1
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Drabo EF, Kelley MA, Gong CL. Appealing to Americans' altruism is not enough to nudge them to accept novel vaccines. J Public Health (Oxf) 2024:fdae048. [PMID: 38570896 DOI: 10.1093/pubmed/fdae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/06/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The role of altruism in the acceptance of novel preventive healthcare technologies like vaccines has not been thoroughly elucidated. METHODS We 1:1 randomized n = 2004 Amazon Mechanical Turk (MTurk) participants residing in the USA into a control or treatment arm with vaccination decisions framed altruistically, to elicit their preferences for COVID-19 vaccination using web-based discrete choice experiments. We used conditional and mixed logit models to estimate the impact of framing decisions in terms of altruism on vaccination acceptance. RESULTS Valid responses were provided by 1674 participants (control, n = 848; treatment, n = 826). Framing vaccination decisions altruistically had no significant effect on vaccination acceptance. Further, respondents' degree of altruism had no association with vaccination acceptance. LIMITATIONS The MTurk sample may not be representative of the American population. We were unable to ascertain concordance between stated and revealed preferences. CONCLUSIONS AND IMPLICATIONS Framing vaccination decisions in terms of altruism does not appear to significantly influence vaccination acceptance and may not be an effective nudging mechanism to increase the uptake of novel vaccines. Instead, a favorable vaccination profile appears to be the primary driver of uptake.
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Affiliation(s)
- Emmanuel F Drabo
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Marcella A Kelley
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA 90007, USA
| | - Cynthia L Gong
- Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, Fetal and Neonatal Institute, University of Southern California, Los Angeles, CA 90027, USA
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2
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Brown C, Ryan MP, Chikermane SG, Kelley MA, Walker TM, Stinis CT. Incremental costs of new permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR). Cardiovasc Revasc Med 2024:S1553-8389(24)00071-X. [PMID: 38429171 DOI: 10.1016/j.carrev.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Affiliation(s)
| | - Michael P Ryan
- MPR Consulting, Cincinnati, OH, United States of America
| | | | | | - Tara M Walker
- Edwards Lifesciences, Irvine, CA, United States of America
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3
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Linder JA, Persell SD, Kelley MA, Friedberg M, Goldstein NJ, Knight TK, Kaiser KM, Doctor JN, Mack WJ, Tibbels J, McCabe B, Haenchen S, Meeker D. Antibiotic prescribing for acute respiratory infections during the coronavirus disease 2019 (COVID-19) pandemic: Patterns in a nationwide telehealth service provider. Infect Control Hosp Epidemiol 2024:1-4. [PMID: 38329093 DOI: 10.1017/ice.2023.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
We examined 3,046,538 acute respiratory infection (ARI) encounters with 6,103 national telehealth physicians from January 2019 to October 2021. The antibiotic prescribing rates were 44% for all ARIs; 46% were antibiotic appropriate; 65% were potentially appropriate; 19% resulted from inappropriate diagnoses; and 10% were related to coronavirus disease 2019 (COVID-19) diagnosis.
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Affiliation(s)
- Jeffrey A Linder
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Primary Care Innovation, Institute for Public Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen D Persell
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Primary Care Innovation, Institute for Public Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marcella A Kelley
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
- School of Pharmacy, University of Southern California, Los Angeles, California
| | - Mark Friedberg
- Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts
| | - Noah J Goldstein
- Anderson School of Management, University of California at Los Angeles, Los Angeles, California
| | - Tara K Knight
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | - Katrina M Kaiser
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | - Jason N Doctor
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | - Wendy J Mack
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | | | - Daniella Meeker
- Yale School of Medicine, Yale University, New Haven, Connecticut
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4
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Doctor JN, Kelley MA, Goldstein NJ, Lucas J, Knight T, Stewart EP. A randomized trial looking at planning prompts to reduce opioid prescribing. Nat Commun 2024; 15:263. [PMID: 38216566 PMCID: PMC10786898 DOI: 10.1038/s41467-023-44573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024] Open
Abstract
Prior work has demonstrated that personalized letters are effective at reducing opioid and benzodiazepine prescribing, but it is unclear whether If/when-then planning prompts would enhance this effect. We conducted a decedent-clustered trial which randomized 541 clinicians in Los Angeles County to receive a standard (n = 284), or comparator (n = 257) version of a letter with If/when-then prompts. We found a significant 12.85% (6.83%, 18.49%) and 8.32% (2.34%, 13.93%) decrease in the primary outcomes morphine (MME) and diazepam milligram equivalents (DME), respectively. This study confirms the benefit of planning prompts, and repeat letter exposure among clinicians with poor patient outcomes. Limitations include lack of generalizability and small sample size. Clinicaltrials.gov registration: NCT03856593.
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Affiliation(s)
- Jason N Doctor
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, 90089, USA.
| | | | - Noah J Goldstein
- UCLA Anderson School of Management, UCLA Geffen School of Medicine, Los Angeles, CA, 90095, USA
| | - Jonathan Lucas
- Department of Medical Examiner-Coroner, County of Los Angeles, Los Angeles, CA, USA
| | - Tara Knight
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, 90089, USA
| | - Emily P Stewart
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, 90089, USA
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5
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Kelley MA, Lev R, Lucas J, Knight T, Stewart E, Menchine M, Doctor JN. Association of Fatal Overdose Notification Letters With Prescription of Benzodiazepines: Secondary Analysis of a Randomized Clinical Trial. JAMA Intern Med 2022; 182:1099-1100. [PMID: 35994260 PMCID: PMC9396468 DOI: 10.1001/jamainternmed.2022.3372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/18/2022] [Indexed: 11/14/2022]
Abstract
This secondary analysis of a randomized clinical trial examines the association of receipt of an injunction letter from a medical examiner following a patient’s drug overdose with patterns of benzodiazepine prescribing among physicians.
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Affiliation(s)
- Marcella A. Kelley
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles
| | - Roneet Lev
- Emergency Department, Scripps Mercy Hospital San Diego, San Diego, California
| | - Jonathan Lucas
- Department of Medical Examiner–Coroner, County of Los Angeles, California
| | - Tara Knight
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
- Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Emily Stewart
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles
| | - Michael Menchine
- Department of Emergency Medicine, University of Southern California, Los Angeles
| | - Jason N. Doctor
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles
- Sol Price School of Public Policy, University of Southern California, Los Angeles
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Padula WV, Miano MA, Kelley MA, Crawford SA, Choy BH, Hughes RM, Grosso R, Pronovost PJ. A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19. Value Health 2022; 25:890-896. [PMID: 35667779 PMCID: PMC8536499 DOI: 10.1016/j.jval.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Since 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed. METHODS We analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals' real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses. RESULTS Model results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model. CONCLUSIONS Patient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients' comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts.
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Affiliation(s)
- William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA; Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
| | - Marlea A Miano
- Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Marcella A Kelley
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Samuel A Crawford
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Bryson H Choy
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Robert M Hughes
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Riley Grosso
- Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Peter J Pronovost
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA; School of Medicine, Case-Western Reserve University, Cleveland, OH, USA
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7
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Kelley MA, Persell SD, Linder JA, Friedberg MW, Meeker D, Fox CR, Goldstein NJ, Knight TK, Zein D, Sullivan M, Doctor JN. The protocol of the Application of Economics & Social psychology to improve Opioid Prescribing Safety trial 2 (AESOPS-2): Availability of opioid harm. Contemp Clin Trials 2022; 112:106650. [PMID: 34896295 PMCID: PMC8869359 DOI: 10.1016/j.cct.2021.106650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 11/29/2021] [Accepted: 12/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND High levels of opioid prescribing in the United States has resulted in an alarming trend in opioid-related harms. The objective of Trial 2 of the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS-2) is to dampen the intensity and frequency of opioid prescribing in accordance with the Centers for Disease Control and Prevention recommendation to "go low and slow". We aim to accomplish this by notifying clinicians of harmful patient outcomes, which we expect to increase the mental availability of risks associated with opioid use. METHODS The trial is multi-site. Random assignment determines if prescribers to persons who suffer an opioid overdose (fatal or nonfatal) learn of this event (intervention) or practice usual care (control). Clinicians in the intervention group receive a letter notifying them of their patient's overdose. The primary outcome is the change in clinician weekly milligram morphine equivalent (MME) prescribed in a 6-month period before and after receiving the letter. Additional outcomes are the change in the proportion of patients prescribed at least 50 daily MME and in the proportion of patients referred to medication assisted treatment. Group differences in these outcomes will be compared using an intent-to-treat difference-in-differences framework with a mixed-effects regression model to estimate clinician MME. DISCUSSION The AESOPS-2 trial will provide new knowledge about whether increasing prescribers' awareness of patients' opioid-related overdoses leads to a reduction in opioid prescribing. Additionally, this trial may better inform how to reduce opioid use disorder and opioid overdoses by lowering population exposure to these drugs. TRIAL REGISTRATION ClinicalTrials.gov: NCT04758637.
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Affiliation(s)
- Marcella A. Kelley
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA.,School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Stephen D. Persell
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey A. Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Daniella Meeker
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA.,Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Craig R. Fox
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA
| | - Noah J. Goldstein
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA
| | - Tara K. Knight
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA
| | - Dina Zein
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA
| | - Mark Sullivan
- School of Medicine, University of Washington, School of Medicine, Seattle, WA
| | - Jason N. Doctor
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA.,School of Pharmacy, University of Southern California, Los Angeles, CA.,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
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8
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Kelley MA, Lucas J, Stewart E, Goldman D, Doctor JN. Opioid-related deaths before and after COVID-19 stay-at-home orders in Los Angeles County. Drug Alcohol Depend 2021; 228:109028. [PMID: 34500239 PMCID: PMC8411574 DOI: 10.1016/j.drugalcdep.2021.109028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Opioid-related morbidity and mortality has increased during the COVID-19 pandemic, yet specific information about the communities most affected remains unknown. Our objective is to evaluate decedent-level associations with an opioid-related death following the implementation of stay-at-home orders in Los Angeles County. METHODS This retrospective cohort study used data from the L.A. County Medical Examiner-Coroner to identify opioid-related deaths in 2019 and 2020. We used logistic regression to analyze the change in opioid-related deaths following a 30-day washout period after the start of stay-at-home orders. Independent variables included decedent age, gender, race and ethnicity, heroin or fentanyl present at the time of death, census tract-level education, and a scheduled drug prescription in the year before death. RESULTS Opioid-related deaths in L.A. County are most common in census tracts where a small percentage of the population has a Bachelor's degree. Following stay-at-home orders, Non-Hispanic Caucasian individuals had significantly more opioid-related deaths than Hispanic individuals (risk ratio (RR): 1.82 [95 % CI, 1.10-3.02]; P < 0.05) after adjusting for age, gender, and heroin or fentanyl use. Racial and ethnic differences in mortality were not explained by census tract-level education or recent scheduled drug prescriptions. DISCUSSION There has been an alarming rise in opioid-related deaths in L.A. County during 2020. The increase in opioid-related overdose deaths following the onset of COVID-19 and related policies occurred most often among Non-Hispanic Caucasian individuals. Further research on this trend's underlying cause is needed to inform policy recommendations during these simultaneous public health crises.
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Affiliation(s)
- Marcella A. Kelley
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Jonathan Lucas
- Department of Medical Examiner-Coroner, County of Los Angeles, CA, USA
| | - Emily Stewart
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Dana Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Jason N. Doctor
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA,Corresponding author at: The Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
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9
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Kelley MA, Persell SD, Linder JA, Friedberg MW, Meeker D, Fox CR, Goldstein NJ, Knight TK, Zein D, Rowe TA, Sullivan MD, Doctor JN. The protocol of the Application of Economics & Social psychology to improve Opioid Prescribing Safety Trial 1 (AESOPS-1): Electronic health record nudges. Contemp Clin Trials 2021; 103:106329. [PMID: 33636344 PMCID: PMC8089040 DOI: 10.1016/j.cct.2021.106329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a lack of evidence that long-term opioid use offers benefit for noncancer pain and an abundance of evidence of harm. Despite clinical guidelines and education, prescribing continues at a higher rate than before the opioids crisis. The objective of trial 1 of the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS-1) is to discourage unnecessary opioid prescribing in primary care by applying "behavioral insights"-empirically-tested social and psychological interventions that affect choice. METHODS AESOPS-1 randomizes primary care clinics in Illinois and California to behavioral intervention or control. Both arms receive opioid guideline education. Clinics randomized to the behavioral intervention arm receive nudges within the electronic health record (EHR) including: 1) an "accountable justification" entered in the chart, 2) a precommitment to address high-risk prescriptions, and 3) a "PainTracker" that broadens discussions about pain. The control arm receives no EHR-based intervention. The primary outcome is the change in weekly milligram morphine equivalents (MME) prescribed. The secondary outcome is the change in the proportion of patients prescribed at least 50 daily MME. To evaluate these outcomes, we will use a difference-in-differences mixed-effects regression model on clinician MME weekly or daily dose. The analysis will be "intent-to-treat." The intervention period is 18-months, with a 6-month follow-up period to measure persistence of effects. DISCUSSION The AESOPS-1 trial will evaluate the effect of EHR-based interventions in reducing noncancer opioid prescribing in primary care. AESOPS-1 may demonstrate practical and scalable strategies to lower unnecessary population exposure to opioids.
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Affiliation(s)
- Marcella A Kelley
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America; School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America
| | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Mark W Friedberg
- Blue Cross Blue Shield of Massachusetts, Boston, MA, United States of America
| | - Daniella Meeker
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Craig R Fox
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Noah J Goldstein
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Tara K Knight
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America; Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, United States of America
| | - Dina Zein
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America
| | - Theresa A Rowe
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Mark D Sullivan
- School of Medicine, University of Washington, School of Medicine, Seattle, WA, United States of America
| | - Jason N Doctor
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America; School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America; Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, United States of America.
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10
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Hollin IL, Janssen E, Kelley MA, Bridges JFP. Do people have differing motivations for participating in a stated-preference study? Results from a latent-class analysis. BMC Med Inform Decis Mak 2021; 21:44. [PMID: 33549068 PMCID: PMC7868025 DOI: 10.1186/s12911-021-01412-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Researchers and policy makers have long suspected that people have differing, and potentially nefarious, motivations for participating in stated-preference studies such as discrete-choice experiments (DCE). While anecdotes and theories exist on why people participate in surveys, there is a paucity of evidence exploring variation in preferences for participating in stated-preference studies. METHODS We used a DCE to estimate preferences for participating in preference research among an online survey panel sample. Preferences for the characteristics of a study to be conducted at a local hospital were assessed across five attributes (validity, relevance, bias, burden, time and payment) and described across three levels using a starring system. A D-efficient experimental design was used to construct three blocks of 12 choice tasks with two profiles each. Respondents were also asked about factors that motivated their choices. Mixed logistic regression was used to analyze the aggregate sample and latent class analysis identified segments of respondents. RESULTS 629 respondents completed the experiment. In aggregate "study validity" was most important. Latent class results identified two segments based on underlying motivations: a quality-focused segment (76%) who focused most on validity, relevance, and bias and a convenience-focused segment (24%) who focused most on reimbursement and time. Quality-focused respondents spent more time completing the survey (p < 0.001) and were more likely to identify data quality (p < 0.01) and societal well-being (p < 0.01) as motivations to participate. CONCLUSIONS This information can be used to better understand variability in motivations to participate in stated-preference surveys and the impact of motivations on response quality.
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Affiliation(s)
- Ilene L Hollin
- Department of Health Services Administration and Policy, Temple University College of Public Health, Ritter Annex, 1301 Cecil B. Moore Ave Rm. 537, Philadelphia, PA, 19122, USA.
| | - Ellen Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marcella A Kelley
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Kelley MA, Benz H, Engdahl S, Bridges JFP. Identifying the benefits and risks of emerging integration methods for upper limb prosthetic devices in the United States: an environmental scan. Expert Rev Med Devices 2019; 16:631-641. [DOI: 10.1080/17434440.2019.1626231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Marcella A Kelley
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center of Excellence in Regulatory Science and Innovation, Baltimore, MD, USA
| | - Heather Benz
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Susannah Engdahl
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - John F P Bridges
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center of Excellence in Regulatory Science and Innovation, Baltimore, MD, USA
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12
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Navas-Nacher EL, Kelley MA, Birnbaum-Weitzman O, Gonzalez P, Ghiachello AL, Kaplan RC, Lee DJ, Bandiera FC, Bangdiwala SI, Barr RG, Daviglus ML. Association between exposure to household cigarette smoking behavior and cigarette smoking in Hispanic adults: Findings from the Hispanic Community Health Study/Study of Latinos. Prev Med 2015; 77:35-40. [PMID: 25912154 PMCID: PMC5877796 DOI: 10.1016/j.ypmed.2015.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cigarette smoking behavior is highly determined by social influences during childhood and adolescence. This phenomenon has not been fully evaluated in the Hispanic/Latino population. PURPOSE To examine the association between exposure to household cigarette smoking behavior (HCSB) and adult cigarette smoking among a diverse Hispanic/Latino population living in four US urban centers. The effect of acculturation on cigarette smoking was also evaluated. METHODS Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (n=13,231, ages 18-74years, collected between March 2008 and June 2011) were analyzed using logistic regression. RESULTS HCSB exposure was an independent risk factor for adult current cigarette smoking in Hispanic/Latinos (OR 1.7; 95% CI 1.4, 2.1) after controlling for relevant confounders including socio-demographic and cultural factors. Cubans and Puerto Ricans had the highest prevalence of HCSB exposure (59% and 47% respectively) and highest prevalence of current cigarette smoking (26% and 32%) compared with other Hispanic/Latino groups, (p<.01). CONCLUSIONS Our data suggest that exposure to HCSB in Hispanics/Latinos living in the US is an independent predictor of adult cigarette smoking, and this association appears to be strongest in Cubans and Puerto Ricans.
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Affiliation(s)
- E L Navas-Nacher
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 W. Polk St. Suite #246, 246 COMW-MC 764, Chicago, IL 60612, USA.
| | - M A Kelley
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., (M/C 923), Chicago, IL 60612, USA
| | - O Birnbaum-Weitzman
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33124, USA
| | - P Gonzalez
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123-4311, USA
| | - A L Ghiachello
- Department of Preventive Medicine, Northwestern University, 680 N. Lakeshore Dr., Suite #1400, Chicago, IL, 60611, USA
| | - R C Kaplan
- Albert Einstein College of Medicine, 1300 Morris Park Ave., Belfer Building, Rm. #1306B, Bronx, NY, 10461, USA
| | - D J Lee
- Department of Public Health Sciences, University of Miami, 1120 N.W. 14th St., Rm #911, Miami, FL, 33136, USA
| | - F C Bandiera
- School of Public Health, University of Texas, 1200 Pressler St., Houston, TX 77030, USA
| | - S I Bangdiwala
- Department of Biostatistics, University of North Carolina at Chapel Hill, 137 E. Franklin St., Suite #203, Campus Box 8030, Chapel Hill, NC 27514-4145, USA
| | - R G Barr
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, PH 9 East Room 105, 630 West 168th Street, New York, NY 10032, USA
| | - M L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 W. Polk St. Suite #246, 246 COMW-MC 764, Chicago, IL 60612, USA
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Abstract
Although a consensus has emerged over the value of intensive care units (ICUs) in improving both the outcome and efficiency of critical care, the optimal staffing configuration of physicians who provide this care remains controversial. The value of open ICUs, where many clinicians can admit and care for patients, versus closed ICUs, where an on-site intensivist or housestaff team (or both) provides primary care of the critically ill patient is one aspect of this controversy. The roles of the intensivist, the ICU housestaff team, and the ICU director have also been debated. This article reviews the available literature on physician staffing in critical care units and its relationship to outcome and cost-effectiveness of care.
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Affiliation(s)
- G Y Lipschik
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Walcott-McQuigg JA, Zerwic JJ, Dan A, Kelley MA. An ecological approach to physical activity in African American women. Medscape Womens Health 2001; 6:3. [PMID: 11965217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Physical activity in women has assumed increasing significance as a policy issue as a result of the release of the 1996 Surgeon General's Report on Physical Activity and Health. This report revealed that women in the United States were less likely than men to adhere to the recommended guidelines for physical activity. African American women are less likely than white women to participate in leisure time physical activity across age, occupational, and income groups. The purpose of this study was to use the Ecological Model of Health Promotion to explore policy, environmental, and individual factors influencing physical activity of middle- to older-aged African American women in a mixed income community in a large midwestern city. Focus group discussions were held with 3 groups of women -- administrators/community leaders, exercisers, and nonexercisers. Thirty-three women between the ages of 40 and 78 participated in the study. The women identified 6 themes influencing physical activity: perceptions of physical activity and exercise; perceived barriers to exercise; perceived benefits of and motivators to exercise; past and present opportunities for exercise; factors that enhance the successful delivery of an exercise program; and coalition building to deliver an exercise program to women in the community. The results of this study reveal that to successfully increase physical activity in an ethnic urban community, researchers and other concerned individuals need to collaborate at multiple ecological levels, with an initial emphasis on establishing coalitions between institutions, community groups, policy makers, and individuals.
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Brilli RJ, Spevetz A, Branson RD, Campbell GM, Cohen H, Dasta JF, Harvey MA, Kelley MA, Kelly KM, Rudis MI, St Andre AC, Stone JR, Teres D, Weled BJ. Critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Crit Care Med 2001; 29:2007-19. [PMID: 11588472 DOI: 10.1097/00003246-200110000-00026] [Citation(s) in RCA: 287] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- R J Brilli
- Division of Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Peacock NR, Kelley MA, Carpenter C, Davis M, Burnett G, Chavez N, Aranda V. Pregnancy discovery and acceptance among low-income primiparous women: a multicultural exploration. Matern Child Health J 2001; 5:109-18. [PMID: 11573836 DOI: 10.1023/a:1011301232549] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES As part of a larger study exploring psychosocial factors that influence self-care and use of health care services during pregnancy, we investigated the process of pregnancy discovery and acceptance among a culturally diverse group of women who had given birth to their first child in the year preceding data collection. METHODS Eighty-seven low-income women from four cultural groups (African American, Mexican, Puerto Rican, and white) participated in eight focus groups held in their communities. The focus groups were ethnically homogenous and stratified by early and late entry into prenatal care. A social influence model guided the development of focus group questions, and the study followed a participatory action research model, with community members involved in all phases of the research. RESULTS Issues that emerged from the focus groups as possible influences on timing of pregnancy recognition include the role of pregnancy signs and symptoms and pregnancy risk perception in the discovery process, the role of social network members in labeling and affirming the pregnancy, concerns about disclosure, "planning" status of the pregnancy, and perceived availability of choices for resolving an unintended pregnancy. CONCLUSIONS The pregnancy discovery process is complex, and when protracted, can potentially result in delayed initiation of both prenatal care and healthful pregnancy behaviors. Enhancing our understanding of pregnancy discovery and acceptance has clear implications for primary and secondary prevention. Future research is needed to further explain the trajectory of pregnancy discovery and acceptance and its influence on health behaviors and pregnancy outcome.
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Affiliation(s)
- N R Peacock
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 60612, USA.
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19
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Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA 2000; 284:2762-70. [PMID: 11105183 DOI: 10.1001/jama.284.21.2762] [Citation(s) in RCA: 659] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
CONTEXT Two important areas of medicine, care of the critically ill and management of pulmonary disease, are likely to be influenced by the aging of the US population. OBJECTIVE To estimate current and future requirements for adult critical care and pulmonary medicine physicians in the United States. DESIGN, SETTING, AND PARTICIPANTS Analysis of existing population, patient, and hospital data sets and prospective, nationally representative surveys of intensive care unit (ICU) directors (n = 393) and critical care specialists (intensivists) and pulmonary specialists (pulmonologists) (n = 421), conducted from 1996 to 1999. MAIN OUTCOME MEASURES Influence of patient, physician, regional, hospital, and payer characteristics on current practice patterns; forecasted future supply of and demand for specialist care through 2030. Separate models for critical care and pulmonary disease. Base-case projections with sensitivity analyses to estimate the impact of future changes in training and retirement, disease prevalence and management, and health care reform initiatives. RESULTS In 1997, intensivists provided care to 36.8% of all ICU patients. Care in the ICU was provided more commonly by intensivists in regions with high managed care penetration. The current ratio of supply to demand is forecast to remain in rough equilibrium until 2007. Subsequently, demand will grow rapidly while supply will remain near constant, yielding a shortfall of specialist hours equal to 22% of demand by 2020 and 35% by 2030, primarily because of the aging of the US population. Sensitivity analyses suggest that the spread of current health care reform initiatives will either have no effect or worsen this shortfall. A shortfall of pulmonologist time will also occur before 2007 and increase to 35% by 2020 and 46% by 2030. CONCLUSIONS We forecast that the proportion of care provided by intensivists and pulmonologists in the United States will decrease below current standards in less than 10 years. While current health care reform initiatives and modification of existing practice patterns may temporarily forestall this problem, most anticipated effects are minor in comparison with the growing disease burden created by the aging US population. JAMA. 2000;284:2762-2770.
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Affiliation(s)
- D C Angus
- Room 604, Scaife Hall, Critical Care Medicine, University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213, USA.
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Abstract
The consequences of unintended first pregnancy on the mental health of cohabitating couples (N = 124) were examined in the third trimester of pregnancy and at four months postpartum. Results indicated that the influence of unintended pregnancy on parental depressive symptoms is complex and via different mechanisms for men and women. Pregnancy viewed as unintended by males and intended by their partners appeared to pose the greatest risk for postpartum depressive symptoms, particularly in women.
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Affiliation(s)
- S J Leathers
- Jane Addams College of Social Work, University of Illinois, Chicago, USA
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21
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Kelley MA. Pulmonary embolism: a treatable cause of cardiac arrest? Am J Med 2000; 109:427-8. [PMID: 11020399 DOI: 10.1016/s0002-9343(00)00577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kelley MA, Weber DJ, Gilligan P, Cohen MS. Breakthrough pneumococcal bacteremia in patients being treated with azithromycin and clarithromycin. Clin Infect Dis 2000; 31:1008-11. [PMID: 11049784 DOI: 10.1086/318157] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/1999] [Revised: 03/27/2000] [Indexed: 11/03/2022] Open
Abstract
Streptococcus pneumoniae strains have exhibited decreasing susceptibility to penicillins and macrolides during the past several years. We reviewed the medical charts of all patients with pneumococcal bacteremia who were admitted to a university hospital over a period of 1 year, to identify failures of outpatient therapy. Of 41 patients admitted with pneumococcal bacteremia, 4 had previously taken either azithromycin or clarithromycin for 3-5 days. All 4 had pneumococcal strains that exhibited low-level resistance to macrolide antibiotics. Among pneumococci, low-level resistance to macrolides can lead to clinical failure, and resistance to macrolides should be considered during the selection of empiric therapy for patients with presumed pneumococcal infections.
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Affiliation(s)
- M A Kelley
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA.
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Reshetar RA, Norcini JJ, Mills LE, Kelley MA, Rackow EC. The first decade of the American Board of Internal Medicine certification in critical care medicine: an overview of examinees and certificate holders from 1987 through 1996. Crit Care Med 2000; 28:1191-5. [PMID: 10809304 DOI: 10.1097/00003246-200004000-00046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OVERVIEW This study reviews the first decade of critical care medicine (CCM) certification by the American Board of Internal Medicine (1987-1996). Included are the characteristics of examinee and certificate-holder groups; examination performances from different underlying disciplines of internal medicine, with or without formal CCM training; and the influence of background and a training program as correlates of examination performance. DATA SOURCES The CCM certification examination has been offered biennially since November 1987. Performance data on the American Board of Internal Medicine examinations in internal medicine and its subspecialties and added qualifications were available for candidates taking the CCM examinations. For examinees with formal CCM training, residency program director ratings, and information regarding the program characteristics of size and percentage of United States and Canadian medical graduates were also available. STUDY SELECTION All examinees who ever attempted certification were included in this study. The study cohort for each of the five examination administrations consists of all first-time takers. CONCLUSIONS Cohort sizes have decreased since formal training became an admission requirement in 1993. Percentages of International Medical Graduates and women attempting and achieving certification have increased steadily. Examination performance was positively associated with formal training, internal medicine examination performance, recent medical training, and pulmonary disease certification. For those with formal training, performance was also positively associated with training program director ratings of overall clinical competence and completion of a training program with a higher proportion of United States and Canadian medical graduates.
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Abstract
Hypertension during pregnancy is a leading cause of maternal and perinatal mortality and morbidity. Current thinking on the diagnosis and management of the hypertensive disorders of pregnancy is presented, along with triage and risk management issues.
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Affiliation(s)
- M A Kelley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
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25
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Abstract
Economic forces have stimulated a growing role for physician "hospitalists" in caring for patients hospitalized by other physicians, and the question of whether hospital care constitutes a new medical specialty has been raised. Three recently recognized specialties--emergency medicine, family practice, and critical care--originated from trends in medical practice. All three fulfill the major criteria for a medical specialty: scientific legitimacy, the development of new training pathways, and the existence of academic departments. The hospitalist movement is currently underdeveloped in each of these areas. By training, most hospitalists are internists who are well prepared to care for inpatients. Internal medicine must determine how this new movement fits into the traditional framework of general internal medicine and medical subspecialties. Until it does, the future of inpatient medicine as a recognized specialty will remain uncertain.
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Affiliation(s)
- M A Kelley
- University of Pennsylvania Medical Center, Philadelphia 19104, USA
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26
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Abstract
OBJECTIVES The objective of this study was to explore the relation between prenatal care characteristics and satisfaction among Medicaid recipients. METHODS African-American (n = 75) and Mexican-American (n = 26) nonadolescent primiparous pregnant women who had at least three prenatal care visits participated in a 25-minute telephone survey that asked them about satisfaction with prenatal care (art of care, technical quality, physical environment, access, availability and efficacy); prenatal care characteristics (practitioner attributes, service availability, and features of the delivery of care); and, personal characteristics (sociodemographics, health status and behaviors, and pregnancy-related variables). Univariate and multivariable analyses were conducted to explore the relations between personal characteristics and satisfaction and between care characteristics and satisfaction. RESULTS For the overall sample, the following prenatal care characteristics were associated with increased satisfaction: having procedures explained by the provider, short waiting times at the prenatal care site, the availability of ancillary services, and reporting that the prenatal care practitioner was male. When examining the data by ethnicity, whether the provider explained procedures was the most important determinant of satisfaction for both African-American and Mexican-American women. CONCLUSIONS Knowledge of the care characteristics that impact low-income pregnant women's satisfaction can be utilized to alter service delivery to increase use of prenatal care and ultimately to improve perinatal outcomes.
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Affiliation(s)
- A Handler
- Maternal and Child Health Training Program of the University of Illinois School of Public Health Community Health Sciences Division, Chicago 60612, USA
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Williams DR, Kelley MA. Core competency-based education, certification, and practice: the nurse-midwifery model. Adv Pract Nurs Q 1998; 4:63-71. [PMID: 9874965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
It has been more than 70 years since the first nurse-midwives came to practice in the United States, and over 20 years since the American College of Nurse-Midwives (ACNM) established nationally recognized standards and core competencies for nurse-midwifery education, certification, and practice. Certified nurse-midwives are licensed in all 50 states and in the District of Columbia (DC) and have prescribing privileges in 45 states plus DC. More recent standard-setting activities include the establishment of a national mechanism for continuing competency assessment; adoption of the bachelor's degree as the minimum academic requirement for certification; development of national standards for education and certification of direct entry midwives; and placement of an 8-year time limit on certificates.
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Affiliation(s)
- D R Williams
- American College of Nurse-Midwives, Washington, DC, USA
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Handler A, Rosenberg D, Johnson T, Raube K, Kelley MA. Prospective recruitment of women receiving prenatal care from diverse provider arrangements: a potential strategy. Matern Child Health J 1997; 1:173-7. [PMID: 10728241 DOI: 10.1023/a:1026273429603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study describes the use of a Medicaid managed care list to prospectively recruit into a research project pregnant women receiving care from a variety of providers. METHOD A list of women enrolled in Medicaid managed care was used to recruit pregnant African-American and Latina women into a study of prenatal care satisfaction. Due to privacy concerns, the researchers were not able to directly access names from the list. Instead, a managed care contract agency sent recruitment letters to 1009 pregnant African-American and Latina Medicaid recipients. Response rates by ethnicity and several other key variables are calculated. The biases associated with this method of recruiting pregnant women from a variety of providers are discussed. RESULTS Thirty-five percent of the women contacted returned consent forms and agreed to have researchers approach them; the response rate for African-American women was 43% and for Latinas was 29% (p < 0.0001). Respondents were younger and later in their pregnancies than nonrespondents, but did not differ from them by zip code of residence. The women recruited into the study obtained prenatal care from a diverse group of providers. CONCLUSIONS While the use of a prospectively generated list of pregnant Medicaid recipients to recruit low-income pregnant women into a research study may be associated with some selection bias, the potential cost savings, decreased effort, and diminished recall bias may make their use a feasible sampling alternative, particularly when the researcher desires to recruit women seeking care from a variety of provider arrangements.
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Affiliation(s)
- A Handler
- University of Illinois School of Public Health, Chicago 60612, USA.
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Schnader J, Smith RM, Britt EJ, Katz AS, Kelley MA, Schraufnagel D. Hemoptysis, hepatopulmonary syndrome, and respiratory failure: clinical conference on management dilemmas. Chest 1997; 111:1724-32. [PMID: 9187200 DOI: 10.1378/chest.111.6.1724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- J Schnader
- Department of Medicine, Wright State University School of Medicine and the Dayton VA Medical Center, Ohio 45428, USA
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Abstract
Control and social gratification at work and in other social roles have been shown to be predictive of depression in general adult populations, yet the potential importance of these factors in the postpartum period has not been explored. This study examines the influence of self-reported social gratification, support, and control at work and in the parenting role on depressive symptomatology for both men and women in the postpartum period. A model including perceptions of control, social gratification, and support in these two life domains is tested at 6 months postpartum in a sample of 108 first-time parents. When this model is compared to a parallel model using information obtained 6 months before the birth, strong support for the increased significance of these variables in the postpartum period is found. The need to include work and role-related variables in a comprehensive stress-diathesis model of postpartum depression for both men and women is discussed.
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Affiliation(s)
- S J Leathers
- Prevention Research Center at The University of Illinois at Chicago, 60607, USA
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Abstract
BACKGROUND Previous studies suggest that most patients with pulmonary embolism die of their underlying diseases and pulmonary embolism is itself responsible for a minority of deaths. It has not been determined whether pulmonary embolism is associated with increased mortality among patients with different specific diseases. METHODS We assessed the mortality in 1,487 patients who had lung scans to pursue the diagnosis of pulmonary embolism. An outcome classification committee prospectively reviewed deaths occurring up to 1 year after each patient's entry into the study. RESULTS Ninety-five (23.8%) patients with pulmonary embolism and 189 (18.9%) without pulmonary embolism died within 1 year of study entry (estimated relative risk, 1.34; 95% confidence interval, 1.01 to 1.79). Mortality according to pulmonary embolism status was different among patients with COPD from mortality among patients who did not have COPD (interaction p = 0.03). Of 45 patients with COPD and pulmonary embolism, 24 (53.3%; 95% confidence interval, 38.8 to 67.9%) died within 1 year. After adjustment for patient characteristics, the estimated risk of dying within 1 year was 1.94 times (95% confidence interval, 1.17 to 3.24) for patients with COPD and pulmonary embolism compared with those without pulmonary embolism, and 1.14 (95% confidence interval, 0.85 to 1.54) for patients without COPD (interaction p = 0.08). CONCLUSIONS Patients with COPD and pulmonary embolism have an increased 1-year mortality. Further study is needed to clarify the reason(s) for the increase in mortality.
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Affiliation(s)
- J L Carson
- Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903, USA
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Abstract
BACKGROUND Patient satisfaction is considered, together with health status, to be an outcome of the delivery of health care services as well as a measure of its quality. A focus group study of 50 low-income Mexican-American Puerto Rican, African-American, and white women in Chicago, Illinois, explored the characteristics of prenatal care that affect women's satisfaction. METHODS Transcripts from the focus groups were analyzed using researcher-derived coding categories to develop broad themes. RESULTS Despite their diverse ethnic backgrounds, participants revealed few differences with respect to what they value in prenatal care. Aspects of care that appeared to affect women's satisfaction included the "art of care, " the technical competence of the practitioner, continuity of caregiver, and the atmosphere and physical environment of the care setting. The one characteristic that did not appear to affect satisfaction was the caregiver's ethnicity. CONCLUSION Knowledge of how the characteristics of prenatal care affect women's satisfaction can help increase use of care and ultimately improve perinatal outcomes.
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Abstract
This study compares the benefits of aspirin and warfarin prophylactic agents for patients with thromboembolic disease after total joint arthroplasty. It is a prospective randomized study of 388 patients having total hip or total knee surgery. All consecutive patients having total hip or total knee surgery were entered into this study and evaluated with preoperative and postoperative ventilation perfusion scans and a postoperative venogram. The aspirin and warfarin treatment groups were compared by size and location of venographically revealed clots and changes in ventilation perfusion scans. The results showed that there was no difference in the size or location of deep venous thrombosis in the aspirin or warfarin treatment groups. The venogram was negative in 44.5% of patients; 28.8% had small ++calf clots, 16% had large calf clots, 3.9% had popliteal clots, and 6.7% had femoral clots. Patients with total knee replacement had a 2.6 times greater incidence of calf deep venous thrombosis than patients with total hip replacement. There was no difference between the aspirin and warfarin groups in the incidence of changes in ventilation perfusion scans (18.9%). There was no difference between the 2 groups in bleeding complications. The results suggest that aspirin and warfarin are equivalent in prophylaxis against thromboembolic disease, as determined by prevention of venographic changes or changes in ventilation perfusion scans.
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Affiliation(s)
- P A Lotke
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Kelley MA. Osler meets the marketplace--speculations on the future of internal medicine in the 21st century. Trans Am Clin Climatol Assoc 1996; 107:249-262. [PMID: 8725575 PMCID: PMC2376567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- M A Kelley
- University of Pennsylvania Medical Center, Philadelphia 19104, USA
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35
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Abstract
An unusual case of discontinuous hard tissue hyperostosis is described in a 25-30-year-old female dating between 4000 and 5500 BP from northern Chile. This specimen was one of 104 individuals examined from the Morro-1 site, which is known to represent the Chinchorro culture. The only other reported case from antiquity dates to 500 AD (Lester [1969] J. Bone Joint Surg. [Am.] 49:142-143). A review and comparison of this case to the medical literature supports a diagnosis of melorheostosis. Differential diagnosis is presented with the ruling out of nonspecific manifestations of osteomyelitis/periostitis as the most likely alternative diagnosis.
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Affiliation(s)
- M A Kelley
- Department of Anthropology, California State University, Sacramento 95819, USA
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Abstract
OBJECTIVE The transition to parenthood has been occurring within the context of the increasing labor force participation of women and potential stress-related costs of "nontraditional" as well as "traditional" gender role choices of new parents. This study addressed the extent to which gender role-related stressors lead to increased problem drinking across the transition to parenthood. METHOD Fifty-five married couples expecting their first child were obtained from seven Chicago area hospitals and surveyed with a mailed questionnaire at two points in time: (1) during the second trimester of pregnancy and (2) at 6 months following childbirth. The study examined both wives' and husbands' changes in problem-related drinking by comparing problem drinking during the 6 months prior to pregnancy (retrospectively assessed at Time 1) with drinking during the 6 months following childbirth using a modified form of the Michigan Alcoholism Screening Test. In addition, the study contrasted problem drinkers with nonproblem drinkers following parenthood with regard to role overload (overwhelming demands from work and family roles), role deprivation (loss of work role following parenthood) and role deterioration (decreased support from role relationships). RESULTS The data show increased problem drinking for both mothers and fathers but fail to support either role overload or role deprivation hypotheses. However, the data are congruent with the role deterioration perspective. CONCLUSIONS If these findings are replicated, future studies of gender roles and alcohol abuse should focus greater attention on the perceived quality of social roles beyond noting their presence or absence.
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Affiliation(s)
- J A Richman
- Department of Psychiatry, University of Illinois at Chicago 60612, USA
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Abstract
This qualitative study explored the broad aspects of stress and coping in the work and home experiences of pregnant women who worked in the service industry. The participants described home roles of mother, spouse/partner, and homemaker that were particularly valued and significant. Work provided income and a cultural setting for socialization, personal growth, and social support. The participants coped with the additional demands of pregnancy by adopting health promotion measures and scheduling routines at work and home in different ways. However, pregnant working women often are pulled in many directions at once, and their health eventually may be affected.
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Affiliation(s)
- M A Kelley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
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38
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Cowen J, Kelley MA. Pulmonary embolism in the critically ill: strategies for prevention and treatment. J Crit Illn 1994; 9:988-91. [PMID: 10150698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Most ICU patients are at high risk for developing deep venous thrombosis; thus, they should be considered candidates for prophylaxis against pulmonary emboli (PE). If early ambulation is not an option, give low-dose heparin or apply lower extremity pneumatic compression. When PE cannot be prevented, rapid treatment is mandatory. Inotropic agents can be used to improve right ventricular contractility; however, the role of volume loading for augmenting preload is controversial. Heparin is the first-line therapy for halting ongoing thrombosis; administer a 5,000- to 10,000-U bolus, followed by a continuous infusion of about 35,000 U/d. Thrombolysis, embolectomy, and occlusive devices are other therapeutic options.
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Affiliation(s)
- J Cowen
- Department of pulmonary and critical care medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
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39
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Kelley MA, Abbuhl S. Massive pulmonary embolism. Clin Chest Med 1994; 15:547-60. [PMID: 7982346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Massive pulmonary embolism remains a clinical challenge where rapid diagnosis and appropriate therapy have a critical impact on patient outcome. This article reviews the pathophysiology, diagnosis, and therapeutic options involved in the management of pulmonary embolism. Clinical case discussions illustrate the principles that are described by the authors.
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Affiliation(s)
- M A Kelley
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia
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40
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Joe A, Hamer DH, Kelley MA, Pereira ME, Keusch GT, Tzipori S, Ward HD. Role of a Gal/GalNAc-specific sporozoite surface lectin in Cryptosporidium parvum-host cell interaction. J Eukaryot Microbiol 1994; 41:44S. [PMID: 7804243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- A Joe
- Div. Geo. Med. and Infect. Dis., Tufts-New England Med. Ctr, Boston, MA 02111
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41
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Abstract
A number of fundamental issues must be considered in preparing the education system to produce more primary care physicians. Governmental controls and redirection of resources will force significant changes in the structuring of approaches to both undergraduate and graduate education in primary care. Particularly challenging will be restructuring and funding medical student programs in primary care, given a nearly certain requirement that more than 50% of medical school graduates enter primary care disciplines. Institutions will need to make strategic resource allocations to compete for the funding once the allocation process begins. Educational institutions will also face a cultural adaptation to primary care as an educational priority. This paper presents a model to study costs and funding for residency programs as they move from the traditional inpatient orientation to an outpatient focus. The authors suggest that for medical student education, the development of large academic health care systems may make funding primary care education more feasible.
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Affiliation(s)
- F D Burg
- Department of Pediatrics, University of Pennsylvania Medical School, Philadelphia 19104-6087
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42
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Cowen JS, Kelley MA. Errors and bias in using predictive scoring systems. Crit Care Clin 1994; 10:53-72. [PMID: 8118733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Scoring systems used to predict clinical outcomes for critically ill patients have been refined in the past decade, yet even the most recently developed systems contain flaws that limit their application. In general, prediction rules are derived by defining an association between a number of clinical variables and a particular outcome in a reference patient population. By systematically examining the qualities of the independent variables and the size and scope of the derivation data set, potential sources of error and bias can be identified. Existing and future predictive systems must be validated on large groups of patients and continuously updated to keep pace with new approaches to the practice of critical care medicine.
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Affiliation(s)
- J S Cowen
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia
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43
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Abstract
Acetabular growth and development in the axial plane was evaluated by computed tomography (CT) scan. One hundred seventy normal hips of children ranging in age from 6 months to 17 years were evaluated for axial acetabular index, anterior and posterior center-edge angles (CEA), and acetabular anteversion. The acetabulum deepens and becomes increasingly spherical with time until the age of 13 years. Little further change in acetabular shape occurs once the triradiate cartilage closes. Closure ensues between the ages of 11 and 13 years, occurring slightly earlier in girls. Posterior bony coverage of the femoral head is greater than anterior coverage at all times. Acetabular anteversion showed little change as the acetabulum developed. Establishing normal values for axial development of the hip and acetabulum allows a better three-dimensional concept of the different pathologic conditions and aids in treatment planning.
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Affiliation(s)
- L S Weiner
- Department of Orthopaedics, Mount Sinai Medical Center, New York, NY 10029
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44
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Abstract
Women's roles have undergone rapid transformation in recent decades and appear to affect the decision to breast-feed. Research in this area has been hampered by the lack of valid instruments to measure the relevant domains of gender-role related considerations. This study developed a scale to measure gender-role attitudes toward breast-feeding in primiparous women. Ninety-one married women, recruited during childbirth education classes in the Chicago metropolitan area, were surveyed by mail at eight weeks postpartum regarding their experiences as new mothers. Questionnaire items measuring infant feeding method (breast-feeding, bottle feeding) and attitudes toward breast-feeding were developed specifically for this investigation. Validity and reliability were assessed by structural equations analysis using LISREL. The LISREL fit statistics supported a one factor measurement model and combining the six items into a scale. Reliability analysis yielded a standardized alpha coefficient of .74. If results of future research are promising, the scale could be used to target new mothers with multiple roles for education and support and to evaluate interventions designed to promote positive breast-feeding attitudes and behavior.
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Affiliation(s)
- M A Kelley
- University of Illinois, Chicago School of Public Health 60612
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45
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Affiliation(s)
- M A Kelley
- School of Public Health, University of Illinois at Chicago
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46
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Kelley MA, Perloff JD, Morris NM, Liu W. Primary care arrangements and access to care among African-American women in three Chicago communities. Women Health 1992; 18:91-106. [PMID: 1462604 DOI: 10.1300/j013v18n04_06] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
African-American women of child-bearing age residing in three high-risk communities in Chicago were surveyed regarding their primary care arrangements and access to care (n = 552). This study examined factors which differentiated women who used office-based practices from those who used institutional settings (community clinics, health department clinics, hospital-based clinics) for primary care. Results of multivariate analysis indicate that women who used office-based practices were more likely than those who used institutional settings to see the same provider, to walk to their provider, to have less travel time and to walk in without an appointment. They were less likely to be hospitalized in the past year and less likely to report the availability of family planning at their usual source of care. Satisfaction with care, insurance status and sociodemographic characteristics were not associated with use of a particular facility type. Implications for organizing comprehensive health services for this population are discussed.
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Affiliation(s)
- M A Kelley
- School of Public Health, University of Illinois, Chicago
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47
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Abstract
BACKGROUND Pulmonary embolism is a potentially fatal disorder. Information about the outcome of clinically recognized pulmonary embolism is sparse, particularly given that new treatments for more seriously ill patients are now available. METHODS We prospectively followed 399 patients with pulmonary embolism diagnosed by lung scanning and pulmonary angiography, who were enrolled in a multicenter diagnostic trial. We reviewed all hospitalizations, all new investigations of pulmonary embolism, and all deaths among the patients within one year of diagnosis. RESULTS Of the 399 patients, 375 (94 percent) received treatment for pulmonary embolism, usually conventional anticoagulation. Only 10 patients (2.5 percent) died of pulmonary embolism; 9 of them had clinically suspected recurrent pulmonary embolism. Clinically apparent pulmonary embolism recurred in 33 patients (8.3 percent), of whom 45 percent died during follow-up. Ninety-five patients with pulmonary embolism (23.8 percent) died within one year. The conditions associated with these deaths were cancer (relative risk, 3.8; 95 percent confidence interval, 2.3 to 6.4), left-sided congestive heart failure (relative risk, 2.7; 95 percent confidence interval, 1.5 to 4.6), and chronic lung disease (relative risk, 2.2; 95 percent confidence interval, 1.2 to 4.0). The most frequent causes of death in patients with pulmonary embolism were cancer (in 34.7 percent), infection (22.1 percent), and cardiac disease (16.8 percent). CONCLUSIONS When properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death, and it recurred in only a small minority of patients. Most deaths were due to underlying diseases. Patients with pulmonary embolism who had cancer, congestive heart failure, or chronic lung disease had a higher risk of dying within one year than did other patients with pulmonary embolism.
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Affiliation(s)
- J L Carson
- Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903
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Kelley MA, Perloff JD, Morris NM, Liu W. The role of perceived barriers in the use of a comprehensive prenatal care program. J Health Soc Policy 1991; 3:81-9. [PMID: 10121850 DOI: 10.1300/j045v03n04_07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study focused on the use of community-based networks for prenatal care by black women in three high-risk communities in Chicago. We examined factors associated with use of network affiliated medical providers among 177 women. Sociodemographic factors and health status measures had no effect on network affiliated provider use. However, perceived barriers to care differentiated those who used affiliated providers from those who used alternative sources for care. Out of ten possible barriers, the odds ratios for job demands, travel time to providers and child care were significantly different from one. Implications for program modifications and expansion are discussed.
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Affiliation(s)
- M A Kelley
- School of Public Health, University of Illinois at Chicago
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49
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Abstract
One hundred forty mothers of children with chronic illnesses seen in two pediatric specialty clinics of a major urban teaching hospital were surveyed regarding their primary care arrangements and satisfaction with care received. Three dimensions of maternal satisfaction were measured: general satisfaction, satisfaction with access to care and satisfaction with doctor conduct (physician humaneness and technical quality). Results of multivariate analyses indicate that receipt of anticipatory guidance, access to care during evening hours and having a child in excellent reported health status were significantly associated with at least two of the three dimensions of maternal satisfaction. Findings have implications for organizing comprehensive, accessible primary care in the community, which is consistent with recent trends in child health policy. Results supported the need for enrichment of primary care for children with chronic illnesses to allow for physician continuity, provision of information and advice to families and extended office hours.
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Affiliation(s)
- M A Kelley
- University of Illinois, School of Public Health, Chicago 60612
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50
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Abstract
PURPOSE To provide a clinical approach to the diagnosis of pulmonary embolism. DATA IDENTIFICATION An English-language literature search using MEDLINE (1982 to 1990) and bibliographic reviews of textbooks and review articles. STUDY SELECTION In addition to several reviews, studies that evaluated the diagnostic technology of pulmonary embolism were selected. Preference was given to studies with a prospective design, particularly those done within the past decade. DATA EXTRACTION Studies were assessed independently by three unblinded observers. Data were chosen to describe the efficacy of diagnostic technology on the basis of disease prevalence, sensitivity and specificity, and predictive value. RESULTS OF DATA ANALYSIS A normal lung scan or pulmonary angiogram rules out the diagnosis of clinically important pulmonary embolism with at least 95% certainty. Lung scan interpretations indicating high or low probability have approximately a 15% error in diagnosing or ruling out pulmonary embolism. The accuracy of either scan result improves when the clinical suspicion of pulmonary embolism matches the lung scan result. Serial impedance plethysmography of the lower extremities may exclude thromboembolism with 95% certainty in patients without high-probability lung scan results or cardiopulmonary disease. CONCLUSIONS The combination of clinical suspicion and the results of the lung scan and impedance plethysmography appear to offer acceptable diagnostic accuracy in evaluating many patients suspected of having pulmonary embolism. The usefulness of this approach for patients with cardiopulmonary disease is still unknown.
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Affiliation(s)
- M A Kelley
- University of Pennsylvania School of Medicine, Philadelphia
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