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Bantjes J, Kessler MJ, Hunt X, Stein DJ, Kessler RC. Treatment rates and barriers to mental health service utilisation among university students in South Africa. Int J Ment Health Syst 2023; 17:38. [PMID: 37946243 PMCID: PMC10633973 DOI: 10.1186/s13033-023-00605-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Mental health problems are common and impairing among university students, yet only a minority of students with psychological disorders access treatment. Understanding barriers to treatment is integral to planning services, especially in resource constrained settings like South Africa (SA). METHODS Data collected across 17 institutions in the online SA National Student Mental Health Survey were used to: (1) estimate 12-month prevalence of common mental health problems and self-harm; (2) estimate the proportion of students receiving treatments for the various mental health problems; (3) explore barriers to treatment; and (4) investigate sociodemographic predictors of treatment mediated through the various barriers endorsed by students with mental health problems. Prevalence analyses were carried out using cross-tabulations and prediction analyses using modified Poisson regression models. RESULTS Prevalence of clinically significant mental health problems is high relative to international comparisons, with the prevalence of severe, mild and moderate symptoms of any disorder and/or self-harm of 24.8% (SD = 0.3), 18.8% (SD = 0.3) and 27.6% (SD = 0.4) respectively. Treatment rates were 35.2% (S.E. = 0.6) among students with mental health problems who perceived need for treatment and 21.3% (S.E. = 0.4) irrespective of perceived need. Treatment rates were highest for mood disorders (29.9%, S.E. = 0.6) and lowest for externalising disorders (23.8%, S.E. = 0.5). Treatment rates were much less variable across disorder types among students with perceived need than irrespective of perceived need, indicating that perceived need mediated the associations of disorder types with received treatment. Adjusting for disorder profile, probability of obtaining treatment was significantly and positively associated with older age, female gender, study beyond the first year, traditional sexual orientation, and diverse indicators of social advantage (full-time study, high parent education, and attending Historically White Institutions). Among students with mental health problems, numerous barriers to treatment were reported adjusting for disorder profile, including lack of perceived need (39.5%, S.E. = 0.5) and, conditional on perceived need, psychological (54.4%, S.E. = 1.0), practical (77.3%, S.E. = 1.1), and other (79.1%, S.E. = 1.1) barriers. Typically, students reported multiple barriers to treatment. Differences in perceived need explained the gender difference in treatment, whereas practical barriers were most important in accounting for the other predictors of treatment. CONCLUSION Mental health problems are highly prevalent but seldom treated among SA university students. Although many barriers were reported, practical barriers were especially important in accounting for the associations of social disadvantage with low rates of treatment. Many of these practical barriers are however addressable.
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Affiliation(s)
- Jason Bantjes
- Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | | | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Morlock R, Morlock A. Think Before You Ink: Perception, Prevalence, and Correlates of Tattooing and Tattoo Regret in US Adults. Cureus 2023; 15:e48167. [PMID: 38046700 PMCID: PMC10693284 DOI: 10.7759/cureus.48167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Few population-based studies have examined the perception and prevalence of tattoos and tattoo regret in the general United States (US) adult population. Our objective was to report the perception of people with tattoos and describe the prevalence, socio-demographics, health-related quality of life, and the extent of tattoo regret in US adults. Methods Data were assessed from a cross-sectional study of US adults. Participants were recruited using a random stratified sampling framework similar to the US Census. Data collected for all participants included socio-demographic and clinical characteristics, general health-related quality of life (Veterans RAND 12-item), depression (Patient Health Questionnaire 9-item), anxiety (Generalized Anxiety Disorder 7-item), and perceptions of those with tattoos. Those with tattoos also answered questions about their tattoo(s), including age when first tattooed, reasons for getting a tattoo, and tattoo regret. Categorical data were described by percentages, and continuous data by mean and standard deviation. Proportions were compared with Chi-squared tests and the means with ANOVA. A logistic regression controlling for confounding variables was carried out to assess factors predictive of tattoo regret. Results Of the 3033 participants, 35.3% (1,072) reported having a tattoo. Those more likely to have a tattoo were female (58% vs. 45%), younger (38 vs. 46 years), smoked cigarettes (38% vs. 19% non-smoker), and/or reported an alcohol or drug problem (10% vs. 5%). Those without tattoos were more likely to perceive those with tattoos as less attractive, intelligent, professional, and more rebellious. More time (in years) with a tattoo, having a tattoo on the face, neck, hands, wrist, or fingers, getting a tattoo because of peer pressure, being impaired when getting a tattoo, and experiencing an adverse event related to a tattoo were predictive of tattoo regret. Older age and remembrance as the reason for a tattoo were predictive of not having tattoo regret. Conclusion More than one-third of the study sample comprised of adults in the US reported having at least one tattoo. While most people, regardless of their tattoo status, perceived tattooed and non-tattooed individuals equally, tattooed individuals were more likely to be perceived negatively than positively by those without tattoos. Whether tattooed or not, being aware of varying perceptions of tattoo status may be helpful in facilitating positive outcomes.
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Affiliation(s)
- Robert Morlock
- Health Services Research, Acumen Health Research Institute, Ann Arbor, USA
| | - Amy Morlock
- Health Services Research, Acumen Health Research Institute, Ann Arbor, USA
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Wilson R, Cuthbertson L, Sasaki A, Russell L, Kazis LE, Sawatzky R. Validation of an Adapted Version of the Veterans RAND 12-Item Health Survey for Older Adults Living in Long-Term Care Homes. THE GERONTOLOGIST 2023; 63:1467-1477. [PMID: 36866495 PMCID: PMC10581377 DOI: 10.1093/geront/gnad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure of physical and mental health status. An adapted version of the VR-12 was developed for use with older adults living in long-term residential care (LTRC) homes in Canada: VR-12 (LTRC-C). This study aimed to evaluate the psychometric validity of the VR-12 (LTRC-C). RESEARCH DESIGN AND METHODS Data for this validation study were collected via in-person interviews for a province-wide survey of adults living in LTRC homes across British Columbia (N = 8,657). Three analyses were conducted to evaluate validity and reliability: (1) confirmatory factor analyses were conducted to validate the measurement structure; (2) correlations with measures of depression, social engagement, and daily activities were examined to evaluate convergent and discriminant validity; and (3) Cronbach's alpha (r) statistics were obtained to evaluate internal consistency reliability. RESULTS A measurement model with 2 correlated latent factors (representing physical health and mental health), 4 cross-loadings, and 4 correlated items resulted in an acceptable fit (root-mean-square error of approximation = 0.07; comparative fit index = 0.98). Physical and mental health were correlated in expected directions with measures of depression, social engagement, and daily activities, though the magnitudes of the correlations were quite small. Internal consistency reliability was acceptable for physical and mental health (r > 0.70). DISCUSSION AND IMPLICATIONS This study supports the use of the VR-12 (LTRC-C) to measure perceived physical and mental health among older adults living in LTRC homes.
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Affiliation(s)
- Rozanne Wilson
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver, British Columbia, Canada
| | - Ayumi Sasaki
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lara Russell
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Lewis E Kazis
- Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, Massachusetts, USA
- Department of Pulmonary Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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Katz IR, Liebmann EP, Resnick SG, Hoff RA, Schmidt EM. Progress toward a performance measure for mental health based on a generic patient- reported outcome measure: Findings from the Veterans Outcome Assessment survey. Psychiatry Res 2022; 317:114797. [PMID: 36030700 DOI: 10.1016/j.psychres.2022.114797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
Abstract
We report on studies conducted to develop outcome-based performance measures (PROM-PMs) based on generic patient-reported outcome measures (PROMs) that could support strategies for quality improvement applicable to all patients in a mental health system. Data were from the Veterans Outcome Assessment Survey at baseline and three months for the Mental Component Score (MCS-12), a widely used measure of mental health-related quality of life, for 15,540 outpatients beginning treatment in General Mental Health clinics in 140 Veterans Affairs (VA) facilities. Mental health diagnoses from medical records were coded using hierarchical categories. Mental health staffing levels and quality measures were from administrative data. Changes in MCS-12 scores were associated with demographics, baseline scores, and diagnostic categories; in fully adjusted models, differences between facilities accounted for only 0.5% of the total variance between patients. There were small but significant associations of both baseline and changes in MCS-12 scores with staffing levels and administrative measures of the quality of care that support the potential value of adjusted measures of changes in MCS-12 as a PROM-PM. Remaining issues include the low proportion of variability that can be attributed to differences between facilities and the associations of staffing and quality with possible case-mix adjustment variables.
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Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Philadelphia, PA 19104, United States.
| | - Edward P Liebmann
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Sandra G Resnick
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Rani A Hoff
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Eric M Schmidt
- VA Office of Performance Measurement, Analytics and Performance Integration, Quality and Patient Safety, Veterans Health Administration, Menlo Park, CA 94025, United States; Center for Innovation to Implementation (Ci2i), VA Medical Center, Menlo Park, CA 94025, United States
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Abstract
There has been an increasing emphasis on placing patients at the center of clinical care and health care research and, in particular, assessing outcomes and experiences from the patient's perspective. One of the most widely used patient-reported outcome instruments is the Veterans RAND 12-item Health Survey (VR-12). This article reviews the VR-12 development and its applications over the last 2 decades, including research and potential uses in clinical care.
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Buchholz I, Feng YS, Buchholz M, Kazis LE, Kohlmann T. Translation and adaptation of the German version of the Veterans Rand-36/12 Item Health Survey. Health Qual Life Outcomes 2021; 19:137. [PMID: 33947411 PMCID: PMC8097879 DOI: 10.1186/s12955-021-01722-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The translated and culturally adapted German version of the Veterans Rand 36 Items Health Survey (VR-36), and its short form, the VR-12 counterpart, were validated in a German sample of orthopedic (n = 399) and psychosomatic (n = 292) inpatient rehabilitation patients. METHODS The instruments were analyzed regarding their acceptance, distributional properties, validity, responsiveness and ability to discriminate between groups by age, sex and clinically specific groups. Eligible study participants completed the VR-36 (n = 169) and the VR-12 (n = 177). They also completed validated patient-reported outcome measures (PROs) including the Euroqol-5 Dimensions 5 Level (EQ-5D-5L); Depression, Anxiety and Stress Scale (DASS); Hannover Functional Abilities Questionnaire (HFAQ); and CDC Healthy Days. The VR-12 and the VR-36 were compared to the reference instruments MOS Short Form-12 Items Health Survey (SF-12) version 1.0 and MOS Short Form-36 Items Health Survey (SF-36) version 1.0, using percent of completed items, distributional properties, correlation patterns, distribution measures of known groups validity, and effect size measures. RESULTS Item non-response varied between 1.8%/1.1% (SFVR-36/RESF-36) and 6.5%/8.6% (GHVR-36/GHSF-36). PCS was normally distributed (Kolmogorov-Smirnov tests: p > 0.05) with means, standard deviations and ranges very similar between SF-36 (37.5 ± 11.7 [13.8-66.1]) and VR-36 (38.5 ± 10.1 [11.7-67.8]), SF-12 (36.9 ± 10.9 [15.5-61.6]) and VR-12 (36.2 ± 11.5 [12.7-59.3]). MCS was not normally distributed with slightly differing means and ranges between the instruments (MCSVR-36: 36.2 ± 14.2 [12.9-66.6], MCSSF-36: 39.0 ± 15.6 [2.0-73.2], MCSVR-12: 37.2 ± 13.8 [8.4-70.2], MCSSF-12: 39.0 ± 12.3 [17.6-65.4]). Construct validity was established by comparing correlation patterns of the MCSVR and PCSVR with measures of physical and mental health. For both PCSVR and MCSVR there were moderate (≥ 0.3) to high (≥ 0.5) correlations with convergent (PCSVR: 0.55-0.76, MCSVR: 0.60-0.78) and small correlations (< 0.1) with divergent (PCSVR: < 0.12, MCSVR: < 0.16) self-report measures. Known-groups validity was demonstrated for both VR-12 and VR-36 (MCS and PCS) via comparisons of distribution parameters with significant higher mean PCS and MCS scores in both VR instruments found in younger patients with fewer sick days in the last year and a shorter duration of rehabilitation. CONCLUSIONS The psychometric analysis confirmed that the German VR is a valid and reliable instrument for use in orthopedic and psychosomatic rehabilitation. Yet further research is needed to evaluate its usefulness in other populations.
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Affiliation(s)
- Ines Buchholz
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
| | - You-Shan Feng
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | - Maresa Buchholz
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
| | - Lewis E. Kazis
- Department of Health Law, Policy and Management, School of Public Health, Boston University, 715 Albany St Talbot Building, Boston, MA 02118 USA
| | - Thomas Kohlmann
- University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475 Greifswald, Germany
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Grip and shoulder strength correlation with validated outcome instruments in patients with rotator cuff tears. J Shoulder Elbow Surg 2021; 30:1088-1094. [PMID: 32822876 DOI: 10.1016/j.jse.2020.07.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS/BACKGROUND The ability to better define preoperatively the extent of rotator cuff (RC) dysfunction is desired. The study's purpose was to prospectively examine the relationships between absolute and percentage loss (affected compared to unaffected) of grip and shoulder strength, and RC dysfunction. METHODS Forty-seven consecutive patients with proven RC tears participated in this study. Prior to surgery, bilateral strengths of grip, shoulder abduction, and shoulder external rotation (ER) were measured with a handheld dynamometer, and subjective outcome measures were gathered. RC tear size was determined via arthroscopy. Patient-reported outcomes were gathered on the day of the examination or via e-mail following initial evaluation. Descriptive statistics, difference analysis, and correlation coefficients (reported as either direct or negative) were used to analyze data. Grip, abduction and ER strengths, and percentage loss of grip, abduction, and ER strengths (percentage loss affected vs. unaffected), and tear size were analyzed in relation to all of the scores on selected subjective outcome measurement tools. The P value was set at .05. RESULTS Fair direct correlations were found between grip strength and the Veterans RAND 12-Item Health Survey (VR-12) mental health scores, ER strength and Simple Shoulder Test (SST), abduction strength, and both the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) function score and SST score. Abduction and ER strengths were also found to possess a fair direct correlation. Fair negative correlations were found between the ASES function score and each of the following: percentage loss of abduction strength, percentage loss of ER strength, and tear size in centimeters. Another fair negative correlation was found between the Single Assessment Numerical Evaluation (SANE) score and tear size in centimeters. DISCUSSION Our findings suggest that as shoulder strength decreases, ipsilateral shoulder RC dysfunction increases. Grip strength was not related to shoulder RC dysfunction. CONCLUSION Grip strength was not found to correlate with RC tears. Those with decreased abduction and ER strengths and low ASES scores should be considered more likely to have an RC tear.
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Albanese AM, Bartz-Overman C, Parikh Md T, Thielke SM. Associations Between Activities of Daily Living Independence and Mental Health Status Among Medicare Managed Care Patients. J Am Geriatr Soc 2020; 68:1301-1306. [PMID: 32196634 DOI: 10.1111/jgs.16423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/29/2020] [Accepted: 02/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Although there is a strong cross-sectional association between dependence in activities of daily living (ADLs) and decreased mental health, it is largely unknown how the loss of specific ADLs, or the combination of ADLs, influences mental health outcomes. We examined the effect of ADL independence on mental health among participants in a large survey of Medicare managed care recipients. DESIGN/SETTING Retrospective cohort study. PARTICIPANTS A total of 104,716 participants in cohort 17 of the Medicare Health Outcomes Survey, who completed the baseline and follow-up surveys in 2014 and 2016. MEASUREMENTS Linear regression models estimated the effects of loss of ADL independence on change in Mental Component Summary (MCS) score. RESULTS In an adjusted model, loss of independence in eating, bathing, dressing, and toileting were associated with three- to four-point declines in MCS, suggesting meaningful worsening. In a model that also included all six ADLs, loss of independence in each ADL was associated with declines in MCS, with the largest effects for eating and bathing. MCS decreased by 1.3 per each additional summative loss of ADL independence (P < .001). CONCLUSION Loss of ADL independence was associated with large declines in mental health, with personal care activities showing the largest effects. Additional research can help to characterize the causes of ADL loss, to explore how older adults cope with it, and to identify ways of maximizing resilience. J Am Geriatr Soc 68:1301-1306, 2020.
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Affiliation(s)
- Anita M Albanese
- University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | | | - Toral Parikh Md
- University of Washington School of Medicine, Seattle, Washington, USA
- Health Services Research and Development, Puget Sound Veterans Affairs Medical Center, Seattle, Washington, USA
| | - Stephen M Thielke
- University of Washington School of Medicine, Seattle, Washington, USA
- Geriatric Research, Education and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, Washington, USA
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Abstract
OBJECTIVE This study evaluates the disease burden of sciatica on the US Medicare cohort. BACKGROUND DATA Sciatica is a common disability that has important physical, mental, and economic effects. The Medicare Health Outcomes Survey (HOS) is a demographic and outcomes survey used to monitor the performance of Medicare Advantage health plans in the United States. The HOS includes data on demographics, chronic medical conditions, and patient-reported outcomes. METHODS Medicare HOS data for cohorts from 2007 to 2013 were obtained. Patients were placed into two categories based on the survey results: with or without a history of sciatica. Baseline demographics, chronic medical conditions, and physical health symptoms were aggregated. In addition, average VR-12 physical component summary and mental component summary scores were calculated for each group at baseline and at 2-year follow-up. A Fisher exact test was used to assess significance for categorical variables, and a t-test was used for continuous variables. VR-12 changes as small as 1 to 2 units have been found to be clinically and socially relevant. RESULTS The baseline cohort data of 1,000,952 patients yielded 250,869 patients (25%) who reported the diagnosis of sciatica, compared with 750,083 patients (75%) without sciatica. Patients with a history of sciatica tended to be younger, less educated, and notably with more medical comorbidities. Physical component summary outcomes were approximately 8 units lower in the sciatica group at baseline and 7 units lower at 2-year follow-up. Mental component summary outcomes were 6 units lower in the sciatica group at baseline and 5 units lower at 2-year follow-up. CONCLUSION A large percentage of the US Medicare cohort suffers from symptomatic sciatica. Our study identified a 25% prevalence in the Medicare cohort. In addition, sciatica is associated with an increased incidence of comorbid medical conditions and poor health-related quality of life. LEVEL OF EVIDENCE Level III STUDY DESIGN:: Observational-Cohort Study.
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Kane LT, Namdari S, Plummer OR, Beredjiklian P, Vaccaro A, Abboud JA. Use of Computerized Adaptive Testing to Develop More Concise Patient-Reported Outcome Measures. JB JS Open Access 2020; 5:e0052. [PMID: 32309761 PMCID: PMC7147635 DOI: 10.2106/jbjs.oa.19.00052] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are essential tools that are used to assess health status and treatment outcomes in orthopaedic care. Use of PROMs can burden patients with lengthy and cumbersome questionnaires. Predictive models using machine learning known as computerized adaptive testing (CAT) offer a potential solution. The purpose of this study was to evaluate the ability of CAT to improve efficiency of the Veterans RAND 12 Item Health Survey (VR-12) by decreasing the question burden while maintaining the accuracy of the outcome score. Methods A previously developed CAT model was applied to the responses of 19,523 patients who had completed a full VR-12 survey while presenting to 1 of 5 subspecialty orthopaedic clinics. This resulted in the calculation of both a full-survey and CAT-model physical component summary score (PCS) and mental component summary score (MCS). Several analyses compared the accuracy of the CAT model scores with that of the full scores by comparing the means and standard deviations, calculating a Pearson correlation coefficient and intraclass correlation coefficient, plotting the frequency distributions of the 2 score sets and the score differences, and performing a Bland-Altman assessment of scoring patterns. Results The CAT model required 4 fewer questions to be answered by each subject (33% decrease in question burden). The mean PCS was 1.3 points lower in the CAT model than with the full VR-12 (41.5 ± 11.0 versus 42.8 ± 10.4), and the mean MCS was 0.3 point higher (57.3 ± 9.4 versus 57.0 ± 9.6). The Pearson correlation coefficients were 0.97 for PCS and 0.98 for MCS, and the intraclass correlation coefficients were 0.96 and 0.97, respectively. The frequency distribution of the CAT and full scores showed significant overlap for both the PCS and the MCS. The difference between the CAT and full scores was less than the minimum clinically important difference (MCID) in >95% of cases for the PCS and MCS. Conclusions The application of CAT to the VR-12 survey demonstrated an ability to lessen the response burden for patients with a negligible effect on score integrity.
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Affiliation(s)
- Liam T Kane
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Surena Namdari
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Joseph LM, Berry DC, Jessup A, Davison J, J. Schneider B, I. Twersky J. Implementing and feasibility testing depression screening using the electronic medical record for patients with type 2 diabetes admitted to the hospital. Nurs Open 2019; 6:30-38. [PMID: 30534392 PMCID: PMC6279719 DOI: 10.1002/nop2.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/05/2018] [Indexed: 11/11/2022] Open
Abstract
AIM Is it feasible to implement a programme to screen for depression in patients admitted to the hospital for diabetes complications and use the electronic medical record to notify providers of their patient's depression score and give suggestions for medication and counselling? DESIGN A feasibility study was conducted with patients hospitalized with diabetes and depression in the Durham Veterans Affairs Medical Center, Durham, North Carolina, United States. METHODS Patients with type 2 diabetes were screened for depression. The healthcare provider was notified via the electronic medical record about the patients' depression scores. The provider discussed options for management of depression with the patient and initiated treatment. RESULTS The process of screening for depression at admission, notifying the provider by way of electronic medical record that the patient screened positive for depression with suggestions for medication and counseling was feasible and acceptable to providers and patients.
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Affiliation(s)
| | - Diane C. Berry
- The University of North Carolina at Chapel Hill School of NursingChapel HillNorth Carolina
| | - Ann Jessup
- The University of North Carolina at Chapel Hill School of NursingChapel HillNorth Carolina
| | - Jean Davison
- The University of North Carolina at Chapel Hill School of NursingChapel HillNorth Carolina
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Thigpen CA, Floyd SB, Chapman C, Tokish JM, Kissenberth MJ, Hawkins RJ, Brooks JM. Comparison of Surgeon Performance of Rotator Cuff Repair: Risk Adjustment Toward a More Accurate Performance Measure. J Bone Joint Surg Am 2018; 100:2110-2117. [PMID: 30562291 DOI: 10.2106/jbjs.18.00211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Movement toward a value-based health-care system necessitates the development of performance measures to compare physicians, hospitals, and health-care systems. Patient-reported outcomes (PROs) are a potential metric. However, valid use of PROs hinges on the ability to risk-adjust for baseline patient differences across a surgeon's panel of patients. The purpose of this study was to propose an approach for baseline risk adjustment and evaluate the importance of risk adjustment when comparing surgeons' performance of rotator cuff repair. METHODS Patients (n = 995) treated with arthroscopic rotator cuff repair by 34 surgeons from 2010 to 2017 were identified from a large sports medicine clinical data registry. A linear regression model was used to adjust for baseline PROs, patient demographics, and clinical characteristics to predict American Shoulder and Elbow Surgeons (ASES) change scores for each surgeon. A risk-adjusted performance measure was calculated as the difference between the average unadjusted ASES change scores and the risk-adjusted predicted ASES change scores across all patients treated by a surgeon. RESULTS The differences between unadjusted and risk-adjusted performance scores varied widely across surgeons (range, -13.8 to 10.3 ASES points). Use of the risk-adjusted performance scores resulted in a dramatic change in the relative ranking of surgeons, compared with the ranking based on the observed ASES change scores, with 31 of the 34 surgeons' rank changing following risk adjustment. On average, the observed ASES scores improved from 49.5 ± 17.5 at baseline to 78.0 ± 22.5 at 6 months across all surgeons. In the risk-adjustment model (R = 0.44), male sex, Workers' Compensation status, higher scores on the Veterans RAND 12-item Health Survey (VR-12), lower baseline ASES scores, fair and poor tendon quality, and night pain all had a significant effect on the predicted ASES change scores (p < 0.05). CONCLUSIONS Our results show wide variation of nearly 25 points in the risk-adjusted 6-month ASES performance difference from the highest to the lowest-performing surgeons. Additionally, 91% of surgeons' rank changed following risk adjustment. This suggests that performance measurement that does not account for baseline patient characteristics would likely result in incorrect conclusions about a surgeon's relative performance based on PROs. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charles A Thigpen
- ATI Physical Therapy, Greenville, South Carolina.,Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina
| | - Sarah B Floyd
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina.,Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina
| | - Cole Chapman
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina.,Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina
| | | | | | - Richard J Hawkins
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina.,Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina
| | - John M Brooks
- Center for Effectiveness Research in Orthopaedics, Greenville, South Carolina.,Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina
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13
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Lapin BR, Kinzy TG, Thompson NR, Krishnaney A, Katzan IL. Accuracy of Linking VR-12 and PROMIS Global Health Scores in Clinical Practice. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1226-1233. [PMID: 30314624 DOI: 10.1016/j.jval.2018.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine the accuracy of general health cross-walk tables in a clinical sample of patients with spine disorders. Published tables (Schalet BD, Rothrock NE, Hays RD, et al. Linking physical and mental health summary scores from the Veterans RAND 12-Item Health Survey (VR-12) to the PROMIS(®) Global Health Scale. J Gen Intern Med 2015;30:1524-30) link scores from the Veterans RAND 12-Item Health Survey (VR-12) to the 10-Item Patient-Reported Outcome Measurement Information System (PROMIS), a global health scale metric for both mental (GMH) and physical (GPH) summary scores. METHODS We assessed the accuracy of administered PROMIS and VR-12 scores with scores predicted by cross-walks in 4606 adult patients seen in a spine clinic from October 2015 to 2016. Accuracy of linking scores was evaluated using Pearson correlation, intraclass correlation coefficients, and mean and SD of score differences. Bland-Altman plots were used to graphically assess the levels of agreement. The consistency in scores' discrimination across levels of pain severity, depression, and other patient characteristics was assessed. Bootstrap methods estimated linking precision across varying sample sizes. RESULTS Actual and cross-walked PROMIS scores showed moderate correlation (ICC(3,1): GMH 0.73; GPH 0.81), with Bland-Altman plots suggesting smaller differences between scores in patients with lower and higher general health. Significant discrimination between patient subgroups was demonstrated reliably by both actual and estimated scores. Bootstrapped resamples indicated adequate precision for 200 patients (95% confidence interval for mean difference: GMH -1.38 to 0.60; GPH 0.39 to 1.93). CONCLUSIONS VR-12 and PROMIS global health scores can be accurately linked within a sample of patients with spine disorders; nevertheless, bias is high and precision is low for linking on the patient level. Linked scores at the group level for more than 200 patients can be used in comparative effectiveness research and for comparing results across studies.
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Affiliation(s)
- Brittany R Lapin
- Center for Outcomes Research and Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | - Tyler G Kinzy
- Center for Outcomes Research and Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas R Thompson
- Center for Outcomes Research and Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Ajit Krishnaney
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Irene L Katzan
- Center for Outcomes Research and Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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14
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A new algorithm to build bridges between two patient-reported health outcome instruments: the MOS SF-36® and the VR-12 Health Survey. Qual Life Res 2018; 27:2195-2206. [DOI: 10.1007/s11136-018-1850-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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15
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Odden MC, Peralta CA, Berlowitz DR, Johnson KC, Whittle J, Kitzman DW, Beddhu S, Nord JW, Papademetriou V, Williamson JD, Pajewski NM. Effect of Intensive Blood Pressure Control on Gait Speed and Mobility Limitation in Adults 75 Years or Older: A Randomized Clinical Trial. JAMA Intern Med 2017; 177:500-507. [PMID: 28166324 PMCID: PMC5699455 DOI: 10.1001/jamainternmed.2016.9104] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Intensive blood pressure (BP) control confers a benefit on cardiovascular morbidity and mortality; whether it affects physical function outcomes is unknown. OBJECTIVE To examine the effect of intensive BP control on changes in gait speed and mobility status. DESIGN, SETTING, AND PARTICIPANTS This randomized, clinical trial included 2636 individuals 75 years or older with hypertension and no history of type 2 diabetes or stroke who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Data were collected from November 8, 2010, to December 1, 2015. Analysis was based on intention to treat. INTERVENTIONS Participants were randomized to intensive treatment with a systolic BP target of less than 120 mm Hg (n = 1317) vs standard treatment with a BP target of less than 140 mm Hg (n = 1319). MAIN OUTCOMES AND MEASURES Gait speed was measured using a 4-m walk test. Self-reported information concerning mobility was obtained from items on the Veterans RAND 12-Item Health Survey and the EQ-5D. Mobility limitation was defined as a gait speed less than 0.6 meters per second (m/s) or self-reported limitations in walking and climbing stairs. RESULTS Among the 2629 participants in whom mobility status could be defined (996 women [37.9%]; 1633 men [62.1%]; mean [SD] age, 79.9 [4.0] years), median (interquartile range) follow-up was 3 (2-3) years. No difference in mean gait speed decline was noted between the intensive- and standard-treatment groups (mean difference, 0.0004 m/s per year; 95% CI, -0.005 to 0.005; P = .88). No evidence of any treatment group differences in subgroups defined by age, sex, race or ethnicity, baseline systolic BP, chronic kidney disease, or a history of cardiovascular disease were found. A modest interaction was found for the Veterans RAND 12-Item Health Survey Physical Component Summary score, although the effect did not reach statistical significance in either subgroup, with mean differences of 0.004 (95% CI, -0.002 to 0.010) m/s per year among those with scores of at least 40 and -0.008 (95% CI, -0.016 to 0.001) m/s per year among those with scores less than 40 (P = .03 for interaction). Multistate models allowing for the competing risk of death demonstrated no effect of intensive treatment on transitions to mobility limitation (hazard ratio, 1.06; 95% CI, 0.92-1.22). CONCLUSIONS AND RELEVANCE Among adults 75 years or older in SPRINT, treating to a systolic BP target of less than 120 mm Hg compared with a target of less than 140 mm Hg had no effect on changes in gait speed and was not associated with changes in mobility limitation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01206062.
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Affiliation(s)
- Michelle C Odden
- School of Biological and Population Health Sciences, Oregon State University, Corvallis
| | | | - Dan R Berlowitz
- Bedford Veterans Affairs Hospital, Bedford, Massachusetts4School of Public Health, Boston University, Boston, Massachusetts
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Jeffrey Whittle
- Department of Medicine, Medical College of Wisconsin, Milwaukee7Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Dalane W Kitzman
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Srinivasan Beddhu
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah10Department of Medicine, University of Utah School of Medicine, Salt Lake City
| | - John W Nord
- Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah10Department of Medicine, University of Utah School of Medicine, Salt Lake City
| | | | - Jeff D Williamson
- Section on Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicholas M Pajewski
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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16
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Eliason MJ, McElroy JA, Garbers S, Radix A, Toms Barker L. Comparing women with and without disabilities in five-site "Healthy Weight" interventions for lesbian/bisexual women over 40. Disabil Health J 2016; 10:271-278. [PMID: 28025087 DOI: 10.1016/j.dhjo.2016.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/18/2016] [Accepted: 12/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lesbian/bisexual women with physical disabilities (LBPD) are an under-studied population. OBJECTIVES This study compared LBPD to LB women without physical disabilities as defined by the Americans with Disabilities Act on socio-demographic variables, health characteristics, and quality of life, physical activity, weight, and nutrition outcomes following a health intervention. METHODS Data came from the Healthy Weight in Lesbian and Bisexual Women Study (HWLB) where 376 LB women were recruited into five geographically dispersed interventions. Baseline data were examined to compare women with and without physical disabilities as defined by the ADA, and pre/post intervention data were analyzed for differences in treatment outcomes including quality of life, physical activity, nutrition, and body size. RESULTS Compared to women without disability, LBPD were more likely to be bisexual or another sexual identity than lesbian, single, report poor or fair health status, postmenopausal, and had a higher body mass index and waist circumference to height ratio. LBPD women were less likely to work and to drink heavily, and reported reduced physical and mental health quality of life. In spite of these differences, after the intervention, LBPD had similar outcomes to women without disabilities on most measures, and were more likely to show improvements in physical quality of life and consumption of fruits/vegetables. CONCLUSIONS Although different from women without disabilities on many socio-demographic and health variables at baseline, the study suggests that LBPD have similar outcomes to women without disabilities, or may even do better, in group health interventions.
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Affiliation(s)
- Michele J Eliason
- Department of Health Education, HSS 110, San Francisco State University, 1600 Holloway, San Francisco, CA 94132, USA.
| | - Jane A McElroy
- University of Missouri, Department of Family & Community Medicine, MA306, Medical Sciences Building, Columbia, MO 65212, USA.
| | - Samantha Garbers
- Population & Family Health at Columbia University's Mailman School of Public Health, USA.
| | - Asa Radix
- Callen Lorde Community Health Center, New York, NY, USA.
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17
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Blalock SJ, Gildner PL, Jones JL, Bowling JM, Casteel CH. Relationship Between Perceived Risk of Falling and Adoption of Precautions to Reduce Fall Risk. J Am Geriatr Soc 2016; 64:1313-7. [DOI: 10.1111/jgs.14136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Susan J. Blalock
- Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Paula L. Gildner
- Injury Prevention Research Center; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jennifer L. Jones
- Injury Prevention Research Center; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - James M. Bowling
- Injury Prevention Research Center; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Carri H. Casteel
- Injury Prevention Research Center; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- Injury Prevention Research Center; University of Iowa; Iowa City Iowa
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18
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The Role of Geography in the Assessment of Quality: Evidence from the Medicare Advantage Program. PLoS One 2016; 11:e0145656. [PMID: 26727371 PMCID: PMC4703195 DOI: 10.1371/journal.pone.0145656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022] Open
Abstract
The Affordable Care Act set in motion a renewed emphasis on quality of care evaluation. However, the evaluation strategies of quality by the Centers for Medicare and Medicaid Services do not consider geography when comparisons are made among plans. Using an overall measure of a plan's quality in the public sector--the Medicare Advantage (MA) star ratings--we explored the impact of geography in these ratings. We identified 2,872 U.S counties in 2010. The geographic factor predicted a larger fraction of the MA ratings' compared to socio-demographic factors which explained less. Also, after the risk adjustments, almost half of the U.S. states changed their ranked position in the star ratings. Further, lower MA star ratings were identified in the Southeastern region. These findings suggest that the geographic component effect on the ratings is not trivial and should be considered in future adjustments of the metric, which may enhance the transparency, accountability, and importantly level the playing field more effectively when comparing quality across health plans.
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Functional Status and Hospital Readmissions Using the Medical Expenditure Panel Survey. J Gen Intern Med 2015; 30:965-72. [PMID: 25691236 PMCID: PMC4471038 DOI: 10.1007/s11606-014-3170-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hospital readmissions are expensive and they may signal poor quality of care. Whether functional status is related to hospital readmissions using a representative U.S sample remains unexplored . OBJECTIVE We aimed to assess the relationship between functional status and all-cause 30-day hospital readmissions using a representative sample of the US population. DESIGN This was a retrospective observational study (2003-2011). PATIENTS The study included 3,772 patients who completed the SF-12 before being hospitalized. Three hundred and eighteen (8.4%) were readmitted within 30 days after being discharged. MEASUREMENTS The Medical Expenditure Panel Survey (MEPS) was employed. Functional status was measured with the Short-Form 12-Item Health Survey Version 2® (SF-12). The probability of being readmitted was estimated using a logistic model controlling for demographic characteristics, comorbid conditions, insurance coverage, physical (PCS) and mental (MCS) summaries of the SF-12, reason for hospitalization, length of hospital stay, region, and residential area. RESULTS A one-unit difference in PCS reduced the odds of readmission by 2% (odds ratio 0.98 [95% CI, 0.97 to 0.99]; p < 0.001), which implies an 18% reduction in the odds of readmissions for a ten-unit difference (one standard deviation) in PCS. The c-statistic of the model was 0.72. CONCLUSION Baseline physical function is associated with hospital readmissions. The SF-12 improves the ability to identify patients at high risk of hospital readmission.
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20
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Kent EE, Ambs A, Mitchell SA, Clauser SB, Smith AW, Hays RD. Health-related quality of life in older adult survivors of selected cancers: data from the SEER-MHOS linkage. Cancer 2014; 121:758-65. [PMID: 25369293 DOI: 10.1002/cncr.29119] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/29/2014] [Accepted: 09/18/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research on health-related quality of life (HRQOL) among older adult cancer survivors is mostly confined to breast cancer, prostate cancer, colorectal cancer, and lung cancer, which account for 63% of all prevalent cancers. Much less is known about HRQOL in the context of less common cancer sites. METHODS HRQOL was examined with the 36-Item Short Form Health Survey, version 1, and the Veterans RAND 12-Item Health Survey in patients with selected cancers (kidney cancer, bladder cancer, pancreatic cancer, upper gastrointestinal cancer, cancer of the oral cavity and pharynx, uterine cancer, cervical cancer, thyroid cancer, melanoma, chronic leukemia, non-Hodgkin lymphoma, and multiple myeloma) and in individuals without cancer on the basis of data linked from the Surveillance, Epidemiology, and End Results cancer registry system and the Medicare Health Outcomes Survey. Scale scores, Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, and a utility metric (Short Form 6D/Veterans RAND 6D), adjusted for sociodemographic characteristics and other chronic conditions, were calculated. A 3-point difference in the scale scores and a 2-point difference in the PCS and MCS scores were considered to be minimally important differences. RESULTS Data from 16,095 cancer survivors and 1,224,549 individuals without a history of cancer were included. The results indicated noteworthy deficits in physical health status. Mental health was comparable, although scores for the Role-Emotional and Social Functioning scales were worse for patients with most types of cancer versus those without cancer. Survivors of multiple myeloma and pancreatic malignancies reported the lowest scores, with their PCS/MCS scores less than those of individuals without cancer by 3 or more points. CONCLUSIONS HRQOL surveillance efforts revealed poor health outcomes among many older adults and specifically among survivors of multiple myeloma and pancreatic cancer.
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Affiliation(s)
- Erin E Kent
- Applied Research Program, National Cancer Institute, Rockville, Maryland
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21
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Dy SM, Pfoh ER, Salive ME, Boyd CM. Health-related quality of life and functional status quality indicators for older persons with multiple chronic conditions. J Am Geriatr Soc 2013; 61:2120-2127. [PMID: 24320819 PMCID: PMC4459785 DOI: 10.1111/jgs.12555] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To explore central challenges with translating self-reported measurement tools for functional status and health-related quality of life (HRQOL) into ambulatory quality indicators for older people with multiple chronic conditions (MCCs). DESIGN Review. SETTING Sources including the National Quality Measures Clearinghouse and National Quality Forum were reviewed for existing ambulatory quality indicators relevant to functional status, HRQOL, and people with MCCs. PARTICIPANTS Seven informants with expertise in indicators using functional status and HRQOL. MEASUREMENTS Informant interviews were conducted to explore knowledge about these types of indicators, particularly usability and feasibility. RESULTS Nine important existing indicators were identified in the review. For process, identified indicators addressed whether providers assessed functional status; outcome indicators addressed quality of life. In interviews, informants agreed that indicators using self-reported data were important in this population. Challenges identified included concerns about usability due to inability to discriminate quality of care adequately between organizations and feasibility concerns regarding high data collection burden, with a correspondingly low response rate. Validity was also a concern because evidence is mixed that healthcare interventions can improve HRQOL or functional status for this population. As a possible first step, a structural standard could be systematic collection of these measures in a specific setting. CONCLUSION Although functional status and HRQOL are important outcomes for older people with MCCs, few relevant ambulatory quality indicators exist, and there are concerns with usability, feasibility, and validity. Further research is needed on how best to incorporate these outcomes into quality indicators for people with MCCs.
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Affiliation(s)
- Sydney M. Dy
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth R. Pfoh
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Marcel E. Salive
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, Maryland
| | - Cynthia M. Boyd
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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22
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Evaluating outcomes of care and targeting quality improvement using Medicare health outcomes survey data. J Ambul Care Manage 2013; 35:260-2. [PMID: 22955086 DOI: 10.1097/jac.0b013e31826746ad] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Medicare Health Outcomes Survey (HOS) provides a rich source of outcomes data on the Medicare Advantage (MA) program for the US Department of Health and Human Services, managed care organizations participating in Medicare, quality improvement organizations, and health services researchers working to improve quality of care for Medicare enrollees. Since 1998, the Centers for Medicare and Medicaid Services has collected longitudinal functional status information to assess the performance of Medicare managed care organizations. This introduction reviews the goals of the HOS program, how the HOS supports health care reform, and outlines recent HOS studies exploring data applications for monitoring outcomes and implementing quality improvement activities.
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