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Saba MA, Goharpey S, Attarbashi Moghadam B, Salehi R, Afshani SM. Validation and responsiveness of the Persian version of HeartQoL questionnaire in cardiac rehabilitation after coronary artery bypass grafting: An observational study. ARYA Atheroscler 2020; 16:170-177. [PMID: 33598037 PMCID: PMC7867308 DOI: 10.22122/arya.v16i4.2098] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Decision making and the quality of care provided for chronic diseases have been shown to improve through patient participation. The HeartQoL questionnaire is a core health-related quality of life (HRQOL) tool specifically designed for individuals with ischemic heart disease (IHD) who have undergone interventions such as cardiac rehabilitation (CR). METHODS In this observational and multicenter study, 150 patients were recruited. The participants completed the HeartQoL, MacNew Heart Disease Questionnaire, and Short Form Health Survey (SF-36) on entering CR for validity assessment. The HeartQoL along with a Global Rating of Change (GRoC) scale (for responsiveness measurement) were completed by 100 participants 3 months later. RESULTS The mean age of all participants in validity assessment was 61.87 ± 8.13 years. Cronbach's alphas of the total scales ranged from 0.70 to 0.81 and of the subscales from 0.70 to 0.82. The Pearson correlation coefficient was used to determine construct validity; similar constructs were confirmed with correlation coefficients ranging from 0.50 to 0.69 and dissimilar constructs with correlation coefficients ranging from 0.28 to 0.29 (P < 0.010). The assessment of the responsiveness of the questionnaire indicated that the area under curve (AUC) was greater than 0.70 (range: 0.74 to 0.91) and the optimal cut-off point was 0.65. CONCLUSION The Persian version of the HeartQoL questionnaire demonstrated satisfactory psychometric properties in the sample of participants admitted to CR after coronary artery bypass grafting (CABG). The present study results showed that the HRQOL can be used by clinicians and researchers in conjunction with other outcome measures to gain additional information about symptoms relevant to HRQOL in patients referred to CR and to evaluate change over time.
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Affiliation(s)
- Maryam A. Saba
- PhD Candidate, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahin Goharpey
- Assistant Professor, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behrouz Attarbashi Moghadam
- Associate Professor, Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Associate Professor, Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sayed Mohammadreza Afshani
- Assistant Professor, Department of Cardiovascular Disease, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Chang HC, Liang J, Hsu HC, Lin SK, Chang TH, Liu SH. Regular exercise and the trajectory of health-related quality of life among Taiwanese adults: a cohort study analysis 2006-2014. BMC Public Health 2019; 19:1352. [PMID: 31646989 PMCID: PMC6806516 DOI: 10.1186/s12889-019-7662-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/20/2019] [Indexed: 12/26/2022] Open
Abstract
Background Physical activity is related to health-related quality of life, but little evidence from multiple waves of panel data in Asian countries area available. This study aims to explore the impacts of different degree of regular exercise on the trajectories of physical and mental dimensions of health-related quality of life (HRQOL) for community-dwelling Taiwanese adults during 2006–2014. Methods Data were derived from the “Landseed Integrated Outreaching Neighborhood Screening (LIONS)” study, with 6182 adults enrolled at the baseline and subsequently followed up to three times till 2014. Linear mixed-effects modeling approach was employed to evaluate the growth curve models of HRQOL (with 16,281 observations) by linear & quadratic time effects, regular exercise (5-level moderate-intensity physical activity), and major influential factors of HRQOL. Results Regular exercise showed significantly positive dose-response effects on physical HRQOL (β =1.27~2.54), and regular exercise of 150 min or more showed positive effects on mental HRQOL (β = 1.55~2.03). Besides, irregular exercise could also improve both physical and mental HRQOL (β = 1.27 & β = 0.87). However, such effects were not significant over time (at time slope) on HRQOL. In addition, physical and mental HRQOL improved across time (β = 1.01 and 1.49, respectively), but the time quadratic effect would significantly offset a little bit on physical dimension (β = − 0.22). Moreover, being female, increasing age, living alone, or poorer health status were related to lower physical HRQOL; and being younger, living alone, or poorer health status were associated with lower mental HRQOL. Conclusions The positive dose-response relationship between regular exercise and HRQOL or its domains was demonstrated for community-dwelling Taiwanese adults. Thus, a regular exercise habit (better ≧150 min per week) is advised for community-based healthcare professionals and the government to incorporate into health promotion strategies and plans.
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Affiliation(s)
- Huan-Cheng Chang
- Division of Family Medicine, Department of Community Medicine, Landseed International Hospital, No.77, Guangtai Rd., Pingzhen Dist., Taoyuan, 32449, Taiwan, Republic of China.,Department of Health Care Management, Chang Gung University, No.259, Wen-Hwa 1st Rd., Kwei-Shan Dist., Taoyuan, 33302, Taiwan, Republic of China
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, M3007, SPH II, Ann Arbor, MI, 48109, USA
| | - Hui-Chuan Hsu
- School of Public Health, Taipei Medical University, No.250, Wuxing Street, Taipei, 11031, Taiwan, Republic of China. .,Research Center of Health Equity, College of Public Health, Taipei Medical University, No.250, Wuxing Street, Taipei, 11031, Taiwan, Republic of China.
| | - Sung-Kai Lin
- Landseed Sports Medicine Center, Landseed International Hospital, No.77, Guangtai Rd., Pingzhen Dist., Taoyuan, 32449, Taiwan, Republic of China
| | - Ting-Huan Chang
- Department of Medical Education, Research and Quality Management, Landseed International Hospital, No.77, Guangtai Rd., Pingzhen Dist., Taoyuan, 32449, Taiwan, Republic of China
| | - Shu-Hui Liu
- Division of Health Care Management, Department of Community Medicine, Landseed International Hospital, No.77, Guangtai Rd., Pingzhen Dist., Taoyuan, 32449, Taiwan, Republic of China
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Intriago M, Maldonado G, Cardenas J, Rios C. Quality of life in Ecuadorian patients with established rheumatoid arthritis. Open Access Rheumatol 2019; 11:199-205. [PMID: 31565005 PMCID: PMC6732902 DOI: 10.2147/oarrr.s216975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/24/2019] [Accepted: 08/16/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate quality of life in patients with established rheumatoid arthritis (RA) and identify the factors that negatively affect it. Methods This was a cross-sectional study with patients with established RA from a rheumatology center in Ecuador. The RA Quality of Life (RAQoL) questionnaire was used to assess QoL and the Health Assessment Questionnaire — disability index (HAQ-DI) questionnaire for functional capacity. In addition, demographics, clinical characteristics, and markers of disease activity were included. Data were analyzed using SPSS 22. Results Of 186 patients, 89.8% were women, with a mean age of 51 years, 86.6% had symmetrical polyarticular involvement, 40.3% erosions, 46.8% morning stiffness, 46.8% xerophthalmia, and 39.2% fatigue. Depression was the most frequent comorbidity — 42.5%. The mean HAQ-DI score was 0.8, and 26.9% had functional disability. The mean RAQoL score was 7.2. Xerophthalmia, xerostomia, fatigue, morning stiffness, and depression were related to higher scores in the RAQoL (p<0.05). The mean RAQoL was higher in patients with more disease activity and comorbidities (p<0.05). Likewise, patients with functional disability had a mean RAQoL score of 15.6 versus 4.1 in patients without disability (p<0.05). There were positive correlations between RAQoL and ESR, CRP, painful-joint count, swollen-joint count, VAS of pain, and physician assessment (p<0.05). Conclusion QoL is severely affected in patients with RA. Depression, fatigue, morning stiffness, pain, high disease activity, and disability have a negative effect on QoL in RA. Likewise, patients with more comorbidities and extraarticular manifestations show worse QoL.
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Affiliation(s)
- Maria Intriago
- Rheumatology Department, Universidad Espiritu Santo, Guayaquil, Ecuador
| | | | - Jenny Cardenas
- Rheumatology Department, Universidad Espiritu Santo, Guayaquil, Ecuador
| | - Carlos Rios
- Rheumatology Department, Universidad Espiritu Santo, Guayaquil, Ecuador
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Goode AP, Taylor SS, Hastings SN, Stanwyck C, Coffman CJ, Allen KD. Effects of a Home-Based Telephone-Supported Physical Activity Program for Older Adult Veterans With Chronic Low Back Pain. Phys Ther 2018; 98:369-380. [PMID: 29669086 PMCID: PMC6692845 DOI: 10.1093/ptj/pzy026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Chronic low back pain (CLBP) is highly prevalent in older adults, leading to functional decline. OBJECTIVE The objective of this study was to evaluate physical activity (PA) only and PA plus cognitive-behavioral therapy for pain (CBT-P) among older adult veterans with CLBP. DESIGN This study was a pilot randomized trial comparing a 12-week telephone-supported PA-only intervention group (PA group) or PA plus CBT-P intervention group (PA + CBT-P group) and a wait-list control group (WL group). SETTING The study setting was the Durham Veterans Affairs Health Care System. PARTICIPANTS The study participants were 60 older adults with CLBP. INTERVENTIONS The PA intervention included stretching, strengthening, and aerobic activities; CBT-P covered activity pacing, relaxation techniques, and cognitive restructuring. MEASUREMENTS Feasibility measures included enrollment and completion metrics; acceptability was measured by completed phone calls. Primary outcomes included the Timed "Up & Go" Test and the PROMIS Health Assessment Questionnaire. Generalized linear mixed models were used to estimate changes within and between groups. Effect sizes were calculated with the Cohen d. Adverse effects were measured by self-report. RESULTS The mean participant age was 70.3 years; 53% were not white, and 93% were men. Eighty-three percent of participants completed the study, and the mean number of completed phone calls was 10 (of 13). Compared with the results for the WL group, small to medium treatment effects were found for the intervention groups in the Timed "Up & Go" Test (PA group: -2.94 [95% CI = -6.24 to 0.35], effect size = -0.28; PA + CBT-P group: -3.26 [95% CI = -6.69 to 0.18], effect size = -0.31) and the PROMIS Health Assessment Questionnaire (PA group: -6.11 [95% CI = -12.85 to 0.64], effect size = -0.64; PA + CBT-P group: -4.10 [95% CI = -11.69 to 3.48], effect size = -0.43). Small treatment effects favored PA over PA + CBT-P. No adverse effects were noted. LIMITATIONS This was a pilot study, and a larger study is needed to verify the results. CONCLUSIONS This pilot trial demonstrated that home-based telephone-supported PA interventions were feasible, acceptable, and safe for older adult veterans. The results provide support for a larger trial investigating these interventions.
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Affiliation(s)
- Adam P Goode
- Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University Medical Center, 2200 W. Main St, Durham, NC 27703 (USA),Address all correspondence to Dr Goode at:
| | - Shannon Stark Taylor
- Department of Behavioral, Social, and Population Health Sciences, University of South Carolina School of Medicine–Greenville, Greenville, South Carolina; and Department of Family Medicine, Greenville Health System, Greenville, South Carolina
| | - Susan N Hastings
- Center for Health Services Research in Primary Care, Geriatrics Research, Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina; and Division of Geriatrics, Center for the Study of Aging, Duke University, Durham, North Carolina
| | - Catherine Stanwyck
- Center for Health Services Research in Primary Care, Durham VA Health Care System; and Division of General Internal Medicine, Duke University Medical Center
| | - Cynthia J Coffman
- Center for Health Services Research in Primary Care, Durham VA Health Care System; and Division of General Internal Medicine, Duke University Medical Center
| | - Kelli D Allen
- Thurston Arthritis Research Center and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Center for Health Services Research in Primary Care, Durham VA Health Care System
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Xu RH, Cheung AWL, Wong ELY. Examining the health-related quality of life using EQ-5D-5L in patients with four kinds of chronic diseases from specialist outpatient clinics in Hong Kong SAR, China. Patient Prefer Adherence 2017; 11:1565-1572. [PMID: 28979104 PMCID: PMC5602472 DOI: 10.2147/ppa.s143944] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) measures have been increasingly employed in the evaluation of health utility. The aim of this study was to evaluate the impact of four different kinds of chronic diseases on the HRQoL of patients from specialist outpatient clinics in Hong Kong (HK) using the 5-level EQ-5D (EQ-5D-5L) value set. PATIENTS AND METHODS Patients who attended one of the 26 Hospital Authority's specialist outpatient clinics and met inclusion criteria were potentially sampled. The value of EQ-5D-5L (HK version) that asks the respondent to describe and rate his or her health status was used as the dependent variable. Four kinds of long-term health conditions and other demographic, socioeconomic, and health service use characteristics have been analyzed as independent variables. Chi-square test, robust one-way ANOVA, and the two-part model have been used to analyze the data. RESULTS A total of 7,496 (53.7%) patients reported to have at least one kind of chronic diseases. The mean score for hypertension (mean =0.882, standard error [SE] =0.207) is higher than the others, which followed by cancer, diabetes, and heart disease. Patients who were male, young, higher education attainment, and with chronic conditions got a higher EQ-5D score. In the two-part model, all the four long-standing health conditions were statistically significant in logistic model, but the magnitude of coefficients changed significantly in ordinary least squares model. CONCLUSION Chronic diseases have a significant negative impact on patients' HRQoL, but there might be a varying effect depending on what kind of chronic diseases patients had. Further research is also needed to plan appropriate strategies to improve patient-centered care.
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Affiliation(s)
- Richard Huan Xu
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Annie Wai Ling Cheung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eliza Lai-Yi Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Correspondence: Eliza Lai-Yi Wong, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F School of Public Health, Hospital of Prince Whales Hospital, Shatin, NT, Hong Kong SAR, China, Tel +852 252 8406, Email
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Goldstein JE, Jackson ML, Fox SM, Deremeik JT, Massof RW. Clinically Meaningful Rehabilitation Outcomes of Low Vision Patients Served by Outpatient Clinical Centers. JAMA Ophthalmol 2015; 133:762-9. [PMID: 25856370 DOI: 10.1001/jamaophthalmol.2015.0693] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To facilitate comparative clinical outcome research in low vision rehabilitation, we must use patient-centered measurements that reflect clinically meaningful changes in visual ability. OBJECTIVE To quantify the effects of currently provided low vision rehabilitation (LVR) on patients who present for outpatient LVR services in the United States. DESIGN, SETTING, AND PARTICIPANTS Prospective, observational study of new patients seeking outpatient LVR services. From April 2008 through May 2011, 779 patients from 28 clinical centers in the United States were enrolled in the Low Vision Rehabilitation Outcomes Study. The Activity Inventory, a visual function questionnaire, was administered to measure overall visual ability and visual ability in 4 functional domains (reading, mobility, visual motor function, and visual information processing) at baseline and 6 to 9 months after usual LVR care. The Geriatric Depression Scale, Telephone Interview for Cognitive Status, and Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning questionnaires were also administered to measure patients' psychological, cognitive, and physical health states, respectively, and clinical findings of patients were provided by study centers. MAIN OUTCOMES AND MEASURES Mean changes in the study population and minimum clinically important differences in the individual in overall visual ability and in visual ability in 4 functional domains as measured by the Activity Inventory. RESULTS Baseline and post-rehabilitation measures were obtained for 468 patients. Minimum clinically important differences (95% CIs) were observed in nearly half (47% [95% CI, 44%-50%]) of patients in overall visual ability. The prevalence rates of patients with minimum clinically important differences in visual ability in functional domains were reading (44% [95% CI, 42%-48%]), visual motor function (38% [95% CI, 36%-42%]), visual information processing (33% [95% CI, 31%-37%]), and mobility (27% [95% CI, 25%-31%]). The largest average effect size (Cohen d = 0.87) for the population was observed in overall visual ability. Age (P = .006) was an independent predictor of changes in overall visual ability, and logMAR visual acuity (P = .002) was predictive of changes in visual information processing. CONCLUSIONS AND RELEVANCE Forty-four to fifty percent of patients presenting for outpatient LVR show clinically meaningful differences in overall visual ability after LVR, and the average effect sizes in overall visual ability are large, close to 1 SD.
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Affiliation(s)
- Judith E Goldstein
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Lou Jackson
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston
| | - Sandra M Fox
- San Antonio Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio4Lions Low Vision Center of Texas, The University of Texas Health Science Center School at San Antonio
| | - James T Deremeik
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert W Massof
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wu M, Brazier JE, Kearns B, Relton C, Smith C, Cooper CL. Examining the impact of 11 long-standing health conditions on health-related quality of life using the EQ-5D in a general population sample. Eur J Health Econ 2015; 16:141-51. [PMID: 24408476 PMCID: PMC4339694 DOI: 10.1007/s10198-013-0559-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/18/2013] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Health-related quality of life (HRQoL) measures have been increasingly used in economic evaluations for policy guidance. We investigate the impact of 11 self-reported long-standing health conditions on HRQoL using the EQ-5D in a UK sample. METHODS We used data from 13,955 patients in the South Yorkshire Cohort study collected between 2010 and 2012 containing the EQ-5D, a preference-based measure. Ordinary least squares (OLS), Tobit and two-part regression analyses were undertaken to estimate the impact of 11 long-standing health conditions on HRQoL at the individual level. RESULTS The results varied significantly with the regression models employed. In the OLS and Tobit models, pain had the largest negative impact on HRQoL, followed by depression, osteoarthritis and anxiety/nerves, after controlling for all other conditions and sociodemographic characteristics. The magnitude of coefficients was higher in the Tobit model than in the OLS model. In the two-part model, these four long-standing health conditions were statistically significant, but the magnitude of coefficients decreased significantly compared to that in the OLS and Tobit models and was ranked from pain followed by depression, anxiety/nerves and osteoarthritis. CONCLUSIONS Pain, depression, osteoarthritis and anxiety/nerves are associated with the greatest losses of HRQoL in the UK population. The estimates presented in this article should be used to inform economic evaluations when assessing health care interventions, though improvements can be made in terms of diagnostic information and obtaining longitudinal data.
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Affiliation(s)
- Mengjun Wu
- Institute of Mental Health, University of Nottingham, Innovation Park, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK,
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Goldstein JE, Chun MW, Fletcher DC, Deremeik JT, Massof RW. Visual ability of patients seeking outpatient low vision services in the United States. JAMA Ophthalmol 2015; 132:1169-77. [PMID: 25073745 DOI: 10.1001/jamaophthalmol.2014.1747] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Most patients with low vision are elderly and have functional limitations from other health problems that could add to the functional limitations caused by their visual impairments. OBJECTIVE To identify factors that contribute to visual ability measures in patients who present for outpatient low vision rehabilitation (LVR) services. DESIGN, SETTING, AND PARTICIPANTS As part of a prospective, observational study of new patients seeking outpatient LVR, 779 patients from 28 clinical centers in the United States were enrolled in the Low Vision Rehabilitation Outcomes Study (LVROS) from April 25, 2008, through May 2, 2011. The Activity Inventory (AI), an adaptive visual function questionnaire, was administered to measure overall visual ability and visual ability in 4 functional domains (reading, mobility, visual motor function, and visual information processing) at baseline before LVR. The Geriatric Depression Scale, Telephone Interview for Cognitive Status, and Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning questionnaires were also administered to measure patients' psychological, cognitive, and physical health states, respectively. MAIN OUTCOMES AND MEASURES Predictors of visual ability and functional domains as measured by the AI. RESULTS Among the 779 patients in the LVROS sample, the mean age was 76.4 years, 33% were male, and the median logMAR visual acuity score was 0.60 (0.40-0.90 interquartile range). Correlations were observed between logMAR visual acuity and baseline visual ability overall (r = -0.42) and for all functional domains. Visual acuity was the strongest predictor of visual ability (P < .001) and reading ability (P < .001) and had a significant independent effect on the other functional domains. Physical ability was independently associated with (P < .001) overall visual ability as well as mobility and visual motor function. Depression had a consistent independent effect (P < .001) on overall visual ability and on all functional domains, whereas cognition had an effect on only reading and mobility (P < .001). CONCLUSIONS AND RELEVANCE Visual ability is a multidimensional construct, with visual acuity, depression, physical ability, and cognition explaining more than one-third of the variance in visual ability as measured by the AI. The significant contributions of the nonvisual factors to visual ability measures and the rehabilitation potential (ie, ceiling) effects they may impose on LVR are important considerations when measuring baseline visual ability and ultimately LVR outcomes in ongoing clinical research.
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Affiliation(s)
- Judith E Goldstein
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa W Chun
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Donald C Fletcher
- Department of Ophthalmology, Smith-Kettlewell Eye Research Institute, California Pacific Medical Center, San Francisco4Department of Ophthalmology, University of Kansas, Kansas City
| | - James T Deremeik
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert W Massof
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
PURPOSE This study is an evaluation of the responsiveness of preference-based outcome measures to the effects of low vision rehabilitation (LVR). It assesses LVR-related changes in EQ-5D utilities in patients who exhibit changes in Activity Inventory (AI) measures of visual ability. METHODS Telephone interviews were conducted on 77 low-vision patients out of a total of 764 patients in the parent study of "usual care" in LVR. Activity Inventory results were filtered for each patient to include only goals and tasks that would be targeted by LVR. RESULTS The EQ-5D utilities have weak correlations with all AI measures but correlate best with AI goal scores at baseline (r = 0.48). Baseline goal scores are approximately normally distributed for the AI, but EQ-5D utilities at baseline are skewed toward the ceiling (median, 0.77). Effect size for EQ-5D utility change scores from pre- to post-LVR was not significantly different from zero. The AI visual function ability change scores corresponded to a moderate effect size for all functional domains and a large effect size for visual ability measures estimated from AI goal ratings. CONCLUSIONS This study found that the EQ-5D is unresponsive as an outcome measure for LVR and has poor sensitivity for discriminating low vision patients with different levels of ability.
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Affiliation(s)
- Alexis G Malkin
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Iezzoni LI. Quality of care for Medicare beneficiaries with disabilities under the age of 65 years. Expert Rev Pharmacoecon Outcomes Res 2014; 6:261-73. [DOI: 10.1586/14737167.6.3.261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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El Emrani L, Bendriss A, Senhaji M. Santé et qualité de vie : situation pour la population de Tétouan (Maroc). Santé Publique 2013. [DOI: 10.3917/spub.135.0639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chan TL, Goldstein JE, Massof RW; Low Vision Research Network Study Group. Comparison of clinician-predicted to measured low vision outcomes. Optom Vis Sci 2013; 90:776-87. [PMID: 23873036 DOI: 10.1097/OPX.0b013e31829d99d1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare low-vision rehabilitation (LVR) clinicians' predictions of the probability of success of LVR with patients' self-reported outcomes after provision of usual outpatient LVR services and to determine if patients' traits influence clinician ratings. METHODS The Activity Inventory (AI), a self-report visual function questionnaire, was administered pre-and post-LVR to 316 low-vision patients served by 28 LVR centers that participated in a collaborative observational study. The physical component of the Short Form-36, Geriatric Depression Scale, and Telephone Interview for Cognitive Status were also administered pre-LVR to measure physical capability, depression, and cognitive status. After patient evaluation, 38 LVR clinicians estimated the probability of outcome success (POS) using their own criteria. The POS ratings and change in functional ability were used to assess the effects of patients' baseline traits on predicted outcomes. RESULTS A regression analysis with a hierarchical random-effects model showed no relationship between LVR physician POS estimates and AI-based outcomes. In another analysis, kappa statistics were calculated to determine the probability of agreement between POS and AI-based outcomes for different outcome criteria. Across all comparisons, none of the kappa values were significantly different from 0, which indicates that the rate of agreement is equivalent to chance. In an exploratory analysis, hierarchical mixed-effects regression models show that POS ratings are associated with information about the patient's cognitive functioning and the combination of visual acuity and functional ability, as opposed to visual acuity or functional ability alone. CONCLUSIONS Clinicians' predictions of LVR outcomes seem to be influenced by knowledge of patients' cognitive functioning and the combination of visual acuity and functional ability-information clinicians acquire from the patient's history and examination. However, clinicians' predictions do not agree with observed changes in functional ability from the patient's perspective; they are no better than chance.
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Hamar B, Coberley CR, Pope JE, Rula EY. Impact of a senior fitness program on measures of physical and emotional health and functioning. Popul Health Manag 2013; 16:364-72. [PMID: 23560492 DOI: 10.1089/pop.2012.0111] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The SilverSneakers fitness program is a health plan benefit for Medicare beneficiaries that provides older adults with fitness center membership, customized group exercise classes, and a supportive social environment that promotes socialization among participants. This study evaluated the impact of the SilverSneakers program on physical and emotional health and activities of daily living (ADLs). A quasi-experimental retrospective analysis compared annual survey responses from SilverSneakers members (treatment N=5586) to a matched national random sample of Medicare Advantage organization beneficiaries (comparison N=22,344) in Cohort 10 of the Medicare Health Outcomes Survey. Matching was performed based on 6 demographic and 6 disease status variables. Survey responses from 2007 and 2009 were evaluated using categorical and logistic regression analysis. The treatment group showed significantly better physical and emotional health and lower impairment in both 2007 and 2009, less impairment for 4 of 6 ADLs in 2007, and all 6 in 2009, and a higher average number of days of good health within the prior month for both years. Three-year longitudinal analyses indicated a significantly more favorable survey response trend for the treatment group for nearly all measures of health and ADLs. Members who exercised less frequently had poorer health and functioning. Overall, participation in the SilverSneakers program was associated with more favorable overall physical and social/emotional health status and fewer activity impairments, suggesting that the provision of senior-oriented group fitness programs may be a valuable approach to improve quality of life and reduce the burden associated with declining health and functioning as older adults age.
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Affiliation(s)
- Brent Hamar
- Center for Health Research, Healthways, Inc. , Franklin, Tennessee
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Goldstein JE, Massof RW, Deremeik JT, Braudway S, Jackson ML, Kehler KB, Primo SA, Sunness JS. Baseline traits of low vision patients served by private outpatient clinical centers in the United States. ACTA ACUST UNITED AC 2012; 130:1028-37. [PMID: 22893074 DOI: 10.1001/archophthalmol.2012.1197] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To characterize the traits of low vision patients who seek outpatient low vision rehabilitation (LVR) services in the United States. METHODS In a prospective observational study, we enrolled 764 new low vision patients seeking outpatient LVR services from 28 clinical centers in the United States. Before their initial appointment, multiple questionnaires assessing daily living and vision, physical, psychological, and cognitive health states were administered by telephone. Baseline clinical visual impairment measures and disorder diagnoses were recorded. RESULTS Patients had a median age of 77 years, were primarily female (66%), and had macular disease (55%), most of which was nonneovascular age-related macular degeneration. More than one-third of the patients (37%) had mild vision impairment with habitual visual acuity (VA) of 20/60 or greater. The VA correlated well with contrast sensitivity (r = -0.52) but poorly with self-reported vision quality. The intake survey revealed self-reported physical health limitations, including decreased endurance (68%) and mobility problems (52%). Many patients reported increased levels of frustration (42%) and depressed mood (22%); memory and cognitive impairment (11%) were less frequently endorsed. Patients relied on others for daily living support (87%), but many (31%) still drove. CONCLUSIONS Most patients seeking LVR are geriatric and have macular disease with relatively preserved VA. The disparity between VA and subjective quality of vision suggests that LVR referrals are based on symptoms rather than on VA alone. Patients seen for LVR services have significant physical, psychological, and cognitive disorders that can amplify vision disabilities and decrease rehabilitation potential.
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Gramm L, Farin E, Jaeckel WH. Psychometric properties of the German version of the MacNew heart disease health-related quality of life questionnaire. Health Qual Life Outcomes 2012; 10:83. [PMID: 22817770 PMCID: PMC3418185 DOI: 10.1186/1477-7525-10-83] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/06/2012] [Indexed: 12/26/2022] Open
Abstract
Background There is a lack of German-language, disease-specific health related quality of life instruments applicable in cardiac rehabilitation. The purpose of this project was to investigate the psychometric properties of the German version of the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) in patients undergoing cardiac rehabilitation. Methods The MacNew was filled out by 5692 inpatients. We analysed acceptance (number of missing values), ceiling and floor effects, reliability (Cronbach’s α), factor structure (confirmatory factor analysis), construct validity (correlation with a generic health-related quality of life instrument), and sensitivity to change. Results Two items had more than 7% missing data. We observed neither floor nor ceiling effects. Cronbach’s α of the scales ranged from 0.78 (physical scale) to 0.95 (global scale). Confirmatory factor analysis failed to reproduce the proposed factor structure (CFI = 0.882; TLI = 0.871; RMSEA = 0.074). We therefore drafted our own model (CFI = 0.932; TLI = 0.921; RMSEA = 0.064), and observed a correlation pattern largely conforming to the hypotheses with a generic health-related quality of life instrument. The effect sizes we noted between the start and end of rehabilitation fell between 0.66 and 0.74; at the 6-month follow-up they ranged from 0.69 to 0.92. Conclusions The German version of the MacNew Heart Disease Health-related Quality of Life Questionnaire is a suitable instrument with which to measure the impairment experienced by individuals with heart disease during inpatient cardiologic rehabilitation. The social and the global scale must be interpreted cautiously.
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Affiliation(s)
- Lukas Gramm
- Department of Quality Management and Social Medicine (AQMS), University Medical Center Freiburg, Engelbergerstrasse 21, 79106, Freiburg, Germany.
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Waimann CA, Dal Pra FM, Marengo MF, Schneeberger EE, Gagliardi S, Cocco JA, Sanchez M, Garone A, del Moral RE, Rillo OL, Salcedo M, Rosa JE, Ceballos F, Soriano ER, Citera G. Quality of life of patients with rheumatoid arthritis in Argentina: reliability, validity, and sensitivity to change of a Spanish version of the Rheumatoid Arthritis Quality of Life questionnaire. Clin Rheumatol 2012; 31:1065-71. [PMID: 22476205 DOI: 10.1007/s10067-012-1976-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 03/07/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire is the first needs-based instrument specifically designed to measure quality of life (QoL) of patients with rheumatoid arthritis (RA). The aims of our study were to develop an Argentinean version of the RAQoL and to determine its reproducibility, validity, and sensitivity to change in patients with RA. Translation process was performed according to internationally accepted methodology. Internal consistency and test-retest reliability were calculated. Criterion and construct validity were assessed by comparing the RAQoL with parameters of disease activity, the Health Assessment Questionnaire (HAQ), and the Medical Outcomes Study 36-item health survey (SF-36) questionnaire. Sensitivity to change was measured at 6-12 months using standardized response mean (SRM). The minimal important change was defined as a change of 1 or 1.96 times the standard error of measurement. A total of 97 patients with RA were included. Cronbach's α was 0.93, and test-retest reliability was 0.95. The RAQoL showed moderate to strong correlation with parameters of disease activity, the HAQ, and the SF-36. Functional status was the main determinant of patients' level of QoL. The SRM of the RAQoL was 0.24. Agreement between 20 % improvement in RAQoL and ACR20 response was moderate. Minimal important change was 2.2 (1 SEM) or 4.3 (1.96 SEM). The Argentinean version of the RAQoL is the first Spanish translation of this questionnaire. Our findings show it to be valid, reliable, and sensitive to changes in RA clinical status.
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Han PKJ, Lee M, Reeve BB, Mariotto AB, Wang Z, Hays RD, Yabroff KR, Topor M, Feuer EJ. Development of a prognostic model for six-month mortality in older adults with declining health. J Pain Symptom Manage 2012; 43:527-39. [PMID: 22071167 PMCID: PMC3289041 DOI: 10.1016/j.jpainsymman.2011.04.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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: 08/08/2010] [Revised: 04/13/2011] [Accepted: 04/20/2011] [Indexed: 11/28/2022]
Abstract
CONTEXT Estimation of six-month prognosis is essential in hospice referral decisions, but accurate, evidence-based tools to assist in this task are lacking. OBJECTIVES To develop a new prognostic model, the Patient-Reported Outcome Mortality Prediction Tool (PROMPT), for six-month mortality in community-dwelling elderly patients. METHODS We used data from the Medicare Health Outcomes Survey linked to vital status information. Respondents were 65 years old or older, with self-reported declining health over the past year (n=21,870), identified from four Medicare Health Outcomes Survey cohorts (1998-2000, 1999-2001, 2000-2002, and 2001-2003). A logistic regression model was derived to predict six-month mortality, using sociodemographic characteristics, comorbidities, and health-related quality of life (HRQOL), ascertained by measures of activities of daily living and the Medical Outcomes Study Short Form-36 Health Survey; k-fold cross-validation was used to evaluate model performance, which was compared with existing prognostic tools. RESULTS The PROMPT incorporated 11 variables, including four HRQOL domains: general health perceptions, activities of daily living, social functioning, and energy/fatigue. The model demonstrated good discrimination (c-statistic=0.75) and calibration. Overall diagnostic accuracy was superior to existing tools. At cut points of 10%-70%, estimated six-month mortality risk sensitivity and specificity ranged from 0.8% to 83.4% and 51.1% to 99.9%, respectively, and positive likelihood ratios at all mortality risk cut points ≥40% exceeded 5.0. Corresponding positive and negative predictive values were 23.1%-64.1% and 85.3%-94.5%. Over 50% of patients with estimated six-month mortality risk ≥30% died within 12 months. CONCLUSION The PROMPT, a new prognostic model incorporating HRQOL, demonstrates promising performance and potential value for hospice referral decisions. More work is needed to evaluate the model.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME 04105, USA.
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Abstract
OBJECTIVE This study tested a healthy immigrant effect (HIE) and postimmigration health status changes among late life immigrants. METHODS Using three waves of the Second Longitudinal Study of Aging (1994-2000) and the linked mortality file through 2006, this study compared (a) chronic health conditions, (b) longitudinal trajectories of self-rated health, (c) longitudinal trajectories of functional impairments, and (d) mortality between three groups (age 70+): (i) late life immigrants with less than 15 years in the United States (n = 133), (ii) longer term immigrants (n = 672), and (iii) U.S.-born individuals (n = 8,642). Logistic and Poisson regression, hierarchical generalized linear modeling, and survival analyses were conducted. RESULTS Late life immigrants were less likely to suffer from cancer, had lower numbers of chronic conditions at baseline, and displayed lower hazards of mortality during the 12-year follow-up. However, their self-rated health and functional status were worse than those of their counterparts over time. CONCLUSION A HIE was only partially supported among older adults.
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Baumann C, Erpelding ML, Perret-Guillaume C, Gautier A, Régat S, Collin JF, Guillemin F, Briançon S. Health-related quality of life in French adolescents and adults: norms for the DUKE Health Profile. BMC Public Health 2011; 11:401. [PMID: 21619606 PMCID: PMC3123210 DOI: 10.1186/1471-2458-11-401] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 05/27/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The continual monitoring of population health-related quality of life (HRQoL) with validated instruments helps public health agencies assess, protect, and promote population health. This study aimed to determine norms for the French adolescent and adult general population for the Duke Health Profile (DUKE) questionnaire in a large representative community sample. METHODS We randomly selected 17,733 French people aged 12 to 75 years old in 2 steps, by households and individuals, from the National Health Barometer 2005, a periodic population study by the French National Institute for Prevention and Health Education. Quality of life and other data were collected by computer-assisted telephone interview. RESULTS Normative data for the French population were analyzed by age, gender and self-reported chronic disease. Globally, function scores (best HRQoL=100) for physical, mental, social, and general health, as well as perceived health and self-esteem, were 72.3 (SEM 0.2), 74.6 (0.2), 66.8 (0.1), 71.3 (0.1), 71.3 (0.3), 76.5 (0.1), respectively. Dysfunction scores (worst HRQoL=100) for anxiety, depression, pain and disability domains were 30.9 (0.1), 27.6 (0.2), 34.3 (0.3), 3.1 (0.1), respectively. CONCLUSION The French norms for adolescents and adults for the DUKE could be used as a reference for other studies assessing HRQoL, for specific illnesses, in France and for international comparisons.
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Affiliation(s)
- Cédric Baumann
- Nancy-Université, Université Paul Verlaine Metz, Université Paris Descartes, EA 4360 Apemac, Nancy, France
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Finkelman MD, He Y, Kim W, Lai AM. Stochastic curtailment of health questionnaires: A method to reduce respondent burden. Stat Med 2011; 30:1989-2004. [DOI: 10.1002/sim.4231] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 02/15/2011] [Indexed: 11/07/2022]
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Mooney V, Matheson LN, Verna J, Leggett S, Dreisinger TE, Mayer JM. Performance-integrated self-report measurement of physical ability. Spine J 2010; 10:433-40. [PMID: 20338829 DOI: 10.1016/j.spinee.2010.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 02/05/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The technology of self-report measures has advanced rapidly over the past few years. Recently, this technology was used to develop a performance-integrated self-report measure for use with patients with musculoskeletal impairments that may lead to work disability. Psychometric studies of the new measure in patient populations have been successful. A validation study of the measure with adults in good general health is necessary. PURPOSE The purpose of this study was to assess the concurrent validity of a new performance-integrated self-report measure, the multidimensional task ability profile (MTAP). STUDY DESIGN/SETTING A prospective validation study was conducted in which a self-report measure was administered online, and a physical performance test was administered at various clinics in North America. PATIENT SAMPLE One hundred ninety-six (34% male) adult volunteers in good general health participated in this study. OUTCOME MEASURES Self-report measure-MTAP. Physiologic measure-EPIC Lift Capacity test. METHODS The MTAP was administered online within 1 week of formal testing of lift capacity using a standardized lift capacity test, the EPIC Lift Capacity test. MTAP scores were compared with performance on the EPIC Lift Capacity test. Stepwise regression analysis was used to identify the strength of the relationship between the two measures and the relative explanation of lift capacity variance by the MTAP score, along with gender and age. RESULTS The combination of MTAP score, gender, and age demonstrated a regression coefficient of R=0.82, which accounts for 67.3% of the variance in lift capacity. CONCLUSIONS The MTAP displayed good concurrent validity compared with actual physical performance as assessed by the EPIC Lift Capacity test. Modern performance-integrated self-report measures, such as the MTAP, have the potential to provide information about functional capacity that is sufficiently useful to confirm status and help guide treatment algorithms.
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Affiliation(s)
- Vert Mooney
- U.S. Spine & Sport Foundation, San Diego, CA 92123, USA
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Harman JS, Scholle SH, Ng JH, Pawlson LG, Mardon RE, Haffer SC, Shih S, Bierman AS. Association of Health Plans' Healthcare Effectiveness Data and Information Set (HEDIS) performance with outcomes of enrollees with diabetes. Med Care 2010; 48:217-23. [PMID: 20125042 DOI: 10.1097/MLR.0b013e3181ca3fe6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few quality of care evaluations examine the relationship between clinical processes and patient outcomes. OBJECTIVE To determine the association between health plan performance on Healthcare Effectiveness Data and Information Set (HEDIS) clinical processes and intermediate outcome measures and Health Outcomes Survey (HOS) self-reported physical and mental health scores among Medicare plan enrollees with diabetes. RESEARCH DESIGN Secondary data analysis of 2002 HEDIS and 2001-2003 HOS data. SUBJECTS This study focused on Medicare plan enrollees with self-reported diabetes (N = 8184). MEASURES Plan-level HEDIS diabetes care measures for 2002 and longitudinal, patient-level 2001-2003 HOS physical and mental health outcomes scores. Hierarchical linear models estimated the relationship between plan HEDIS performance on diabetes process of care and intermediate outcome measures and 2-year changes in enrollee HOS physical and mental health scores. RESULTS Each 10% point improvement in plan performance on HEDIS intermediate outcomes (ie, the proportion of well-controlled diabetes) was related to significant positive increase in the probability of being healthy as measured by both enrollee physical health scores (7 percentage point increase, P < 0.05) and mental health scores (11 percentage point increase, P < 0.01). Similar increases in plan process of care measures were associated with increases in the probability of being healthy as measured by enrollee mental health scores (11 percentage point increase, P < 0.001). CONCLUSIONS This study represents one of the first attempts to link plan HEDIS performance to changes in enrollee health. The results suggest that improved quality of care, as measured by process and intermediate outcomes measures for diabetes, can result in better health among patients with diabetes. Further research should address whether this relationship exists in other quality measures, clinical conditions, and populations.
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Resnik L, Liu D, Mor V, Hart DL. Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes. Phys Ther 2008; 88:989-1004. [PMID: 18689610 PMCID: PMC2527215 DOI: 10.2522/ptj.20070110] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [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: 04/06/2007] [Accepted: 06/09/2008] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Little is known about organizational and service delivery factors related to quality of care in physical therapy. This study sought to identify characteristics related to differences in practice outcomes and service utilization. SUBJECTS The sample comprised 114 outpatient clinics and 1,058 therapists who treated 16,281 patients with low back pain syndromes during the period 2000-2001. Clinics participated with the Focus on Therapeutic Outcomes, Inc (FOTO) database. METHODS Hierarchical linear models were used to risk adjust treatment outcomes and number of visits per treatment episode. Aggregated residual scores from these models were used to classify each clinic into 1 of 3 categories in each of 3 types of performance groups: (1) effectiveness, (2) utilization, and (3) overall performance (ie, composite measure of effectiveness and utilization). Relationships between clinic classification and the following independent variables were examined by multinomial logistic regression: years of therapist experience, number of physical therapists, ratio of physical therapists to physical therapist assistants, proportion of patients with low back pain syndromes, number of new patients per physical therapist per month, utilization of physical therapist assistants, and setting. RESULTS Clinics that were lower utilizers of physical therapist assistants were 6.6 times more likely to be classified into the high effectiveness group compared with the low effectiveness group, 6.7 times more likely to be classified in the low utilization group compared with the high utilization group, and 12.4 times more likely to be classified in the best performance group compared with the worst performance group. Serving a higher proportion of patients with low back pain syndromes was associated with an increased likelihood of being classified in the lowest or middle group. Years of physical therapist experience was inversely associated with being classified in the middle utilization group compared with the highest utilization group. DISCUSSION AND CONCLUSION These findings suggest that, in the treatment of patients with low back pain syndromes, clinics that are low utilizers of physical therapist assistants are more likely to provide superior care (ie, better patient outcomes and lower service use).
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Affiliation(s)
- Linda Resnik
- Providence VA Medical Center, Department of Community Health, Brown University, 2 Stimson Ave, Providence, RI 02912, USA.
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Resnik L, Liu D, Hart DL, Mor V. Benchmarking physical therapy clinic performance: statistical methods to enhance internal validity when using observational data. Phys Ther 2008; 88:1078-87. [PMID: 18689608 DOI: 10.2522/ptj.20070327] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Many clinics and payers are beginning programs to collect and interpret outcomes related to quality of care and provider performance (ie, benchmarking). OUTCOMES assessment is commonly done using observational research designs, which makes it important for those involved in these endeavors to appreciate the underlying challenges and limitations of these designs. This perspective article discusses the advantages and limitations of using observational research to evaluate quality of care and provider performance in order to inform clinicians, researchers, administrators, and policy makers who want to use data to guide practice and policy or critically appraise observational studies and benchmarking efforts. Threats to internal validity, including potential confounding, patient selection bias, and missing data, are discussed along with statistical methods commonly used to address these limitations. An example is given from a recent study comparing physical therapy clinic performance in terms of patient outcomes and service utilization with and without the use of these methods. The authors demonstrate that crude differences in clinic outcomes and service utilization tend to be inflated compared with the differences that are statistically adjusted for selected threats to internal validity. The authors conclude that quality of care measurement and ranking procedures that do not use similar methods may produce findings that may be misleading.
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Abstract
STUDY DESIGN Analytic cross-sectional and cohort study. OBJECTIVE This study examines the prevalence and associations of low back pain (LBP) and depressive symptoms in a large population of elderly (65+), community-dwelling subjects. SUMMARY OF BACKGROUND DATA In adults, depression has been identified as predictive for LBP, while depression has also been found to be a possible consequence of LBP. METHODS Data of the Health Outcomes Survey that include a baseline (N = 91,347) and a follow-up survey (N = 55,690) after 2 years were analyzed cross-sectionally and prospectively. Degree of depressive symptoms and disabling LBP were described at both time points, as well as their interrelationships. An ordinal logistic regression analysis was performed to model the effects of different sociodemographic, clinical, and functional variables on LBP and depressive symptoms after 2 years. RESULTS Depressive symptoms were found in about 20% of the sample. Baseline depression symptoms increased the odds of disabling LBP after 2 years independently of sociodemographic characteristics, medical, and functional status. Disabling LBP at baseline increased the odds of depressive symptoms after 2 years to a similar degree. CONCLUSION Among community-dwelling elderly persons, depressive symptoms and disabling LBP are widespread. Depressive symptoms predict disabling LBP and vice versa. The set of predictors and their extent of contribution to the prognosis are strikingly similar. Research is warranted to identify possible common pathogenic mechanisms or mediating factors.
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Affiliation(s)
- Thorsten Meyer
- Institute of Social Medicine, Medical University Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
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Abstract
BACKGROUND Prior research on selection bias in Medicare plans has demonstrated favorable enrollment of healthier beneficiaries, resulting in plan overpayment. However, total selection bias depends not only on who enrolls, but also on who disenrolls. Few studies examine selectivity in disenrollment; it is unclear how those who leave plans differ from those who remain. OBJECTIVE The examination of health status and plan characteristics as potential predictors of voluntary disenrollment from Medicare managed care. RESEARCH DESIGN Baseline data on health of Medicare managed care enrollees are from the 1998 Medicare Health Outcomes Survey, merged with data on enrollment status and plan characteristics. Beneficiary voluntary disenrollment, versus continuous enrollment, 24 months after completing the survey was modeled as a function of perceived health in 1998 and plan characteristics. The sample included 109,882 community-dwelling elderly. RESULTS Between 1998 and 2000, 24% of Medicare managed care enrollees voluntarily disenrolled from plans. Poor perceived physical and mental health significantly increased the odds of voluntary disenrollment. Odds of disenrollment were higher for members of plans that increased premiums and had low market share between 1998 and 2000. Conversely, gaining drug coverage in a plan between 1998 and 2000 lowered the odds of disenrollment (relative to no coverage). CONCLUSION Medicare plans experience favorable selection bias partly because sicker members are likelier to disenroll. Plan-level policies that influence market share and benefits, particularly pharmaceutical coverage, also have important effects on disenrollment, regardless of health effects. Understanding both individual and plan influences on disenrollment is critical to benefit coverage and disenrollment restriction ("lock in") policies.
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Affiliation(s)
- Judy H Ng
- National Committee for Quality Assurance, Washington, District of Columbia 20036, USA.
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Gesell SB, Clark PA, Mylod DE, Wolosin RJ, Drain M, Lanser P, Hall MF. Hospital-level correlation between clinical and service quality performance for heart failure treatment. J Healthc Qual 2007; 27:33-44. [PMID: 17514856 DOI: 10.1111/j.1945-1474.2005.tb00587.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/29/2022]
Abstract
A national cross-sectional study correlates the satisfaction ratings of heart failure patients (diagnosis related group 127) and the Centers for Medicare & Medicaid Services' process-based quality measures for heart failure treatment for 32 hospitals during the first and second quarters of 2004. Two of the four measures of clinical quality showed statistically significant, moderately strong, positive correlations with a global measure of satisfaction and with, respectively, 5 and 7 subscales of the 10 subscales of satisfaction under examination (Pearson's r ranged between .40 and .67, 2-tailed; p < .05). Findings demonstrate that quality need not be a zero-sum issue, with clinical quality and service quality competing for resources and attention.
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Selim AJ, Kazis LE, Rogers W, Qian SX, Rothendler JA, Spiro A, Ren XS, Miller D, Selim BJ, Fincke BG. Change in health status and mortality as indicators of outcomes: comparison between the Medicare Advantage Program and the Veterans Health Administration. Qual Life Res 2007; 16:1179-91. [PMID: 17530447 DOI: 10.1007/s11136-007-9216-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 08/11/2006] [Accepted: 04/06/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Comparing health outcomes with adequate methodology is central to performance assessments of health care systems. We compared the Medicare Advantage Program (MAP) and the Veterans Health Administration (VHA) with regard to changes in health status and mortality. METHODS We used the Death-Master-File for vital status and the Short-Form 36 to determine physical (PCS) and mental (MCS) health at baseline and at 2 years. We compared the probability of being alive with the same or better (than would be expected by chance) PCS (or MCS) at 2 years and mortality, while adjusting for case-mix. Given the geographic variations in MAP enrollment, we did a regional sub-analysis. RESULTS There were no significant differences in the probability of being alive with the same or better PCS except for the South (VHA 65.8% vs. MAP 62.5%, P = .0014). VHA patients had a slightly higher probability than MAP patients of being alive with the same or better MCS (71.8% vs. 70.1%, P = .002) but no significant regional variations. The hazard ratios for mortality in the MAP were higher than in the VHA across all regions. CONCLUSION With the use of appropriate methodology, we found small differences in 2-year health outcomes that favor the VHA.
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Affiliation(s)
- Alfredo J Selim
- Center for Health Quality, Outcomes, and Economic Research, A Health Services Research and Development Field Program, VA Medical Center, Bedford, MA, USA.
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Abstract
OBJECTIVES To evaluate the power of several self-reported depressive symptoms to predict nursing home admission (NHA). DESIGN A Cox proportional hazards model was used to estimate the risk of NHA. SETTING Data were from the Health Outcomes Survey (a national random sample of 137,000 Medicare + Choice enrollees aged 65 and older), the Nursing Home Minimum Data Set, and the Medicare Enrollment Database. PARTICIPANTS Medicare beneficiaries aged 65 and older enrolled in a Medicare Managed Care Plan who were self-respondents to the questionnaire and were not institutionalized at the time of the survey. MEASUREMENTS Variables were self-reported functional status, chronic health conditions, demographics, and several mood-related questions. RESULTS After controlling for age, race, sex, marital status, home ownership, functional status, and comorbid conditions, individuals who identified themselves as feeling sad or depressed much of the time over the previous year were at significantly higher risk of NHA. CONCLUSION A single question about depressive symptoms can be used to identify individuals at higher risk of NHA. There may be benefit from better screening and treatment of depression in community-based older people. Depression and social support may be linked. This study was targeted and did not attempt to explain everything that affects NHA. Investigation of the relationship between social support, depression, and NHA should be considered in future research.
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Affiliation(s)
- Yael Harris
- Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland 21244, USA.
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Lubetkin EI, Jia H, Franks P, Gold MR. Relationship among sociodemographic factors, clinical conditions, and health-related quality of life: examining the EQ-5D in the U.S. general population. Qual Life Res 2006; 14:2187-96. [PMID: 16328899 DOI: 10.1007/s11136-005-8028-5] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.6] [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] [Accepted: 05/26/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Health-related quality of life (HRQL) measures are used increasingly in evaluations of clinical and population-based outcomes and in economic analyses. We investigate the influence of demographic, socioeconomic, and chronic disease factors on the HRQL of a representative U.S. sample. METHODS We examined data from 13,646 adults in the 2000 Medical Expenditure Panel Survey, a nationally representative sample of the U.S. general population, who completed a self-administered questionnaire containing the EQ-5D, a preference-based measure. We assessed the relationships between EQ-5D scores and sociodemographic variables, including age, sex, race/ethnicity, income and education, and six common chronic conditions. RESULTS In fully adjusted models, EQ-5D scores decreased with increasing category of age and were lower for persons with a lower income and educational attainment as well as each of the six conditions. Although the EQ-5D scores were lower for females and Whites compared with Blacks such differences were not of a magnitude considered to be clinically important. CONCLUSIONS In the U.S., sociodemographic factors and clinical conditions are strongly associated with scores on the EQ-5D. Population health studies and risk-adjustment models should account and adjust for these factors when assessing the performance of health programs and clinical care.
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Affiliation(s)
- Erica I Lubetkin
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY Medical School, New York, NY 10031, USA.
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Abstract
PURPOSE An indicator system for measuring the quality of rehabilitation centres ('Quality Profile' of rehabilitation centres) is presented. The implementation of the concept is explained with the aid of results regarding structural, process and outcome quality in 26 cardiac and orthopaedic rehabilitation centres. METHOD In each centre, structural, process and outcome quality, including patient and employee satisfaction, are measured. Process quality is determined by means of a peer review procedure that includes examination of 20 randomly selected cases on the basis of discharge reports and therapy plans. The medical outcome is measured by a prospective study with three measurement time points and a sample of approx. N=200 patients per centre. RESULTS Overall, the level of quality of the medical rehabilitation in the institutions participating in the study must be considered high. However, on almost all quality dimensions, even after a risk adjustment there are clear differences between centres, which point to the usefulness of benchmarking analyses and the need for improvements in quality in some centres. CONCLUSIONS The indicator system presented is a starting-point for comprehensive, comparative measurement of the quality of in-patient rehabilitation centres that, with regard to its principles, also appears applicable to other areas of health care.
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Affiliation(s)
- E Farin
- Department of Quality Management and Social Medicine, University Hospital Freiburg, D79106 Freiburg, Germany.
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Jones N, Jones SL, Miller NA. The Medicare Health Outcomes Survey program: overview, context, and near-term prospects. Health Qual Life Outcomes 2004; 2:33. [PMID: 15248895 PMCID: PMC479698 DOI: 10.1186/1477-7525-2-33] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Accepted: 07/12/2004] [Indexed: 11/24/2022] Open
Abstract
In 1996, the Centers for Medicare & Medicaid Services (CMS) initiated the Medicare Health Outcomes Survey (HOS). It is the first national survey to measure the quality of life and functional health status of Medicare beneficiaries enrolled in managed care. The program seeks to gather valid and reliable health status data in Medicare managed care for use in quality improvement activities, public reporting, plan accountability and improving health outcomes based on competition. The context that led to the development of the HOS was formed by the convergence of the following factors: 1) a recognized need to monitor the performance of managed care plans, 2) technical expertise and advancement in the areas of quality measurement and health outcomes assessment, 3) the existence of a tested functional health status assessment tool (SF-36)1, which was valid for an elderly population, 4) CMS leadership, and 5) political interest in quality improvement. Since 1998, there have been six baseline surveys and four follow up surveys. CMS, working with its partners, performs the following tasks as part of the HOS program: 1) Supports the technical/scientific development of the HOS measure, 2) Certifies survey vendors, 3) Collects Health Plan Employer Data and Information Set(HEDIS)2 HOS data, 4) Cleans, scores, and disseminates annual rounds of HOS data, public use files and reports to CMS, Quality Improvement Organizations (QIOs), Medicare+Choice Organizations (M+COs), and other stakeholders, 5) Trains M+COs and QIOs in the use of functional status measures and best practices for improving care, 6) Provides technical assistance to CMS, QIOs, M+COs and other data users, and 7) Conducts analyses using HOS data to support CMS and HHS priorities.CMS has recently sponsored an evaluation of the HOS program, which will provide the information necessary to enhance the future administration of the program. Information collected to date reveals that the HOS program is a valuable tool that provides a rich set of data that is useful for quality monitoring and improvement efforts. To enhance the future of the HOS program, many stakeholders recommend the implementation of incentives to encourage the use of the data, while others identify the need to monitor the health status of plan disenrollees.Overall, the HOS program represents an important vehicle for collecting outcomes data from Medicare beneficiaries. The new Medicare Prescription Drug, Improvement, and Modernization Act (2003) mandates the collection and use of data for outcomes measurement. Consequently, it is important to improve HOS to most effectively meet the mandate.
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Affiliation(s)
- Nathaniel Jones
- Maryland Institute for Policy Analysis and Research (MIPAR), University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Stephanie L Jones
- Maryland Institute for Policy Analysis and Research (MIPAR), University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Nancy A Miller
- Maryland Institute for Policy Analysis and Research (MIPAR), University of Maryland, Baltimore County (UMBC), 1000 Hilltop Circle, Baltimore, MD 21250, USA
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Abstract
OBJECTIVE We examined the relationship between health-related social disengagements, as opposed to disengagements related to financial and other non-health-related factors, and subsequent risk of disability and death among initially nondisabled elderly diabetic patients enrolled in Medicare Managed Care plans. RESEARCH DESIGN AND METHODS We used data from the Medicare Health Outcomes Survey (HOS) Cohort 1 Baseline (1998) and Cohort 1 Follow-Up (2000). Through mail and telephone surveys, trained interviewers collected information on sociodemographic variables, physical and mental health functioning (using Medical Outcomes Study Short Form-36 [SF-36]), activities of daily living (ADL), and medical conditions. This study reported on diabetic subjects aged >or=65 years with no ADL disability at baseline (n = 8949). Health-related social disengagement (degree to which physical health or emotional problems interfere with social activities) was derived from the social functioning subscale of SF-36 (range 0-100; higher scores depicting better social functioning). RESULTS For each 10-point increase in social functioning score at baseline, older diabetic subjects in our study experienced an 18% less chance of any ADL disability (odds ratio [OR] 0.82, 95% CI 0.75-0.89; P < 0.001) and a 12% less chance of death (0.88, 0.78-1.00; P = 0.043) over a 2-year period, adjusting for demographic factors, comorbidities, depression, and general health (assessed by the SF-36). CONCLUSIONS Among initially nondisabled older diabetic subjects, health-related interferences with social activities at baseline may be early warning signs of subsequent ADL disability and premature death, independent of other measures of health status.
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Affiliation(s)
- Yong-Fang Kuo
- Sealy Center on Aging, The University of Texas Medical Branch Galveston, TX 77555-0460, USA.
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Ellis BH, Bannister WM, Cox JK, Fowler BM, Shannon ED, Drachman D, Adams RW, Giordano LA. Utilization of the propensity score method: an exploratory comparison of proxy-completed to self-completed responses in the Medicare Health Outcomes Survey. Health Qual Life Outcomes 2003; 1:47. [PMID: 14570594 PMCID: PMC222919 DOI: 10.1186/1477-7525-1-47] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2003] [Accepted: 09/18/2003] [Indexed: 11/10/2022] Open
Abstract
Background This research examined the use of the propensity score method to compare proxy-completed responses to self-completed responses in the first three baseline cohorts of the Medicare Health Outcomes Survey, administered in 1998, 1999, and 2000, respectively. A proxy is someone other than the respondent who completes the survey for the respondent. Methods The propensity score method of matched sampling was used to compare proxy and self-completed responses. A propensity score is a value that equals the estimated probability of a given individual belonging to a treatment group given the observed background characteristics of that individual. Proxy and self-completed responses were compared on demographics, the SF-36, chronic conditions, activities of daily living, and depression-screening questions. For each individual survey respondent, logistic regression was used to calculate the probability that this individual belonged to the proxy respondent group (propensity score). Pre and post adjustment comparisons were tested by calculating effect sizes. Results Differences between self and proxy-completed responses were substantially reduced with the use of the propensity score method. However, differences were still found in the SF-36, several demographics, several impaired activities of daily living, several chronic conditions, and one depression-screening question. Conclusion The propensity score method helped to reduce differences between proxy-completed and self-completed survey responses, thereby providing an approximation to a randomized controlled experiment of proxy-completed versus self-completed survey responses.
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Affiliation(s)
- Beth Hartman Ellis
- Surveys, Research & Analysis Health Services Advisory Group, Inc. Phoenix, AZ 85020 United States of America
| | - Wade M Bannister
- Information Planning Data Group Mercer Human Resource Consulting Phoenix, Arizona 85016 United States of America
| | - Jacquilyn Kay Cox
- Surveys, Research & Analysis Health Services Advisory Group, Inc. Phoenix, AZ 85020 United States of America
| | - Brenda M Fowler
- Surveys, Research & Analysis Health Services Advisory Group, Inc. Phoenix, AZ 85020 United States of America
| | - Erin Dowd Shannon
- Surveys, Research & Analysis Health Services Advisory Group, Inc. Phoenix, AZ 85020 United States of America
| | - David Drachman
- Surveys, Research & Analysis Health Services Advisory Group, Inc. Phoenix, AZ 85020 United States of America
| | - Randall W Adams
- Surveys, Research & Analysis Health Services Advisory Group, Inc. Phoenix, AZ 85020 United States of America
| | - Laura A Giordano
- Surveys, Research & Analysis Health Services Advisory Group, Inc. Phoenix, AZ 85020 United States of America
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Abstract
OBJECTIVE To determine if a question about symptoms of depression in a mail survey predicts mortality after adjusting for a large number of covariates. DESIGN National cross-sectional survey of 141,589 enrollees in Medicare, age 65 and older. Analyses used multivariate logistic regression models with death as the outcome. RESULTS Response to a question about sadness or anhedonia was associated with death in 2 years (OR = 1.32; 95% CI = 1.2, 1.4). Results were consistent across age, gender, and presence/absence of known heart disease. Other responses associated with death were older age, male gender, and self-reported cancers, shortness of breath, heart failure, smoking, and other characteristics. Higher education and being married appeared to protect from death. DISCUSSION A single survey question about feelings of sadness or anhedonia is predictive of death in 2 years.
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