Health care reform has strengthened the link between performance and reimbursement, exemplified b... more Health care reform has strengthened the link between performance and reimbursement, exemplified by valuebased purchasing and accountable care organizations. This has led to a heightened responsibility for physician leaders to improve physician performance. However, providing actionable assessments of physician outcomes is not as straightforward as it may seem. The physician leader is faced with myriad choices regarding how to evaluate physician performance and implement an improvement strategy. Fortunately there is a thoughtful, analytically based approach that enhances the success of physician improvement initiatives. Physician leaders should answer the following three questions for the clinical conditions under consideration in order to develop a performance improvement strategy:
American journal of medical quality : the official journal of the American College of Medical Quality, 2016
A number of quality rating systems to rank health care providers have been developed over the yea... more A number of quality rating systems to rank health care providers have been developed over the years with the intention of helping consumers make informed health care purchasing decisions. Many use sets of individual quality measures to calculate a global rating. The utility of a global rating for consumer choice hinges on the relationships among included measures and the extent to which they jointly reflect an underlying dimension of quality. Publicly reported data on 4 quality domains-complication, mortality, readmission, and patient safety-from Centers for Medicare & Medicaid Services' Hospital Compare website were used to examine correlations among individual measures within each measure group (within-group correlations) and correlations between pairs of measures across different measure groups (between-group correlations). Modest within-group correlations were found in only 2 domains (mortality and readmission), and there were no meaningful between-group associations. These ...
Journal of public health management and practice : JPHMP, Jan 10, 2017
Measures of population health at the subcounty level are needed to identify areas for focused int... more Measures of population health at the subcounty level are needed to identify areas for focused interventions and to support local health improvement activities. To extend the County Health Rankings population health measurement model to the ZIP code level using widely available hospital and census-derived data sources. Retrospective administrative data study. Missouri. Missouri FY 2012-2014 hospital inpatient, outpatient, and emergency department discharge encounters (N = 36 176 377) and 2015 Nielsen data. ZIP code-level health factors and health outcomes indices. Statistically significant measures of association were observed between the ZIP code-level population health indices and published County Health Rankings indices. Variation within counties was observed in both urban and rural areas. Substantial variation of the derived measures was observed at the ZIP code level with 20 (17.4%) Missouri counties having ZIP codes in both the top and bottom quintiles of health factors and hea...
Racial disparities exist in the rates of diabetes complications in the United States and in the s... more Racial disparities exist in the rates of diabetes complications in the United States and in the state of Missouri. It is unclear to what degree such disparities involve diabetes-related preventive care. We sought evidence for racial disparities in diabetes-related preventive care between non-Hispanic blacks and whites in Missouri. We analyzed data from the Missouri Behavioral Risk Factor Surveillance System from 1994 through 2002. This state-specific survey is conducted annually among a representative sample of Missourians. We examined data from 842 Missourians who reported a diagnosis of type 1 or type 2 diabetes and who had consulted a health professional in the 12 months before they were interviewed. We analyzed reported receipt of glycosylated hemoglobin testing, foot examinations, and dilated eye examinations in the year before interview. Non-Hispanic blacks were significantly less likely than whites to report having had glycosylated hemoglobin testing (odds ratio [OR], 0.47; 9...
Most patient satisfaction studies put an emphasis on finding key drivers (attribute) to increase ... more Most patient satisfaction studies put an emphasis on finding key drivers (attribute) to increase overall patient satisfaction. However, it is not clear how much health care managers need to improve certain attributes to attain the target overall patient satisfaction level. The study aims at finding not only what attributes, but also how much these attributes need to be improved to attain the target levels of patient satisfaction. The study uses an ordinal logistic regression model to analyze attribute reactions to salient drivers. This approach would significantly enhance health care managers' capabilities to develop a strategic plan to improve their patient satisfaction levels.
... We particularly appreciate the praise offered by O'Connor and Shewchuk that the quality a... more ... We particularly appreciate the praise offered by O'Connor and Shewchuk that the quality and impact of our article would be as sound as those published by Ware and Davies; Bowers, Swan, and Koehler; Cleary and McNeil; and Taylor and Cronin. ...
American Journal of Obstetrics and Gynecology, 2007
CLARK, MICHAEL BELFORT, GARY DILDY, JANET MEYERS, Presbyterian/StLuke’s Medical Center, Denver, C... more CLARK, MICHAEL BELFORT, GARY DILDY, JANET MEYERS, Presbyterian/StLuke’s Medical Center, Denver, Colorado, St. Mark’s Hospital, Salt Lake City, Utah, HCA Quality Sentinel Events Committee, Nashville, Tennessee OBJECTIVE: To review all patient records discharged with codes for uterine rupture (665.04; 665.14) in a single year (2006) in HCA hospitals to determine the contemporary nature of this obstetrical complication. STUDY DESIGN: All patient charts coded for uterine rupture in HCA in 2006 were redacted, collected in one location, and distributed to a committee of perinatologists and general obstetricians. Case report forms were returned electronically and analyzed for variables of interest to determine validity of coding and quality of care. No personal identification information was available and IRB approval at the senior author’s (RP) hospital was granted. RESULTS: Sixty nine cases were identified of which only 41 were “true” ruptures; the other 28 were silent/occult dehiscenses (23), no rupture (4), and one iatrogenic perforation. In the 41 uterine ruptures, only 20 were in patients with previous cesareans and in 9 of these concurrent use of oxytocics was documented. Fifteen of previously sectioned patients had but one scar and 11 patients were attempting a VBAC; 3 had successful previous VBACs. Among the 21 patients without previous cesareans, 7 had uterine surgery of some type including instrumentation for spontaneous or elective abortion and 14 had no previous uterine manipulation of any type. Oxytocics were documented in 10 of this latter group. Standard of care breaches were identified in 10 of 41 true ruptures; 6 had no previous cesareans and 4 were attempting a VBAC. CONCLUSION: 1. Epidemiological data on uterine rupture based on hospital discharge codes without concurrent chart review are invalid. 2. Patients with previous cesareans represent only half of true uterine ruptures in contemporary practice, possibly due to better selection and/or management of VBAC patients. 3. Signs and symptoms consistent with uterine rupture (especially with concurrent oxytocics and previous uterine instrumentation) should not be dismissed in patients with unscarred uteruses.
Objective: Despite large numbers of emergency encounters, little is known about how emergency dep... more Objective: Despite large numbers of emergency encounters, little is known about how emergency department (ED) patients conceptualize their risk of medical errors. This study examines how safe ED patients feel from medical errors, which errors are of greatest concern, how concerns differ by patient and hospital characteristics, and the relationship between concerns and willingness to return for future care. Methods: Multiwave telephone interviews of 767 patients from 12 EDswere conducted. Patients were asked about their medical safety, concern about eight types of medical errors, and satisfaction with care. Results: Eighty-eight percent of patients believed that their safety from medical errors had been good, very good, or excellent; 38 % of patients reported experiencing at least one specific error-related concern, most commonly misdiagnosis (22 % of all patients), physician errors (16%), medication errors (16%), nursing errors (12%), and wrong test/procedure (10%). Concerns were as...
Joint Commission journal on quality and patient safety / Joint Commission Resources, 2011
Consequences of fall-related injuries can be both physically and financially costly, yet without ... more Consequences of fall-related injuries can be both physically and financially costly, yet without current data, hospitals cannot completely determine the financial cost. As part of the analysis for an initiative to minimize falls with injury, the cost and length of stay attributable to serious fall injury were estimated at three hospitals in a Midwestern health care system In a retrospective case-control study, 57 hospital inpatients discharged between January 1, 2004, and October 16, 2006, who sustained a serious fall-related injury (fracture, subdural hematoma, any injury resulting in surgical intervention, or death) were identified through the incident reporting system and matched to nonfaller inpatient controls by hospital, age within five years, year of discharge, and diagnosis-related group (DRG). Multivariate analyses indicated that operational costs for fallers with serious injury, as compared with controls, were $13,316 more (p < .01; 95% confidence interval [CI], $1,395-$35,561) and that fallers stayed 6.3 days longer than nonfallers (p < .001; 95% CI, 2.4-14.9). Univariate analyses indicated they were also significantly more likely to have diabetes with organ damage, moderate to severe renal disease, and a higher mean score on the Charlson Comorbidity Index. In optimal bipartite matching (OBM) analyses, fallers with serious injury cost $13,806 more (p < .001; 95% CI, $5,808-$29,450) and stayed 6.9 days longer (p < .001; 95% CI, 2.8-14.9). Hospital inpatients who sustained a serious fall-related injury had higher total operational costs and longer lengths of stay than nonfallers. Despite possible limitations regarding the cost allocation methods, the analysis included data from three different hospitals, and supplemental multivariate analyses adjusting for academic hospital status did not meaningfully affect the results.
Although paired donation, list donation and non-directed donation allow more recipients to receiv... more Although paired donation, list donation and non-directed donation allow more recipients to receive living donor transplants, policy makers do not know how willing incompatible potential donors are to participate. We surveyed 174 potential donors ruled out for ABO-incompatibility or positive cross-match about their participation willingness. They were more willing to participate in paired donation as compared to list donation where the recipient receives the next deceased donor kidney (63.8% vs. 37.9%, p < 0.001) or non-directed donation (63.8% vs. 12.1%, p < 0.001). Their list donation willingness was greater when their intended recipients moved to the top versus the top 20% of the waiting list (37.9% vs. 19.0%, p < 0.001). Multivariate logistic regression modeling revealed that potential donors' empathy, education level, relationship with their intended recipient and the length of time their intended recipient was on dialysis also affected willingness. For paired donation, close family members of their intended recipient (odds ratio (OR) = 3.01, confidence intervals (CI) = 1.29, 7.02), with high levels of empathy (OR = 2.68, CI = 1.16, 6.21) and less than a college education (OR = 2.67, CI = 1.08, 6.61) were more willing to participate compared to other donors. Extrapolating these levels of willingness nationally, a 1–11% increase in living donation rates yearly (84–711 more transplants) may be possible if donor-exchange programs were available nationwide.
Journal of healthcare management / American College of Healthcare Executives
With increasing emphasis in healthcare on patient satisfaction, many patient satisfaction studies... more With increasing emphasis in healthcare on patient satisfaction, many patient satisfaction studies have been administered. Most assume that all patients combine their healthcare experiences (such as nursing care, physician care, etc.) in the same way to arrive at their satisfaction; however, no research has been conducted prior to the present study to investigate how patients&#39; health conditions influence the way they combine their healthcare experiences. This study aims to determine how seriously ill patients differ from less seriously ill patients during their combining process. Data were collected from five large hospitals in the St. Louis area by administering a patient satisfaction questionnaire. Multiple linear regression analyses with a scatter term, a severity measure, and interaction effects of the severity measure were conducted while controlling for age, gender, and race. Two models (overall quality of care and willingness to recommend to others) were analyzed, and the severity of illness variable revealed interaction effects with physician care, staff care, food, and scatter term variables in the willingness to recommend model (six attributes were analyzed: admission process, nursing care, physician care, staff care, food, and room). With more seriously ill patients, physician care becomes more important and staff care becomes less important, and seriously ill patients are proportionately more likely to combine their attribute reactions only in the willingness to recommend model. All six attributes are not equally influential. Nursing care and staff care show consistent influence in both models. These findings show that if healthcare managers want to increase their patient satisfaction, they should enhance nursing care and staff care first to experience the most improvement.
To evaluate the role of biophysical response of the coarcted segment to balloon dilatation in the... more To evaluate the role of biophysical response of the coarcted segment to balloon dilatation in the causation of aortic recoarctation. Tertiary care centre/university hospital. Retrospective case series. Records of 67 consecutive infants and children undergoing balloon angioplasty of native aortic coarctations were examined for an 8.7 year period ending September 1993. At 12 months (median) follow up catheterisation, 15 (25%) of 59 children developed recoarctation, defined as a gradient &gt; 20 mm Hg. Stretch (balloon circumference--preballoon coarcted segment circumference/preballoon coarcted segment circumference), gain (postballoon coarcted segment circumference--preballoon coarcted segment circumference), and recoil (balloon circumference--postballoon coarcted segment circumference) were calculated from measurements obtained from cineangiograms performed before and immediately after balloon dilatation. The stretch in 44 children without recoarctation (2.18 (1.23)) was similar (p &gt; 0.1) to that in 15 children with recoarctation (1.90 (0.65)), implying that similar balloon dilating stretch was applied in both groups. Greater gain (p &lt; 0.05) was observed in the group without recoarctation (8.8 (8.0) mm) than in the recoarctation group (5.7 (2.7) mm) but this was not substantiated in the infant population. However, the recoil was greater (p &lt; 0.001) in the group without recoarctation (5.1 (4.3) mm) than in the recoarctation group (2.1 (1.1) mm); this was also true in the infant group. Greater recoil in the patients without recoarctation implies preservation of intact elastic tissue in the coarcted segment. In the recoarctation group, with less recoil, the elastic properties may not have been preserved, thereby causing recoarctation. There might be a more severe degree of cystic medial necrosis in the recoarctation group than in the no recoarctation group. This needs confirmation in future studies.
Raising cigarette prices through taxation is an important policy approach to reduce smoking. Yet,... more Raising cigarette prices through taxation is an important policy approach to reduce smoking. Yet, cigarette price increases may not be equally effective in all subpopulations of smokers. To examine differing effects of state cigarette price changes with individual changes in smoking among smokers of different intensity levels. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US adults originally interviewed in 2001-2002 (Wave 1) and re-interviewed in 2004-2005 (Wave 2): 34 653 were re-interviewed in Wave 2, and 7068 smokers defined at Wave 1 were included in our study. Mixed effects linear regression models were used to assess whether the effects of changes in state cigarette prices on changes in daily smoking behaviour differed by level of daily smoking. In the multivariable model, there was a significant interaction between change in price per pack of cigarettes from Wave 1 to Wave 2 and the number of cigarettes smoked per day (p=0.044). The more cigarettes smoked per day at baseline, the more responsive the smokers were to increases in price per pack of cigarettes (ie, number of cigarettes smoked per day was reduced in response to price increases). Our findings that heavier smokers successfully and substantially reduced their cigarette smoking behaviours in response to state cigarette price increases provide fresh insight to the evidence on the effectiveness of higher cigarette prices in reducing smoking.
Health care reform has strengthened the link between performance and reimbursement, exemplified b... more Health care reform has strengthened the link between performance and reimbursement, exemplified by valuebased purchasing and accountable care organizations. This has led to a heightened responsibility for physician leaders to improve physician performance. However, providing actionable assessments of physician outcomes is not as straightforward as it may seem. The physician leader is faced with myriad choices regarding how to evaluate physician performance and implement an improvement strategy. Fortunately there is a thoughtful, analytically based approach that enhances the success of physician improvement initiatives. Physician leaders should answer the following three questions for the clinical conditions under consideration in order to develop a performance improvement strategy:
American journal of medical quality : the official journal of the American College of Medical Quality, 2016
A number of quality rating systems to rank health care providers have been developed over the yea... more A number of quality rating systems to rank health care providers have been developed over the years with the intention of helping consumers make informed health care purchasing decisions. Many use sets of individual quality measures to calculate a global rating. The utility of a global rating for consumer choice hinges on the relationships among included measures and the extent to which they jointly reflect an underlying dimension of quality. Publicly reported data on 4 quality domains-complication, mortality, readmission, and patient safety-from Centers for Medicare & Medicaid Services' Hospital Compare website were used to examine correlations among individual measures within each measure group (within-group correlations) and correlations between pairs of measures across different measure groups (between-group correlations). Modest within-group correlations were found in only 2 domains (mortality and readmission), and there were no meaningful between-group associations. These ...
Journal of public health management and practice : JPHMP, Jan 10, 2017
Measures of population health at the subcounty level are needed to identify areas for focused int... more Measures of population health at the subcounty level are needed to identify areas for focused interventions and to support local health improvement activities. To extend the County Health Rankings population health measurement model to the ZIP code level using widely available hospital and census-derived data sources. Retrospective administrative data study. Missouri. Missouri FY 2012-2014 hospital inpatient, outpatient, and emergency department discharge encounters (N = 36 176 377) and 2015 Nielsen data. ZIP code-level health factors and health outcomes indices. Statistically significant measures of association were observed between the ZIP code-level population health indices and published County Health Rankings indices. Variation within counties was observed in both urban and rural areas. Substantial variation of the derived measures was observed at the ZIP code level with 20 (17.4%) Missouri counties having ZIP codes in both the top and bottom quintiles of health factors and hea...
Racial disparities exist in the rates of diabetes complications in the United States and in the s... more Racial disparities exist in the rates of diabetes complications in the United States and in the state of Missouri. It is unclear to what degree such disparities involve diabetes-related preventive care. We sought evidence for racial disparities in diabetes-related preventive care between non-Hispanic blacks and whites in Missouri. We analyzed data from the Missouri Behavioral Risk Factor Surveillance System from 1994 through 2002. This state-specific survey is conducted annually among a representative sample of Missourians. We examined data from 842 Missourians who reported a diagnosis of type 1 or type 2 diabetes and who had consulted a health professional in the 12 months before they were interviewed. We analyzed reported receipt of glycosylated hemoglobin testing, foot examinations, and dilated eye examinations in the year before interview. Non-Hispanic blacks were significantly less likely than whites to report having had glycosylated hemoglobin testing (odds ratio [OR], 0.47; 9...
Most patient satisfaction studies put an emphasis on finding key drivers (attribute) to increase ... more Most patient satisfaction studies put an emphasis on finding key drivers (attribute) to increase overall patient satisfaction. However, it is not clear how much health care managers need to improve certain attributes to attain the target overall patient satisfaction level. The study aims at finding not only what attributes, but also how much these attributes need to be improved to attain the target levels of patient satisfaction. The study uses an ordinal logistic regression model to analyze attribute reactions to salient drivers. This approach would significantly enhance health care managers&amp;amp;amp;amp;amp;amp;#39; capabilities to develop a strategic plan to improve their patient satisfaction levels.
... We particularly appreciate the praise offered by O'Connor and Shewchuk that the quality a... more ... We particularly appreciate the praise offered by O'Connor and Shewchuk that the quality and impact of our article would be as sound as those published by Ware and Davies; Bowers, Swan, and Koehler; Cleary and McNeil; and Taylor and Cronin. ...
American Journal of Obstetrics and Gynecology, 2007
CLARK, MICHAEL BELFORT, GARY DILDY, JANET MEYERS, Presbyterian/StLuke’s Medical Center, Denver, C... more CLARK, MICHAEL BELFORT, GARY DILDY, JANET MEYERS, Presbyterian/StLuke’s Medical Center, Denver, Colorado, St. Mark’s Hospital, Salt Lake City, Utah, HCA Quality Sentinel Events Committee, Nashville, Tennessee OBJECTIVE: To review all patient records discharged with codes for uterine rupture (665.04; 665.14) in a single year (2006) in HCA hospitals to determine the contemporary nature of this obstetrical complication. STUDY DESIGN: All patient charts coded for uterine rupture in HCA in 2006 were redacted, collected in one location, and distributed to a committee of perinatologists and general obstetricians. Case report forms were returned electronically and analyzed for variables of interest to determine validity of coding and quality of care. No personal identification information was available and IRB approval at the senior author’s (RP) hospital was granted. RESULTS: Sixty nine cases were identified of which only 41 were “true” ruptures; the other 28 were silent/occult dehiscenses (23), no rupture (4), and one iatrogenic perforation. In the 41 uterine ruptures, only 20 were in patients with previous cesareans and in 9 of these concurrent use of oxytocics was documented. Fifteen of previously sectioned patients had but one scar and 11 patients were attempting a VBAC; 3 had successful previous VBACs. Among the 21 patients without previous cesareans, 7 had uterine surgery of some type including instrumentation for spontaneous or elective abortion and 14 had no previous uterine manipulation of any type. Oxytocics were documented in 10 of this latter group. Standard of care breaches were identified in 10 of 41 true ruptures; 6 had no previous cesareans and 4 were attempting a VBAC. CONCLUSION: 1. Epidemiological data on uterine rupture based on hospital discharge codes without concurrent chart review are invalid. 2. Patients with previous cesareans represent only half of true uterine ruptures in contemporary practice, possibly due to better selection and/or management of VBAC patients. 3. Signs and symptoms consistent with uterine rupture (especially with concurrent oxytocics and previous uterine instrumentation) should not be dismissed in patients with unscarred uteruses.
Objective: Despite large numbers of emergency encounters, little is known about how emergency dep... more Objective: Despite large numbers of emergency encounters, little is known about how emergency department (ED) patients conceptualize their risk of medical errors. This study examines how safe ED patients feel from medical errors, which errors are of greatest concern, how concerns differ by patient and hospital characteristics, and the relationship between concerns and willingness to return for future care. Methods: Multiwave telephone interviews of 767 patients from 12 EDswere conducted. Patients were asked about their medical safety, concern about eight types of medical errors, and satisfaction with care. Results: Eighty-eight percent of patients believed that their safety from medical errors had been good, very good, or excellent; 38 % of patients reported experiencing at least one specific error-related concern, most commonly misdiagnosis (22 % of all patients), physician errors (16%), medication errors (16%), nursing errors (12%), and wrong test/procedure (10%). Concerns were as...
Joint Commission journal on quality and patient safety / Joint Commission Resources, 2011
Consequences of fall-related injuries can be both physically and financially costly, yet without ... more Consequences of fall-related injuries can be both physically and financially costly, yet without current data, hospitals cannot completely determine the financial cost. As part of the analysis for an initiative to minimize falls with injury, the cost and length of stay attributable to serious fall injury were estimated at three hospitals in a Midwestern health care system In a retrospective case-control study, 57 hospital inpatients discharged between January 1, 2004, and October 16, 2006, who sustained a serious fall-related injury (fracture, subdural hematoma, any injury resulting in surgical intervention, or death) were identified through the incident reporting system and matched to nonfaller inpatient controls by hospital, age within five years, year of discharge, and diagnosis-related group (DRG). Multivariate analyses indicated that operational costs for fallers with serious injury, as compared with controls, were $13,316 more (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01; 95% confidence interval [CI], $1,395-$35,561) and that fallers stayed 6.3 days longer than nonfallers (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001; 95% CI, 2.4-14.9). Univariate analyses indicated they were also significantly more likely to have diabetes with organ damage, moderate to severe renal disease, and a higher mean score on the Charlson Comorbidity Index. In optimal bipartite matching (OBM) analyses, fallers with serious injury cost $13,806 more (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001; 95% CI, $5,808-$29,450) and stayed 6.9 days longer (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001; 95% CI, 2.8-14.9). Hospital inpatients who sustained a serious fall-related injury had higher total operational costs and longer lengths of stay than nonfallers. Despite possible limitations regarding the cost allocation methods, the analysis included data from three different hospitals, and supplemental multivariate analyses adjusting for academic hospital status did not meaningfully affect the results.
Although paired donation, list donation and non-directed donation allow more recipients to receiv... more Although paired donation, list donation and non-directed donation allow more recipients to receive living donor transplants, policy makers do not know how willing incompatible potential donors are to participate. We surveyed 174 potential donors ruled out for ABO-incompatibility or positive cross-match about their participation willingness. They were more willing to participate in paired donation as compared to list donation where the recipient receives the next deceased donor kidney (63.8% vs. 37.9%, p < 0.001) or non-directed donation (63.8% vs. 12.1%, p < 0.001). Their list donation willingness was greater when their intended recipients moved to the top versus the top 20% of the waiting list (37.9% vs. 19.0%, p < 0.001). Multivariate logistic regression modeling revealed that potential donors' empathy, education level, relationship with their intended recipient and the length of time their intended recipient was on dialysis also affected willingness. For paired donation, close family members of their intended recipient (odds ratio (OR) = 3.01, confidence intervals (CI) = 1.29, 7.02), with high levels of empathy (OR = 2.68, CI = 1.16, 6.21) and less than a college education (OR = 2.67, CI = 1.08, 6.61) were more willing to participate compared to other donors. Extrapolating these levels of willingness nationally, a 1–11% increase in living donation rates yearly (84–711 more transplants) may be possible if donor-exchange programs were available nationwide.
Journal of healthcare management / American College of Healthcare Executives
With increasing emphasis in healthcare on patient satisfaction, many patient satisfaction studies... more With increasing emphasis in healthcare on patient satisfaction, many patient satisfaction studies have been administered. Most assume that all patients combine their healthcare experiences (such as nursing care, physician care, etc.) in the same way to arrive at their satisfaction; however, no research has been conducted prior to the present study to investigate how patients&#39; health conditions influence the way they combine their healthcare experiences. This study aims to determine how seriously ill patients differ from less seriously ill patients during their combining process. Data were collected from five large hospitals in the St. Louis area by administering a patient satisfaction questionnaire. Multiple linear regression analyses with a scatter term, a severity measure, and interaction effects of the severity measure were conducted while controlling for age, gender, and race. Two models (overall quality of care and willingness to recommend to others) were analyzed, and the severity of illness variable revealed interaction effects with physician care, staff care, food, and scatter term variables in the willingness to recommend model (six attributes were analyzed: admission process, nursing care, physician care, staff care, food, and room). With more seriously ill patients, physician care becomes more important and staff care becomes less important, and seriously ill patients are proportionately more likely to combine their attribute reactions only in the willingness to recommend model. All six attributes are not equally influential. Nursing care and staff care show consistent influence in both models. These findings show that if healthcare managers want to increase their patient satisfaction, they should enhance nursing care and staff care first to experience the most improvement.
To evaluate the role of biophysical response of the coarcted segment to balloon dilatation in the... more To evaluate the role of biophysical response of the coarcted segment to balloon dilatation in the causation of aortic recoarctation. Tertiary care centre/university hospital. Retrospective case series. Records of 67 consecutive infants and children undergoing balloon angioplasty of native aortic coarctations were examined for an 8.7 year period ending September 1993. At 12 months (median) follow up catheterisation, 15 (25%) of 59 children developed recoarctation, defined as a gradient &gt; 20 mm Hg. Stretch (balloon circumference--preballoon coarcted segment circumference/preballoon coarcted segment circumference), gain (postballoon coarcted segment circumference--preballoon coarcted segment circumference), and recoil (balloon circumference--postballoon coarcted segment circumference) were calculated from measurements obtained from cineangiograms performed before and immediately after balloon dilatation. The stretch in 44 children without recoarctation (2.18 (1.23)) was similar (p &gt; 0.1) to that in 15 children with recoarctation (1.90 (0.65)), implying that similar balloon dilating stretch was applied in both groups. Greater gain (p &lt; 0.05) was observed in the group without recoarctation (8.8 (8.0) mm) than in the recoarctation group (5.7 (2.7) mm) but this was not substantiated in the infant population. However, the recoil was greater (p &lt; 0.001) in the group without recoarctation (5.1 (4.3) mm) than in the recoarctation group (2.1 (1.1) mm); this was also true in the infant group. Greater recoil in the patients without recoarctation implies preservation of intact elastic tissue in the coarcted segment. In the recoarctation group, with less recoil, the elastic properties may not have been preserved, thereby causing recoarctation. There might be a more severe degree of cystic medial necrosis in the recoarctation group than in the no recoarctation group. This needs confirmation in future studies.
Raising cigarette prices through taxation is an important policy approach to reduce smoking. Yet,... more Raising cigarette prices through taxation is an important policy approach to reduce smoking. Yet, cigarette price increases may not be equally effective in all subpopulations of smokers. To examine differing effects of state cigarette price changes with individual changes in smoking among smokers of different intensity levels. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US adults originally interviewed in 2001-2002 (Wave 1) and re-interviewed in 2004-2005 (Wave 2): 34 653 were re-interviewed in Wave 2, and 7068 smokers defined at Wave 1 were included in our study. Mixed effects linear regression models were used to assess whether the effects of changes in state cigarette prices on changes in daily smoking behaviour differed by level of daily smoking. In the multivariable model, there was a significant interaction between change in price per pack of cigarettes from Wave 1 to Wave 2 and the number of cigarettes smoked per day (p=0.044). The more cigarettes smoked per day at baseline, the more responsive the smokers were to increases in price per pack of cigarettes (ie, number of cigarettes smoked per day was reduced in response to price increases). Our findings that heavier smokers successfully and substantially reduced their cigarette smoking behaviours in response to state cigarette price increases provide fresh insight to the evidence on the effectiveness of higher cigarette prices in reducing smoking.
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