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At least 1,189 records · Page 66Linked to original sources
PubMed1998

A medical technology index for community hospitals.

This article creates a medical technology index to serve as a benchmark in strategic assessment of community hospitals. An expert panel assigned weights to the six components in the index. Empirical validation is achieved by regressing bond ratings on the index and using the index with eight other factors in explaining net incomes of community hospitals.

Benchmarking↗
PubMed1997

Comparison of three visit-specific patient satisfaction instruments: reliability and validity measures and the effect of four methods of data collection on dimensions of patient satisfaction.

The purposes of this study were to evaluate the reliability and validity of three short-form patient satisfaction instruments and to examine the effects of data collection methods on patient satisfaction ratings. With a framework to assess quality of care from the patient's perspective, acceptability, accessibility, patient satisfaction rating, provider recommendation, and patient demographic data were collected using three patient surveys: the Health Outcomes Institute questionnaire (HOI); the Nalle Clinic survey (Nalle); and a commercially marketed survey (COM). The four methods of data collection were (1) receptionist-distributed at check-in, (2) student-distributed at check-out, (3) mail, and (4) phone. Data were collected on a systematically selected sample of 1,840 patients who were appointed in two family practice departments of the Nalle Clinic in Charlotte, North Carolina. From the 925 completed surveys, the results indicated that the HOI instrument scored higher on the reliability and validity measures in this patient sample than the Nalle or COM surveys. Analysis of variance was then conducted on the HOI scores across the four methods of data collection. The conclusion was that the method of data collection did not significantly influence any of the patient satisfaction indicators in the family practice sample.

Data Collection↗
PubMed1999

The future of physician profiling.

Although enthusiasm for physician profiling dates back to the origins of scientific medicine, the track record of profiling as an intervention is not strong. Profiling appears to be most valuable for simple interventions and processes, but its acceptance, usefulness, and impact will be influenced by future trends. Health care organizations will continue to be complex, and multiple overlapping profiles will be the norm. Technology will advance, but concerns over privacy and confidentiality will influence the social, political, and regulatory approaches to profiling. Public sector purchasers and consumers will increasingly demand profiling, but data will continue to lack the ability to interpret complex profiling data. Medical practice will increasingly accept profiling as part of ongoing quality improvement efforts, but profiling may become focused on key processes, not outcomes. Statistical, cognitive, and epistemological challenges to profiling will remain, and profiling may simultaneously become more complex and more simplified with the rise of information brokers. Greater attention to the human side of profiling will enhance its effectiveness.

Data Collection↗
PubMed1991

Multitrait-multimethod analysis of health-related quality-of-life measures.

Interest in health-related quality of life (HRQOL) is burgeoning and there has been a proliferation of self-report measures of HRQOL. However, only two instruments available for measuring HRQOL have been calibrated using empirically derived preferences; both are long and complex. This study tested a brief survey designed to concurrently assess HRQOL and preferences for different HRQOL states. Multitrait-multimethod (MTMM) analysis was used to evaluate the construct validity of the survey in a convenience sample of 116 persons. Two methods were used to assess six aspects of HRQOL: general health perceptions, meaningful activities, outlook on life, physical suffering, self-care activities, and social relationships. HRQOL preferences were assessed using two methods similar to those used for self-reports, as well as one additional method. The construct validity of self-reported HRQOL was supported. On the other hand, substantial method variance and little valid trait variance was observed for the HRQOL preferences. Results are discussed in terms of their implications for evaluating and measuring HRQOL and related preferences.

Factor Analysis, Statistical↗
PubMed1994

In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care.

Application of techniques such as cost-effectiveness analysis (CEA) is growing rapidly in health care. There are two general approaches to analysis: deterministic models based upon assumptions and secondary analysis of retrospective data, and prospective stochastic analyses in which the design of a clinical experiment such as randomised controlled trial is adapted to collect patient-specific data on costs and effects. An important methodological difference between these two approaches is in the quantification and analysis of uncertainty. Whereas the traditional CEA model utilizes sensitivity analysis, the mean-variance data on costs and effects from a prospective trial presents the opportunity to analyze cost-effectiveness using conventional inferential statistical methods. In this study we explored some of the implications of moving economic appraisal away from deterministic models and toward the experimental paradigm. Our specific focus was on the feasibility and desirability of constructing statistical tests of economic hypotheses and estimation of cost-effectiveness ratios with associated 95% confidence intervals. We show how relevant variances can be estimated for this task and discuss the implications for the design and analysis of prospective economic studies.

Confidence Intervals↗
PubMed1996

Issues of variability and bias affecting multisite measurement of quality of care.

OBJECTIVES: Using data from a randomized trial to improve the quality of ambulatory care, the authors quantify the various sources of variability and bias that affect measures of quality of care and suggest experimental designs and analyses that reduce both bias and variability. METHODS: There is a growing desire among health care researchers and government agencies to profile and compare practitioner performance. Such efforts are complicated by extreme inherent variability in most measures of quality of care, as well as potential biases introduced by "experiments," where patients cannot act as the unit of randomization. When the authors measured practitioner performance for eight patient-care guidelines, they found little association of level of performance across guidelines. Thus, the authors considered performance for each guideline separately, also taking into account variability between patients, practitioners, and practice conditions. RESULTS: Randomization can reduce bias in large studies but should be supplemented by multivariate models. A preintervention and postintervention design can reduce variability, but much of the variability that remains is because of unmeasured patient/error variance. CONCLUSIONS: Incorporation of these concepts into future studies using quality measurements will help researchers design smaller and more sensitive trials to draw more accurate and precise conclusions.

Adult↗
PubMed1997

On becoming 65 in Ontario. Effects of drug plan eligibility on use of prescription medicines.

OBJECTIVES: The authors assess (1) the effects of first-dollar prescription drug insurance coverage provided by the Ontario Drug Benefit plan at age 65 on prescription drug use by seniors, and (2) the differential effects of this coverage on prescription drug use by seniors with varying levels of health status. METHODS: The authors modeled self-reported prescription drug use contained in the 1990 Ontario Health Survey as a function of eligibility for coverage, controlling for health status and other factors. The two-part model was used and was estimated by maximum likelihood. RESULTS: The provision of first-dollar prescription drug insurance coverage at age 65 is associated with an increase in drug use. Increases in drug use are, however, concentrated primarily among individuals with lower levels of health status. Most of the increased use occurs among individuals already under physician supervision, ie, an increase in the level of use among drug users rather than an increase in the probability of use. CONCLUSIONS: As Ontarians turn age 65 and become eligible for publicly subsidized prescription drugs, their use increases but the effect appears to be restricted mainly to persons with lower levels of health status. Given a growing trend toward reduction of public subsidy and increased reliance on patient cost sharing, more research is needed to quantify the use and health effects of such initiatives.

Age Factors↗