men residents (534) and the 90 women residents (519) did not differ significantly. The percentages of the women patients seen by the men and the women residents (58.6% and 68.4%, respectively), however, differed significantly. The mean ages of the women patients seen by the men and the women residents (44.5 years and 39.2 years, respectively) also differed significantly. The women had significantly more encounters with the women patients in five of the ten categories studied. CONCLUSION: The differences between the men and women residents' experiences was significant in several areas. A potentially confounding factor is that the women may have been preferentially placed in team areas with all women staff physicians and the men placed in team areas with all men staff physicians. As family medicine programs aim for levels of exposure that are sufficient and similar for men and women residents, it is important that they evaluate the clinical opportunities for residents in women's health and work to ensure that both men and women residents receive adequate exposure in this area. One step in this direction might be gender-balanced patient populations, which might be obtained by ensuring gender-balanced clinical teams.

Adult↗
PubMed1988

Federal monitoring of the nation's nutritional status. Contributions of the National Center for Health Statistics.

The National Center for Health Statistics conducts a broad program of record-based systems and population surveys providing information on the health and nutritional status of the US population. The record-based systems include vital statistics and health-care surveys. Population surveys include the National Health and Nutrition Examination Survey (NHANES), the National Health Interview Survey, the National Survey of Family Growth, and epidemiologic follow-back surveys. Although all of these data systems provide nutrition-related information, the NHANES collects the most directly relevant nutritional status data through interview and examination of a national probability sample of children and adults. The third NHANES is scheduled to begin in September 1988 and is designed to provide cross-sectional estimates of dietary intake and nutritional status for nutrition-monitoring purposes and to serve as the baseline for longitudinal studies of diet and health.

Anthropometry↗
PubMed1994

Sensitivity, specificity and predictive values of health service based indicators for the surveillance of influenza A epidemics.

BACKGROUND: The Regional Influenza Surveillance Group (GROG) is a French surveillance network set up in 1984. It collects virological specimens and health service based indicators on a weekly basis. Our aim was to assess the predictive value of the health service based indicators for the detection of influenza A epidemics. METHODS: Virological data were used as a gold standard for defining the epidemics. For each health service based indicator, a statistical threshold was used as a test for the identification of epidemic weeks. Finally, an epidemiological criterion was defined in order to improve the specificity and the speed of detection of outbreaks. RESULTS: Health service based indicators have a positive predictive value of around 0.80. They also advance the detection of outbreaks by between 1 and 4 weeks. CONCLUSIONS: These indicators are easy to collect and are useful for the surveillance of influenza epidemics. Such a system is the prerequisite for the rational use of preventive tools.

Disease Outbreaks↗
PubMed2004

A method for analyzing longitudinal outcomes with many zeros.

Health care utilization and cost data have challenged analysts because they are often correlated over time, highly skewed, and clumped at 0. Traditional approaches do not address all these problems, and evaluators of mental health and substance abuse interventions often grapple with the problem of how to analyze these data in a way that accurately represents program impact. Recently, the traditional 2-part model has been extended to mixed-effects mixed-distribution model with correlated random effects to deal simultaneously with excess zeros, skewness, and correlated observations. We introduce and demonstrate this new method to mental health services researchers and evaluators by analyzing the data from a study of assertive community treatment (ACT). The response variable is the number of days of hospitalization, collected every 6 months over 3 years. The explanatory variable is group: ACT vs. standard case management. Diagnosis (schizophrenia vs. bipolar disorder), time, and the baseline values of hospital days are covariates. Results indicate that clients in the ACT group have a higher probability of hospital admission, but tend to have shorter lengths of stay. The mixed-distribution model provides greater specification of a model to fit these data and leads to more refined interpretation of the results.

Adult↗
PubMed1994

Analyzing health outcomes through international comparisons.

There is increasing interest in the conduct of international studies that compare health care outcomes. This paper draws from the literature in sociology, anthropology, and psychology to examine the problems that can be encountered when collecting primary data for comparative purposes. Issues of study design, selection, development, and adaptation of instruments, problems encountered in collecting primary data, and techniques for analyzing comparative data are discussed. The paper is intended as a primer for health services researchers conducting comparative outcomes research in international settings.

Data Collection↗
PubMed1998

Methods of evaluation in outcomes research.

UNLABELLED: This activity is designed for pharmacists, physicians, physician assistants, nurses, and other healthcare team members; payers for health services; and healthcare executives. GOAL: To provide basic information on the methods used and computer software available for evaluating invariant factorial structures, such as those found in health status measurement tools. OBJECTIVES: 1. Discuss why comparison of mean scores may not be appropriate when interpreting humanistic outcomes results. 2. Identify alternative methods for evaluating data from health status measurement tools, such as the SF-36. 3. Define validity, reliability, and structure. 4. Understand the value of structural equation modeling when using health status measurement tools, such as the SF-36. 5. Describe the statistical software used to perform structural equation modeling.

Data Interpretation, Statistical↗
PubMed2003

[Developing an evidence based clinical guideline on cardiac rehabilitation--Phase 2: comparative analysis of the present level of service provision in cardiac rehabilitation based on the KTL statistics].

BACKGROUND: This project aims to develop an evidence based clinical guideline for the rehabilitation of cardiac patients considering recent scientific literature (stage 1), procedures received by cardiac patients undergoing rehabilitation carried by the German Federal Insurance Institute for Salaried Employees (BfA) based on the Classification of Therapeutic Procedures (KTL) (stage 2), and expert agreement of the professionals involved (stage 3). This study presents the results of stage 2. The analysis of the KTL-statistics was carried out to determine whether it is essentially necessary to implement a guideline and to define "critical" aspects, i. e. aspects that require high priority implementation. The project is part of a research programme funded by the BfA. METHODS: 317 out of the 840 possible KTL-codes were attributed to one of twelve therapeutic modules that--according to the results of stage 1--are characteristics of cardiac rehabilitation. For these modules the number of people having received therapeutic procedures belonging to the respective module the duration per patient and per week were calculated. The influence of concomitant factors such as age, gender and indication were analysed multivariately. Furthermore, the hospitals involved were compared. The analyses are based on approximately 87,400 KTL-entries from 5,494 patients (indication: "myocardial infarction" or "coronary artery bypass surgery") treated in 2000. RESULTS: On average the patients receive therapeutic procedures "stemming" from 5.5 modules. More than 90 % receive procedures assigned to the modules "endurance training" or "motivation", respectively, and almost 70 % from "nutrition training". The other modules are rendered not consistently and occasionally to a relatively small degree. Younger patients following a myocardial infarction receive therapeutic procedures more frequently and longer while older patients after bypass surgery are treated less frequently and for a shorter duration. There is substantial variability between individual clinics. DISCUSSION: It appears to be necessary to implement clinical practice guidelines in all evaluated therapeutic modules but "endurance training" and "motivation". An evidence based clinical practice guideline for the rehabilitation of cardiac patients should detail the kind and extent of procedure(s) required. It should also inform about the lack of evidence for variations in treatment with respect to age, gender, or indication. To facilitate monitoring of the degree of implementation of the guideline precise instructions for the documentation using the KTL should be developed and implemented. As a next step towards an evidence based, empirically proven and acceptable guideline this project's results will be discussed with experts from science and clinical practice.

Combined Modality Therapy↗