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- Methodology (23)
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- Transition Probabilities and Multistate Life Tables (7)
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- Age (1)
- Anderson model (1)
- Ankle fracture diagnostic rule clinical algorithm (1)
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Articles 31 - 49 of 49
Full-Text Articles in Physical Sciences and Mathematics
Do Communities Differ In Health Behaviors?, Paula Diehr
Do Communities Differ In Health Behaviors?, Paula Diehr
Paula Diehr
Communities differ in the prevalence of various health behaviors, but it is not known to what extent these differences are due to "different types" of people living in them. We used data from the evaluation of the Henry J Kaiser Family Foundation Community Health Promotion Grant Program to study individual-level and community-level variation in health behaviors for 15 communities. Our results show (1) there was significant variation among these communities in prevalences of smoking, consumption of alcohol and dietary fat, and use of seatbelts; (2) these differences persisted after control for demographic, health status, and other health behavioral characteristics of …
Small Area Variation Analysis. Methods For Comparing Several Diagnosis-Related Groups., Paula Diehr
Small Area Variation Analysis. Methods For Comparing Several Diagnosis-Related Groups., Paula Diehr
Paula Diehr
In small-area variation analysis, the variation of health care utilization rates, e.g., admission rates, among small areas is calculated. Frequently, the variation of one diagnosis, diagnosis-related group (DRG), or procedure is compared with the variation of another. Unfortunately, the methods generally used to make these comparisons are not consistent. They differ on whether they 1) adjust for the prevalence of the DRGs, 2) distinguish between variation among areas and variation within areas, 3) weight all areas equally, and 4) adjust for multiple admissions per person. None has an associated confidence interval. These discrepancies occur in part because there is no …
Can Small-Area Analysis Detect Variation In Surgery Rates? The Power Of Small-Area Variation Analysis., Paula Diehr
Can Small-Area Analysis Detect Variation In Surgery Rates? The Power Of Small-Area Variation Analysis., Paula Diehr
Paula Diehr
A variety of statistical methods can be used in small-area analysis to test whether there is more variation than would be expected by chance alone. However, the power of these methods to detect existing variation has never been studied. The authors used data regarding back surgery in Washington State to suggest several types of variation that might exist (alternative hypotheses), and then used computer simulation to determine the power, or the probability of detecting this variation. The chi-square test had the highest power of all methods considered against most alternative hypotheses. Power is higher if there are no multiple admissions, …
Reproducibility And Responsiveness Of Health Status Measures. Statistics And Strategies For Evaluation, Paula Diehr, Richard Deyo
Reproducibility And Responsiveness Of Health Status Measures. Statistics And Strategies For Evaluation, Paula Diehr, Richard Deyo
Paula Diehr
Before being introduced to wide use, health status instruments should be evaluated for reliability and validity. Increasingly, they are also tested for responsiveness to important clinical changes. Although standards exist for assessing these properties, confusion and inconsistency arise because multiple statistics are used for the same property; controversy exists over how to measure responsiveness; many statistics are unavailable on common software programs; strategies for measuring these properties vary; and it is often unclear how to define a clinically important change in patient status. Using data from a clinical trial of therapy for back pain, we demonstrate the calculation of several …
Estimating County Percentages Of People Without Health Insurance, Paula Diehr
Estimating County Percentages Of People Without Health Insurance, Paula Diehr
Paula Diehr
County data on the percentage of people without health insurance are seldom available, although state program planning requires such information. As part of an evaluation of Washington's Basic Health Plan (BHP), we conducted a telephone survey in nine Washington counties to estimate the percentage of people under the age of 65 who were uninsured. We used regression analysis to estimate the percentage uninsured in a county as a function of the percentage unemployed. Two validation approaches yielded very good results, suggesting that the equation could be used to estimate the percentage uninsured in unsurveyed counties. The variation ranged from 15% …
A Small Area Simulation Approach To Determining Variation In Dental Procedure Rates, Paula Diehr
A Small Area Simulation Approach To Determining Variation In Dental Procedure Rates, Paula Diehr
Paula Diehr
All small area analyses need to compare the observed variability in rates to that expected by chance alone, but the expected variability is usually not known. This paper uses patient-level data for five dental procedures to simulate the distributions of the summary statistics that are usually generated in such studies. These statistics are found to vary greatly even under the "null hypothesis" that all dentists are using procedures at the same rates. The simulated dentist rates are compared to observed rates obtained in a different study. These findings illustrate problems that can occur in small area analysis studies, and emphasize …
Use Of A Preferred Provider Plan By Employees Of The City Of Seattle, Paula Diehr
Use Of A Preferred Provider Plan By Employees Of The City Of Seattle, Paula Diehr
Paula Diehr
Little is known about the use of services in a preferred provider organization (PPO). We studied a preferred provider arrangement between Pacific Medical Center and employees of the City of Seattle. In the second 12 months of this program 8,529 subjects submitted at least one claim; of these, only 420 (4.9%) ever used the preferred provider. Those who used the PPO at least once differed significantly from those who never used it on age, sex, employee/dependent status, and utilization in the previous year. Outpatient and total charges were higher for PPO users than for nonusers before and after control for …
What Is Too Much Variation? The Null Hypothesis In Small-Area Analysis, Paula Diehr
What Is Too Much Variation? The Null Hypothesis In Small-Area Analysis, Paula Diehr
Paula Diehr
A small-area analysis (SAA) in health services research often calculates surgery rates for several small areas, compares the largest rate to the smallest, notes that the difference is large, and attempts to explain this discrepancy as a function of service availability, physician practice styles, or other factors. SAAs are often difficult to interpret because there is little theoretical basis for determining how much variation would be expected under the null hypothesis that all of the small areas have similar underlying surgery rates and that the observed variation is due to chance. We developed a computer program to simulate the distribution …
Treatment Modality And Quality Differences For Black And White Breast Cancer Patients Treated In Community Hospitals, Paula Diehr
Treatment Modality And Quality Differences For Black And White Breast Cancer Patients Treated In Community Hospitals, Paula Diehr
Paula Diehr
This study assessed the relationship of race and patterns of care, defined by an expert NCI-appointed committee, for 7,781 patients with breast cancer treated in 107 hospitals in 45 communities between 1982 and 1985. After control for age and stage of disease, black patients had significantly different care from white patients for four of the ten patterns examined. They were less likely to have a progesterone receptor assay or to be referred for postmastectomy rehabilitation, two patterns deemed desirable for all patients. Black patients were also more likely to receive liver scans and radiation therapy in situations in which these …
Prediction Of Fracture In Patients With Acute Musculoskeletal Ankle Trauma, Paula Diehr
Prediction Of Fracture In Patients With Acute Musculoskeletal Ankle Trauma, Paula Diehr
Paula Diehr
X-rays taken for ankle trauma contribute significantly to the cost of health care in this country. In an attempt to find clinical correlates of ankle fracture 36 detailed historical and physical examination variables were collected from 587 consecutive patients with ankle trauma, and ankle x-rays were taken of all patients. The association of each variable with the final diagnosis of fracture, rupture, or sprain was tested; 21 variables were significant predictors of fracture (vs. sprain and rupture) and 15 were not significantly associated with final diagnosis. The variables were used in a linear discriminant analysis to develop a rule which …
The Effect Of Age On The Care Of Women With Breast Cancer In Community Hospitals, Paula Diehr, Joe Chu
The Effect Of Age On The Care Of Women With Breast Cancer In Community Hospitals, Paula Diehr, Joe Chu
Paula Diehr
We studied the process of care received by 1,680 female breast cancer patients treated in 17 community hospitals. The probability of receiving various diagnostic, consultation, therapy, or rehabilitation services was almost always significantly associated with patient age for one or more disease stages. Most often there was a linear trend for older patients to receive fewer services (e.g., biopsies prior to definitive treatment, number of lymph nodes examined, chemotherapy, radiation therapy) but other age patterns also were found. Age was not significantly associated with clinical staging or estrogen receptors.
Factors Explaining The Use Of Health Care Services By The Elderly, Paula Diehr, Connie Evashwick
Factors Explaining The Use Of Health Care Services By The Elderly, Paula Diehr, Connie Evashwick
Paula Diehr
The Anderson model of health services utilization, which relates use of service to predisposing, enabling, and need factors, has not often been applied to an elderly population. In this study, the factors of the Andersen model were used prospectively to predict utilization for a population sample of 1,317 elderly persons. Taken alone, the NEED construct was the most important single predictor of use of physician services, hospitalizations, ambulatory care, and home care. PREDISPOSING factors were better predictors of the use of dental services. Some of the variables studied were not related to utilization in the direction that would have been …
Small Area Statistics: Large Statistical Problems, Paula Diehr
Small Area Statistics: Large Statistical Problems, Paula Diehr
Paula Diehr
No abstract provided.
Prediction Of Pneumonia In Outpatients With Acute Cough - A Statistical Approach, Paula Diehr
Prediction Of Pneumonia In Outpatients With Acute Cough - A Statistical Approach, Paula Diehr
Paula Diehr
Cough is the fifth most common reason for physician visits, but data on acute cough have rarely been collected in a standardized manner and have not been analyzed in a multivariate fashion. We report data on 1819 patients presenting with cough, all of whom received a standardized history and physical, and a chest X-ray. Only 48 (2.6%) were found to have an acute radiographic infiltrate (pneumonia). The prevalence of common signs and symptoms is shown for the patients with and without pneumonia. Thirty-two of these findings were significant predictors of pneumonia (p less than 0.05, one-tailed). These 32 did not …
Use Of Ambulatory Care Services In Three Provider Plans: Interactions Between Patient Characteristics And Plans, Paula Diehr
Use Of Ambulatory Care Services In Three Provider Plans: Interactions Between Patient Characteristics And Plans, Paula Diehr
Paula Diehr
A previous study of low-income enrollees in a closed-panel health maintenance organization (HMO) and a Blue Cross/Blue Shield (BC/BS) plan showed that the effect on the use of health services of the age, sex, health status, previous health care use, race, and family size of the enrollees was different in the two plans. We have replicated this study using the same two provider plans but studying a different group of white collar, middle class enrollees. A third plan, an experimental independent practice association (IPA), was also available for analysis. Utilization was defined as use (yes/no) and the quantity of use …
Regression Analysis In Health Services Research: The Use Of Dummy Variables, Paula Diehr, Lincoln Nayak Polissar
Regression Analysis In Health Services Research: The Use Of Dummy Variables, Paula Diehr, Lincoln Nayak Polissar
Paula Diehr
Dummy variables frequently are used in regression analysis but often in an incorrect fashion. A brief review of examples in the medical care literature showed that the interpretation of dummy variable regression coefficients and their significance was often incorrect or unclear. This article shows how dummy variables can be used and assessed properly. The importance of testing for the joint effect of a group of dummy variables is stressed. It also gives a standard and useful extension of the dummy variable technique to testing for the effect of collections of variables.
Cluster Analysis To Determine Headache Types, Paula Diehr
Cluster Analysis To Determine Headache Types, Paula Diehr
Paula Diehr
Cluster analysis was used to separate 726 headache patients into clusters of patients with similar symptoms. This was done to answer two questions: what "naturally occurring' groups of patients can be found? And how do these groups correspond to traditional headache types? When only two clusters were required, the best two clusters were tension and migraine-like. However, eight clusters could also be distinguished, and the migraine group then became very small. The clusters were tested for clinical interpretability by having 12 physicians name and prescribe treatment for the clusters. The suggested treatment was similar to what patients had actually received …
Acute Headaches; Presenting Symptoms And Diagnostic Rules To Identify Patients With Tension And Migraine Headache , Paula Diehr
Acute Headaches; Presenting Symptoms And Diagnostic Rules To Identify Patients With Tension And Migraine Headache , Paula Diehr
Paula Diehr
Headache is the ninth most common cause of physician visits, but data on acute headaches have not been collected in a standardized manner and have not been analyzed in a multivariate fashion. We report on 726 patients presenting with acute headaches, which were diagnosed as tension (38%), migraine (25%), no diagnosis (30%), and other (6%). The prevalence of 32 signs and symptoms is shown for each group. Four of these findings were significant predictors of tension headache, and 19 were significant predictors of migraine headache (p<.05). Several diagnostic rules are developed which classify nearly 90% of the headaches correctly, using only three to seven of the findings. On a new set of patients the classification was correct over 80% of the time. It is suggested that most acute headaches could be diagnosed over the telephone or by midlevel providers, which would provide substantial cost savings.
Increased Access To Medical Care: The Impact On Health, Paula Diehr
Increased Access To Medical Care: The Impact On Health, Paula Diehr
Paula Diehr
Many federally financed programs have been launched to improve the access of the poor to medical care, under the assumption that this will improve their health. The effectiveness of these programs, however, has generally been measured by increased utilization rather than by improved health. The few studies which have considered health status have shown small or negative effects. Here, data are presented from a project which provided fully prepaid care to near poor families through existing sources in the community. A group of 748 enrollees was found to report worse health on four of five health indicators after one year …