Statistics and Probability Commons^™

Inadequate Health Numeracy Affects Cancer Screening Practices In Vulnerable Populations, Sherrine Eid Mph, Dorothy Faulkner Phd

Administration & Leadership

No abstract provided.

A Comparison Of Frequentist And Bayesian Approaches To The Estimation Of Long-Stay Per-Diems, Jeff Hatcher, Jason M. Sutherland

Dartmouth Scholarship

Within many diagnosis related group (DRG) systems, there is recognition that a single cost weight per DRG is not suitable, and that cost weights should take into account extremely lengthy hospital stays. Long lengths of stay are considered to be due to factors largely beyond the control of the hospital, and a single weight per DRG would potentially place hospitals under financial risk.

Within Canada's acute-care, inpatient grouping methodology - Case Mix Groups (CMG+) - long-stay episodes represent approximately 4.5% of all discharges. Within a CMG (analogous to DRG), the cost weight assigned to long-stay cases consists of the typical …

Lot Quality Assurance Sampling (Lqas) And The Mozambique Malaria Indicator Surveys, Caitlin Biedron, Marcello Pagano, Bethany L. Hedt, Albert Kilian, Amy Ratcliffe, Samuel Mabunda, Joseph J. Valadez

Harvard University Biostatistics Working Paper Series

No abstract provided.

The Impact Of Being Born With Cleft And Cleft Reparative Surgery On Overall Health And Speech Outcomes, Khatansuudal Evsanaa

Master's Theses

Orofacial cleft is one of the most common and treatable birth defects in the world. If left untreated, orofacial cleft can impair normal speech development, growth, and could lead to a number of health consequences later in life. The main motivation of the study is to measure the impact of being born with cleft and the cleft reparative surgery on overall speech and health cleft for teenagers in India using difference-in-differences approach along with household fixed effects method. An overall health outcome was measured using height, weight, grip strength and BMI, and the speech acceptability was measured using a “Universal …

Abstracts In High Profile Journals Often Fail To Report Harm, Enrique Bernal-Delgado, Elliot S. Fisher

Dartmouth Scholarship

To describe how frequently harm is reported in the abstract of high impact factor medical journals. We carried out a blinded structured review of a random sample of 363 Randomised Controlled Trials (RCTs) carried out on human beings, and published in high impact factor medical journals in 2003. Main endpoint: 1) Proportion of articles reporting harm in the abstract; and 2) Proportion of articles that reported harm in the abstract when harm was reported in the main body of the article. Analysis: Corrected Prevalence Ratio (cPR) and its exact confidence interval were calculated. Non-conditional logistic regression was used.

Reliability, Effect Size, And Responsiveness And Intraclass Correlation Of Health Status Measures Used In Randomized And Cluster-Randomized Trials, Paula Diehr, Lu Chen, Donald L. Patrick, Ziding Feng, Yutaka Yasui

UW Biostatistics Working Paper Series

Background: New health status instruments are described by psychometric properties, such as Reliability, Effect Size, and Responsiveness. For cluster-randomized trials, another important statistic is the Intraclass Correlation for the instrument within clusters. Studies using better instruments can be performed with smaller sample sizes, but better instruments may be more expensive in terms of dollars, lost opportunities, or poorer data quality due to the response burden of longer instruments. Investigators often need to estimate the psychometric properties of a new instrument, or of an established instrument in a new setting. Optimal sample sizes for estimating these properties have not been studied …

Different Public Health Interventions Have Varying Effects, Paula Diehr, Anne B. Newman, Liming Cai, Ann Derleth

UW Biostatistics Working Paper Series

Objective: To compare performance of one-time health interventions to those that change the probability of transitioning from one health state to another. Study Design and Setting: We used multi-state life table methods to estimate the impact of eight types of interventions on several outcomes. Results: In a cohort beginning at age 65, curing all the sick persons at baseline would increase life expectancy by 0.23 years and increase years of healthy life by .54 years. An equal amount of improvement could be obtained with a 12% decrease in the probability of getting sick, a 16% increase in the probability of …

Ranking Usrds Provider-Specific Smrs From 1998-2001, Rongheng Lin, Thomas A. Louis, Susan M. Paddock, Greg Ridgeway

Johns Hopkins University, Dept. of Biostatistics Working Papers

Provider profiling (ranking, "league tables") is prevalent in health services research. Similarly, comparing educational institutions and identifying differentially expressed genes depend on ranking. Effective ranking procedures must be structured by a hierarchical (Bayesian) model and guided by a ranking-specific loss function, however even optimal methods can perform poorly and estimates must be accompanied by uncertainty assessments. We use the 1998-2001 Standardized Mortality Ratio (SMR) data from United States Renal Data System (USRDS) as a platform to identify issues and approaches. Our analyses extend Liu et al. (2004) by combining evidence over multiple years via an AR(1) model; by considering estimates …

Semi-Parametric Single-Index Two-Part Regression Models, Xiao-Hua Zhou, Hua Liang

UW Biostatistics Working Paper Series

In this paper, we proposed a semi-parametric single-index two-part regression model to weaken assumptions in parametric regression methods that were frequently used in the analysis of skewed data with additional zero values. The estimation procedure for the parameters of interest in the model was easily implemented. The proposed estimators were shown to be consistent and asymptotically normal. Through a simulation study, we showed that the proposed estimators have reasonable finite-sample performance. We illustrated the application of the proposed method in one real study on the analysis of health care costs.

Estimating The Retransformed Mean In A Heteroscedastic Two-Part Model, Alan H. Welsh, Xiao-Hua Zhou

UW Biostatistics Working Paper Series

Two distribution free estimators are proposed to estimate the mean of a dependent variable after fitting a semiparametric two-part heteroscedastic regression model to a transformation of the dependent variable. We show that the proposed estimators are consistent and have asymptotic normal distributions. We also compare their finite-sample performance in a simulation study. Finally, we illustrate the proposed methods in a real-world example of predicting in-patient health care costs.

Nonparametric Confidence Intervals For The One- And Two-Sample Problems, Xiao-Hua Zhou, Phillip Dinh

UW Biostatistics Working Paper Series

Confidence intervals for the mean of one sample and the difference in means of two independent samples based on the ordinary-t statistic suffer deficiencies when samples come from skewed distributions. In this article, we evaluate several existing techniques and propose new methods to improve coverage accuracy. The methods examined include the ordinary-t, the bootstrap-t, the biased-corrected acceleration (BCa) bootstrap, and three new intervals based on transformation of the t-statistic. Our study shows that our new transformation intervals and the bootstrap-t intervals give best coverage accuracy for a variety of skewed distributions; and that our new transformation intervals have shorter interval …

Studying Effects Of Primary Care Physicians And Patients On The Trade-Off Between Charges For Primary Care And Specialty Care Using A Hierarchical Multivariate Two-Part Model, John W. Robinson, Scott L. Zeger, Christopher B. Forrest

Johns Hopkins University, Dept. of Biostatistics Working Papers

Objective. To examine effects of primary care physicians (PCPs) and patients on the association between charges for primary care and specialty care in a point-of-service (POS) health plan.

Data Source. Claims from 1996 for 3,308 adult male POS plan members, each of whom was assigned to one of the 50 family practitioner-PCPs with the largest POS plan member-loads.

Study Design. A hierarchical multivariate two-part model was fitted using a Gibbs sampler to estimate PCPs' effects on patients' annual charges for two types of services, primary care and specialty care, the associations among PCPs' effects, and within-patient associations between charges for …

A Hierarchical Multivariate Two-Part Model For Profiling Providers' Effects On Healthcare Charges, John W. Robinson, Scott L. Zeger, Christopher B. Forrest

Johns Hopkins University, Dept. of Biostatistics Working Papers

Procedures for analyzing and comparing healthcare providers' effects on health services delivery and outcomes have been referred to as provider profiling. In a typical profiling procedure, patient-level responses are measured for clusters of patients treated by providers that in turn, can be regarded as statistically exchangeable. Thus, a hierarchical model naturally represents the structure of the data. When provider effects on multiple responses are profiled, a multivariate model rather than a series of univariate models, can capture associations among responses at both the provider and patient levels. When responses are in the form of charges for healthcare services and sampled …

Incorporating Death Into Health-Related Variables In Longitudinal Studies, Paula Diehr, Laura Lee Johnson, Donald L. Patrick, Bruce Psaty

UW Biostatistics Working Paper Series

Background: The aging process can be described as the change in health-related variables over time. Unfortunately, simple graphs of available data may be misleading if some people die, since they may confuse patterns of mortality with patterns of change in health. Methods have been proposed to incorporate death into self-rated health (excellent to poor) and the SF-36 profile scores, but not for other variables.

Objectives: (1) To incorporate death into the following variables: ADLs, IADLs, mini-mental state examination, depressive symptoms, body mass index (BMI), blocks walked per week, bed days, hospitalization, systolic blood pressure, and the timed walk. (2) To …

Optimization Of Breast Cancer Screening Modalities, Yu Shen, Giovanni Parmigiani

Johns Hopkins University, Dept. of Biostatistics Working Papers

Mathematical models and decision analyses based on microsimulations have been shown to be useful in evaluating relative merits of various screening strategies in terms of cost and mortality reduction. Most investigations regarding the balance between mortality reduction and costs have focused on a single modality, mammography. A systematic evaluation of the relative expenses and projected benefit of combining clinical breast examination and mammography is not at present available. The purpose of this report is to provide methodologic details including assumptions and data used in the process of modeling for complex decision analyses, when searching for optimal breast cancer screening strategies …

Smooth Quantile Ratio Estimation With Regression: Estimating Medical Expenditures For Smoking Attributable Diseases, Francesca Dominici, Scott L. Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

In this paper we introduce a semi-parametric regression model for estimating the difference in the expected value of two positive and highly skewed random variables as a function of covariates. Our method extends Smooth Quantile Ratio Estimation (SQUARE), a novel estimator of the mean difference of two positive random variables, to a regression model.

The methodological development of this paper is motivated by a common problem in econometrics where we are interested in estimating the difference in the average expenditures between two populations, say with and without a disease, taking covariates into account. Let Y1 and Y2 be two positive …

Smooth Quantile Ratio Estimation, Francesca Dominici, Leslie Cope, Daniel Q. Naiman, Scott L. Zeger

Johns Hopkins University, Dept. of Biostatistics Working Papers

In a study of health care expenditures attributable to smoking, we seek to compare the distribution of medical costs for persons with lung cancer or chronic obstructive pulmonary disease (cases) to those without (controls) using a national survey which includes hundreds of cases and thousands of controls. The distribution of costs is highly skewed toward larger values, making estimates of the mean from the smaller sample dependent on a small fraction of the biggest values. One approach to deal with the smaller sample is to rely on a simple parametric model such as the log-normal, but this makes the undesirable …

Bootstrap Confidence Intervals For Medical Costs With Censored Observations, Hongyu Jiang, Xiao-Hua Zhou

UW Biostatistics Working Paper Series

Medical costs data with administratively censored observations often arise in cost-effectiveness studies of treatments for life threatening diseases. Mean of medical costs incurred from the start of a treatment till death or certain timepoint after the implementation of treatment is frequently of interest. In many situations, due to the skewed nature of the cost distribution and non-uniform rate of cost accumulation over time, the currently available normal approximation confidence interval has poor coverage accuracy. In this paper, we proposed a bootstrap confidence interval for the mean of medical costs with censored observations. In simulation studies, we showed that the proposed …

Probabilities Of Transition Among Health States For Older Adults, Paula Diehr, Donald L. Patrick

UW Biostatistics Working Paper Series

Goal: To estimate the probabilities of transition among self-rated health states for older adults, and examine how they vary by age and sex. Methods: We used self-rated health (Excellent, Very Good, Good, Fair, Poor, Dead) collected in two longitudinal studies of older adults (Mean age 75) to estimate the probability of transition in two years. We used the estimates to project future health for selected cohorts.

Findings: These older adults were most likely to be in the same health state 2 years later, but a substantial proportion changed in both directions. Transition probabilities varied by initial health state, age and …

Associations Among Hospital Capacity, Utilization, And Mortality Of Us Medicare Beneficiaries, Controlling For Sociodemographic Factors., E. S. Fisher, J. E. Wennberg, T. A. Stukel, J. S. Skinner, S. M. Sharp

Dartmouth Scholarship

To explore whether geographic variations in Medicare hospital utilization rates are due to differences in local hospital capacity, after controlling for socioeconomic status and disease burden, and to determine whether greater hospital capacity is associated with lower Medicare mortality rates.

A Longitudinal Study Of Hospitalization Rates For Patients With Chronic Disease: Results From The Medical Outcomes Study., Eugene C. Nelson, Colleen A. Mchorney, Willard G. Manning, W H. Rogers

Dartmouth Scholarship

To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.

Exploration Of The Incidence Of Identified Emotional Disorders In Selected General Hospitals Of Nebraska, Arlene M. Van Horn

Loma Linda University Electronic Theses, Dissertations & Projects

A descriptive-comparative survey using content analysis of medical records has been done to determine the frequency with which emotional disorders are identified by medical personnel in the population hospitalized in small general hospitals in north-central Nebraska.

A systematic, random sample of medical records was taken from two hospitals arbitrarily included in the study on the basis of bed capacity and distance from mental health facilities.

Each medical record that was reviewed has been placed in a category based on whether an emotional disorder was identified in it by the medical personnel, or whether it contained recorded behaviors that could indicate …