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Articles 1 - 11 of 11
Full-Text Articles in Physical Sciences and Mathematics
Identification Of Ovarian Cancer Symptoms In Health Insurance Claims Data., Paula Diehr, Sean Devlin
Identification Of Ovarian Cancer Symptoms In Health Insurance Claims Data., Paula Diehr, Sean Devlin
Paula Diehr
Background: Women with ovarian cancer have reported abdominal=pelvic pain, bloating, difficulty eating or feeling full quickly, and urinary frequency=urgency prior to diagnosis. We explored these findings in a general population using a dataset of insured women aged 40–64 and investigated the potential effectiveness of a routine review of claims data as a prescreen to identify women at high risk for ovarian cancer. Methods: Data from a large Washington State health insurer were merged with the Seattle-Puget Sound Surveillance, Epidemiology and End Results (SEER) cancer registry for 2000–2004. We estimated the prevalence of symptoms in the 36 months prior to diagnosis …
The Importance Of The Normality Assumption In Large Public Health Data Sets, Paula Diehr, Thomas Lumley
The Importance Of The Normality Assumption In Large Public Health Data Sets, Paula Diehr, Thomas Lumley
Paula Diehr
It is widely but incorrectly believed that the t-test and linear regression are valid only for Normally distributed outcomes. The t-test and linear regression compare the mean of an outcome variable for different subjects. While these are valid even in very small samples if the outcome variable is Normally distributed, their major usefulness comes from the fact that in large samples they are valid for any distribution. We demonstrate this validity by simulation in extremely non-Normal data. We discuss situations in which in other methods such as the Wilcoxon rank sum test and ordinal logistic regression (proportional odds model) have …
Measuring The "Managedness" And Covered Benefits Of Health Plans, Paula Diehr, David Grembowski
Measuring The "Managedness" And Covered Benefits Of Health Plans, Paula Diehr, David Grembowski
Paula Diehr
STUDY AIMS: (1) To develop indexes measuring the degree of managedness and the covered benefits of health insurance plans, (2) to describe the variation in these indexes among plans in one health insurance market, (3) to assess the validity of the health plan indexes, and (4) to examine the association between patient characteristics and the health plan indexes. Measures of the "managedness" and covered benefits of health plans are requisite for studying the effects of managed care on clinical practice and health system performance, and they may improve people's understanding of our complex health care system. DATA SOURCES/STUDY SETTING: As …
Methods For Analyzing Health Care Utilization And Costs, Paula Diehr
Methods For Analyzing Health Care Utilization And Costs, Paula Diehr
Paula Diehr
Important questions about health care are often addressed by studying health care utilization. Utilization data have several characteristics that make them a challenge to analyze. In this paper we discuss sources of information, the statistical properties of utilization data, common analytic methods including the two-part model, and some newly available statistical methods including the generalized linear model. We also address issues of study design and new methods for dealing with censored data. Examples are presented.
Who Enrolled In A State Program For The Uninsured: Was There Adverse Selection?, Paula Diehr
Who Enrolled In A State Program For The Uninsured: Was There Adverse Selection?, Paula Diehr
Paula Diehr
Managed care plans may hesitate to participate in programs for uninsured persons because they fear adverse selection, whereby only the sickest people or highest users would choose to join the program. We studied this issue in Washington State's Basic Health Plan, a demonstration program that provides subsidized health insurance for families earning less than 200% of the poverty level. We interviewed people in three counties who enrolled in the program, and compared them to people in the same counties who were eligible but did not enroll. There were substantial differences between enrollees and eligibles in education, age, income, employment, race, …
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 …
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 …
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 …
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 …
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 …